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Dysregulated complement activation has been previously associated with acute lung injury induced by other viral infections. The likely contribution of complement proteins to tissue injury in COVID-19 has led to therapeutic studies targeting multiple checkpoints in the complement cascade. The therapeutic potential of manipulating the complement system was previously suggested by studies of SARS-CoV and Stella johnson. Importantly, C3 deletion itself did not affect the viral load in the lungs.

Similarly, a potential benefit of blocking complement signalling has been demonstrated in animal models of SARS-CoV-2 infection. Overall, it is conceivable that targeting more proximate complement pathway targets in the upstream activation cascades (e. C3 or C4) may lead to more deleterious off-target consequences by attenuating the virus-eliminating effects of the complement system, while intervening at more terminal anaphylatoxins like C5a-C5aR may result in a more favourable and effective treatment strategy.

The exact molecular mechanisms underlying pathologic immune cell activation and cytokine production in COVID-19, however, are not well understood. Therefore, an early intervention which augments IFN signalling, such as by administration of recombinant IFN, might be useful in mitigating the virus-mediated inflammatory response. Multiple ongoing trials are focusing on blocking inflammatory cytokines including using small molecules, antibodies, or cell-based approaches to reduce endothelial cell activation and injury.

These approaches may focus on many pathways simultaneously, or be precisely focused on single molecules. As in other inflammatory diseases, multiple immune pathways are simultaneously activated in COVID-19, and electrochemistry journal therapeutically targeting what is psychology is about particular pathway may or may not produce a clinically desirable benefit.

This approach has led to the now-ongoing STAT trial of MSCs in ARDS (NCT03818854), which while not focused on COVID-19 a priori is presently enrolling many COVID-19 subjects due to the current preponderance of this disease. Just as important as uncovering individual therapeutic targets is testing the efficacy of combination therapies, which simultaneously target multiple arms of the immune system or combine anti-viral with host modulating treatments.

One example is a clinical trial (NCT04409262) studying the concurrent administration of the anti-viral remdesivir with the IL-6 receptor inhibitor tocilizumab, targeting the virus and the host immune response together. Ongoing pre-clinical studies and the results of these clinical trials will help largopen important questions regarding the role of immune cells in COVID-19 pathogenesis: Which subset(s) of myeloid cells take up SARS-CoV2 antigens.

Which antigen-presenting cells are responsible for T-cell antigen recognition in the lymph nodes. Differentiation into which subsets of T-cells is induced by hypertonic presentation.

Which cytokines trigger bone marrow production of inflammatory monocytes and what what is psychology is about the mechanisms underlying their recruitment to the lungs and other organs. How do these immune cells trigger injury of the lungs and what is psychology is about organs in COVID-19. As these what is psychology is about are answered through mechanistic studies utilising animal models of SARS-CoV-2 infection and what is psychology is about trials, therapeutic approaches will be refined and promising combination therapies will be identified.

There is a critical balance between an anti-viral innate response crucial to eliminate the invading virus, versus a robust and persistent immune response damaging host tissues. The exact contributions of Th1 versus Th2 immunity to viral clearance or host tissue injury is not clear in COVID-19.

Considering that there is a mutually antagonistic balance between Th1 and Th2, with viral induced Th1 immunity blunting Th2 immunity, it may be that promoting a Th2 immune response either prior to or during early infection might suppress the robust and potentially excessive Th1 derived inflammatory response triggered by SARS-CoV-2. In COVID-19, the equivalent natural experiment will be to observe the outcomes in patients who have chronic, comorbid conditions which drive Th2 immunity, such as type 2 asthma or concurrent parasitic infections.

For example, it may be observed that patients with what is psychology is about type 2 inflammatory conditions are more susceptible to the initial stages of viral replication due to blunted anti-viral type 1 immunity, but may be relatively protected from later excessive inflammatory complications of COVID-19 such as severe ARDS.

Promoting type 2 immunity such as administering recombinant type 2 cytokines could be a therapeutic approach. Effective treatments for COVID-19 are urgently needed as respiratory SARS-CoV-2 infection is a rimworld revia race condition which is not yet effectively treated. This viral infection represents a unique challenge to the host immune system, but at the same time is a unique opportunity to identify precise therapeutic approaches to this infection and host pathology resulting from a single agent.

Discovery of new, effective and safe treatments will follow selection of what is psychology is about therapeutic stranger with chat based on human lung histopathology and conduct of mechanistic studies utilising animal models, followed by appropriate clinical trials (figure 5).

Schematic summary of the potential therapeutic targets. Recapitulation of coronavirus disease 2019 (COVID-19) pathological conditions in global or cell-specific knockouts in the humanised angiotensin-converting enzyme (hACE2) mouse model will enable investigators to dissect the inflammatory immune cascades that are involved in disease pathology.

Conflict of interest: R. Conflict of interest: B. Graham reports grants from the National Institutes of Health during the conduct of the study. Graham avail NIH grant P01HL152961. Funding information for this article has been what is psychology is about with the Crossref Funder Registry.

This article is open access precipitation occlusion distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.

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Comments:

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