title: Dynamic changes in clinical features and cytokine/chemokine responses in SARS patients treated with interferon alfacon-1 plus corticosteroids.
abstract: Severe acute respiratory syndrome (SARS), caused by a novel coronavirus, emerged in early 2003 as a major international health crisis. We report on serum cytokine levels, viral load and clinical parameters over the course of the disease in a cohort of nine adult SARS patients treated with steroids and interferon alfacon-1 at North York General Hospital in Toronto, Ontario. Considerable variation among SARS patients with respect to circulating viral load and patterns of SARS-CoV-evoked cytokine responses was recorded. No single cytokine profile was observed in all patients, yet serum concentrations of interferon (IFN)-gamma, interleukin (IL)-10, CXCL10, CCL5 and CXCL8 were found to be elevated above normal levels during the course of the disease in all patients. Expression levels for IL-10, IFN-gamma and CXCL10 consistently peaked within 4 days of peak viral load. IL-12p70, IL-4 and tumour necrosis factor-alpha concentrations were consistently highest within 5 days of peak viral load. These results suggest that elevated levels of inflammatory cytokines are sensitive correlates of disease severity, including lung abnormalities and viral load in serum, and may provide a tool for monitoring disease progression in affected individuals.
authors.affiliation: Toronto General Research Institute & University of Toronto, ON, Canada.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Ward
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Blatt
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Siminovitch
authors.forename: Jiabing
authors.initials: J
authors.lastname: Chen
authors.forename: Anna
authors.initials: A
authors.lastname: Hinek
authors.forename: Bryan
authors.initials: B
authors.lastname: Wolff
authors.forename: Dieu H
authors.initials: DH
authors.lastname: Pham
authors.forename: Hassan
authors.initials: H
authors.lastname: Deif
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: LaMere
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
authors.forename: Gabriella A
authors.initials: GA
authors.lastname: Farcas
authors.forename: Patti
authors.initials: P
authors.lastname: Ferguson
authors.forename: Mary
authors.initials: M
authors.lastname: Latchford
authors.forename: Gary
authors.initials: G
authors.lastname: Levy
authors.forename: Liasum
authors.initials: L
authors.lastname: Fung
authors.forename: James W
authors.initials: JW
authors.lastname: Dennis
authors.forename: Enoch K Y
authors.initials: EK
authors.lastname: Lai
authors.forename: Eleanor N
authors.initials: EN
authors.lastname: Fish
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018946:Chemokine CCL5; D054357:Chemokine CXCL10; D019742:Chemokines, CC / Q000097:blood; D019743:Chemokines, CXC / Q000097:blood; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D007370:Interferon Type I / Q000627:therapeutic use*; D016898:Interferon-alpha; D007371:Interferon-gamma / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011994:Recombinant Proteins; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; C483024:CCL5 protein, human; D018946:Chemokine CCL5; D054357:Chemokine CXCL10; D019742:Chemokines, CC; D019743:Chemokines, CXC; D016207:Cytokines; D005938:Glucocorticoids; D007370:Interferon Type I; D016898:Interferon-alpha; D011994:Recombinant Proteins; C050739:interferon alfacon-1; D007371:Interferon-gamma; D011241:Prednisone; D008775:Methylprednisolone