Covid-19: o papel das Citocinas IL-1, IL-6 e TNF-α na resposta inflamatória
DOI:
https://doi.org/10.34119/bjhrv6n1-021Keywords:
COVID-19, citocinas, inflamação, SARS-CoV-2Abstract
INTRODUÇÃO: A COVID-19, uma patologia provada pelo novo coronavírus que surgiu em Wuhan (China), rapidamente se espalhou pelo mundo e foi declarada como pandemia, infectando milhões de pessoas. Desde então, diversos estudos clínicos estão sendo realizados com o objetivo entender os mecanismos de transmissão, a resposta imunológica e possíveis tratamentos. Nesse ínterim, descobriu-se que a mortalidade pelo vírus está diretamente relacionada com a chamada “tempestade de citocinas”, ou hipercitocinemia, uma liberação concentrada de diversos mediadores inflamatórios que ativam exageradamente as células do sistema imunológico, causando danos significativos aos tecidos e órgãos do corpo, podendo originar falência múltipla dos órgãos ou mesmo morte. Dessa forma, o controle da tempestade de citocinas nos casos graves da COVID-19 pode diminuir a mortalidade e aumentar a taxa de sobrevivência, indicando a necessidade de maiores pesquisas acerca dessa temática. OBJETIVO: Traçar o perfil das citocinas pró-inflamatórias IL-1, IL-6 e TNF- α na resposta inflamatória ao COVID-19. MÉTODOS: Neste estudo, realizou-se uma revisão bibliográfica do tipo revisão integrativa da literatura, utilizando como fonte de dados catalogados no PubMed, SciELO, Periódicos Capes. COVID-19, citocinas, inflamação, SARS-CoV-2, TNF- α foram unitermos, com publicações nos últimos 4 anos. Os filtros da busca bibliográfica foram definidos para trabalhos de língua inglesa, publicados a partir do ano de 2019 e com o texto completo disponível, sendo encontrados 2069 artigos. A seguir, a partir dos critérios de inclusão e exclusão pré-definidos e a leitura subsequente dos títulos, resumos e trabalhos na íntegra, incluiu-se, nessa revisão, um total de 47 artigos. RESULTADOS: Dos 20 estudos que testaram a concentração sérica de TNF-α, 14 encontraram uma diferença estatística entre os grupos do estudo, associando-se os níveis da citocina com a progressão da gravidade e em concordância com o que é preconizado atualmente. Já em relação à IL-1β, dos 14 estudos que testaram sua concentração sérica, 11 trabalhos explicitaram que não houve diferença estatística dos níveis da citocina entre os grupos de gravidade, encontrando-se relevância estatística apenas comparando-se indivíduos infectados com o grupo controle. Por fim, dos 46 trabalhos que testaram a concentração sérica de IL-6, todos os 46 encontraram uma diferença estatística entre os grupos do estudo, associando-se os níveis da citocina com a progressão da gravidade. Além disso, 29 dentre esses especificaram que, na análise multivariada, os níveis séricos de IL-6 mostraram-se bons preditores de gravidade e de mortalidade da COVID-19. CONCLUSÃO: Depreende-se que o TNF-α, a IL-1β e, principalmente, a IL-6, têm grande relevância na progressão da forma severa da doença, já que estão diretamente relacionados à tempestade de citocinas e um quadro de hiperinflamação.
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