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10.3390/ijms22042108

http://scihub22266oqcxt.onion/10.3390/ijms22042108
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suck abstract from ncbi


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pmid33672738      Int+J+Mol+Sci 2021 ; 22 (4): ä
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  • Innate Receptor Activation Patterns Involving TLR and NLR Synergisms in COVID-19, ALI/ARDS and Sepsis Cytokine Storms: A Review and Model Making Novel Predictions and Therapeutic Suggestions #MMPMID33672738
  • Root-Bernstein R
  • Int J Mol Sci 2021[Feb]; 22 (4): ä PMID33672738show ga
  • Severe COVID-19 is characterized by a "cytokine storm", the mechanism of which is not yet understood. I propose that cytokine storms result from synergistic interactions among Toll-like receptors (TLR) and nucleotide-binding oligomerization domain-like receptors (NLR) due to combined infections of SARS-CoV-2 with other microbes, mainly bacterial and fungal. This proposition is based on eight linked types of evidence and their logical connections. (1) Severe cases of COVID-19 differ from healthy controls and mild COVID-19 patients in exhibiting increased TLR4, TLR7, TLR9 and NLRP3 activity. (2) SARS-CoV-2 and related coronaviruses activate TLR3, TLR7, RIG1 and NLRP3. (3) SARS-CoV-2 cannot, therefore, account for the innate receptor activation pattern (IRAP) found in severe COVID-19 patients. (4) Severe COVID-19 also differs from its mild form in being characterized by bacterial and fungal infections. (5) Respiratory bacterial and fungal infections activate TLR2, TLR4, TLR9 and NLRP3. (6) A combination of SARS-CoV-2 with bacterial/fungal coinfections accounts for the IRAP found in severe COVID-19 and why it differs from mild cases. (7) Notably, TLR7 (viral) and TLR4 (bacterial/fungal) synergize, TLR9 and TLR4 (both bacterial/fungal) synergize and TLR2 and TLR4 (both bacterial/fungal) synergize with NLRP3 (viral and bacterial). (8) Thus, a SARS-CoV-2-bacterium/fungus coinfection produces synergistic innate activation, resulting in the hyperinflammation characteristic of a cytokine storm. Unique clinical, experimental and therapeutic predictions (such as why melatonin is effective in treating COVID-19) are discussed, and broader implications are outlined for understanding why other syndromes such as acute lung injury, acute respiratory distress syndrome and sepsis display varied cytokine storm symptoms.
  • |Acute Lung Injury/drug therapy/*immunology/metabolism[MESH]
  • |Animals[MESH]
  • |COVID-19 Drug Treatment[MESH]
  • |COVID-19/*immunology[MESH]
  • |Cytokine Release Syndrome/drug therapy/*immunology/metabolism[MESH]
  • |Humans[MESH]
  • |Inflammation/drug therapy/immunology[MESH]
  • |NLR Proteins/*immunology[MESH]
  • |Respiratory Distress Syndrome/drug therapy/*immunology/metabolism[MESH]
  • |SARS-CoV-2/immunology[MESH]
  • |Sepsis/drug therapy/*immunology/metabolism[MESH]


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