You are currently viewing the abstract.
View Full TextLog in to view the full text
AAAS login provides access to Science for AAAS members, and access to other journals in the Science family to users who have purchased individual subscriptions.
More options
Download and print this article for your personal scholarly, research, and educational use.
Buy a single issue of Science for just $15 USD.
Taming cytokine storm
Hyperactivation of immune cells leading to “cytokine storm” contributes to acute lung injury in patients with COVID-19 pneumonia. Host signaling proteins and effector molecules contributing to cytokine storm are potential targets for pharmacotherapy of COVID-19. Roschewski et al. conducted an observational study evaluating off-label use of acalabrutinib, an inhibitor of the Bruton tyrosine kinase (BTK) enzyme, in 19 hospitalized COVID-19 patients requiring oxygen supplementation. Biomarkers of inflammation reverted toward normal in most treated patients. Correlative studies of blood monocytes from patients with severe COVID-19 showed increases in BTK activation and production of interleukin-6, a key driver of cytokine storm, compared with healthy control monocytes. These findings helped inform the design of a randomized controlled clinical trial to further test the therapeutic potential of acalabrutinib in COVID-19.
Abstract
Patients with severe COVID-19 have a hyperinflammatory immune response suggestive of macrophage activation. Bruton tyrosine kinase (BTK) regulates macrophage signaling and activation. Acalabrutinib, a selective BTK inhibitor, was administered off label to 19 patients hospitalized with severe COVID-19 (11 on supplemental oxygen and 8 on mechanical ventilation), 18 of whom had increasing oxygen requirements at baseline. Over a 10- to 14-day treatment course, initiation of acalabrutinib treatment was associated with improved oxygenation in a majority of patients, often within 1 to 3 days, and had no discernable toxicity. Measures of inflammation—C-reactive protein and interleukin-6 (IL-6)—normalized quickly in most patients, as did lymphopenia, in correlation with improved oxygenation. At the end of acalabrutinib treatment, 8 of 11 (72.7%) patients in the supplemental oxygen cohort had been discharged on room air, and 4 of 8 (50%) patients in the mechanical ventilation cohort had been successfully extubated, with 2 of 8 (25%) discharged on room air. Ex vivo analysis revealed significantly elevated BTK activity, as evidenced by autophosphorylation, and increased IL-6 production in blood monocytes from patients with severe COVID-19 compared with blood monocytes from healthy volunteers. These results suggest that targeting excessive host inflammation with a BTK inhibitor is a therapeutic strategy in severe COVID-19 and has led to a confirmatory international prospective randomized controlled clinical trial.
- Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution License 4.0 (CC BY).
This is an open-access article distributed under the terms of the Creative Commons Attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.