Aspects of immunopathology in humans during ssRNA virus infections - what do we know and do we have a foundation for treatment? - A narrative review - Part One

Background: The pathophysiological mechanisms underlying single-stranded RNA (ssRNA) virus infections have been investigated extensively and at an accelerated pace in recent years, largely driven by the COVID-19 pandemic. Particular attention has been given to their potential roles in respiratory insufficiency, endothelial dysfunction, thrombosis, and inflammatory responses within the central nervous system. Aim: This narrative review aims to summarize important pathophysiological mechanisms and pathways reported in the literature on respiratory ssRNA virus infections. Key findings are used to explain the outcome of present treatments and to suggest a more immuno-pathological based treatment strategy in these patients. Method: The review is based on studies extracted from an extensive body of literature, encompassing basic research in biochemistry, immunology, virology, and genetics, as well as clinical and therapeutic studies, all indexed in the PubMed database. Results: A species specific human immunological pathway reaction occurs against respiratory ssRNA viral genome antigen. It encompasses by an inferior interferon response limiting the force of the viral defense. A viral independent immunoinflammatory response, with monocytic cell infiltration in the lung ensues and may become severe, characterized by fortifying endothelial activation, a prothrombogenic pathway, and respiratory insufficiency. The pro-inflammatory response has potential ability of becoming chronic, with propagation to the central nervous system, but all responses seem potential treatable from an immune-pathological perspective. Conclusion: The review may serve as a template for treatment and for future studies. It can be concluded that it is essential to have broad immunopathological knowledge when treating and developing strategies for ssRNA virus infections. Keywords : RNA virus, innate immunity, COVID-19, RSV, Influenza