Covid-19 Hyperinflammation and Post-Covid-19 Illness May Be Rooted in Mast Cell Activation Syndrome
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2020Autor
Afrin, Lawrence B.
Weinstock, Leonard B.
Molderings, Gerhard J.
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Resumo
Objectives: One-fifth of Covid-19 patients suffer a severely symptomatic, hyperinflammatory
course, but specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2.
Though only recently recognized, MC activation syndrome (MCAS), usually due to acquired
MC clonality, is a chronic multisystem disorder with inflammatory and allergic themes and
estimated prevalence of 17%. We describe a novel conjecture explaining how MCAS might
cause propensity for severe acute Covid-19 infection and chronic post-Covid-19 illnesses.
Methods: Observations of Covid-19 illness in patients with/without MCAS, set against our
extensive clinical experience with MCAS. Results: The prevalence of MCAS is concordant with the prevalence of severe cases within the
Covid-19-infected population. Much of Covid-19’s hyperinflammation is concordant with
manners of inflammation which MC activation can drive. Drugs with activity against MCs or
their mediators have been preliminarily observed helpful in Covid-19 patients. None of our
treated MCAS patients who have endured Covid-19 infection have suffered severe courses of the
infection, let alone mortality.
Conclusions: Hyperinflammatory cytokine storms in many severely symptomatic Covid-19
patients may be rooted in aberrant response to SARS-CoV-2 by the dysfunctional MCs of MCAS
rather than normal response by normal MCs. If provable, our conjecture has significant
therapeutic and prognostic implications.
Palabras clave
Covid-19; SARS-CoV-2; Mast cell activation syndrome; Mast cell activation disease; Medical hypothesisLink para o recurso
https://doi.org/10.1016/j.ijid.2020.09.016Collections
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