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1、5354_08_p535-54412/6/042:30PMPage535VIRALIMMUNOLOGYVolume17,Number4,2004©MaryAnnLiebert,Inc.Pp.535–544SevereAcuteRespiratorySyndrome,aPathologicalImmuneResponsetotheNewCoronavirus—ImplicationsforUnderstandingofPathogenesis,Therapy,DesignofVaccines,andEpidemiologyJESUSF.BERMEJOandM.ANGELESMUÑOZ-FERNA
2、NDEZABSTRACTFindingscomingfromautopsiesandserumofSARSpatientssuggestanimportantimmune-in-flammatoryimplicationintheevolutiontorespiratorydistress.ConditionssuchasHIVinfectionortreatmentwithimmunosuppressors(incancerorautoimmunediseases)arenotamongthebadprognosisfactorsfordevelopmentofdistress.Todate
3、,therehavebeennoreportedcasefatalitiesinchildren,probablyduetotheirmoreimmatureimmunesystem.Ourconclusionsfollow:(1)ThemilderformofSARSinchildrenandtheapparentprotectivefactorthatimmunosupressionrep-resentrulesoutasignificantviralcytopathiceffect(theywouldbethemostaffected).(2)Theevi-denceforimmunei
4、mplicationindistressstronglysupportsimmunomodulatorsfortherapy:phos-phodiesteraseinhibitors(duetotheirdown-modulatingactivityonproinflammatorycytokines);inhaledcorticoids(aimedatproducingalocalimmunomodulation);teophyllineornedocromilsodium(whichpreventsinflammatorycellrecruitmentintotheairwaywall).
5、(3)Anearlyim-munomodulatorytherapy,basedonthelevelsofproinflammatorycytokinesandclinicalparame-terstoevaluatetherespiratoryfunctionsuchasarterialoxygensaturation,couldpreventtheoc-currenceofdistress.(4)Vaccinedesignshouldconsidertheimmuneoriginofdistress.(5)Physiciansshouldbeawareofmildlysymptomatic
6、patients(children,immuno-compromisedhosts)toavoidtransmissiontoimmunocompetentadults.INTRODUCTIONficationoftissuesandfluidswheretheviruswaspresent,characterizationofpossiblereservoirs,andachievementEVEREACUTERESPIRATORYSYNDROME(SARS)pro-ofananimalmodel(30,36).However,wefeelthereareSduced774deathswor
7、ldwideduringthefirst(andsostillunsolvedquestionsregardingSARSpathogenesis:farthemain)outburstin2003.SARShasreturnedinWhatistheunderlyingcauseofrespiratorydistress?Is2004intheformoflimitedfocusesthatha
