{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T09:01:32Z","timestamp":1765357292341,"version":"3.37.3"},"reference-count":91,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007013","name":"F. Hoffmann-La Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Acute respiratory distress syndrome (ARDS), associated with high mortality rate, affects up to 67% of hospitalized COVID-19 patients. Early evidence indicated that the pathogenesis of COVID-19 evoked ARDS is, at least partially, mediated by hyperinflammatory cytokine storm in which interleukin 6 (IL-6) plays an essential role. The corticosteroid dexamethasone is an effective treatment for severe COVID-19 related ARDS. However, trials of other immunomodulatory therapies, including anti-IL6 agents such as tocilizumab and sarilumab, have shown limited evidence of benefit as monotherapy. But recently published large trials have reported added benefit of tocilizumab in combination with dexamethasone in severe COVID-19 related ARDS. <jats:italic>In silico<\/jats:italic> tools can be useful to shed light on the mechanisms evoked by SARS-CoV-2 infection and of the potential therapeutic approaches. Therapeutic performance mapping system (TPMS), based on systems biology and artificial intelligence, integrate available biological, pharmacological and medical knowledge to create mathematical models of the disease. This technology was used to identify the pharmacological mechanism of dexamethasone, with or without tocilizumab, in the management of COVID-19 evoked ARDS. The results showed that while dexamethasone would be addressing a wider range of pathological processes with low intensity, tocilizumab might provide a more direct and intense effect upon the cytokine storm. Based on this <jats:italic>in silico<\/jats:italic> study, we conclude that the use of tocilizumab alongside dexamethasone is predicted to induce a synergistic effect in dampening inflammation and subsequent pathological processes, supporting the beneficial effect of the combined therapy in critically ill patients. Future research will allow identifying the ideal subpopulation of patients that would benefit better from this combined treatment.<\/jats:p>","DOI":"10.1371\/journal.pone.0280677","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T18:44:00Z","timestamp":1676486640000},"page":"e0280677","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Artificial intelligence assessment of the potential of tocilizumab along with corticosteroids therapy for the management of COVID-19 evoked acute respiratory distress syndrome"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8215-872X","authenticated-orcid":true,"given":"Cristina","family":"Seg\u00fa-Verg\u00e9s","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-6682","authenticated-orcid":true,"given":"Laura","family":"Artigas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireia","family":"Coma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard W.","family":"Peck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"pone.0280677.ref001","doi-asserted-by":"crossref","first-page":"107602","DOI":"10.1016\/j.intimp.2021.107602","article-title":"The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials","volume":"96","author":"WT Lin","year":"2021","journal-title":"Int Immunopharmacol"},{"issue":"12","key":"pone.0280677.ref002","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/S2213-2600(20)30370-2","article-title":"Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study","volume":"8","author":"G Grasselli","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"2","key":"pone.0280677.ref003","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5694\/mja2.50674","article-title":"COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS","volume":"213","author":"PG Gibson","year":"2020","journal-title":"Med J Aust"},{"issue":"1","key":"pone.0280677.ref004","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s13054-020-03240-7","article-title":"Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey","volume":"24","author":"SJ Tzotzos","year":"2020","journal-title":"Crit Care"},{"issue":"16","key":"pone.0280677.ref005","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1001\/jama.2020.4326","article-title":"Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State","volume":"323","author":"M Arentz","year":"2020","journal-title":"JAMA"},{"key":"pone.0280677.ref006","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.cytogfr.2020.05.003","article-title":"The cytokine storm in COVID-19: An overview of the involvement of the chemokine\/chemokine-receptor system","volume":"53","author":"F Coperchini","year":"2020","journal-title":"Cytokine Growth Factor Rev"},{"issue":"10223","key":"pone.0280677.ref007","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"pone.0280677.ref008","doi-asserted-by":"crossref","first-page":"102569","DOI":"10.1016\/j.autrev.2020.102569","article-title":"Immunomodulatory therapy for the management of severe COVID-19. 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