Authors: Unal G, Turan B, Balcioglu YH

PMID: 32498007 PMCID: PMC7255327 DOI: 10.1016/j.mehy.2020.109891


Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) which leads to COVID-19, was first seen in Wuhan province of China in December 2019 and spread globally in a short time. COVID-19 was announced as a pandemic by WHO on March 11th, 2020 and approximately 4 million people infected with the virus and 275.000 died until May 11th, 2020. Symptoms of COVID-19 may range from mild such as subfebrile fever to severe symptoms such as respiratory and multiorgan failures. Acute respiratory distress syndrome (ARDS) is a critical consequence of infection, leading to the most of the death due to COVID-19. A crucial part of COVID-19 patients with ARDS presents an excess pro-inflammatory cytokine release, which may be related to cytokine storm syndrome in the respiratory system. It has been shown that many patients with COVID-19 had increased serum levels of pro-inflammatory cytokines such as IL-6, IL-1β, IL-2, IL-8, IL-17, granulocyte-colony-stimulating factor (G-CSF), granulocyte-macrophage CSF, and TNF-α. However, corticosteroids and other immunosuppressant agents have not been encouraged in COVID-19 because of their given deteriorating effects to already vulnerable respiratory tract. At this point, research into novel treatment approaches that focus on direct antiviral effect and immunomodulatory effects has increased to identify the ideal therapeutics for COVID-19.

Keywords: COVID-19; Cytokines; Immunomodulation; Immunopharmacology; Mood stabilizers; Valproic acid; Viral replication.