tetano
Editor, Senior Moderator
Front Immunol
. 2021 Nov 11;12:749291.
doi: 10.3389/fimmu.2021.749291. eCollection 2021.
Effects of β-Blockers on the Sympathetic and Cytokines Storms in Covid-19
Hayder M Al-Kuraishy[SUP] 1 [/SUP], Ali Ismail Al-Gareeb[SUP] 1 [/SUP], Gomaa Mostafa-Hedeab[SUP] 2 [/SUP], Keneth Iceland Kasozi[SUP] 3 4 [/SUP], Gerald Zirintunda[SUP] 5 [/SUP], Akhmed Aslam[SUP] 6 [/SUP], Mamdouh Allahyani[SUP] 7 [/SUP], Susan Christina Welburn[SUP] 3 8 [/SUP], Gaber El-Saber Batiha[SUP] 9 [/SUP]
Affiliations
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a causative virus in the development of coronavirus disease 2019 (Covid-19) pandemic. Respiratory manifestations of SARS-CoV-2 infection such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) leads to hypoxia, oxidative stress, and sympatho-activation and in severe cases leads to sympathetic storm (SS). On the other hand, an exaggerated immune response to the SARS-CoV-2 invasion may lead to uncontrolled release of pro-inflammatory cytokine development of cytokine storm (CS). In Covid-19, there are interactive interactions between CS and SS in the development of multi-organ failure (MOF). Interestingly, cutting the bridge between CS and SS by anti-inflammatory and anti-adrenergic agents may mitigate complications that are induced by SARS-CoV-2 infection in severely affected Covid-19 patients. The potential mechanisms of SS in Covid-19 are through different pathways such as hypoxia, which activate the central sympathetic center through carotid bodies chemosensory input and induced pro-inflammatory cytokines, which cross the blood-brain barrier and activation of the sympathetic center. β2-receptors signaling pathway play a crucial role in the production of pro-inflammatory cytokines, macrophage activation, and B-cells for the production of antibodies with inflammation exacerbation. β-blockers have anti-inflammatory effects through reduction release of pro-inflammatory cytokines with inhibition of NF-κB. In conclusion, β-blockers interrupt this interaction through inhibition of several mediators of CS and SS with prevention development of neural-cytokine loop in SARS-CoV-2 infection. Evidence from this study triggers an idea for future prospective studies to confirm the potential role of β-blockers in the management of Covid-19.
Keywords: Beta blockers; SARS-CoV-2; cytokine storm; pharmacology and Covid; sympathetic storm.
. 2021 Nov 11;12:749291.
doi: 10.3389/fimmu.2021.749291. eCollection 2021.
Effects of β-Blockers on the Sympathetic and Cytokines Storms in Covid-19
Hayder M Al-Kuraishy[SUP] 1 [/SUP], Ali Ismail Al-Gareeb[SUP] 1 [/SUP], Gomaa Mostafa-Hedeab[SUP] 2 [/SUP], Keneth Iceland Kasozi[SUP] 3 4 [/SUP], Gerald Zirintunda[SUP] 5 [/SUP], Akhmed Aslam[SUP] 6 [/SUP], Mamdouh Allahyani[SUP] 7 [/SUP], Susan Christina Welburn[SUP] 3 8 [/SUP], Gaber El-Saber Batiha[SUP] 9 [/SUP]
Affiliations
- PMID: 34867978
- PMCID: PMC8637815
- DOI: 10.3389/fimmu.2021.749291
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a causative virus in the development of coronavirus disease 2019 (Covid-19) pandemic. Respiratory manifestations of SARS-CoV-2 infection such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) leads to hypoxia, oxidative stress, and sympatho-activation and in severe cases leads to sympathetic storm (SS). On the other hand, an exaggerated immune response to the SARS-CoV-2 invasion may lead to uncontrolled release of pro-inflammatory cytokine development of cytokine storm (CS). In Covid-19, there are interactive interactions between CS and SS in the development of multi-organ failure (MOF). Interestingly, cutting the bridge between CS and SS by anti-inflammatory and anti-adrenergic agents may mitigate complications that are induced by SARS-CoV-2 infection in severely affected Covid-19 patients. The potential mechanisms of SS in Covid-19 are through different pathways such as hypoxia, which activate the central sympathetic center through carotid bodies chemosensory input and induced pro-inflammatory cytokines, which cross the blood-brain barrier and activation of the sympathetic center. β2-receptors signaling pathway play a crucial role in the production of pro-inflammatory cytokines, macrophage activation, and B-cells for the production of antibodies with inflammation exacerbation. β-blockers have anti-inflammatory effects through reduction release of pro-inflammatory cytokines with inhibition of NF-κB. In conclusion, β-blockers interrupt this interaction through inhibition of several mediators of CS and SS with prevention development of neural-cytokine loop in SARS-CoV-2 infection. Evidence from this study triggers an idea for future prospective studies to confirm the potential role of β-blockers in the management of Covid-19.
Keywords: Beta blockers; SARS-CoV-2; cytokine storm; pharmacology and Covid; sympathetic storm.