Cytokine storm is the cryptic killer behind coronavirus disease-2019 infections, review of the current evidence to identify therapeutic options

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) is currently a rapidly disseminating viral infection that turned into a global pandemic with daily increasing mortality. The exaggerated host immune response (hypercytokinemia) caused by SARS-CoV-2 was found to be the main contributor to fatality rather than the genuine effect of the viral infection. The challenging situation caused by the absence of definitive antiviral therapy, as well as the implication of cytokine storm syndrome (CSS) in cases of SARS-CoV-2, necessitate screening for alternate therapeutic targets and examining the possibility of repurposing already approved drugs. Treatment of CSS using immunomodulators and immunosuppressants – indicated for inflammatory diseases, autoimmune diseases and viral infections, with acceptable safety and efficacy – represents a potential therapeutic option for reducing mortality associated with SARS-CoV-2. This article aims to review the role of cytokines in CSS, present an overview of immunomodulators and immunosuppressive clinically indicated to counteract the effect of cytokines with the overarching goal of drawing attention to potential therapeutic options for further investigation, clinical trials, and pharmaceutical research.