Öz
Neutrophil leukocytes (NL) are the fastest-reacting cells on
the front line struggling against pathogenic microorganisms in the body. Swift
response by the NLs in the patients with COVID-19 is useful for the body,
although the untoward, inadvertently proceeding in this response is thought to
enhance life-threatening pulmonary damage and pave the way to death of the
patient. The phenomenon known as ‘cytokine storm’ is a general term describing
this unwanted reaction by the body and is the result of complicated intriguing
cellular and biochemical processes.
So-called “neutrophil extracellular traps” (NETs) trigger
progressing to ARDS and respiratory failure in critical cases with COVID-19.
rhDNAse (Dornase alfa) is an agent postulated to hydrolyze DNA networks
released by the killed NLs and thus reverse the deadly process in the lungs.
Its major drawbacks are cost and inability to apply to mild-to-moderate cases
in order to prevent deterioration to a critical illness. Nonetheless, it can
represent a promising new therapeutic modality in the future.
Anahtar Kelimeler
Kaynakça
- Barnes BJ, Adrover JM, Baxter-Stoltzfus A, et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps J Exp Med. (2020) 217 (6): e20200652
- Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans [published online ahead of print, 2020 May 27]. Lancet Respir Med. 2020;S2213-2600(20)30243-5. doi:10.1016/S2213-2600(20)30243-5
- Yao XH, Li TY, He ZC, et al. [A Pathological Report of Three COVID-19 Cases by Minimal Invasive Autopsies] [Article in Chinese] Zhonghua Bing Li Xue Za Zhi. 2020;49(5):411-417. doi:10.3760/cma.j.cn112151-20200312-00193
- Papayannopoulos, V., D. Staab, and A. Zychlinsky. 2011. Neutrophil elastase enhances sputum solubilization in cystic fibrosis patients receiving DNase therapy. PLoS One. 2011;6(12):e28526.
- Erdeve O, Uras N, Atasay B, Arsan S. Efficacy and safety of nebulized recombinant human DNase as rescue treatment for persistent atelectasis in newborns: case-series. Croat Med J. 48 (2),234–9. 2007.
- Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care. 9 (4), R351-6. 2005.
- Fitzgerald DA, Hilton J, Jepson B, Smith L. A crossover, randomized, controlled trial of dornase alfa before versus after physiotherapy in cystic fibrosis. Pediatrics 2005;116(4):e549-54.
- Çalkavur Ş, Olukman Ö, Ercan G, et al. Practice of Intratracheal and Inhaled Recombinant Human Deoxyribonuclease (rhDNase) Therapy in Neonates with Persistent Atelectasis: A Rescue Treatment. Turkiye Klinikleri J Med Sci. 2013;33(4):1143-50.
- Livingston MH, Mahant S, Connolly B, et al. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr 2020 Feb 3. doi: 10.1001/jamapediatrics.2019.5863. [Epub ahead of print]
- Lv, X., T. Wen, J. Song, D. Xie, L. Wu, X. Jiang, P. Jiang, and Z. Wen. 2017. Extracellular histones are clinically relevant mediators in the pathogenesis of acute respiratory distress syndrome. Respir. Res. 18:165. https://doi.org/10.1186/s12931-017-0651-5
- Caudrillier, A., K. Kessenbrock, B.M. Gilliss, J.X. Nguyen, M.B. Marques, M. Monestier, P. Toy, Z. Werb, and M.R. Looney. 2012. Platelets induce neutrophil extracellular traps in transfusion-related acute lung injury. J. Clin. Invest. 122:2661–2671. https://doi.org/10.1172/JCI61303
- Cortjens B, de Jong R, Bonsing JG, van Woensel JBM, Antonis AFG, Bem RA. Local dornase alfa treatment reduces NETs-induced airway obstruction during severe RSV infection. Thorax 2018 Jun;73(6):578-580. doi: 10.1136/thoraxjnl-2017-210289. Epub 2017 Aug 5.
Öz
Nötrofil lökositler (NL) vücutta hastalık yapan mikroorganizmalarla
savaşın en ön cephesindeki hücrelerdir ve hemen yanıt verirler. COVID-19
olgularında da NL’lerin hızla yanıt vermesi olumlu, iyileştirici bir faktördür;
fakat bu yanıtın istenmeyen aşırı bir noktaya gelmesinin akciğer hasarını
artırdığı ve ölüme giden yolu tetiklediği düşünülmektedir. ‘Sitokin fırtınası’
kavramı bu abartılı yanıtın genel adıdır ve birçok hücresel ve biyokimyasal
yanıtın ilişkilerinin sonucudur. Akciğerde “neutrophil extracellular traps”
(NETs) oluşumu COVID-19 enfeksiyonunun ARDS’ye ve solunum yetmezliğine
ilerlemesinin belirleyici sürecidir. rhDNAz (Dornase alfa) burada lökositlerden
açığa çıkan DNA’ları parçalayarak süreci geriye çevirebilmektedir. Pahalılığı
ve orta şiddetteki hastalarda uygulanamaması şu an çekinceleri oluştursa da
gelecek için ümit veren bir tedavi modalitesi olabilir.
Anahtar Kelimeler
Kaynakça
- Barnes BJ, Adrover JM, Baxter-Stoltzfus A, et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps J Exp Med. (2020) 217 (6): e20200652
- Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans [published online ahead of print, 2020 May 27]. Lancet Respir Med. 2020;S2213-2600(20)30243-5. doi:10.1016/S2213-2600(20)30243-5
- Yao XH, Li TY, He ZC, et al. [A Pathological Report of Three COVID-19 Cases by Minimal Invasive Autopsies] [Article in Chinese] Zhonghua Bing Li Xue Za Zhi. 2020;49(5):411-417. doi:10.3760/cma.j.cn112151-20200312-00193
- Papayannopoulos, V., D. Staab, and A. Zychlinsky. 2011. Neutrophil elastase enhances sputum solubilization in cystic fibrosis patients receiving DNase therapy. PLoS One. 2011;6(12):e28526.
- Erdeve O, Uras N, Atasay B, Arsan S. Efficacy and safety of nebulized recombinant human DNase as rescue treatment for persistent atelectasis in newborns: case-series. Croat Med J. 48 (2),234–9. 2007.
- Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care. 9 (4), R351-6. 2005.
- Fitzgerald DA, Hilton J, Jepson B, Smith L. A crossover, randomized, controlled trial of dornase alfa before versus after physiotherapy in cystic fibrosis. Pediatrics 2005;116(4):e549-54.
- Çalkavur Ş, Olukman Ö, Ercan G, et al. Practice of Intratracheal and Inhaled Recombinant Human Deoxyribonuclease (rhDNase) Therapy in Neonates with Persistent Atelectasis: A Rescue Treatment. Turkiye Klinikleri J Med Sci. 2013;33(4):1143-50.
- Livingston MH, Mahant S, Connolly B, et al. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr 2020 Feb 3. doi: 10.1001/jamapediatrics.2019.5863. [Epub ahead of print]
- Lv, X., T. Wen, J. Song, D. Xie, L. Wu, X. Jiang, P. Jiang, and Z. Wen. 2017. Extracellular histones are clinically relevant mediators in the pathogenesis of acute respiratory distress syndrome. Respir. Res. 18:165. https://doi.org/10.1186/s12931-017-0651-5
- Caudrillier, A., K. Kessenbrock, B.M. Gilliss, J.X. Nguyen, M.B. Marques, M. Monestier, P. Toy, Z. Werb, and M.R. Looney. 2012. Platelets induce neutrophil extracellular traps in transfusion-related acute lung injury. J. Clin. Invest. 122:2661–2671. https://doi.org/10.1172/JCI61303
- Cortjens B, de Jong R, Bonsing JG, van Woensel JBM, Antonis AFG, Bem RA. Local dornase alfa treatment reduces NETs-induced airway obstruction during severe RSV infection. Thorax 2018 Jun;73(6):578-580. doi: 10.1136/thoraxjnl-2017-210289. Epub 2017 Aug 5.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Acil Tıp, Bulaşıcı Hastalıklar |
| Bölüm | Derleme |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2020 |
| Gönderilme Tarihi | 21 Nisan 2020 |
| Kabul Tarihi | 11 Mayıs 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 2 Sayı: 2 |
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https://doi.org/10.1177/00302228211010587
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