Upon viral infection, the initial step for clearing the virus depends on the successful recognition of infected cells by the immune system, which depends on cell surface receptor interactions, followed by the subsequent immune response. Given that viruses alter protein synthesis and thus affect cell surface receptors, the immune response encounters several barriers such as decreased recognition by immune cells and ineffective cytotoxicity by the exhaustion of T cells. Therefore, a holistic therapeutic approach that relies on targeting the viral infection at two levels might be worth considering: the first includes altering mucosal epithelial barriers and preventing viral entry to host cells (via targeting TMPRSS2 for instance) and the second encompasses immune-based treatment (e.g. interferon treatments emulating/stimulating anti-viral responses or anti-inflammatory agents) that are likely to and even proving to be valuable.
Interestingly, the prostate differs from other organs in our body by being immune privileged; it is not mucosal like the lung or colon tissues. That is since the prostate is immune-privileged (not a site of innate immune responses), it is possible that androgen-deprivation therapy could serve as adjunctive therapy with immune-based therapies to reduce risk of SARS-CoV-2 infection in prostate cancer patients specifically, and COVID-19 patients in general, independent of local mechanisms in the prostate itself.
Written by: Hisham F. Bahmad and Wassim Abou-Kheir, Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut
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