MEDICAL INTELLIGENCE REPORT: “Macrophage Activation Syndrome” (MAS), COVID-19 Disease and Cyclosporine Therapy

Honorable Rep. Fitzpatrick, Mr. President and VP Pence,

I write here in urgent follow-up to my prior communication with you regarding the potential power of the Calcineurin Inhibitor class of drug (e.g., Cyclosporine and Tacrolimus).

Four days ago, one of Nature Magazine’s sister journals published the a paper on the characteristics of COVID-19 disease. You may read this paper HERE.

This paper highlights some of the mechanistic basis and phenotype exhibited by COVID-19 patients. These phenotypes are highly reminiscent of that seen in patients with “Macrophage Activation Syndrome”, or MAS.

I propose that the COVID-19 virus may be triggering a very similar pathological process as is seen in MAS. The difference of course is that the nidus of entry for the virus are the patient’s lungs where the initial pathology is reminiscent of an acutely rejecting lung transplant. That is, Ground Glass Opacities (GGO) show up on chest CT scan, accompanied with progressive respiratory symptoms (Dyspnea, Shortness of Breath and respiratory failure) as the patient deteriorates, which subsequently morph into a MAS-like systemic syndrome — followed by death.

It is my suggestion that the President of the United States and our COVID-19 task force in the executive branch (and in congress) seriously consider opening the door to the use of one of the most classical, ubiquitous and abundantly available pharmacological modalities used in the treatment of both MAS and lung allograft rejection: That is, the Calcineurin Inhibitor class of drugs (i.e., Cyclosporine and Tacrolimus).

Many rheumatologists with expertise in treatment of MAS (and other Cytokine Release Syndromes) consider Cyclosporine a first-line drug in the treatment. Of course, currently we do have much more sophisticated biologics in development currently, one of which has actually been used for treatment of COVID-19 disease (i.e., anti-IL6, Tiziana). BUT, in this current war that’s been unleashed upon us, we are not going to have time to scale up production of this advanced drug in the time frame that COVID-19 will be ravaging our economy and hospitals.

Of course, a concern some infectious disease specialists might raise is that use of Calcineurin Inhibition for prevention and treatment of might prevent a curative immune response necessary to fight the COVID-19 infection. To those colleagues, I will only state that if you/we are willing and able to deploy the anti-IL6 agent, which is a MASSIVE immunosuppressive weapon, compared to the Cyclosporine related agents, we must consider why we are being intellectually reluctant to deploy Cyclosporine.

Again, it is the proposition of this Intellgence Report that we quickly consider and accept the potential utility of the Calcineurin Inhibitor class of drugs, both as a prophylaxis and as a treatment modality, for immediate use in patients with COVID-19 disease — and potentially even as prophylaxis.

The similarity between COVID-19 disease and MAS is striking and should not be ignored — as is the clinical presentation of COVID-19 respiratory disease in its similarity to acute lung allograft rejection…..Both are diseases that are treated with Cyclosporine agents. If the proposition in this brief Intellgence report is correct, to not deploy (or at least try) Cyclosporine and its related agents for prevention and treatment of COVID-19 mortality may become a major error in our war effort in response to COVID-19.

May the good Lord save the United States of America — our children’s home.

I write for the record.

Yours,

Hooman (For Amy J. Reed and her good friend US Rep. Mike Fitzpatrick).