The modern concept of etiology, pathogenesis, the role of anticytokine therapy and methods of extracorporeal treatment for new coronavirus infection (SARS-CoV-2). Review

Abstract

"The review highlights the relevance and significance of the new coronavirus infection, characterizes the virus, the route of invasion, and organ damage. The attention is focused on the risk factors of viral invasion, and the premorbid background of patients. Special attention is paid to the virus interaction with the ACE-2 receptors and the role of the latter in multiorgan dysfunction. The role of the immune system in the antiviral response is covered. We also considered independent predictors of death in new coronavirus infection. The mechanisms of lung damage in COVID-19 are reviewed with particular attention to the pathophysiological mechanism of the synthesis of pro-inflammatory cytokines and the role of the latter in organ dysfunction. A definition of the ""cytokine storm"" that is usually understood as an overactive immune response with the release of a large number of interferons, interleukins, chemokines, and other mediators is given. The review highlights the most significant and currently known pathogenetic chains of cytokine production. Among them are proinflammatory cytokines, the most significant are Il-1, Il-6, TNF. High cytokine levels are associated with poor outcomes. Special attention is paid to the feasibility and role of anti-cytokine therapy with drugs tocilizumab and sarilumab. It has been noted that treatment aimed at the pathogenetic mechanisms of the development of the ""cytokine storm"" by antagonists of the Il-6 receptor can interrupt this life-threatening inflammatory response and, consequently, multiorgan dysfunction. The main pathogenetic pathways and risk factors for the development of acute kidney injury (Acute Kidney Injury – AKI) in SARS-CoV-2 have been analyzed. The use of extracorporeal treatment methods, possibly the main methods of combating the massive release of the pool of medium-molecular compounds during the development of a ""cytokine storm"" are reviewed. It is noted that along with anti-cytokine therapy, extracorporeal methods can effectively reduce the level of proinflammatory cytokines and prevent multiple organ damage. The main issues of expediency, role and place of application of various extracorporeal methods in complex intensive care for new coronavirus infection (SARS-CoV-2) are highlighted. © 2022 JSC Vidal Rus. All rights reserved."