“The linkage of cytokine storm in COVID-19 may be nothing more than a tempest in a teapot" (Sinha et al, JAMA, 2020). Recent data has "unmasked the lipid mediator storm occurring in the lungs of patients afflicted with severe COVID-19" (Archambault et al, FASEB, 2021). The most increased COX metabolites were TxB2 >> PGE2 ~ 12-HHTrE > PGD2. TXA2 promotes bronchoconstriction and activate leukocytes and platelets, which is consistent with the enhanced platelet activation and thrombosis in COVID-19 and the strong link between TxB2 and ARDS. PGD2 action via the DPr2 receptor promotes eosinophilia in COVID-19 (Lucas et al, Nature, 2020). "Testing whether blocking the deleterious effects of PGD2 and TxA2 with the dual DPr2/TPr antagonist Ramatroban might be beneficial in COVID-19 is of interest" (Archambault et al, FASEB, 2021).
Cytokine levels in COVID-19 are comparable to that in influenza suggesting a minimal role of cytokines during severe SARS-CoV-2 infection