01 January 1970 67 8K Report

Dysregulation of pro-inflammatory cytokines promotes immune-mediated injuries 1.

Both epithelial-cell proliferation and an increase in macrophages in the lung are associated with SARS 2. Pathogen-associated molecular patterns (PAMPs) such as 2019 novel coronavirus, proinflammatory cytokines, and lipopolysaccharide (LPS), cause macrophage transition. Macrophages activated in this transition termed M1 macrophages that promote inflammation 3. PAMPs are primarily sensed by members of the Toll-like receptor (TLR) family and this sensation activate transcriptional factor NF-κB that promotes secretion of proinflammatory cytokines 3. Activated or infected immune cells secrete excessive proinflammatory cytokines including MIP-1α, RANTES, IP-10, IL-1-6-8, TNF-α, TGF-β1, MCP-1and MCP-1 4. These cytokines promote severe lung injury 1.

Thalidomide is an immunomodulatory agent with strong antiangiogenic properties with COX-2 inhibitor celecoxib. Thalidomide inhibits the mRNA encoding such as TNF-α and VEGF. In addition, thalidomide modulates activated or irregulated NF-κB, resulting in suppressing severe lung injuries.

However, we are ordered not to conduct clinical trials with thalidomide and celecoxib

by Ministry of Health, Labor and Welfare, Japan. Because thalidomide is the dangerous drug.

I think it would be difficult to save the patients with severe pneumonia who could be saved with this regimen in the future. I would like you to recommend to the Japanese Ministry of Health, Labor and Welfare to take appropriate measures in Japan from the Form.

Please post your opinion in the form that Japanese people could have effective treatment for 2019-nCoV infection. https://www.kantei.go.jp/jp/forms/goiken_ssl.html

1. Jiang Gu , Christine Korteweg

Pathology and Pathogenesis of Severe Acute Respiratory Syndrome

Am J Pathol, 170 (4), 1136-47 Apr 2007

2. John M Nicholls , Leo L M Poon, Kam C Lee, et al

Lung Pathology of Fatal Severe Acute Respiratory Syndrome

Lancet, 361 (9371), 1773-8 2003 May 24

3. Yannic Nonnenmacher, Karsten Hiller

Biochemistry of Proinflammatory Macrophage Activation

Cell Mol Life Sci, 75 (12), 2093-2109 Jun 2018

4. Chaolin Huang, Yeming Wang,Prof Xingwang Li, et al

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

The Lancet Journal

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