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Macrophage activation syndrome in COVID-19

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The novel coronavirus epidemic is characterized by high rates of morbidity and relatively high mortality. Laboratory test results in patients include leukopenia, an increase in liver function tests and ferritin levels reaching hundreds, and sometimes thousands of units. These data remind us about the macrophage activation syndrome (MAC). Secondary hemophagocytic lymphohistiocytosis syndrome, MAC, which pathogenesis is based on a defect in the mechanisms of T-cell cytotoxicity and decreased level of natural killer cells associated with the defect in the perforin-encoding gene as well as hyperproduction of a number of cytokines – interleukin (IL)-1â, tumor necrosis factor-á, etc. by T-lymphocytes and histiocytes, indirectly leading to the activation of macrophages and production of proinflammatory cytokines, in particular IL-6 hyperproduction. MAC is one of "hyperferritinemic syndromes". These disorders have similar clinical and laboratory manifestations, and they also respond to similar treatments, suggesting that hyperferritinemia may be involved in the overall pathogenesis and is characterized by elevated ferritin level and cytokine storm. Despite the fact that data on the immune and inflammatory status in patients with COVID-19 have only started to appear, it is already clear that hyperinflammation and coagulopathy affect the disease severity and increase the risk of death in patients infected with SARS-CoV-2. Hence, understanding the pathogenesis of the novel coronavirus infection can help in its early diagnostics and treatment.

About the Authors

K. N. Grigorieva
Sechenov University
Russian Federation

Kristina N. Grigoreva – MD, Medical Resident, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

V. O. Bitsadze
Sechenov University
Russian Federation

Victoria O. Bitsadze – MD, Dr Sci Med, Professor of RAS, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 6506003478; Researcher ID: F-8409-2017

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 57194547147; Researcher ID: F-8384-2017

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

M. V. Tretyakova
«Medical Center» LLC
Russian Federation

Maria V. Tretyakova – MD, PhD, Obstetrician-Gynecologist, Department of Gynecology

15/1 Timura Frunze Str., Moscow 119021

D. V. Blinov
Institute for Preventive and Social Medicine; Lapino Clinic Hospital, MD Medical Group
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Head of Medical and Scientific Affairs, Institute for Preventive and Social Medicine; Neurologist, Lapino Clinical Hospital, MD Medical Group

Scopus Author ID: 6701744871; Researcher ID: E-8906-2017; RSCI: 9779-8290

4–10 Sadovaya-Triumfalnaya Str., Moscow 127006

1st Uspenskoye Highway, 111, Moscow Region, Odintsovo District, Lapino 143081

V. I. Tsibizova
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Valentina I. Tsibizova – MD, PhD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics; Physician, Department of Functional and Ultrasound Diagnostics, Almazov National Medical Research Centre

2 Akkuratova Str., Saint Petersburg 197341

D. A. Ponomarev
Vorokhobov City Clinical Hospital № 67, Moscow Healthcare Department
Russian Federation

Dmitry A. Ponomarev – Head of Maternity Hospital № 4 – Branch of Vinogradov City Clinical Hospital

2/44 Salyama Adilya Str., Moscow 123423

A. S. Shkoda
Vorokhobov City Clinical Hospital № 67, Moscow Healthcare Department
Russian Federation

Andrey S. Shkoda – MD, Dr Sci Med, Professor, Chief Physician

2/44 Salyama Adilya Str., Moscow 123423

E. A. Orudzhova
Vorokhobov City Clinical Hospital № 67, Moscow Healthcare Department
Russian Federation

Esmira A. Orudzhova – MD, Head of Antenatal Outpatient Care Center, Maternity Hospital № 1 – Branch of Vorokhobov City Clinical Hospital № 67

2/44 Salyama Adilya Str., Moscow 123423

E. Grandone
Sechenov University; Tor Vergata University of Rome

Elvira Grandone – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health, Sechenov University; Professor, Thrombosis and Haemostasis Research Unit, Department of Medical Genetics, Ospedale "Casa Sollievo della Sofferenza", San Giovanni Rotondo (Rome, Italy)

Scopus Author ID: 7006391091; Researcher ID: M-1127-2019

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991


G. Rizzo
Sechenov University; Tor Vergata University of Rome

Giuseppe Rizzo – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health, Sechenov University; Professor, Director, Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata (Rome, Italy)

Scopus Author ID: 7102724281; Researcher ID: G-8234-2018

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya – MD, Dr Sci Med, Academician of RAS, Professor, Head of the Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 57222220144; Researcher ID: M-5660-2016

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991


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For citations:

Grigorieva K.N., Bitsadze V.O., Khizroeva J.K., Tretyakova M.V., Blinov D.V., Tsibizova V.I., Ponomarev D.A., Shkoda A.S., Orudzhova E.A., Grandone E., Rizzo G., Makatsariya A.D. Macrophage activation syndrome in COVID-19. Obstetrics, Gynecology and Reproduction. 2021;15(3):313-320.

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