Dissecting influenza virus pathogenesis uncovers a novel chemical approach to combat the infection

The cytokine storm is an aggressive immune response characterized by the recruitment of inflammatory leukocytes and exaggerated levels of cytokines and chemokines at the site of infection. Here we review evidence that cytokine storm directly contributes to the morbidity and mortality resulting from influenza virus infection and that sphingosine-1-phosphate (S1P) receptor agonists can abort cytokine storms providing significant protection against pathogenic human influenza viral infections. In experiments using murine models and the human pathogenic 2009 influenza viruses, S1P1 receptor agonist alone reduced deaths from influenza virus by over 80% as compared to lesser protection (50%) offered by the antiviral neuraminidase inhibitor oseltamivir. Optimal protection of 96% was achieved by combined therapy with the S1P1 receptor agonist and oseltamivir. The functional mechanism of S1P receptor agonist(s) action and the predominant role played by pulmonary endothelial cells as amplifiers of cytokine storm during influenza infection are described.

► Cytokine storm plays a direct role in causation of injury due to influenza.
► Signaling via S1P1 receptor on pulmonary endothelial cells initiates lung pathology.
► S1P1 receptor agonist blocks the influenza-induced cytokine storm.
► S1P1 receptor agonist does not block host immune control over influenza.
► Pulmonary endothelial cells are the central regulators of cytokine storm.