Complement cascade in severe forms of COVID-19: Recent advances in therapy

Nassima Chouaki Benmansour (1) , Julien Carvelli (2) , Eric Vivier (3)

1 Institut Paoli-Calmettes
2 APHM - Assistance Publique - Hôpitaux de Marseille
3 CIML - Centre d'Immunologie de Marseille - Luminy

The complement system is an essential component of the innate immune system. The three complement pathways (classical, lectin, alternative) are directly or indirectly activated by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). In the most severe forms of COVID-19, overactivation of the complement system may contribute to the cytokine storm, endothelial inflammation (endotheliitis) and thrombosis. No antiviral drug has yet been shown to be effective in COVID-19. Therefore, immunotherapies represent a promising therapeutic in the immunopathological phase (following the viral phase) of the disease. Complement blockade, mostly C5a-C5aR axis blockade, may prevent acute respiratory distress syndrome (ARDS) from worsening or progression to death. Clinical trials are underway.

Keywords: COVID‐19; SARS‐CoV‐2; complement; C5a; cytokine storm

Domains: Life Sciences [q-bio]; Immunology

Nassima Chouaki Benmansour, Julien Carvelli, Eric Vivier. Complement cascade in severe forms of COVID-19: Recent advances in therapy. European Journal of Immunology, 2021, pp.1-8. ⟨10.1002/eji.202048959⟩. ⟨hal-03226299⟩