Title:The Role of Interleukin-6 in the Pathogenesis, Prognosis and Treatment of Severe COVID-19
Volume: 28
Issue: 26
Author(s): Ilias Giannakodimos, Georgia-Vasiliki Gkountana, Dimosthenis Lykouras, Kiriakos Karkoulias*Sotiris Tsakas
Affiliation:
- Department of Respiratory Medicine, University Hospital of Patras, Rio Patras,Greece
Keywords:
COVID-19, Interleukin-6, Tocilizumab, SARS-CoV-2, Pandemic, Coronavirus.
Abstract: A newly identified virus appeared in Wuhan, China, in December 2019, was
named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and caused the
coronavirus disease 2019 (COVID-19). SARS-CoV-2 presents similarities with two previous
coronavirus pandemics, MERS (Middle East Respiratory Syndrome) and SARSCoV,
concerning phylogenetic origin, structural composition, and clinical symptoms,
thus, leading to common pathogenic mechanisms. The purpose of this review is to declare
the role of interleukin-6 (IL-6) in the pathogenesis, prognosis, and treatment of
COVID-19 by comparing its effect on SARS-CoV and MERS cases. Increased levels of
IL-6 comprise the key for the stimulation of cytokine storm and the progression of
SARS, MERS, and COVID-19 cases. Especially, in COVID-19 patients, the overactivation
of NF-kΒ, which is caused by the binding of coronavirus spike protein S to alveolar
epithelial cells, up-regulates IL-6 and promotes its systematic circulation, causing alveolar
damage and extrapulmonary injury. Additionally, IL-6 can be used to evaluate respiratory
failure and identify asymptomatic patients. Tocilizumab (TCZ), a monoclonal antibody
which blocks IL-6 signaling, comprises a remedial option against COVID-19. TCZ
improves oxygenation, reduces fever, and decreases levels of IL-6. IL-6 plays a major
role in the pathogenesis of cytokine storm and the progression of COVID-19 and may be
used as a therapeutic target against COVID-19. However, further research is needed concerning
the relation of IL-6 in COVID-19 cases, and more clinical trials are required to
declare TCZ as a treatment option.
