Inhibition of Bruton tyrosine kinase in patients with severe COVID-19.
Agammaglobulinaemia Tyrosine Kinase
/ antagonists & inhibitors
Aged
Aged, 80 and over
Benzamides
/ pharmacology
Betacoronavirus
COVID-19
Coronavirus Infections
/ drug therapy
Critical Illness
Female
Follow-Up Studies
Humans
Inflammation
/ drug therapy
Interleukin-6
/ metabolism
Male
Middle Aged
Monocytes
/ metabolism
Pandemics
Pneumonia, Viral
/ drug therapy
Prospective Studies
Pyrazines
/ pharmacology
Respiration, Artificial
SARS-CoV-2
Treatment Outcome
COVID-19 Drug Treatment
Journal
Science immunology
ISSN: 2470-9468
Titre abrégé: Sci Immunol
Pays: United States
ID NLM: 101688624
Informations de publication
Date de publication:
05 06 2020
05 06 2020
Historique:
received:
26
05
2020
accepted:
03
06
2020
entrez:
7
6
2020
pubmed:
7
6
2020
medline:
20
6
2020
Statut:
ppublish
Résumé
Patients with severe COVID-19 have a hyperinflammatory immune response suggestive of macrophage activation. Bruton tyrosine kinase (BTK) regulates macrophage signaling and activation. Acalabrutinib, a selective BTK inhibitor, was administered off-label to 19 patients hospitalized with severe COVID-19 (11 on supplemental oxygen; 8 on mechanical ventilation), 18 of whom had increasing oxygen requirements at baseline. Over a 10-14 day treatment course, acalabrutinib improved oxygenation in a majority of patients, often within 1-3 days, and had no discernable toxicity. Measures of inflammation - C-reactive protein and IL-6 - normalized quickly in most patients, as did lymphopenia, in correlation with improved oxygenation. At the end of acalabrutinib treatment, 8/11 (72.7%) patients in the supplemental oxygen cohort had been discharged on room air, and 4/8 (50%) patients in the mechanical ventilation cohort had been successfully extubated, with 2/8 (25%) discharged on room air. Ex vivo analysis revealed significantly elevated BTK activity, as evidenced by autophosphorylation, and increased IL-6 production in blood monocytes from patients with severe COVID-19 compared with blood monocytes from healthy volunteers. These results suggest that targeting excessive host inflammation with a BTK inhibitor is a therapeutic strategy in severe COVID-19 and has led to a confirmatory international prospective randomized controlled clinical trial.
Identifiants
pubmed: 32503877
pii: 5/48/eabd0110
doi: 10.1126/sciimmunol.abd0110
pmc: PMC7274761
pii:
doi:
Substances chimiques
Benzamides
0
IL6 protein, human
0
Interleukin-6
0
Pyrazines
0
Agammaglobulinaemia Tyrosine Kinase
EC 2.7.10.2
BTK protein, human
EC 2.7.10.2
acalabrutinib
I42748ELQW
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2020, American Association for the Advancement of Science.
Références
Lancet. 2020 Feb 22;395(10224):565-574
pubmed: 32007145
Cell Host Microbe. 2016 Feb 10;19(2):181-93
pubmed: 26867177
Zhonghua Bing Li Xue Za Zhi. 2020 May 8;49(5):411-417
pubmed: 32172546
JAMA. 2020 Apr 6;:
pubmed: 32250385
Lancet Infect Dis. 2020 Apr;20(4):425-434
pubmed: 32105637
Annu Rev Immunol. 2018 Apr 26;36:157-191
pubmed: 29237128
Eur Heart J Acute Cardiovasc Care. 2013 Mar;2(1):77-83
pubmed: 24062937
Nat Rev Immunol. 2020 Jun;20(6):375-388
pubmed: 32132681
J Immunol. 2013 May 15;190(10):5207-15
pubmed: 23596312
Lancet. 2020 Feb 15;395(10223):473-475
pubmed: 32043983
Front Immunol. 2019 Feb 01;10:119
pubmed: 30774631
Lancet. 2020 Feb 15;395(10223):507-513
pubmed: 32007143
Immunity. 2016 Jan 19;44(1):73-87
pubmed: 26777396
Proc Natl Acad Sci U S A. 2015 Feb 17;112(7):2145-50
pubmed: 25646432
Lancet. 2003 Nov 29;362(9398):1828-38
pubmed: 14654323
Nature. 2012 Jan 18;481(7381):278-86
pubmed: 22258606
J Med Virol. 2005 Feb;75(2):185-94
pubmed: 15602737
Lancet. 2018 Feb 17;391(10121):659-667
pubmed: 29241979
Cancer Cell. 2017 Jun 12;31(6):833-843.e5
pubmed: 28552327
Arthritis Res Ther. 2011 Jul 13;13(4):R115
pubmed: 21752263
J Allergy Clin Immunol. 2017 Oct;140(4):1054-1067.e10
pubmed: 28216434
MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):458-464
pubmed: 32298251
Biochem Biophys Res Commun. 2018 May 5;499(2):260-266
pubmed: 29567473
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Blood. 2020 May 21;135(21):1912-1915
pubmed: 32302379
J Med Virol. 2020 Jul;92(7):814-818
pubmed: 32253759
J Crit Care. 2011 Oct;26(5):510-516
pubmed: 21036535
Pediatr Rheumatol Online J. 2017 Jan 17;15(1):5
pubmed: 28095869
Haematologica. 2020 Jan 16;:
pubmed: 31949019
J Virol. 2009 Apr;83(7):3039-48
pubmed: 19004938
Cell. 2010 Feb 5;140(3):436-436.e2
pubmed: 20144765
J Pharmacol Exp Ther. 2017 Nov;363(2):240-252
pubmed: 28882879
EMBO J. 2000 Jun 15;19(12):2793-802
pubmed: 10856225
JAMA. 2020 Feb 7;:
pubmed: 32031570
N Engl J Med. 2016 Jan 28;374(4):323-32
pubmed: 26641137
Nature. 2020 May 7;:
pubmed: 32380511
Nat Med. 2015 Jul;21(7):677-87
pubmed: 26121197
Nat Commun. 2015 Jun 10;6:7360
pubmed: 26059659
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Blood. 2016 Oct 13;128(15):1940-1943
pubmed: 27503501
Front Immunol. 2017 Nov 08;8:1454
pubmed: 29167667
Am J Physiol Lung Cell Mol Physiol. 2018 Jul 1;315(1):L52-L58
pubmed: 29516781
Nat Commun. 2013;4:1833
pubmed: 23673618
Cell. 2013 Mar 28;153(1):272-272.e1
pubmed: 23540703
Eur Respir J. 2015 May;45(5):1463-78
pubmed: 25792631
Cardiovasc Pathol. 2020 May 7;48:107233
pubmed: 32434133
Clin Exp Immunol. 2004 Apr;136(1):95-103
pubmed: 15030519
Blood. 2006 Nov 15;108(10):3253-61
pubmed: 16868248
Curr Oncol. 2019 Apr;26(2):e233-e240
pubmed: 31043832
Cell Death Differ. 2020 May;27(5):1451-1454
pubmed: 32205856
J Biol Regul Homeost Agents. 2020 Mar 14;34(2):
pubmed: 32171193