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Tocilizumab. Its name is almost scarier than the disease itself, and yet,Yet, in Naples this drug has helped patients in serious condition due to Coronavirus.

Tocilizumab, or Atlizumab, is a monoclonal antibody humanized developed by pharmaceutical companies Hoffmann-La Roche e Chugai and placed on sale under the trade names Tocilizumab and RoActemra.

It is a drug immunosuppressant, mainly studied for the treatment of autoimmune diseases, acting as a modulator of the excessive immune system reactions typical in rheumatoid arthritis, psoriatic arthritis, lupus, and psoriasis.

Tocilizumab is active against the receptor of theinterleukin-6 (IL-6R). Interleukin-6 (IL-6), also called interferon beta-2, regulates the physiology of inflammation and is a cytokine which plays an important role in the immune response and is involved in the pathogenesis of many diseases, such as the autoimmune diseases, the multiple myeloma and the prostate cancer.

The idea of using Tocilizumab for the treatment of Coronavirus came to oncologists at Pascale, a hospital company specializing in the treatment of cancer patients, and was immediately passed on to Chinese hospitals, which tested its efficacy on about 20 patients.

An exchange of ideas, an intuition and then, with the administration, the confirmation that one of the drugs used to treat some autoimmune diseases may also have positive effects in counteracting coronavirus. "We used Tocilizumab on two patients at Cotugno Hospital," they explained from the "Pascale" in Naples. And their conditions have improved.

How it works. In severe cases of Covid-19 infection, the onset of severe pneumonia (with recourse to intensive care and the risk of death) is not only due to Sars- Cov-2 virus replication, but also to an overreaction of the immune system, which, in some cases, becomes the very cause of damage and progression of symptoms.

Paradoxically, in short, the immune system complicates matters and generates what physicians call a "storm of cytokines," proteins that regulate the migration of immune cells to the site of infection and an inflammatory state that causes tissue damage at the level of the lung interstitium. Doctors are therefore attempting, in some cases, to use drugs already on the market for different diseases, but always related to an excessive immune response.

"We are an oncology institute, we certainly don't treat flu," explains Franco Buonaguro of the National Cancer Institute Ircss Fondazione Pascale in Naples, Italy. "But one evening six days ago, while chatting with my colleagues, we were reflecting on new oncology drugs that can cause side effects related to overloading the small circle between the heart and lung and generate a storm of a particular cytokine, called 'interleukin 6' (as in severe cases of Covid, ed.). To address this problem, Tocilizumab, a drug that modulates the immediate and excessive immune system reactions typical in rheumatoid arthritis, lupus and psoriasis, is used. "Hence, the insight that it could perhaps lower the level of interleukin-6 in severe cases of Covid."

The drug in question had already been used by Chinese colleagues whose experience served to rule out the possibility that it might create unexpected side effects. "From the Chinese colleagues, we found that they were already using it," Buonaguro explains. In 21 Chinese patients, it was successful with no problematic side effects. "We immediately used it on two patients at Cotugno Hospital in Naples. One severe and already intubated, the other about to be. Within 24 hours, in both patients the interleukin level dropped. Within 48 hours, the first patient was 'extubated,' while the second no longer needed to be intubated. These are possible approaches because these drugs, although marketed for other diseases, have passed all clinical trials for safety."

This incredible discovery, made at this dramatic time for our country is an opportunity to reflect about the topic that has long been the subject of our interest namely the immune system and autoimmune diseases and their treatment.

First of all, it would be interesting to discuss with immunologists and experts whether the patient who already has autoimmune problems is more or less vulnerable to Covid19. I have not yet read anything that can give unambiguous answers on this. Certainly every case is different and every clinical picture is peculiar and responds in its own way.

Wanting to speculate, I thought that if a person has autoimmune problems and is taking cortisone, antibiotics or other immunosuppressant drugs, they might be more susceptible to infection. But then I tried to ask myself how a patient already treated with this very drug that is used to help Covid19 pneumonia might react when faced with the virus. Could its preventive use protect the patient or even make him more prone to complications?

Does the drug only help in the advanced stage of the disease with severe pneumonia or can it prevent pneumonia from occurring?

I also wondered whether being a person with an already overexpressed immune system therefore more active than normal but not treated with immunosuppressive drugs could be a negative state that makes one contract the virus more easily or even be immune to it.

If the coronavirus triggers this storm of cytokines but patients with autoimmunity have these substances in their system could they already act as a shield against the disease? In simpler words, the autoimmune disease in this case would be, rather than a problem, the solution for not getting sick with Covid19, it is just a hypothesis that I hope will soon be answered by experts.

I have also reflected on another disturbing aspect that can be deduced from this matter. If this one-time drug is used to treat coronavirus, is it correct to do so for long periods, for months and even years, in patients with autoimmunity, or is it too drastic and violent a measure that may in time cause other serious problems to arise?

In the meantime, one should not let one's guard down at all, and one should continue all the protocol that many people do to treat immune system problems based on antioxidants and substances that definitely help one deal with any pathogen in a more responsive way and with well-equipped defenses.

Any good news, such as the possibility of using this drug, which appears to be of actual help, should ONLY BE A HOPE AND should absolutely NOT be conceived as AN INVITATION TO LOWER YOUR GUARD.

So immune or autoimmune stay the same AT HOME.