The field of infectious disease plays out like a war game in which our immune system battles against viruses which each have their own secret weapons to disable or disrupt our defense systems. In the case of COVID, it too possesses various means of sabotaging our defenses in order to gain an upper hand. The complexity of our immune system, with multiple cell types and multiple messengers coordinating the response, provides many targets. Researchers believe that suppression of our type I interferon response may allow COVID 19 to trigger the infamous cytokine storm which kills many.
The plot trajectory that has played out in the international scene regarding COVID 19 has kept many glued to the science news like never before. First, we all waited to learn what was causing this disease which seemed to cause Chinese citizens to drop like flies. Next, we watched the epidemiology and public health news to learn how far it had spread and if it was knocking on our doors. Currently we watch the news for signs of new therapies or new vaccines.
During this time, many are now likely familiar with a term called cytokine storm. The term has been around pre-COVID, but its use has grown exponentially. It describes the hyperactivity of inflammatory processes responding to the COVID 19 infection. These processes normally fight the virus and then calm down once the threat is vanquished. With cytokine storm, the process of inflammation itself becomes the aggressor, causing tissue and organ damage. The excessive response sprays immune and inflammation bullets all over the place.
With enough damage to a given organ, the patient may die from the cytokine storm. In response to this severity and risk of death, scientists have scrambled to understand the cytokine storm like tornado storm chasers following twisters across the plains. Many attempts have been made to use currently available immune modulating therapies to turn off or turn down this storm. The benefits have been limited and disappointing.
One likely reason for disappointment likely arises from our limited understanding of what caused the cytokine storm. While we sometimes get lucky with finding a therapy without understanding its mechanism of action, understanding more often precedes efficacious therapies. Therefore, this article’s research takes a step closer to effective responses when it uncovers a potential mechanism by which SARS CoV2 disables the immune system.
Normally, our body responds to viral invasions with a type I interferon response. As messengers of the immune system necessary for proper function, this group of interferons set off a cascade of both inflammatory and anti-inflammatory events. This balance allows both a counterattack on the viral invader and brakes to prevent excessive damage to body tissue during the battle.
While each virus, such as flu, other coronaviruses, and so on possess their own secrets to immune evasion, SARS CoV2, behind COVID 19, appears to at least utilize a down-regulation of this interferon type 1 response. While turning down the interferon response lowers the inflammatory defenses, allowing further viral replication, it also turns down the brakes on our immune system. Eventually, this can lead to cytokine storm in some patients. This cytokine storm sweeps through and amplifies the damage.
As a functional medicine physician, I really appreciate this deeper understanding of the mechanisms by which COVID 19 harms our patients. I just hope they continue even deeper and look at why some patients experience cytokine storm and some do not. I don’t believe this is all viral related but confidently assert that the terrain therapy must play a major role in this disease. The terrain theory holds that a given individual’s genetic makeup and metabolic individuality due to lifestyle and life exposures contributes at least equally to whether that individual experiences disease, experiences, disease progression, or experiences disease remission.
Knowing the patient specific factors which allow the cytokine storm to whip into a frenzy would offer great opportunities for intervention and saving lives.