К некоторым аспектам иммуносупрессоров и их аэрозольной доставке в легкие при лечении COVID-19

Ключевым патогенетическим звеном COVID-19 являются нарушения иммунного гомеостаза, которые часто проявляются гипериммунным ответом на патоген, приводящим к тяжелому неконтролируемому воспалению в легких, осложнениям и летальному исходу. Соответственно, определенный терапевтический потенциал заложен в средствах разных фармакологических групп с различными механизмами действия, но имеющими некоторую общность по направленности подавления иммунного ответа, что не редко отражено в классификациях объединяющим понятием иммуносупрессоры. Наиболее перспективными из них являются иммунобиологические препараты, к которым относятся моноклональные антитела, а также средства пуринергической регуляции. Имеются единичные попытки использования путем применения определенного подхода «классических» иммуносупрессоров, цитостатиков и ингибиторов кальциневрина, нашедших место в трансплантологии и онкологии, но от применения, которых с целью лечения неконтролируемого воспаления дыхательных путей отказались еще в конце прошлого столетия. Аэрозольный путь введения лекарственных средств оптимизирует лечение как по эффективности их воздействия, так и по уменьшению побочных эффектов и находит соответствующее применение при использовании ИС с целью лечения неконтролируемого воспаления дыхательных путей. Однако анализ возможностей подобного спектра иммуносупрессоров и их аэрозольной доставки в легкие при лечении COVID-19 не осуществлялся, что и явилось целью настоящей работы.

Анализ в методологическом плане проводился с использованием различных баз данных биомедицинской научной информации, включая такие, как: Index Medicus, PubMed, Embase, Cohrane реестр клинических исследований Clinical Trials gov и патентные базы.

В результате дана оценка эффективности воздействия различных подгрупп ИС при COVID-19, в том числе при ингаляционном их введении в дыхательные пути. Проанализирована роль центрального регулятора иммунного ответа, регуляторных T-клеток в патогенезе COVID-19, охарактеризован их терапевтический потенциал в зависимости от фазы и тяжести заболевания, дозы препарата. Отражены методы и подходы использования иммуносупрессоров, преимущества и недостатки. Определены целесообразность и перспективы их применения.

В заключении отмечается, что эффективность цитостатиков и ингибиторов кальциневрина при лечении воспаления дыхательных путей при COVID-19 остается неподтвержденной и бесперспективной. Большие надежды в этом плане подают биологические препараты, включая моноклональные антитела и средства пуринергической регуляции.

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