Targeting innate immunity by blocking CD14: Novel approach to control inflammation and organ dysfunction in COVID-19 illness

The SARS-CoV-2 pandemic has produced an unprecedented rush to develop new therapies, ranging from immunizations and antivirals to host-directed therapies to dampen potentially deleterious host inflammatory responses. With a sense of urgency, many groups have proposed repurposing approved drugs for other indications that might be deployed rapidly to control the viral infection or improve host responses. However, many of these therapies are based on drug availability rather than on a rational understanding of important steps in pathogenesis, particularly in the lungs, that lead to critical illness and life-threatening acute respiratory failure. Here we propose that the viral infection initially triggers a profound activation of innate immunity in the lungs that generates a self-perpetuating cytokine storm affecting the entire body. Inhibiting key proximal points in innate immunity pathways is feasible and offers a science-based approach to improving outcomes in moderate to severe COVID-19 illness.