rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-5-30rsp-2986Research ArticleПРОБЛЕМЫ РЕВМАТОЛОГИИ В ПЕРИОД ПАНДЕМИИ КОРОНОВИРУСНОЙ БОЛЕЗНИ 2019PROBLEMS OF RHEUMATOLOGY DURING THE 2019 CORONAVIRUS PANDEMICКоронавирусная болезнь 2019 (COVID-19) и аутоиммунитетCoronavirus disease 2019 (COVID-19) and autoimmunityhttps://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

Насонов Евгений Львович

115522, Москва, Каширское шоссе, 34а

119991, Москва, ул. Трубецкая, 8, стр. 2

Evgeny Nasonov

115522, Moscow, Kashirskoye Highway, 34A

119991, Moscow, Trubetskaya str., 8, building 2

nasonov@irramn.ruФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian Federation202102032021591530Copyright © Насонов Е.Л., 20212021Насонов Е.Л.Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2986

Пандемия коронавирусной болезни 2019 (coronavirus disease, COVID-19), этиологически связанной с вирусом SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), привлекла внимание медицинского сообщества к новым клиническим и фундаментальным проблемам иммунопатологии заболеваний человека. В течение года, прошедшего с начала пандемии, было проведено беспрецедентное число клинических и фундаментальных исследований, посвященных проблемам эпидемиологии, вирусологии, иммунологии и молекулярной биологии, клинического течения, полиморфизма и фармакотерапии COVID-19, объединивших ученых и врачей практически всех биологических и медицинских специальностей. Эти усилия увенчались созданием нескольких типов вакцин против инфекции SARS-CoV-2 и в целом разработкой более рациональных подходов к ведению пациентов. 2020 год является юбилейным, поскольку именно 70 лет назад (в 1950 году) Т. Рейхштейн, Э. Кендалл и Ф. Хенч были удостоены Нобелевской премии, за «открытия, касающиеся гормонов коры надпочечников, структуры и биологических эффектов». Не менее важное значение имеют исследования, касающиеся применения генно-инженерных биологических препаратов и «таргетных» противовоспалительных препаратов, модулирующих внутриклеточную сигнализацию цитокинов, которые в течение последних 20 лет специально разрабатывались для лечения иммуновоспалительных ревматических заболеваний (ИВРЗ). В процессе детального анализа спектра клинических проявлений и иммунопатологических нарушений при COVID-19 стало очевидным, что инфекция SARS-CoV-2 сопровождается развитием широкого спектра экстрапульмональных клинических и лабораторных нарушений, некоторые из которых характерны для ИВРЗ и других аутоиммунных и аутовоспалительных заболеваний человека. Все вместе это послужило основанием для «репозиционирования» (drug repurposing) и применения по незарегистрированным показаниям (off-label) при COVID-19 противовоспалительных препаратов, ранее специально разработанных для лечения ИВРЗ. В статье обсуждаются перспективы лечения COVID-19 с использованием глюкокортикоидов, генно-инженерных биологических препаратов, ингибиторов JAK и других препаратов, блокирующих эффекты провоспалительных цитокинов.

The coronavirus 2019 pandemic (coronavirus disease, COVID-19), etiologically related to the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2), has once again reawakened healthcare professionals’ interest towards new clinical and conceptual issues of human immunology and immunopathology. An unprecedented number of clinical trials and fundamental studies of epidemiology, virology, immunology and molecular biology, of the COVID-19 clinical course polymorphism and pharmacotherapy have been conducted within one year since the outbreak of 2019 pandemic, bringing together scientists of almost all biological and physicians of almost all medical specialties. Their joint efforts have resulted in elaboration of several types of vaccines against SARS-CoV-2 infection and, in general, fashioning of more rational approaches to patient management. Also important for COVID-19 management were all clinical trials of biologics and “targeted” anti-inflammatory drugs modulating intracellular cytokine signaling, which have been specifically developed for treatment immune-mediated inflammatory rheumatic disease (IMIRDs) over the past 20 years. It became obvious after a comprehensive analysis of the entire spectrum of clinical manifestations and immunopathological disorders in COVID-19 is accompanied by a wide range of extrapulmonary clinical and laboratory disorders, some of which are characteristic of IMIRDs and other autoimmune and auto-in-flammatory human diseases. All these phenomena substantiated the practice of anti-inflammatory drugs repurposing with off-label use of specific antirheumatic agents for treatment of COVID-19. This paper discusses potential use of glucocorticoids, biologics, JAK inhibitors, etc., blocking the effects of pro-inflammatory cytokines for treatment of COVID-19.

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The authors declare that there are no conflicts of interest present.