In a study from France, 12 patients in stage 2b or 3 COVID-19 associated pneumonia were treated with i.v. anakinra and compared to 10 patients receiving standard-of-care treatment. Those within the experimental group significantly improved clinically, experienced no deaths, and experienced decreased usage of mechanical ventilation. The main drawback of the study is the small sample size.

Application of Anakinra to Treat Inflammation-Associated Respiratory Failure in COVID-19

Serum amyloid P (SAP) is a serum protein produced by hepatocytes that belong to the pentraxin family of proteins that also includes C-reactive protein.  SAP is secreted into the blood and is capable of binding to various molecules, such as bacterial polysacchardies, DNA, and viral and bacterial proteins.  Phagocytic cells bind to SAP and can then engulf the molecules that the SAP bounded.  Previous studies have demonstrated that SAP calms the innate immune system because they induce the production of immuno-regulatory macrophages and decrease neutrophil levels.  Previous studies have also shown that SAP is effective in inhibiting influenza A virus infections and fibrosis.

Serum Amyloid P

Hamilton College

Although the leading cause of mortality from COVID-19 is acute respiratory distress syndrome (ARDS), new data demonstrates the potential of cytokine storm syndrome in patients with severe COVID-19. 

Severe COVID-19 patients should have hyperinflammation screenings for laboratory markers, including increased levels of ferritin, decreased platelet counts, or erythrocyte sedimation rate. The HScore table should be applied when deciding potential therapy options and in the consideration of immunosuppression to reduce inflammation and improve mortalitly. 

- Biomarkers of cytokine storm syndrome and status in COVID-19
- Treatments for cytokine storm syndrome and potential utility in COVID-19

Cytokine Release Syndrome and COVID-19

Henderson, L. A., Canna, S. W., Schulert, G. S., Volpi, S., Lee, P. Y., Kernan, K. F., ... & Hoyt, K. J. (2020). On the alert for cytokine storm: Immunopathology in COVID‐19. Arthritis & Rheumatology. https://onlinelibrary.wiley.com/doi/full/10.1002/art.41285

On the Alert for Cytokine Storms: Immunopathology in COVID-19

Biomarkers of cytokine storm syndrome and status in COVID-19

Treatments for cytokine storm syndrome and potential utility in COVID-19

SARS-CoV-2 is known to activate mast cells in affected patients, along with other immune cells including monocytes/macrophages, neutrophils, T cells, killer cells, and resident tissue epithelial and endothelial cells. These various groups cells have been thought to induce the "cytokine storm syndrome" that is experienced by COVID-19 patients. However, since mast cells are well-expressed throughout the body (including the CNS) and are involved in certain neuroinflammatory diseases, it is hypothesized that their activation by SARS-CoV-2 upregulates certain neuroinflammatory responses, which may result in some of the other symptoms observed in COVID-19 patients, including ischemic stroke.

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