An eagerly awaited paper by researchers from a pioneering group of US university medical schools including Harvard, suggests that controlling inflammatory response in COVID-19 may be as important for treatment as antiviral therapies. This group published a shocking discovery in late 2017 about the lethal effects of cancer treatment, Cytokine Storms and inflammation, and how it can be countered. Parallel research with Rheumatoid Arthritis pioneered in Australia over the last decade supports their findings.(1)
Cytokine Storms, which are an overreaction of the immune system to COVID-19, are a major contributor to patient mortality. Cytokine Storms are also well known in cancer treatment, and other fields into which the US researchers had spent years investigating. So they are well placed to contribute to the COVID-19 fight, but with a different perspective to virologists and immunologists.
They have been able to apply decades of inflammation research across a number of diseases, to similar conditions caused by COVID-19. These include acute respiratory distress syndrome, septic shock, blood clotting, and multiple organ dysfunction syndromes.
University of California, Davis-based team members began researching cytokine storms 16 years ago. Co-author Bruce Hammock, a UC Davis distinguished professor who holds a joint appointment with the Department of Entomology and Nematology and the UC Davis Comprehensive Cancer Center says, “What we really need to do is not so much block cytokines as to move upstream to modulate them and resolve them rather than block inflammation.”
Current therapeutic strategies in COVID-19 focus on inhibiting a single pro-inflammatory cytokine rather than broadly inhibiting the body's inflammatory response.
"Finding new ways to dampen the body's inflammatory response to COVID-19 will likely be as important as finding effective antiviral therapies to control COVID-19 infection and reduce life-threatening organ damage,“ according to Molly Gilligan, from the University of Minnesota,
The therapy involves increasing levels of Specialised Pro-Resolving Mediators (SPMs) such as Resolvins. These omega-3 fatty acid derived lipid mediators serve as the body's natural "stop" signals to inflammation.
"What is exciting for us is that these lipid mediators that 'turn off,' or resolve, inflammation are already in clinical trials for other inflammation-driven diseases, such as eye disease, periodontal disease and pain," said Dipak Panigrahy, an assistant professor of pathology in Beth Israel Deaconess Medical Center, Harvard Medical School. "The mediators can quickly be applied to turn off inflammation in COVID-19 patients."
Application of these mediators for inflammation moved well beyond research and clinical trials for Rheumatoid Arthritis in Australia years ago. In a world first announced in 2014, researchers at the Royal Adelaide Hospital in Australia found that Fish Oil can help to reduce symptoms of Rheumatoid Arthritis and increase the likelihood of achieving disease remission with fewer disease-modifying anti-rheumatic drugs.
According to that study lead who is Head of the Royal Adelaide Hospital Rheumatology Unit, Professor Susanna Proudman “A high background of Omega 3 fats and hence Resolvin activity, achieved with a Fish Oil supplement, could dampen the immune response triggered by the Coronavirus SARS-CoV-2 that causes excessive tissue inflammation and damage.” (2)
Another area besides COVID-19 where excessive inflammation and immune response leads to Cytokine Storms is cancer, and in particular with treatment, which is where the US research published a shocking discovery published in late 2017.(3) Like immunotherapies that are the leading edge in cancer treatment, use of SPMs in COVID-19 treatment, would highlight the role of therapies that support the patient’s own mechanisms for regenerating and restoring normal physiological function, according to Professor Charles Serhan. His team discovered Resolvins and other SPMs almost 20 years ago.
He suggests, that a paradigm shift is emerging in our understanding of the resolution of inflammation.
So, a silver lining with COVID-19 might be the acceleration of the role of SPMs into mainstream medicine. That could lead to a Nobel Prize for Medicine for Professor Charles Serhan and his researchers sooner than expected from an otherwise “painfully” slow medical evolution.
Cures and vaccines may finally arrive, but meanwhile, it would be wise to immediately also consider use of this research for the management of COVID-19. For far too many people, particularly in developing countries, it will be their only hope should they catch the virus.
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Footnotes
1. The Paper:
Panigrahy, D., Gilligan, M.M., Huang, S. et al.
Inflammation resolution: a dual-pronged approach to averting cytokine storms in COVID-19?.
Cancer Metastasis Rev (2020).
https://doi.org/10.1007/s10555-020-09889-4
Some background on Inflammation Resolution:
A must see video - watch to the end for the punchline.
https://youtu.be/adZyYfIWKbY
A good background article
https://harvardmagazine.com/2020/04/resolution-of-inflammation
2. Breakthrough treatment for rheumatoid arthritis patients
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/news+and+media/all+media+releases/breakthrough+treatment+for+rheumatoid+arthritis+patients?
3. Cancer treatment item from 2017:
Chemotherapy-generated debris from dead and dying cancer cells can stimulate tumor growth
https://www.news-medical.net/news/20171201/Chemotherapy-generated-debris-from-dead-and-dying-cancer-cells-can-stimulate-tumor-growth.aspx