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Fig. 1 | Critical Care

Fig. 1

From: Blocking IL-1 to prevent respiratory failure in COVID-19

Fig. 1

Rationale for use of anakinra in severe coronavirus. The SARS-Cov-2 will cause epithelial damage leading to the release of IL-1α that will (1) recruit neutrophils and monocytes to the site of infection and (2) induce IL-1β in monocyte/macrophages. Moreover, the 2019 nCov will induce pro-IL-1β in monocyte/macrophages which in turn will induce more IL-1 that will recruit and activate more innate immune cells. This autoinflammatory loop where IL-1 (IL-1α and IL-1β) can induce production and release of more IL-1 has to be tightly regulated because an ongoing loop will activate and recruit more innate immune cells independent of the initial trigger. Anakinra blocks the IL-1 receptor (IL-1R) and thus will prevent autoinflammation by blocking effects of IL-1α released from dead epithelial cells, as well as IL-1β produced by immune cells. IL-1-induced IL-6 will also be blocked. The autoinflammatory loop can exacerbate from increase innate immune response into uncontrolled MAS a spectrum that associates with increasing ferritin levels

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