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Aranda-Valderrama and Kaynar published a model to determine the flow of cytokines and proinflammatory cells in the pulmonary alveoli of patients affected by ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> They observed how inactive IL-1&#946; &#40;pro-IL-1&#946;&#41; progresses to active IL-1&#946; inside the alveolar macrophages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This IL-1&#946; generates the activation of the alveolar macrophage&#44; thereby triggering the release of proinflammatory molecules such as IL-6&#44; IL-18&#44; TNF&#44; G-CSF and CCCL2&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In 2006&#44; He et al&#46; studied the high number of inflammatory cytokines in patients with ARDS secondary to coronavirus &#40;CoV&#41; infection&#46; Autopsies of these patients showed elevated MCP-1&#44; TGF-&#946;1&#44; TNF-&#945;&#44; IL-1&#946; and IL-6&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This and other publications<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> also study the NLPR3 inflammasome and its influence on alveolar macrophage activation in ARDS patients&#46; This is a complex of proteins that interact in a unidirectional manner generating an inflammatory cascade&#46; Innate immunity responds to infection and tissue damage by activating this molecular platform&#46; In human clinical research&#44; four classes of inflammasomes related to inflammatory processes have been described&#58; NLRP1&#44; NLRC4&#44; NLRP3 and AIM-2&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Of these&#44; NLRP3 is the best studied&#46; Inflammasomes have the common purpose of processing and activating caspase-1&#44; the enzyme responsible for the maturation of pro-IL-1&#946; y and pro-IL-18&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This protein group can detect molecular patterns linked to potential danger&#44; either endogenous &#40;DAMPs&#41; or exogenous &#40;PAMPs&#41; signals that activate various intracellular signalling pathways&#44; mainly through toll-like receptors &#40;TLRs&#41;&#44; culminating in the activation of different pro-inflammatory transcription factors such as nuclear factor kappa B &#40;NF-kB&#41; or activator protein 1 &#40;AP-1&#41;&#46; These danger signals can also lead to inflammasome activation and maturation of de IL-1&#946; and IL-18 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The NLRP3 inflammasome can cause epithelial and endothelial damage in the lung parenchyma&#44; leading to severe respiratory disorders such as ARDS and acute lung injury &#40;ALI&#41;&#44; possibly resulting in severe pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">It is likely that COVID-19 infection can trigger a violent immune response and in turn activate the NLRP3 inflammasome in alveolar macrophages&#44; causing a potentially fatal &#8220;storm&#8221; of cytokines&#44; notably IL-1&#946;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We currently have a drug called anakinra&#44; which neutralises the biological activity of interleukin-1 alpha and &#223; by competitively inhibiting their binding to the interleukin-1 type I receptor&#46; Another available molecule is canakinumab&#44; which binds with high affinity specifically to IL-1&#946; and neutralises its biological activity by blocking interaction with IL-1 receptors&#44; thus preventing IL-1&#946; induced gene activation and the production of inflammatory mediators&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">These drugs that can block IL-1&#946; activity have shown efficacy in the treatment of autoinflammatory diseases such as neonatal-onset multisystem inflammatory disease &#40;CINCA&#41;&#44; Muckle-Wells syndrome &#40;MWS&#41;&#44; familial cold autoinflammatory syndrome &#40;FCAS&#41;&#44; Still&#39;s disease and cryopyrin-associated diseases&#44; a rare genetic disease caused by an autosomal dominant mutation in the NLRP3 gene&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The link between the presence of an NLRP3 inflammasome and the origin of the inflammatory cascade in ARDS has been confirmed in the medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> The initiating pathway of IL-1&#946; makes it a specific and central target for controlling the pro-inflammatory picture generated in the pulmonary alveolus&#46; It is thus a potential therapeutic target in patients who may progress to ARDS after COVID-19 infection&#46; The use of anakinra &#40;anti IL 1&#946; R&#41; or canakinumab &#40;anti IL 1&#946;&#41; is a therapeutic option to control alveolar inflammation secondary to COVID-19 infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">However&#44; these are different drugs with equally different pharmacokinetics and pharmacodynamics&#46; The peak serum concentration &#40;C<span class="elsevierStyleInf">max</span>&#41; of canakinumab occurs approximately 7 days after a single subcutaneous dose of 150&#8239;mg administered to patients with cryopyrin-associated periodic syndrome &#40;adult CAPS&#41;&#46; The mean terminal half-life is 26 days and mean peak plasma concentration &#40;C<span class="elsevierStyleInf">max</span>&#41; after a single subcutaneous dose of 150&#8239;mg in a typical adult CAPS patient &#40;70&#8239;kg&#41; is 15&#46;9&#8239;&#956;g&#47;mL and an absolute bioavailability after subcutaneous administration of 66&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Anakinra&#44; in contrast&#44; has an absolute bioavailability of 95&#37; for healthy adults after a 70&#8239;mg subcutaneous bolus injection&#46; The C<span class="elsevierStyleInf">max</span> of anakinra is generally 3&#8211;7&#8239;h after subcutaneous administration of clinically relevant doses &#40;1&#8722;2&#8239;mg&#47;kg&#47;day&#41; and the terminal half-life ranges from 4&#8239;h to 6&#8239;h&#46; It is therefore a drug with a shorter half-life than canakinumab and thus with great potential for use in a clinical emergency such as ARDS due to COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It is likely that using the immunosuppressive biologic therapies is a way to control ARDS due to COVID-19&#46; However&#44; other scenarios must be considered beyond the individual potential of each molecule where even 2 or more of these lines of treatment can be added&#46; While we need randomised clinical trials to advance the safety and efficacy of anakinra in ARDS due to COVID-19&#44; this option should be considered when current treatments are ineffective or unavailable&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The outcome of the SARS-CoV-2 &#40;COVID-19&#41; infection fundamentally affects the lung field&#44; causing ACUTE RESPIRATORY DISTRESS SYNDROME &#40;ARDS&#41;&#46; This process is an inflammatory picture&#44; involving an NLRP3 INFLAMOSOME-triggered cytokine storm&#44; the main player in alveolar destruction&#46; IL-1 beta stands out among the cytokines that are triggered in this picture&#46; ANAKINRA is a potent biological drug&#44; capable of blocking this IL 1 beta&#46; We propose its use in controlling ARDS secondary to COVID-19 infection&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El desenlace de la infecci&#243;n por SARS-CoV-2 &#40;COVID-19&#41; afecta fundamentalmente al campo pulmonar&#44; ocasionando un cuadro de S&#205;NDROME DE DISTR&#201;S RESPIRATORIO AGUDO &#40;SDRA&#41;&#46; Este proceso es un cuadro inflamatorio&#44; protagonizado por una cascada de citocinas bajo el amparo del INFLAMOSOMA NLRP3&#44; responsable principal de la destrucci&#243;n alveolar&#46; De entre todas las citocinas que se desencadenan en este cuadro destaca la IL beta&#46; ANAKINRA es un potente f&#225;rmaco biol&#243;gico&#44; capaz de bloquear esta IL 1 beta&#46; Proponemos su uso&#44; de cara a controlar el SDRA secundario a la infecci&#243;n por COVID-19&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of acute respiratory distress syndrome &#40;ARDS&#41; is triggered after an initial injury that interacts through alarmin receptors and TLRs that activate nuclear transcription factors&#44; including NF-&#954;B&#46; Subsequently&#44; a potent acute immune response triggered primarily by IL-1&#223; results in macrophage&#47;neutrophil activation and recruitment&#46; The cell-mediated immune response results in tissue damage&#44; which promotes the development of oedema and epithelial damage&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">IL&#58; interleukin&#59; MAPK&#58; Mitogen-activated protein kinase&#59; MMPs&#58; Matrix metalloproteinases&#59; NETs&#58; Neutrophil extracellular traps&#59; PAMPS&#58; Pathogen-associated molecular patterns&#59; ROS&#58; Reactive oxygen species&#59; TLR&#58; Toll-like receptor&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; version adapted from the original by Aranda-Valderrama et al&#46; Scientific illustrator&#58; Miguel Soto&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pathophysiology of ARDS&#46; The initial inflammatory stimulus activates alveolar macrophages through TLR and NLRP signalling&#46; Activated alveolar macrophages release proinflammatory cytokines and recruit circulating macrophages and neutrophils to injury sites&#46; This influx of persistently activated neutrophils and macrophages causes extensive damage to epithelial and endothelial lung tissue&#44; resulting in an impaired alveolar-capillary barrier&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ENaC&#58; Epithelial sodium channel&#59; Na&#58; Sodium&#59; NETs&#58; Neutrophil Extracellular Traps&#59; TLR&#58; Toll-like receptor&#59; U&#58; Ubiquitination&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Source&#58; version adapted from the original by Seung Hye Han et al&#46; Scientific illustrator&#58; Miguel Soto&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of hospitalized patients with acute respiratory distress syndrome caused by COVID-19 and H1N1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Tang"
                            1 => "R&#46; Du"
                            2 => "R&#46; Wang"
                            3 => "T&#46; Cao"
                            4 => "L&#46; Guan"
                            5 => "C&#46; Yang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.chest.2020.03.032"
                      "Revista" => array:3 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "2020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS&#46; Plasma IL-1 beta and IL-6 levels are consistent and efficient predictors of outcome over time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;U&#46; Meduri"
                            1 => "S&#46; Headley"
                            2 => "G&#46; Kohler"
                            3 => "F&#46; Stentz"
                            4 => "E&#46; Tolley"
                            5 => "R&#46; Umberger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.107.4.1062"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "1995"
                        "volumen" => "107"
                        "paginaInicial" => "1062"
                        "paginaFinal" => "1073"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7705118"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory cytokines in the BAL of patients with ARDS&#46; Persistent elevation over time predicts poor outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;U&#46; Meduri"
                            1 => "G&#46; Kohler"
                            2 => "S&#46; Headley"
                            3 => "E&#46; Tolley"
                            4 => "F&#46; Stentz"
                            5 => "A&#46; Postlethwaite"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.108.5.1303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "1995"
                        "volumen" => "108"
                        "paginaInicial" => "1303"
                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7587434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Dinarello"
                            1 => "A&#46; Simon"
                            2 => "J&#46;W&#46; van der Meer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrd3800"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Drug Discov&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "633"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22850787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The basic science and molecular mechanisms of lung injury and acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Aranda-Valderrama"
                            1 => "A&#46;M&#46; Kaynar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AIA.0000000000000207"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Anesthesiol Clin&#46;"
                        "fecha" => "2018"
                        "volumen" => "56"
                        "paginaInicial" => "1"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30204601"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expression of elevated levels of pro-inflammatory cytokines in SARS-CoV-infected ACE2&#43; cells in SARS patients&#58; relation to the acute lung injury and pathogenesis of SARS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; He"
                            1 => "Y&#46; Ding"
                            2 => "Q&#46; Zhang"
                            3 => "X&#46; Che"
                            4 => "Y&#46; He"
                            5 => "H&#46; Shen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/path.2067"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pathol&#46;"
                        "fecha" => "2006"
                        "volumen" => "210"
                        "paginaInicial" => "288"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17031779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The acute respiratory distress syndrome&#58; from mechanism to translation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Han"
                            1 => "R&#46;K&#46; Mallampalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1402513"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol&#46;"
                        "fecha" => "2015"
                        "volumen" => "194"
                        "paginaInicial" => "855"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25596299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sensing and reacting to microbes through the inflammasomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Franchi"
                            1 => "R&#46; Munoz-Planillo"
                            2 => "G&#46; N&#250;&#241;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ni.2231"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Immunol&#46;"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "325"
                        "paginaFinal" => "332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22430785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical role for the NLRP3 inflammasome during acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Grailer"
                            1 => "B&#46;A&#46; Canning"
                            2 => "M&#46; Kalbitz"
                            3 => "M&#46;D&#46; Haggadone"
                            4 => "R&#46;M&#46; Dhond"
                            5 => "A&#46;V&#46; Andjelkovic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1400368"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol&#46;"
                        "fecha" => "2014"
                        "volumen" => "192"
                        "paginaInicial" => "5974"
                        "paginaFinal" => "5983"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24795455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The NLRP3 inflammasome is required for the development of hypoxemia in LPS&#47;mechanical ventilation acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;D&#46; Jones"
                            1 => "T&#46;R&#46; Crother"
                            2 => "R&#46;A&#46; Gonzalez-Villalobos"
                            3 => "M&#46; Jupelli"
                            4 => "S&#46; Chen"
                            5 => "J&#46; Dagvadorj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                            "web" => "Medline"
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                      "titulo" => "The efficacy&#44; safety and tolerability of canakinumab in the treatment of familial mediterranean fever&#58; a systematic review of the literature"
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                        0 => array:2 [
                          "etal" => false
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                        ]
                      ]
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Special Article
Proposal for the use of anakinra in acute respiratory distress secondary to COVID-19
Propuesta de uso de anakinra en el distrés respiratorio agudo secundario a COVID-19
Alejandro Muñoz-Jiméneza,
Corresponding author
amj@ser.es

Corresponding author.
, Esteban Rubio-Romeroa, José Luis Marenco de la Fuenteb
a Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Servicio de Reumatología, Hospital Universitario Virgen de Valme, Sevilla, Spain
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pathophysiology of ARDS&#46; The initial inflammatory stimulus activates alveolar macrophages through TLR and NLRP signalling&#46; Activated alveolar macrophages release proinflammatory cytokines and recruit circulating macrophages and neutrophils to injury sites&#46; This influx of persistently activated neutrophils and macrophages causes extensive damage to epithelial and endothelial lung tissue&#44; resulting in an impaired alveolar-capillary barrier&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ENaC&#58; Epithelial sodium channel&#59; Na&#58; Sodium&#59; NETs&#58; Neutrophil Extracellular Traps&#59; TLR&#58; Toll-like receptor&#59; U&#58; Ubiquitination&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Source&#58; version adapted from the original by Seung Hye Han et al&#46; Scientific illustrator&#58; Miguel Soto&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the most serious complications in patients infected with COVID-19 is cardiopulmonary failure termed acute respiratory distress syndrome &#40;ARDS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since 1995&#44; several authors have highlighted the central role of IL-1 Beta &#40;IL-1&#41; in the inflammatory cascade of ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> There are 2 publications involving more than 20 patients&#44; showing elevated IL-1&#946; levels in plasma and bronchoalveolar lavage&#46; In addition to these publications&#44; many others describe an increase in countless proinflammatory cytokines &#40;IL-1&#44; IL-6&#44; TNF-alpha&#44; IL-8&#44; etc&#46;&#41; in the alveoli of patients with ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2018&#44; Aranda-Valderrama and Kaynar published a model to determine the flow of cytokines and proinflammatory cells in the pulmonary alveoli of patients affected by ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> They observed how inactive IL-1&#946; &#40;pro-IL-1&#946;&#41; progresses to active IL-1&#946; inside the alveolar macrophages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This IL-1&#946; generates the activation of the alveolar macrophage&#44; thereby triggering the release of proinflammatory molecules such as IL-6&#44; IL-18&#44; TNF&#44; G-CSF and CCCL2&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In 2006&#44; He et al&#46; studied the high number of inflammatory cytokines in patients with ARDS secondary to coronavirus &#40;CoV&#41; infection&#46; Autopsies of these patients showed elevated MCP-1&#44; TGF-&#946;1&#44; TNF-&#945;&#44; IL-1&#946; and IL-6&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This and other publications<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> also study the NLPR3 inflammasome and its influence on alveolar macrophage activation in ARDS patients&#46; This is a complex of proteins that interact in a unidirectional manner generating an inflammatory cascade&#46; Innate immunity responds to infection and tissue damage by activating this molecular platform&#46; In human clinical research&#44; four classes of inflammasomes related to inflammatory processes have been described&#58; NLRP1&#44; NLRC4&#44; NLRP3 and AIM-2&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Of these&#44; NLRP3 is the best studied&#46; Inflammasomes have the common purpose of processing and activating caspase-1&#44; the enzyme responsible for the maturation of pro-IL-1&#946; y and pro-IL-18&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This protein group can detect molecular patterns linked to potential danger&#44; either endogenous &#40;DAMPs&#41; or exogenous &#40;PAMPs&#41; signals that activate various intracellular signalling pathways&#44; mainly through toll-like receptors &#40;TLRs&#41;&#44; culminating in the activation of different pro-inflammatory transcription factors such as nuclear factor kappa B &#40;NF-kB&#41; or activator protein 1 &#40;AP-1&#41;&#46; These danger signals can also lead to inflammasome activation and maturation of de IL-1&#946; and IL-18 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The NLRP3 inflammasome can cause epithelial and endothelial damage in the lung parenchyma&#44; leading to severe respiratory disorders such as ARDS and acute lung injury &#40;ALI&#41;&#44; possibly resulting in severe pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">It is likely that COVID-19 infection can trigger a violent immune response and in turn activate the NLRP3 inflammasome in alveolar macrophages&#44; causing a potentially fatal &#8220;storm&#8221; of cytokines&#44; notably IL-1&#946;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We currently have a drug called anakinra&#44; which neutralises the biological activity of interleukin-1 alpha and &#223; by competitively inhibiting their binding to the interleukin-1 type I receptor&#46; Another available molecule is canakinumab&#44; which binds with high affinity specifically to IL-1&#946; and neutralises its biological activity by blocking interaction with IL-1 receptors&#44; thus preventing IL-1&#946; induced gene activation and the production of inflammatory mediators&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">These drugs that can block IL-1&#946; activity have shown efficacy in the treatment of autoinflammatory diseases such as neonatal-onset multisystem inflammatory disease &#40;CINCA&#41;&#44; Muckle-Wells syndrome &#40;MWS&#41;&#44; familial cold autoinflammatory syndrome &#40;FCAS&#41;&#44; Still&#39;s disease and cryopyrin-associated diseases&#44; a rare genetic disease caused by an autosomal dominant mutation in the NLRP3 gene&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The link between the presence of an NLRP3 inflammasome and the origin of the inflammatory cascade in ARDS has been confirmed in the medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> The initiating pathway of IL-1&#946; makes it a specific and central target for controlling the pro-inflammatory picture generated in the pulmonary alveolus&#46; It is thus a potential therapeutic target in patients who may progress to ARDS after COVID-19 infection&#46; The use of anakinra &#40;anti IL 1&#946; R&#41; or canakinumab &#40;anti IL 1&#946;&#41; is a therapeutic option to control alveolar inflammation secondary to COVID-19 infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">However&#44; these are different drugs with equally different pharmacokinetics and pharmacodynamics&#46; The peak serum concentration &#40;C<span class="elsevierStyleInf">max</span>&#41; of canakinumab occurs approximately 7 days after a single subcutaneous dose of 150&#8239;mg administered to patients with cryopyrin-associated periodic syndrome &#40;adult CAPS&#41;&#46; The mean terminal half-life is 26 days and mean peak plasma concentration &#40;C<span class="elsevierStyleInf">max</span>&#41; after a single subcutaneous dose of 150&#8239;mg in a typical adult CAPS patient &#40;70&#8239;kg&#41; is 15&#46;9&#8239;&#956;g&#47;mL and an absolute bioavailability after subcutaneous administration of 66&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Anakinra&#44; in contrast&#44; has an absolute bioavailability of 95&#37; for healthy adults after a 70&#8239;mg subcutaneous bolus injection&#46; The C<span class="elsevierStyleInf">max</span> of anakinra is generally 3&#8211;7&#8239;h after subcutaneous administration of clinically relevant doses &#40;1&#8722;2&#8239;mg&#47;kg&#47;day&#41; and the terminal half-life ranges from 4&#8239;h to 6&#8239;h&#46; It is therefore a drug with a shorter half-life than canakinumab and thus with great potential for use in a clinical emergency such as ARDS due to COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It is likely that using the immunosuppressive biologic therapies is a way to control ARDS due to COVID-19&#46; However&#44; other scenarios must be considered beyond the individual potential of each molecule where even 2 or more of these lines of treatment can be added&#46; While we need randomised clinical trials to advance the safety and efficacy of anakinra in ARDS due to COVID-19&#44; this option should be considered when current treatments are ineffective or unavailable&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The outcome of the SARS-CoV-2 &#40;COVID-19&#41; infection fundamentally affects the lung field&#44; causing ACUTE RESPIRATORY DISTRESS SYNDROME &#40;ARDS&#41;&#46; This process is an inflammatory picture&#44; involving an NLRP3 INFLAMOSOME-triggered cytokine storm&#44; the main player in alveolar destruction&#46; IL-1 beta stands out among the cytokines that are triggered in this picture&#46; ANAKINRA is a potent biological drug&#44; capable of blocking this IL 1 beta&#46; We propose its use in controlling ARDS secondary to COVID-19 infection&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El desenlace de la infecci&#243;n por SARS-CoV-2 &#40;COVID-19&#41; afecta fundamentalmente al campo pulmonar&#44; ocasionando un cuadro de S&#205;NDROME DE DISTR&#201;S RESPIRATORIO AGUDO &#40;SDRA&#41;&#46; Este proceso es un cuadro inflamatorio&#44; protagonizado por una cascada de citocinas bajo el amparo del INFLAMOSOMA NLRP3&#44; responsable principal de la destrucci&#243;n alveolar&#46; De entre todas las citocinas que se desencadenan en este cuadro destaca la IL beta&#46; ANAKINRA es un potente f&#225;rmaco biol&#243;gico&#44; capaz de bloquear esta IL 1 beta&#46; Proponemos su uso&#44; de cara a controlar el SDRA secundario a la infecci&#243;n por COVID-19&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of acute respiratory distress syndrome &#40;ARDS&#41; is triggered after an initial injury that interacts through alarmin receptors and TLRs that activate nuclear transcription factors&#44; including NF-&#954;B&#46; Subsequently&#44; a potent acute immune response triggered primarily by IL-1&#223; results in macrophage&#47;neutrophil activation and recruitment&#46; The cell-mediated immune response results in tissue damage&#44; which promotes the development of oedema and epithelial damage&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">IL&#58; interleukin&#59; MAPK&#58; Mitogen-activated protein kinase&#59; MMPs&#58; Matrix metalloproteinases&#59; NETs&#58; Neutrophil extracellular traps&#59; PAMPS&#58; Pathogen-associated molecular patterns&#59; ROS&#58; Reactive oxygen species&#59; TLR&#58; Toll-like receptor&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; version adapted from the original by Aranda-Valderrama et al&#46; Scientific illustrator&#58; Miguel Soto&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pathophysiology of ARDS&#46; The initial inflammatory stimulus activates alveolar macrophages through TLR and NLRP signalling&#46; Activated alveolar macrophages release proinflammatory cytokines and recruit circulating macrophages and neutrophils to injury sites&#46; This influx of persistently activated neutrophils and macrophages causes extensive damage to epithelial and endothelial lung tissue&#44; resulting in an impaired alveolar-capillary barrier&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ENaC&#58; Epithelial sodium channel&#59; Na&#58; Sodium&#59; NETs&#58; Neutrophil Extracellular Traps&#59; TLR&#58; Toll-like receptor&#59; U&#58; Ubiquitination&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Source&#58; version adapted from the original by Seung Hye Han et al&#46; Scientific illustrator&#58; Miguel Soto&#46;</p>"
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                          "etal" => true
                          "autores" => array:6 [
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                      "doi" => "10.1378/chest.107.4.1062"
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                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "1995"
                        "volumen" => "107"
                        "paginaInicial" => "1062"
                        "paginaFinal" => "1073"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7705118"
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                            5 => "A&#46; Postlethwaite"
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                      "doi" => "10.1378/chest.108.5.1303"
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                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "1995"
                        "volumen" => "108"
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                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7587434"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases"
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                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Dinarello"
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                        "tituloSerie" => "Nat Rev Drug Discov&#46;"
                        "fecha" => "2012"
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                        "paginaFinal" => "652"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AIA.0000000000000207"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Anesthesiol Clin&#46;"
                        "fecha" => "2018"
                        "volumen" => "56"
                        "paginaInicial" => "1"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30204601"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expression of elevated levels of pro-inflammatory cytokines in SARS-CoV-infected ACE2&#43; cells in SARS patients&#58; relation to the acute lung injury and pathogenesis of SARS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; He"
                            1 => "Y&#46; Ding"
                            2 => "Q&#46; Zhang"
                            3 => "X&#46; Che"
                            4 => "Y&#46; He"
                            5 => "H&#46; Shen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/path.2067"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pathol&#46;"
                        "fecha" => "2006"
                        "volumen" => "210"
                        "paginaInicial" => "288"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17031779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The acute respiratory distress syndrome&#58; from mechanism to translation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Han"
                            1 => "R&#46;K&#46; Mallampalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1402513"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol&#46;"
                        "fecha" => "2015"
                        "volumen" => "194"
                        "paginaInicial" => "855"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25596299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sensing and reacting to microbes through the inflammasomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Franchi"
                            1 => "R&#46; Munoz-Planillo"
                            2 => "G&#46; N&#250;&#241;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ni.2231"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Immunol&#46;"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "325"
                        "paginaFinal" => "332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22430785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical role for the NLRP3 inflammasome during acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Grailer"
                            1 => "B&#46;A&#46; Canning"
                            2 => "M&#46; Kalbitz"
                            3 => "M&#46;D&#46; Haggadone"
                            4 => "R&#46;M&#46; Dhond"
                            5 => "A&#46;V&#46; Andjelkovic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1400368"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol&#46;"
                        "fecha" => "2014"
                        "volumen" => "192"
                        "paginaInicial" => "5974"
                        "paginaFinal" => "5983"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24795455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The NLRP3 inflammasome is required for the development of hypoxemia in LPS&#47;mechanical ventilation acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;D&#46; Jones"
                            1 => "T&#46;R&#46; Crother"
                            2 => "R&#46;A&#46; Gonzalez-Villalobos"
                            3 => "M&#46; Jupelli"
                            4 => "S&#46; Chen"
                            5 => "J&#46; Dagvadorj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1165/rcmb.2013-0087OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Cell Mol Biol&#46;"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "270"
                        "paginaFinal" => "280"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24007300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melatonin as an anti-inflammatory agent modulating inflammasome activation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Favero"
                            1 => "L&#46; Franceschetti"
                            2 => "F&#46; Bonomini"
                            3 => "L&#46;F&#46; Rodella"
                            4 => "R&#46; Rezzani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Int J Endocrinol&#46;"
                        "fecha" => "2017"
                        "volumen" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Dinarello"
                            1 => "A&#46; Simon"
                            2 => "J&#46;W&#46; van der Meer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrd3800"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Drug Discov&#46;"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "633"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22850787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NLRP3 &#40;NALP3&#44; Cryopyrin&#41; facilitates in vivo caspase-1 activation&#44; necrosis&#44; and HMGB1 release via inflammasome-dependent and -independent pathways"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;B&#46; Willingham"
                            1 => "I&#46;C&#46; Allen"
                            2 => "D&#46;T&#46; Bergstralh"
                            3 => "W&#46;J&#46; Brickey"
                            4 => "M&#46;T&#46; Huang"
                            5 => "D&#46;J&#46; Taxman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.0900138"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol&#46;"
                        "fecha" => "2009"
                        "volumen" => "183"
                        "paginaInicial" => "2008"
                        "paginaFinal" => "2015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19587006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anakinra&#44; a recombinant human interleukin-1 receptor antagonist &#40;r-metHuIL-1ra&#41;&#44; in patients with rheumatoid arthritis&#58; a large&#44; international&#44; multicenter&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "R&#46;M&#46; Fleischmann"
                            1 => "J&#46; Schechtman"
                            2 => "R&#46; Bennett"
                            3 => "M&#46;L&#46; Handel"
                            4 => "G&#46;R&#46; Burmester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.10870"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum&#46;"
                        "fecha" => "2003"
                        "volumen" => "48"
                        "paginaInicial" => "927"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12687534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy&#44; safety and tolerability of canakinumab in the treatment of familial mediterranean fever&#58; a systematic review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Kacar"
                            1 => "S&#46; Savic"
                            2 => "J&#46;C&#46;H&#46; van der Hilst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/JIR.S206204"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Inflamm Res&#46;"
                        "fecha" => "2020"
                        "volumen" => "13"
                        "paginaInicial" => "141"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32210604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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