701
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Kumar A, Prasoon P, Sekhawat PS, Pareek V, Faiq MA, Kumari C, Narayan RK, Kulandhasamy M, Kant K. Pathogenesis guided therapeutic management of COVID-19: an immunological perspective. Int Rev Immunol 2020; 40:54-71. [PMID: 33111578 DOI: 10.1080/08830185.2020.1840566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lack of standardized therapeutic approaches is arguably the significant contributor to the high burden of mortality observed in the ongoing pandemic of the Coronavirus disease, 2019 (COVID-19). Evidence is accumulating on SARS-CoV-2 specific immune cell dysregulation and consequent tissue injury in COVID-19. Currently, no definite drugs or vaccines are available against the disease; however initial results of the ongoing clinical trials have raised some hope. In this article, taking insights from the emerging empirical evidence about host-virus interactions, we deliberate upon plausible pathogenic mechanisms and suitable therapeutic approaches for COVID-19.
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Affiliation(s)
- Ashutosh Kumar
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Pranav Prasoon
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Pittsburgh Center for Pain Research, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Prakash S Sekhawat
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Hematology, Nil RatanSircar Medical College and Hospital (NRSMCH), Kolkata, India
| | - Vikas Pareek
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,National Brain Research Center, Manesar, Haryana, India
| | - Muneeb A Faiq
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,NYU Robert I Grossman School of Medicine, New York University (NYU) Langone Health Center, New York, New York, USA
| | - Chiman Kumari
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Anatomy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi K Narayan
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Maheswari Kulandhasamy
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Biochemistry, Maulana Azad Medical College (MAMC), New Delhi, India
| | - Kamla Kant
- Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India.,Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
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702
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Roberts KA, Colley L, Agbaedeng TA, Ellison-Hughes GM, Ross MD. Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction. Front Cardiovasc Med 2020; 7:598400. [PMID: 33195487 PMCID: PMC7649150 DOI: 10.3389/fcvm.2020.598400,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
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Affiliation(s)
- Kirsty A. Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Liam Colley
- School of Sport, Health & Exercise Science, Bangor University, Bangor, United Kingdom
| | - Thomas A. Agbaedeng
- Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Georgina M. Ellison-Hughes
- Centre for Human and Physiological Sciences, Faculty of Life Sciences & Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom,*Correspondence: Georgina M. Ellison-Hughes
| | - Mark D. Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom,Mark D. Ross
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703
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Liu D, Zhang T, Wang Y, Xia L. Tocilizumab: The Key to Stop Coronavirus Disease 2019 (COVID-19)-Induced Cytokine Release Syndrome (CRS)? Front Med (Lausanne) 2020; 7:571597. [PMID: 33195318 PMCID: PMC7649275 DOI: 10.3389/fmed.2020.571597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 disease is an unprecedented international public health emergency and considerably impacts the global economy and health service system. While awaiting the development of an effective vaccine, searching for the therapy for severe or critical COVID-19 patients is essential for reducing the mortality and alleviating the tension of the health service system. Cytokine release syndrome (CRS) induced by elevated interleukin-6 was recognized to underscore the pathology of severe COVID-19 patients. Inhibiting CRS by agents suppressing IL-6 may relieve symptoms, shorten the hospital stay and reduce the need for oxygen therapy. Although evidence from randomized, double-blinded clinical trials is still lacking, the IL-6R inhibitor tocilizumab (TCZ) has shown some clinical benefits in the treatment of severe COVID-19 patients and have been included in clinical guidelines. In this review, we focused on the possible mechanisms of TCZ in the treatment of CRS and highlighted some significant considerations in the use of TCZ to treat COVID-19 patients.
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Affiliation(s)
| | | | | | - Limin Xia
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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704
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Roberts KA, Colley L, Agbaedeng TA, Ellison-Hughes GM, Ross MD. Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction. Front Cardiovasc Med 2020; 7:598400. [PMID: 33195487 PMCID: PMC7649150 DOI: 10.3389/fcvm.2020.598400] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
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Affiliation(s)
- Kirsty A. Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Liam Colley
- School of Sport, Health & Exercise Science, Bangor University, Bangor, United Kingdom
| | - Thomas A. Agbaedeng
- Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Georgina M. Ellison-Hughes
- Centre for Human and Physiological Sciences, Faculty of Life Sciences & Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Mark D. Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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705
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Bizzotto J, Sanchis P, Abbate M, Lage-Vickers S, Lavignolle R, Toro A, Olszevicki S, Sabater A, Cascardo F, Vazquez E, Cotignola J, Gueron G. SARS-CoV-2 Infection Boosts MX1 Antiviral Effector in COVID-19 Patients. iScience 2020; 23:101585. [PMID: 32989429 PMCID: PMC7510433 DOI: 10.1016/j.isci.2020.101585] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 09/16/2020] [Indexed: 01/14/2023] Open
Abstract
In a published case-control study (GSE152075) from SARS-CoV-2-positive (n = 403) and -negative patients (n = 50), we analyzed the response to infection assessing gene expression of host cell receptors and antiviral proteins. The expression analysis associated with reported risk factors for COVID-19 was also assessed. SARS-CoV-2 cases had higher ACE2, but lower TMPRSS2, BSG/CD147, and CTSB expression compared with negative cases. COVID-19 patients' age negatively affected ACE2 expression. MX1 and MX2 were higher in COVID-19 patients. A negative trend for MX1 and MX2 was observed as patients' age increased. Principal-component analysis determined that ACE2, MX1, MX2, and BSG/CD147 expression was able to cluster non-COVID-19 and COVID-19 individuals. Multivariable regression showed that MX1 expression significantly increased for each unit of viral load increment. Altogether, these findings support differences in ACE2, MX1, MX2, and BSG/CD147 expression between COVID-19 and non-COVID-19 patients and point out to MX1 as a critical responder in SARS-CoV-2 infection.
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Affiliation(s)
- Juan Bizzotto
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Pablo Sanchis
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Mercedes Abbate
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Sofía Lage-Vickers
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Rosario Lavignolle
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Ayelén Toro
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Santiago Olszevicki
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Agustina Sabater
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Florencia Cascardo
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Elba Vazquez
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Javier Cotignola
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
| | - Geraldine Gueron
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Intendente Guiraldes 2160, Buenos Aires, C1428EGA, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, C1428EGA, Argentina
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706
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Sun W, Gao H, Luo Y, Zheng H, Liao X, Xiong D, Xiao L. Management of Immunity Alteration-Induced Chronic Pain During the Coronavirus Disease-2019 (COVID-19) Pandemic. Front Microbiol 2020; 11:572318. [PMID: 33072033 PMCID: PMC7541845 DOI: 10.3389/fmicb.2020.572318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Wuping Sun
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Hong Gao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Yuhui Luo
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Hushan Zheng
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Xiang Liao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Donglin Xiong
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
| | - Lizu Xiao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.,National Key Clinical Pain Medicine of China, Shenzhen, China
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707
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Naeimi R, Ghasemi-Kasman M. Update on cerebrovascular manifestations of COVID-19. Neurol Sci 2020; 41:3423-3435. [PMID: 33083934 PMCID: PMC7574669 DOI: 10.1007/s10072-020-04837-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
The novel member of coronaviruses family, severe acute respiratory coronavirus-2 (SARS-CoV-2), with high structural homology to SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS) has spread rapidly with about 20 million cases infection and over 700,000 deaths. SARS-CoV-2 has been emerged as a worldwide disaster due to non-specific few respiratory and gastrointestinal manifestations at the onset of disease as well as long incubation period. Surprisingly, not only respiratory failure but also the underlying coagulation disorder and neurovascular involvement worsen the clinical outcome of infected patients. In this review article, we describe the probable mechanisms of SARS-CoV-2 infection and stroke occurrence. We will also discuss the cerebrovascular events following SARS-CoV-2 infection, the recommended therapies, and future prospects to better manage these patients in coronavirus disease 2019 (COVID-19) outbreak.
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Affiliation(s)
- Reza Naeimi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Ghasemi-Kasman
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. .,Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, P.O. Box 4136747176, Babol, Iran.
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708
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Cepon-Robins TJ, Gildner TE. Old friends meet a new foe: A potential role for immune-priming parasites in mitigating COVID-19 morbidity and mortality. Evol Med Public Health 2020; 2020:234-248. [PMID: 33235797 PMCID: PMC7665448 DOI: 10.1093/emph/eoaa037] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
The novel virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the associated Coronavirus Disease 2019 (COVID-19) represent a pathogen to which human beings have limited to no evolved immune response. The most severe symptoms are associated with overactive inflammatory immune responses, leading to a cytokine storm, tissue damage, and death, if not balanced and controlled. Hypotheses within Evolutionary Medicine, including the Hygiene/Old Friends Hypothesis, provide an important lens through which to understand and possibly control this overactive immune response. In this article, we explore the role that infection with soil-transmitted helminths (STHs; i.e. intestinal parasitic worms) may play in dampening SARS-CoV-2 symptoms and mitigating the worst COVID-19 outcomes. Specifically, STHs stimulate the immunosuppressive and regulatory T-helper 2 (TH2) branch of the immune system, which decreases ACE2-receptor expression (i.e. receptors SARS-CoV-2 uses to infect host cells), balances the inflammatory TH1/TH17 branches of the immune system triggered by SARS-CoV-2 infection, and reduces inflammation through the release of anti-inflammatory/regulatory cytokines. Because STHs are common and affect the most vulnerable and marginalized members of society, it is especially important to consider how these parasites may impact COVID-19 outcomes. Areas experiencing endemic STH infections are often characterized by a lack of preventative infrastructure and medical care, which may further exacerbate risk of SARS-CoV-2 infection and COVID-19 development. For this reason, we also explore biocultural factors that contribute to disease outcomes for both SARS-CoV-2 and STH infections. Biocultural and Evolutionary Medicine perspectives on COVID-19 are crucial for understanding the global impact of the disease. Lay summary: An evolutionary perspective is required to understand the global impact and various presentations of COVID-19. We consider how coinfection with soil-transmitted helminths (common parasitic worms that coevolved with humans) may suppress inflammatory immune activity, thereby potentially reducing COVID-19 disease severity. Structural and lifestyle factors shaping coinfection patterns are also discussed.
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Affiliation(s)
- Tara J Cepon-Robins
- Department of Anthropology, University of Colorado Colorado Springs, Centennial Hall 120, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918, USA
| | - Theresa E Gildner
- Department of Anthropology, Dartmouth College, Silsby Hall, 3 Tuck Drive, Hanover, NH 03755, USA
- Department of Anthropology, Washington University, Campus Box 1114, One Brookings Drive, St. Louis, MO 63130, USA
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709
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Carissimo G, Xu W, Kwok I, Abdad MY, Chan YH, Fong SW, Puan KJ, Lee CYP, Yeo NKW, Amrun SN, Chee RSL, How W, Chan S, Fan BE, Andiappan AK, Lee B, Rötzschke O, Young BE, Leo YS, Lye DC, Renia L, Ng LG, Larbi A, Ng LF. Whole blood immunophenotyping uncovers immature neutrophil-to-VD2 T-cell ratio as an early marker for severe COVID-19. Nat Commun 2020; 11:5243. [PMID: 33067472 PMCID: PMC7568554 DOI: 10.1038/s41467-020-19080-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 is the novel coronavirus responsible for the current COVID-19 pandemic. Severe complications are observed only in a small proportion of infected patients but the cellular mechanisms underlying this progression are still unknown. Comprehensive flow cytometry of whole blood samples from 54 COVID-19 patients reveals a dramatic increase in the number of immature neutrophils. This increase strongly correlates with disease severity and is associated with elevated IL-6 and IP-10 levels, two key players in the cytokine storm. The most pronounced decrease in cell counts is observed for CD8 T-cells and VD2 γδ T-cells, which both exhibit increased differentiation and activation. ROC analysis reveals that the count ratio of immature neutrophils to VD2 (or CD8) T-cells predicts pneumonia onset (0.9071) as well as hypoxia onset (0.8908) with high sensitivity and specificity. It would thus be a useful prognostic marker for preventive patient management and improved healthcare resource management.
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Affiliation(s)
- Guillaume Carissimo
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore.
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore.
| | - Weili Xu
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Immanuel Kwok
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Mohammad Yazid Abdad
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore
| | - Yi-Hao Chan
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Siew-Wai Fong
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore, 117543
| | - Kia Joo Puan
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Cheryl Yi-Pin Lee
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Nicholas Kim-Wah Yeo
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Siti Naqiah Amrun
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Rhonda Sin-Ling Chee
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Wilson How
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Stephrene Chan
- Department of Haematology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Olaf Rötzschke
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Drive, 117597, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Drive, 117597, Singapore, Singapore
| | - Laurent Renia
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Lai Guan Ng
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Anis Larbi
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore
| | - Lisa Fp Ng
- Infectious Disease Horizontal Technology Center, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore.
- Singapore Immunology Network, Agency for Science, Technology and Research, Immunos, Biopolis, 138648, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, 117596, Singapore, Singapore.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, 8 West Derby Street, Liverpool, L7 3EA, UK.
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710
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Gastaldelli A, Gastaldelli M, Bastianoni S. COVID-19 Infection Pandemic: From the Frontline in Italy. J Am Coll Nutr 2020; 39:677-684. [PMID: 33064066 DOI: 10.1080/07315724.2020.1779147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The infection caused by COVID-19 (i.e. corona virus disease 2019) has caused more than 5.2 million cases and more than 337,000 deaths worldwide. Italy was the European epicenter for virus spread and one with most cases and deaths. The first Italian patient was diagnosed on February 18th, a young man hospitalized in Lombardy (Northern Italy). The Italian government not only isolated the village where he lived, but a few days later put the entire country in lockdown. We have here analyzed the COVID-19 Italian data during the first three months after the outbreak and the effect of lockdown. COVID-19 virus has a high transmission rate and is associated with high fatality rate especially in the older population. The initial reproduction rate of the virus (R0) in Italy was between 2.1 and 3.3 in different Italian regions, with a doubling time between 2.7 and 3.2 days. The number of confirmed cases has now reached 229,000 but after the lockdown R0 is finally below 1. Despite the lockdown, the number of infected and deceased patients in Italy was very high, with a lethality rate higher than in other countries. It is likely that number of cases is underestimating the real since the number of asymptomatic and paucisymptomatic is relatively high. It is important to investigate which patients are more vulnerable and also if other co-factors can account for this high fatality rate, since this pandemia is far from being resolved.
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Affiliation(s)
- Amalia Gastaldelli
- Institute of Clinical Physiology, CNR, Cardiometabolic Risk Unit, Pisa, Italy
| | - Mirco Gastaldelli
- Polyclinic of Abano Terme, Anesthesia and Intensive Care Unit, Padova, Italy
| | - Simone Bastianoni
- Ecodynamics Group, Department of Physical Science, Earth and Environment, University of Siena, Siena, Italy
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711
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Ikewaki N, Rao KS, Archibold AD, Iwasaki M, Senthilkumar R, Preethy S, Katoh S, Abraham SJK. Coagulopathy associated with COVID-19 - Perspectives & Preventive strategies using a biological response modifier Glucan. Thromb J 2020; 18:27. [PMID: 33082714 PMCID: PMC7563912 DOI: 10.1186/s12959-020-00239-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
Direct endothelial injury by viruses and dysregulation of clotting mechanisms due to cytokine storm are the major precipitating factors of mortality in COVID-19; both are attributed to a fundamental dysregulation of the immune system. While immune dysregulation can be attributed to several factors, the risk of associated thrombogenic disruption varies across individuals. This variation depends on several factors, such as comorbidities, including diabetes, hypertension, and cardiovascular diseases. When considering ethnic variations, the vulnerability of Caucasians, African Americans and Hispanics needs to be addressed before arriving at strategies to handle thromboembolic complications, which have been identified in recent reports as the leading causes of mortality in COVID-19. Although evaluation of D-dimer and prothrombin during admission is considered to predict prognosis and mortality, there are no preventive or prophylactic strategies before hospital admission. Herein, we present our perspectives on the effect of regular supplementation with the biological response modifier beta glucan based on its relevance to immune modulation. This effect is of paramount importance in decreasing the development of severe COVID-19 and reducing mortality against the background of coagulopathy, especially in vulnerable populations.
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Affiliation(s)
- Nobunao Ikewaki
- Department of Medical Life Science, Kyushu University of Health and Welfare, Nobeoka, Miyazaki Japan.,Institute of Immunology, Junsei Educational Institute, Nobeoka, Miyazaki Japan
| | - Kosagi-Sharaf Rao
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Panama
| | - Armando Durant Archibold
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Panama
| | - Masaru Iwasaki
- II Department of Surgery & Centre for Advancing Clinical Research (CACR), Yamanashi University- School of Medicine, Chuo, Japan
| | - Rajappa Senthilkumar
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
| | - Senthilkumar Preethy
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
| | - Shojiro Katoh
- Edogawa Evolutionary Laboratory of Science (EELS), Edogawa Hospital, Tokyo, Japan
| | - Samuel J K Abraham
- II Department of Surgery & Centre for Advancing Clinical Research (CACR), Yamanashi University- School of Medicine, Chuo, Japan.,Edogawa Evolutionary Laboratory of Science (EELS), Edogawa Hospital, Tokyo, Japan.,The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India.,GN Corporation Co. Ltd, Kofu, Japan
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712
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Butler DL, Gildersleeve JC. Abnormal antibodies to self-carbohydrates in SARS-CoV-2 infected patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.10.15.341479. [PMID: 33083799 PMCID: PMC7574254 DOI: 10.1101/2020.10.15.341479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
SARS-CoV-2 is a deadly virus that is causing the global pandemic coronavirus disease 2019 (COVID-19). Our immune system plays a critical role in preventing, clearing, and treating the virus, but aberrant immune responses can contribute to deleterious symptoms and mortality. Many aspects of immune responses to SARS-CoV-2 are being investigated, but little is known about immune responses to carbohydrates. Since the surface of the virus is heavily glycosylated, pre-existing antibodies to glycans could potentially recognize the virus and influence disease progression. Furthermore, antibody responses to carbohydrates could be induced, affecting disease severity and clinical outcome. In this study, we used a carbohydrate antigen microarray with over 800 individual components to profile serum anti-glycan antibodies in COVID-19 patients and healthy control subjects. In COVID-19 patients, we observed abnormally high IgG and IgM antibodies to numerous self-glycans, including gangliosides, N -linked glycans, LacNAc-containing glycans, blood group H, and sialyl Lewis X. Some of these anti-glycan antibodies are known to play roles in autoimmune diseases and neurological disorders, which may help explain some of the unusual and prolonged symptoms observed in COVID-19 patients. The detection of antibodies to self-glycans has important implications for using convalescent serum to treat patients, developing safe and effective SARS-CoV-2 vaccines, and understanding the risks of infection. In addition, this study provides new insight into the immune responses to SARS-CoV-2 and illustrates the importance of including host and viral carbohydrate antigens when studying immune responses to viruses.
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Affiliation(s)
- Dorothy L. Butler
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702
| | - Jeffrey C. Gildersleeve
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702
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713
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Abstract
The COVID-19 pandemic is a recently emerging problem. This has caused that the knowledge of the disease has been progressive and, therefore, the therapeutic decisions have been conditioned by this lack of knowledge on the one hand and by the therapeutic limitations on the other. Many published studies are methodologically weak and their conclusions, of limited value, have contributed to creating confusion on the therapeutic approach of the disease. In the present paper, we propose a therapeutic approach based on a new disease staging. The therapeutic approach is divided into two big sections: the pharmacological treatment for the phase of viral replication, cytokine storm or late respiratory events (which includes the adult respiratory distress syndrome (ARDS)) and the treatment of the respiratory failure In every stage, we discuss the pathophysiology and comment (accept or rule out) the pharmacological options according to the present evidence. Moreover, we indicate how respiratory failure should be treated. Some characteristics are based on the evidence found in the literature. Others are the result of my experience in other situations.
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Affiliation(s)
- Christian Domingo Ribas
- Pulmonary Service, Corporació Sanitària Parc Taulí, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona (UAB) Barcelona, Spain
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714
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Van Singer M, Brahier T, Ngai M, Wright J, Weckman AM, Erice C, Meuwly JY, Hugli O, Kain KC, Boillat-Blanco N. COVID-19 risk stratification algorithms based on sTREM-1 and IL-6 in emergency department. J Allergy Clin Immunol 2020; 147:99-106.e4. [PMID: 33045281 PMCID: PMC7546666 DOI: 10.1016/j.jaci.2020.10.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to surges of patients presenting to emergency departments (EDs) and potentially overwhelming health systems. Objective We sought to assess the predictive accuracy of host biomarkers at clinical presentation to the ED for adverse outcome. Methods Prospective observational study of PCR-confirmed COVID-19 patients in the ED of a Swiss hospital. Concentrations of inflammatory and endothelial dysfunction biomarkers were determined at clinical presentation. We evaluated the accuracy of clinical signs and these biomarkers in predicting 30-day intubation/mortality, and oxygen requirement by calculating the area under the receiver-operating characteristic curve and by classification and regression tree analysis. Results Of 76 included patients with COVID-19, 24 were outpatients or hospitalized without oxygen requirement, 35 hospitalized with oxygen requirement, and 17 intubated/died. We found that soluble triggering receptor expressed on myeloid cells had the best prognostic accuracy for 30-day intubation/mortality (area under the receiver-operating characteristic curve, 0.86; 95% CI, 0.77-0.95) and IL-6 measured at presentation to the ED had the best accuracy for 30-day oxygen requirement (area under the receiver-operating characteristic curve, 0.84; 95% CI, 0.74-0.94). An algorithm based on respiratory rate and sTREM-1 predicted 30-day intubation/mortality with 94% sensitivity and 0.1 negative likelihood ratio. An IL-6–based algorithm had 98% sensitivity and 0.04 negative likelihood ratio for 30-day oxygen requirement. Conclusions sTREM-1 and IL-6 concentrations in COVID-19 in the ED have good predictive accuracy for intubation/mortality and oxygen requirement. sTREM-1– and IL-6–based algorithms are highly sensitive to identify patients with adverse outcome and could serve as early triage tools.
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Affiliation(s)
- Mathias Van Singer
- Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Thomas Brahier
- Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Michelle Ngai
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network-Toronto General, Toronto, Ontario, Canada
| | - Julie Wright
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network-Toronto General, Toronto, Ontario, Canada
| | - Andrea M Weckman
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network-Toronto General, Toronto, Ontario, Canada
| | - Clara Erice
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network-Toronto General, Toronto, Ontario, Canada
| | - Jean-Yves Meuwly
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kevin C Kain
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network-Toronto General, Toronto, Ontario, Canada
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715
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SARS-CoV-2 triggers inflammatory responses and cell death through caspase-8 activation. Signal Transduct Target Ther 2020; 5:235. [PMID: 33037188 PMCID: PMC7545816 DOI: 10.1038/s41392-020-00334-0] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to respiratory illness and multi-organ failure in critically ill patients. Although the virus-induced lung damage and inflammatory cytokine storm are believed to be directly associated with coronavirus disease 2019 (COVID-19) clinical manifestations, the underlying mechanisms of virus-triggered inflammatory responses are currently unknown. Here we report that SARS-CoV-2 infection activates caspase-8 to trigger cell apoptosis and inflammatory cytokine processing in the lung epithelial cells. The processed inflammatory cytokines are released through the virus-induced necroptosis pathway. Virus-induced apoptosis, necroptosis, and inflammation activation were also observed in the lung sections of SARS-CoV-2-infected HFH4-hACE2 transgenic mouse model, a valid model for studying SARS-CoV-2 pathogenesis. Furthermore, analysis of the postmortem lung sections of fatal COVID-19 patients revealed not only apoptosis and necroptosis but also massive inflammatory cell infiltration, necrotic cell debris, and pulmonary interstitial fibrosis, typical of immune pathogenesis in the lung. The SARS-CoV-2 infection triggered a dual mode of cell death pathways and caspase-8-dependent inflammatory responses may lead to the lung damage in the COVID-19 patients. These discoveries might assist the development of therapeutic strategies to treat COVID-19.
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716
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Muniangi-Muhitu H, Akalestou E, Salem V, Misra S, Oliver NS, Rutter GA. Covid-19 and Diabetes: A Complex Bidirectional Relationship. Front Endocrinol (Lausanne) 2020; 11:582936. [PMID: 33133024 PMCID: PMC7578412 DOI: 10.3389/fendo.2020.582936] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
Covid-19 is a recently-emerged infectious disease caused by the novel severe acute respiratory syndrome coronavirus SARS-CoV2. SARS-CoV2 differs from previous coronavirus infections (SARS and MERS) due to its high infectivity (reproduction value, R0, typically 2-4) and pre- or asymptomatic transmission, properties that have contributed to the current global Covid-19 pandemic. Identified risk factors for disease severity and death from SARS-Cov2 infection include older age, male sex, diabetes, obesity and hypertension. The reasons for these associations are still largely obscure. Evidence is also emerging that SARS-CoV2 infection exacerbates the underlying pathophysiology of hyperglycemia in people with diabetes. Here, we discuss potential mechanisms through which diabetes may affect the risk of more severe outcomes in Covid-19 and, additionally, how diabetic emergencies and longer term pathology may be aggravated by infection with the virus. We consider roles for the immune system, the observed phenomenon of microangiopathy in severe Covid-19 infection and the potential for direct viral toxicity on metabolically-relevant tissues including pancreatic beta cells and targets of insulin action.
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Affiliation(s)
- Hermine Muniangi-Muhitu
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Elina Akalestou
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Victoria Salem
- Section of Endocrinology, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Shivani Misra
- Section of Metabolic Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Nicholas S. Oliver
- Section of Metabolic Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Guy A. Rutter
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Lee Kong Chian School of Medicine, Nan Yang Technological University, Singapore, Singapore
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717
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Serum Cystatin C and Coronavirus Disease 2019: A Potential Inflammatory Biomarker in Predicting Critical Illness and Mortality for Adult Patients. Mediators Inflamm 2020; 2020:3764515. [PMID: 33061826 PMCID: PMC7545455 DOI: 10.1155/2020/3764515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/10/2020] [Accepted: 08/01/2020] [Indexed: 12/28/2022] Open
Abstract
This study aimed at determining the relationship between baseline cystatin C levels and coronavirus disease 2019 (COVID-19) and investigating the potential prognostic value of serum cystatin C in adult patients with COVID-19. 481 patients with COVID-19 were consecutively included in this study from January 2, 2020, and followed up to April 15, 2020. All clinical and laboratory data of COVID-19 patients with definite outcomes were reviewed. For every measure, COVID-19 patients were grouped into quartiles according to the baseline levels of serum cystatin C. The highest cystatin C level was significantly related to more severe inflammatory conditions, worse organ dysfunction, and worse outcomes among patients with COVID-19 (P values < 0.05). In the adjusted logistic regression analyses, the highest cystatin C level and ln-transformed cystatin C levels were independently associated with the risks of developing critically ill COVID-19 and all-cause death either in overall patients or in patients without chronic kidney disease (P values < 0.05). As a potential inflammatory marker, increasing baseline levels of serum cystatin C might independently predict adverse outcomes for COVID-19 patients. Serum cystatin C could be routinely monitored during hospitalization, which showed clinical importance in prognosticating for adult patients with COVID-19.
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718
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Hojyo S, Uchida M, Tanaka K, Hasebe R, Tanaka Y, Murakami M, Hirano T. How COVID-19 induces cytokine storm with high mortality. Inflamm Regen 2020. [PMID: 33014208 DOI: 10.1186/s41232‐020‐00146‐3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The newly emerging coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, but has rapidly spread all over the world. Some COVID-19 patients encounter a severe symptom of acute respiratory distress syndrome (ARDS) with high mortality. This high severity is dependent on a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier, which is hyper-activation machinery that regulates the nuclear factor kappa B (NF-κB) pathway and stimulated by the simultaneous activation of IL-6-signal transducer and activator of transcription 3 (STAT3) and NF-κB signaling in non-immune cells including alveolar epithelial cells and endothelial cells. We hypothesize that IL-6-STAT3 signaling is a promising therapeutic target for the cytokine storm in COVID-19, because IL-6 is a major STAT3 stimulator, particularly during inflammation. We herein review the pathogenic mechanism and potential therapeutic targets of ARDS in COVID-19 patients.
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Affiliation(s)
- Shintaro Hojyo
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Mona Uchida
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Kumiko Tanaka
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Rie Hasebe
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Yuki Tanaka
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Masaaki Murakami
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Toshio Hirano
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan.,Headquarters, National Institutes for Quantum and Radiological Science and Technology, Chiba, 263-8555 Japan
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719
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Alberca RW, Yendo TM, Leuzzi Ramos YÁ, Fernandes IG, Oliveira LDM, Teixeira FME, Beserra DR, de Oliveira EA, Gozzi-Silva SC, Andrade MMDS, Branco ACCC, Pietrobon AJ, Pereira NZ, de Brito CA, Orfali RL, Aoki V, Duarte AJDS, Benard G, Sato MN. Case Report: COVID-19 and Chagas Disease in Two Coinfected Patients. Am J Trop Med Hyg 2020; 103:2353-2356. [PMID: 33025877 PMCID: PMC7695072 DOI: 10.4269/ajtmh.20-1185] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
American trypanosomiasis, also named Chagas disease (CD), is an anthropozoonosis caused by the protozoan parasite Trypanosoma cruzi. The disease affects millions of people worldwide, leading yearly to approximately 50,000 deaths. COVID-19, generated by SARS-CoV-2, can lead to lymphopenia and death. We hereby describe the first report of two patients with CD and COVID-19 coinfection, from hospitalization until patients' death.
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Affiliation(s)
- Ricardo Wesley Alberca
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Mina Yendo
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Yasmim Álefe Leuzzi Ramos
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Iara Grigoletto Fernandes
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Franciane Mouradian Emidio Teixeira
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Danielle Rosa Beserra
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Araujo de Oliveira
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sarah Cristina Gozzi-Silva
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milena Mary de Souza Andrade
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anna Cláudia Calvielli Castelo Branco
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anna Julia Pietrobon
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nátalli Zanete Pereira
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cyro Alves de Brito
- Technical Division of Medical Biology, Adolfo Lutz Institute, Immunology Center, São Paulo, Brazil
| | - Raquel Leão Orfali
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valéria Aoki
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alberto José da Silva Duarte
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gil Benard
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Notomi Sato
- Departamento de Dermatologia, Faculdade de Medicina FMUSP, Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Universidade de Sao Paulo, Sao Paulo, Brazil
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720
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Shibabaw T. Inflammatory Cytokine: IL-17A Signaling Pathway in Patients Present with COVID-19 and Current Treatment Strategy. J Inflamm Res 2020; 13:673-680. [PMID: 33116747 PMCID: PMC7547786 DOI: 10.2147/jir.s278335] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a globally communicable public health disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV-2). Eradication of COVID-19 appears practically impossible but, therefore, more effective pharmacotherapy is needed. The deteriorated clinical presentation of patients with COVID-19 is mainly associated with hypercytokinemia due to notoriously elevated pro-inflammatory cytokines such as interleukin (IL)-1B, IL-6, IL-8, IL-17, granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), interferon-γ-inducible protein (IP10), monocyte chemoattractant protein (MCP1), and tumor necrosis factor-α (TNFα), and is usually responsible for cytokine release syndrome. In the cytokine storm, up-regulation of T-helper 17 cell cytokine IL-17A, and maybe also IL-17F, is mostly responsible for the immunopathology of COVID-19 and acute respiratory distress syndrome. Herein, I meticulously review the exuberant polarization mechanism of naïve CD4+ T cells toward Th17 cells in response to SARS-CoV-2 infection and its associated immunopathological sequelae. I also, propose, for clinical benefit, targeting IL-17A signaling and the synergic inflammatory cytokine IL-6 to manage COVID-19 patients, particularly those presenting with cytokine storm syndrome.
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Affiliation(s)
- Tewodros Shibabaw
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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721
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Coelho C, Gallo G, Campos CB, Hardy L, Würtele M. Biochemical screening for SARS-CoV-2 main protease inhibitors. PLoS One 2020; 15:e0240079. [PMID: 33022015 PMCID: PMC7537881 DOI: 10.1371/journal.pone.0240079] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023] Open
Abstract
The Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic represents a global challenge. SARS-CoV-2's ability to replicate in host cells relies on the action of its non-structural proteins, like its main protease (Mpro). This cysteine protease acts by processing the viruses' precursor polyproteins. As proteases, together with polymerases, are main targets of antiviral drug design, we here have performed biochemical high throughput screening (HTS) with recombinantly expressed SARS-CoV-2 Mpro. A fluorescent assay was used to identify inhibitors in a compound library containing known drugs, bioactive molecules and natural products. These screens led to the identification of 13 inhibitors with IC50 values ranging from 0.2 μM to 23 μM. The screens confirmed several known SARS-CoV Mpro inhibitors as inhibitors of SARS-CoV-2 Mpro, such as the organo-mercuric compounds thimerosal and phenylmercuric acetate. Benzophenone derivatives could also be identified among the most potent screening hits. Additionally, Evans blue, a sulfonic acid-containing dye, could be identified as an Mpro inhibitor. The obtained compounds could be of interest as lead compounds for the development of future SARS-CoV-2 drugs.
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Affiliation(s)
- Camila Coelho
- Department of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
| | - Gloria Gallo
- Department of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
| | - Claudia B Campos
- Department of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
| | - Leon Hardy
- Department of Physics, University of South Florida, Tampa, FL, United States of America
| | - Martin Würtele
- Department of Science and Technology, Federal University of São Paulo, São José dos Campos, Brazil
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722
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Nakamura Y, Shimizu M, Yamaki T, Kushimoto K, Yamashita A, Hayase K, Yamazaki M, Hashimoto S, Ohta B. Myocardial injury in a patient with severe coronavirus disease: A case report. J Infect Chemother 2020; 27:364-368. [PMID: 33036894 PMCID: PMC7538152 DOI: 10.1016/j.jiac.2020.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) can lead to severe disease or death and is characterized by a wide range of mild to severe symptoms. In addition to the lungs, studies have reported the involvement of the stomach, intestine, and angiotensin-converting enzyme 2 receptors in the heart. CASE REPORT We present a case of a patient with COVID-19 who died soon after developing multi-organ failure and myocardial injury due to COVID-19-associated pneumonia. A 71-year-old man who contracted COVID-19 was admitted to the hospital after presenting with fever for 7 days and developed dyspnea. Following treatment, his respiratory status worsened. Thus, he was transferred to our hospital for intensive care on day 11. Physical examination revealed fever, dyspnea, respiratory distress, and no chest pain. Invasive positive pressure ventilation was initiated for acute respiratory distress syndrome on day 14. On day 15, we observed renal, liver, and coagulation dysfunction, indicating multi-organ failure. Chest radiography did not show clear signs of an increased cardiothoracic ratio or pulmonary congestion. An electrocardiogram (ECG) showed signs of myocardial infarction, which was confirmed by elevated troponin I and creatine kinase levels. The patient's circulatory dynamics did not improve on medication, and he died on day 16. CONCLUSIONS We report the case of a patient with severe COVID-19 who died from an exacerbation of myocardial injury. Clinicians should not only evaluate respiration but also assess the heart by performing a 12-lead ECG, echocardiogram, and myocardial injury marker examination. Together, these tools can help predict which patients will develop severe COVID-19.
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Affiliation(s)
- Yuki Nakamura
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Masaru Shimizu
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Taeka Yamaki
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Kohsuke Kushimoto
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Ayahiro Yamashita
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Kazuma Hayase
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Masaki Yamazaki
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Satoru Hashimoto
- Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
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Platelet activation and platelet-monocyte aggregate formation trigger tissue factor expression in patients with severe COVID-19. Blood 2020; 136:1330-1341. [PMID: 32678428 PMCID: PMC7483437 DOI: 10.1182/blood.2020007252] [Citation(s) in RCA: 540] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent pathogen responsible for the coronavirus disease 2019 (COVID-19). Since its emergence, the novel coronavirus has rapidly achieved pandemic proportions causing remarkably increased morbidity and mortality around the world. A hypercoagulability state has been reported as a major pathologic event in COVID-19, and thromboembolic complications listed among life-threatening complications of the disease. Platelets are chief effector cells of hemostasis and pathological thrombosis. However, the participation of platelets in the pathogenesis of COVID-19 remains elusive. This report demonstrates that increased platelet activation and platelet-monocyte aggregate formation are observed in severe COVID-19 patients, but not in patients presenting mild COVID-19 syndrome. In addition, exposure to plasma from severe COVID-19 patients increased the activation of control platelets ex vivo. In our cohort of COVID-19 patients admitted to the intensive care unit, platelet-monocyte interaction was strongly associated with tissue factor (TF) expression by the monocytes. Platelet activation and monocyte TF expression were associated with markers of coagulation exacerbation as fibrinogen and D-dimers, and were increased in patients requiring invasive mechanical ventilation or patients who evolved with in-hospital mortality. Finally, platelets from severe COVID-19 patients were able to induce TF expression ex vivo in monocytes from healthy volunteers, a phenomenon that was inhibited by platelet P-selectin neutralization or integrin αIIb/β3 blocking with the aggregation inhibitor abciximab. Altogether, these data shed light on new pathological mechanisms involving platelet activation and platelet-dependent monocyte TF expression, which were associated with COVID-19 severity and mortality.
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724
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Sarantis P, Koustas E, Papavassiliou AG, Karamouzis MV. Are cystic fibrosis mutation carriers a potentially highly vulnerable group to COVID-19? J Cell Mol Med 2020; 24:13542-13545. [PMID: 33009727 PMCID: PMC7675715 DOI: 10.1111/jcmm.15941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 02/05/2023] Open
Abstract
Undoubtedly, the new SARS‐CoV‐2 virus poses a grave health threat, plaguing the health and socio‐economic sectors. COVID‐19 disease must be treated quickly and effectively as soon as possible. The main axes in this direction are establishing vaccines, drugs, diagnostic tests, as well as identifying the most vulnerable groups. Probably, there is a correlation between COVID‐19 and cystic fibrosis. Our interest is focused on cystic fibrosis carriers that, due to limited tests, remain undetectable. There is an activation of the inflammatory response in the carriers, as well as in cystic fibrosis patients. First of all, a striking similarity lies between the inflammatory response in COVID‐19 and cystic fibrosis carriers. Notably, ACE‐2 plays the same role in both cases and a similar geographical distribution is observed in both diseases. In conclusion, we suggest that cystic fibrosis mutation carriers are potential members of a certain vulnerable group and the detection of such mutations in the population might be vital for the prevention of SARS‐CoV‐2 virus, and more specifically to limit its serious complications.
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Affiliation(s)
- Panagiotis Sarantis
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Koustas
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios G Papavassiliou
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michalis V Karamouzis
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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725
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Karen Ousey
- School of Human and Health Sciences, University of Huddersfield, Queensgate, West Yorkshire, UK
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726
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Boettler T, Marjot T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Jalan R, Moreau R, Cornberg M, Berg T. Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic. JHEP Rep 2020; 2:100169. [PMID: 32835190 PMCID: PMC7402276 DOI: 10.1016/j.jhepr.2020.100169] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- ACLF, acute-on-chronic liver failure
- COVID-19
- COVID-19, coronavirus disease 2019
- Cancer
- Cirrhosis
- ERC, endoscopic retrograde cholangiography
- HCC, hepatocellular carcinoma
- IL-6, interleukin-6
- LT, liver transplant
- Liver
- MELD, model for end-stage liver disease
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- OGD, oesophagogastroduodenoscopy
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- Telemedicine
- Transplantation
- ULN, upper limit of normal
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Affiliation(s)
- Tobias Boettler
- Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, UK
| | - Philip N. Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mario U. Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Elisa Cordero
- Department of Medicine, University of Seville, Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, Sevilla, CSIC, Spain
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Richard Moreau
- Inserm, Université de Paris, U1149, Centre de Recherche sur l'Inflammation (CRI), UMRS1149, Paris, France
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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727
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Fadini GP, Morieri ML, Boscari F, Fioretto P, Maran A, Busetto L, Bonora BM, Selmin E, Arcidiacono G, Pinelli S, Farnia F, Falaguasta D, Russo L, Voltan G, Mazzocut S, Costantini G, Ghirardini F, Tresso S, Cattelan AM, Vianello A, Avogaro A, Vettor R. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res Clin Pract 2020; 168:108374. [PMID: 32805345 PMCID: PMC7428425 DOI: 10.1016/j.diabres.2020.108374] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. METHODS We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death. RESULTS 413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p < 0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p = 0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p < 0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function. CONCLUSION Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.
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Affiliation(s)
| | | | | | | | | | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | | | - Elisa Selmin
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | - Lucia Russo
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | | | | | - Andrea Vianello
- Department of Cardiothoracic Vascular Sciences and Public Health, University of Padova, Italy
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728
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Albani F, Sepe L, Fusina F, Prezioso C, Baronio M, Caminiti F, Di Maio A, Faggian B, Franceschetti ME, Massari M, Salvaggio M, Natalini G. Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study. EClinicalMedicine 2020; 27:100562. [PMID: 33043287 PMCID: PMC7534836 DOI: 10.1016/j.eclinm.2020.100562] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection is associated with hypercoagulability caused by direct invasion of endothelial cells and\or proinflammatory cytokine release. Thromboprophylaxis with enoxaparin is recommended by current guidelines, but evidence is still weak. The aim of this study was to assess the impact of thromboprophylaxis with enoxaparin on hospital mortality in patients admitted for Coronavirus disease 2019 (COVID-19). The effects of enoxaparin on intensive care admission and hospital length-of-stay were evaluated as secondary outcomes. METHODS Observational cohort study, with data collected from patients admitted to Poliambulanza Foundation with positive real time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 from 20th February to 10th May 2020. Multivariate logistic regression with overlap weight propensity score was used to model hospital mortality and intensive care admission, hospital length-of-stay was analyzed with a multivariate Poisson regression. Seven hundred and ninety nine (57%) patients who received enoxaparin at least once during the hospitalization were included in the enoxaparin cohort, 604 (43%) patients who did not were included in the control cohort. FINDINGS At the adjusted analysis enoxaparin was associated with lower in-hospital mortality (Odds Ratio 0·53, 95% C.I. 0·40-0·70) compared with no enoxaparin treatment. Hospital length-of-stay was longer for patients treated with enoxaparin (Incidence Rate Ratios 1·45, 95% C.I. 1·36-1·54). Enoxaparin treatment was associated with reduced risk of intensive care admission at the adjusted analysis (Odds Ratio 0·48, 95% C.I. 0·32-0·69). INTERPRETATION This study shows that treatment with enoxaparin during hospital stay is associated with a lower death rate and, while results from randomized clinical trials are still pending, this study supports the use of thromboprophylaxis with enoxaparin in all patients admitted for COVID-19. Moreover, when enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission.
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Affiliation(s)
- Filippo Albani
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
- Corresponding author.
| | - Lilia Sepe
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Federica Fusina
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Chiara Prezioso
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
- Department of Intensive Care Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuela Baronio
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Federica Caminiti
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Antonella Di Maio
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Barbara Faggian
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Maria Elena Franceschetti
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Marco Massari
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Marcello Salvaggio
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
| | - Giuseppe Natalini
- Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy
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729
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Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul‐Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet 2020; 151:7-16. [PMID: 32816307 PMCID: PMC9087651 DOI: 10.1002/ijgo.13329] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women represent a potentially high-risk population in the COVID-19 pandemic. OBJECTIVE To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19. SEARCH STRATEGY Relevant databases were searched up until May 29, 2020. SELECTION CRITERIA Case series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19. DATA COLLECTION AND ANALYSIS PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. MAIN RESULTS Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. CONCLUSIONS Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.
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Affiliation(s)
- Ozlem Turan
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
| | - Amir Hakim
- National Heart and Lung InstituteImperial College LondonLondonUK
- Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Pradip Dashraath
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Wong Jing Lin Jeslyn
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Alison Wright
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
| | - Rezan Abdul‐Kadir
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
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730
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Hojyo S, Uchida M, Tanaka K, Hasebe R, Tanaka Y, Murakami M, Hirano T. How COVID-19 induces cytokine storm with high mortality. Inflamm Regen 2020; 40:37. [PMID: 33014208 PMCID: PMC7527296 DOI: 10.1186/s41232-020-00146-3] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
The newly emerging coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, but has rapidly spread all over the world. Some COVID-19 patients encounter a severe symptom of acute respiratory distress syndrome (ARDS) with high mortality. This high severity is dependent on a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier, which is hyper-activation machinery that regulates the nuclear factor kappa B (NF-κB) pathway and stimulated by the simultaneous activation of IL-6-signal transducer and activator of transcription 3 (STAT3) and NF-κB signaling in non-immune cells including alveolar epithelial cells and endothelial cells. We hypothesize that IL-6-STAT3 signaling is a promising therapeutic target for the cytokine storm in COVID-19, because IL-6 is a major STAT3 stimulator, particularly during inflammation. We herein review the pathogenic mechanism and potential therapeutic targets of ARDS in COVID-19 patients.
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Affiliation(s)
- Shintaro Hojyo
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Mona Uchida
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Kumiko Tanaka
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Rie Hasebe
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Yuki Tanaka
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Masaaki Murakami
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan
| | - Toshio Hirano
- Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, 060-0815 Japan.,Headquarters, National Institutes for Quantum and Radiological Science and Technology, Chiba, 263-8555 Japan
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Olwenyi OA, Dyavar SR, Acharya A, Podany AT, Fletcher CV, Ng CL, Reid SP, Byrareddy SN. Immuno-epidemiology and pathophysiology of coronavirus disease 2019 (COVID-19). J Mol Med (Berl) 2020; 98:1369-1383. [PMID: 32808094 PMCID: PMC7431311 DOI: 10.1007/s00109-020-01961-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Abstract
Occasional zoonotic viral attacks on immunologically naive populations result in massive death tolls that are capable of threatening human survival. Currently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infectious agent that causes coronavirus disease (COVID-19), has spread from its epicenter in Wuhan China to all parts of the globe. Real-time mapping of new infections across the globe has revealed that variable transmission patterns and pathogenicity are associated with differences in SARS-CoV-2 lineages, clades, and strains. Thus, we reviewed how changes in the SARS-CoV-2 genome and its structural architecture affect viral replication, immune evasion, and transmission within different human populations. We also looked at which immune dominant regions of SARS-CoV-2 and other coronaviruses are recognized by Major Histocompatibility Complex (MHC)/Human Leukocyte Antigens (HLA) genes and how this could impact on subsequent disease pathogenesis. Efforts were also placed on understanding immunological changes that occur when exposed individuals either remain asymptomatic or fail to control the virus and later develop systemic complications. Published autopsy studies that reveal alterations in the lung immune microenvironment, morphological, and pathological changes are also explored within the context of the review. Understanding the true correlates of protection and determining how constant virus evolution impacts on host-pathogen interactions could help identify which populations are at high risk and later inform future vaccine and therapeutic interventions.
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Affiliation(s)
- Omalla A Olwenyi
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shetty Ravi Dyavar
- Antiviral Pharmacology Laboratory, Center for Drug Discovery, University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony T Podany
- Antiviral Pharmacology Laboratory, Center for Drug Discovery, University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Courtney V Fletcher
- Antiviral Pharmacology Laboratory, Center for Drug Discovery, University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Caroline L Ng
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - St Patrick Reid
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.
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732
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Alves VS, Leite-Aguiar R, Silva JPD, Coutinho-Silva R, Savio LEB. Purinergic signaling in infectious diseases of the central nervous system. Brain Behav Immun 2020; 89:480-490. [PMID: 32717399 PMCID: PMC7378483 DOI: 10.1016/j.bbi.2020.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of infectious diseases affecting the central nervous system (CNS) has been increasing over the last several years. Among the reasons for the expansion of these diseases and the appearance of new neuropathogens are globalization, global warming, and the increased proximity between humans and wild animals due to human activities such as deforestation. Neurotropism affecting normal brain function is shared by organisms such as viruses, bacteria, fungi, and parasites. Neuroinfections caused by these agents activate immune responses, inducing neuroinflammation, excitotoxicity, and neurodegeneration. Purinergic signaling is an evolutionarily conserved signaling pathway associated with these neuropathologies. During neuroinfections, host cells release ATP as an extracellular danger signal with pro-inflammatory activities. ATP is metabolized to its derivatives by ectonucleotidases such as CD39 and CD73; ATP and its metabolites modulate neuronal and immune mechanisms through P1 and P2 purinergic receptors that are involved in pathophysiological mechanisms of neuroinfections. In this review we discuss the beneficial or deleterious effects of various components of the purinergic signaling pathway in infectious diseases that affect the CNS, including human immunodeficiency virus (HIV-1) infection, herpes simplex virus type 1 (HSV-1) infection, bacterial meningitis, sepsis, cryptococcosis, toxoplasmosis, and malaria. We also provide a description of this signaling pathway in emerging viral infections with neurological implications such as Zika and SARS-CoV-2.
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Affiliation(s)
- Vinícius Santos Alves
- Laboratory of Immunophysiology, Biophysics Institute Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raíssa Leite-Aguiar
- Laboratory of Immunophysiology, Biophysics Institute Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joyce Pereira da Silva
- Laboratory of Immunophysiology, Biophysics Institute Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robson Coutinho-Silva
- Laboratory of Immunophysiology, Biophysics Institute Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz Eduardo Baggio Savio
- Laboratory of Immunophysiology, Biophysics Institute Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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733
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Green J, Petty J, Bromley P, Walker K, Jones L. COVID-19 in babies: Knowledge for neonatal care. JOURNAL OF NEONATAL NURSING : JNN 2020; 26:239-246. [PMID: 32837224 PMCID: PMC7340054 DOI: 10.1016/j.jnn.2020.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
Infection is a leading cause of death worldwide in babies under one month of age who are more susceptible to sepsis due to immature host defence mechanisms. Usually, babies may become acutely unwell from infective pathogens due to specific differences in their respiratory and immune systems. However, with the COVID-19 virus, the focus of this paper, it appears that the neonatal population is not significantly affected in the same way as adults. That said, knowledge about this novel virus is rapidly emerging. Therefore, it is vital that neonatal nurses, midwives and other healthcare professionals are adequately informed and educated about the potential impact on neonatal practice. This review paper draws upon key findings and themes from a selection of recent literature to provide an overview of current knowledge on COVID-19 and the implications for care within the neonatal field. The discussion focuses on the nature of COVID-19, its pathophysiology and transmission relevant to maternal and neonatal care. This is followed by implications for practice; namely, maternal issues, the importance of human breast milk, neonatal care relating to parenting and specific management before a final review of the current World Health Organization guidance.
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Affiliation(s)
| | - Julia Petty
- School of Health and Social Work, The University of Hertfordshire, Hatfield, UK
| | - Patricia Bromley
- School of Nursing, College of Health and Medicine, University of Tasmania, Australia
| | | | - Linda Jones
- School of Nursing, College of Health and Medicine, University of Tasmania, Australia
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734
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Lung T, Kazatchkine MD, Risch L, Risch M, Nydegger UE. A consideration of convalescent plasma and plasma derivatives in the care of Severely-ill patients with COVID-19. Transfus Apher Sci 2020; 59:102936. [PMID: 32919880 PMCID: PMC7833822 DOI: 10.1016/j.transci.2020.102936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The pathogenesis and immunopathological damage of severe forms of COVID-19 resemble acute autoimmune disease sparked by SARS-CoV-2, including an early systemic overproduction of proinflammatory cytokines. Such immunopathological features provide a rationale for the use of passive immunotherapy with convalescent plasma as a source of neutralizing anti-viral antibodies and of anti-inflammatory plasma components. While convalescent plasma therapy is now being evaluated in prospective clinical trials, we further consider the therapeutic potential of human hyper immune globulins, and of heterologous, engineered and monoclonal neutralizing antibodies as anti-viral agents to treat COVID-19. Good medical practice procedures are still needed and is why we also discuss the potential use of polyclonal polyspecific immunoglobulins (IVIG), a therapeutic plasma derivative, with potent anti-inflammatory activity, in severe forms of Covid-19.
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Affiliation(s)
- Thomas Lung
- Labormedizinisches Zentrum Dr. Risch, Vaduz, Liechtenstein
| | - Michel D Kazatchkine
- Graduate Institute for International Affairs and Development, Geneva, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Vaduz, Liechtenstein
| | - Martin Risch
- Labormedizinisches Zentrum Dr. Risch, Vaduz, Liechtenstein
| | - Urs E Nydegger
- Labormedizinisches Zentrum Dr. Risch, Vaduz, Liechtenstein.
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735
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Ciabattini A, Garagnani P, Santoro F, Rappuoli R, Franceschi C, Medaglini D. Shelter from the cytokine storm: pitfalls and prospects in the development of SARS-CoV-2 vaccines for an elderly population. Semin Immunopathol 2020; 42:619-634. [PMID: 33159214 PMCID: PMC7646713 DOI: 10.1007/s00281-020-00821-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
The SARS-CoV-2 pandemic urgently calls for the development of effective preventive tools. COVID-19 hits greatly the elder and more fragile fraction of the population boosting the evergreen issue of the vaccination of older people. The development of a vaccine against SARS-CoV-2 tailored for the elderly population faces the challenge of the poor immune responsiveness of the older population due to immunosenescence, comorbidities, and pharmacological treatments. Moreover, it is likely that the inflammaging phenotype associated with age could both influence vaccination efficacy and exacerbate the risk of COVID-19-related "cytokine storm syndrome" with an overlap between the factors which impact vaccination effectiveness and those that boost virulence and worsen the prognosis of SARS-CoV-2 infection. The complex and still unclear immunopathological mechanisms of SARS-CoV-2 infection, together with the progressive age-related decline of immune responses, and the lack of clear correlates of protection, make the design of vaccination strategies for older people extremely challenging. In the ongoing effort in vaccine development, different SARS-CoV-2 vaccine candidates have been developed, tested in pre-clinical and clinical studies and are undergoing clinical testing, but only a small fraction of these are currently being tested in the older fraction of the population. Recent advances in systems biology integrating clinical, immunologic, and omics data can help to identify stable and robust markers of vaccine response and move towards a better understanding of SARS-CoV-2 vaccine responses in the elderly.
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Affiliation(s)
- Annalisa Ciabattini
- Laboratory of Molecular Microbiology and Biotechnology (LA.M.M.B.), Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Paolo Garagnani
- Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institute at Huddinge University Hospital, SE-171 77, Stockholm, Sweden
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139, Bologna, Italy
- Interdepartmental Centre 'L. Galvan' (CIG), University of Bologna, Via G. Petroni 26, 40139, Bologna, Italy
| | - Francesco Santoro
- Laboratory of Molecular Microbiology and Biotechnology (LA.M.M.B.), Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Rino Rappuoli
- GSK, Siena, Italy
- vAMRes Lab, Toscana Life Sciences, Siena, Italy
- Faculty of Medicine, Imperial College, London, UK
| | | | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology (LA.M.M.B.), Department of Medical Biotechnologies, University of Siena, Siena, Italy.
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736
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Ferguson J, Volk S, Vondracek T, Flanigan J, Chernaik A. Empiric Therapeutic Anticoagulation and Mortality in Critically Ill Patients With Respiratory Failure From SARS-CoV-2: A Retrospective Cohort Study. J Clin Pharmacol 2020; 60:1411-1415. [PMID: 32885463 DOI: 10.1002/jcph.1749] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
The pathophysiology of respiratory failure associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains under investigation. One hypothesis is that progressive endothelial damage from the virus leads to microvascular thrombosis. It is uncertain if empiric therapeutic anticoagulation provides benefit over standard deep vein thrombosis (DVT) prophylaxis in critically ill patients with SARS-CoV-2. A retrospective cohort study was performed to evaluate adult patients admitted to the intensive care unit at 3 hospitals with polymerase chain reaction-confirmed SARS-CoV-2-associated respiratory failure requiring invasive mechanical ventilation. A Kaplan-Meier survival analysis was used to compare patients who were initiated on therapeutic anticoagulation prior to the time of intubation and those receiving standard DVT prophylaxis doses. The primary outcome was the difference in the 28-day mortality of patients between the 2 groups. Twenty-eight-day mortality did not differ between groups, occurring in 26.1% of patients who received therapeutic anticoagulation and 29.5% of those who received a prophylactic dose only (hazard ratio, 0.52; P = .055). There was no difference in 28-day mortality between groups in patients who were admitted with a serum D-dimer ≥ 2 µg/mL (hazard ratio, 0.67; P = .41). Empiric therapeutic anticoagulation in patients who require invasive mechanical ventilation for confirmed SARS-CoV-2 infection does not improve 28-day mortality compared with standard DVT prophylaxis, even among those with elevated D-dimer levels.
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Affiliation(s)
- John Ferguson
- Rocky Mountain Pulmonary and Critical Care, Wheat Ridge, Colorado, USA
| | - Stacy Volk
- Lutheran Medical Center, Wheat Ridge, Colorado, USA
| | | | - John Flanigan
- Good Samaritan Medical Center, Lafayette, Colorado, USA
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737
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Sumarmi S. Kerja Harmoni Zat Gizi dalam Meningkatkan Imunitas Tubuh Terhadap Covid-19: Mini Review. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i3.2020.250-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
ABSTRACTBackground: The Covid-19 pandemic in Indonesia has been running since March 2020. Efforts to break the chain of transmission of the disease caused by the new SARS-CoV 2 coronavirus are by avoiding contact by practicing social & physical distancing and improving personal hygiene, and increase immunity or body defense against the corona virus.Purpose: This article discusses the role of macro nutrients and micronutrients that have the potential to increase immunity such as omega-3 fatty acids, several water soluble vitamins such as vitamin B6, vitamin C, as well as fat soluble vitamins such as vitamin A, vitamin D and vitamin E. as well as several minerals such as Fe, Zn, Se. The mechanisms of innate immunity and adaptive immunity that involve these nutrients will be discussed in depth, as well as how the cellular mechanism fights the corona virus.Discussion: The mechanism for the entry of the corona virus into the cell is through a mechanism called endocytosis, in which the virus is captured by the receptors on the surface of the cell, then drawn into the cell. Spike protein (protein S) facilitates the entry of viruses into target cells, especially lung cells.Conclusion The body's defense mechanisms against the corona virus are: 1) strengthening the body's frontline defenses or innate immunity; 2) stimulates the production of IgM and IgG immunoglobulins in the circulation; 3) blocking the virus from binding to the ACE-2 receptor; 4) reduce the intensity of cytokine storms; 5) reduce the speed of virus replication. ABSTRAKLatar Belakang: Pandemi Covid-19 di Indonesia telah berjalan sejak bulan Maret 2020. Upaya untuk memutus rantai penularan penyakit yang disebabkan oleh virus corona jenis baru SARS-CoV 2 adalah dengan menghidari kontak dengan cara mempraktekkan social & physical distancing dan meningkatkan kebersihan diri, serta meningkatkan imunitas atau pertahanan tubuh terhadap virus corona. Tujuan: Artikel ini membahas peran zat gizi makro dan zat gizi mikro yang berpotensi untuk meningkatkan imunitas seperti asam lemak omega-3, beberapa vitamin larut air seperti vitamin B6, vitamin C, juga vitamin larut lemak seperti vitamin A, vitamin D dan vitamin E, serta beberapa mineral seperti Fe, Zn, Se. Mekanisme innate immunity dan adaptive immunity yang melibatkan zat gizi tersebut akan dibahas secara mendalam, serta bagaimana mekanisme selular melawan virus corona. Ulasan: Mekanisme masuknya virus corona ke dalam sel adalah melalui mekanisme yang disebut endositosis, yaitu virus ditangkap oleh reseptor yang terdapat di permukaan sel, kemudian ditarik masuk ke dalam sel. Spike protein (protein S) bertugas memfasilitasi masuknya virus ke dalam sel target, terutama sel paru.Kesimpulan Mekanisme pertahanan tubuh melawan virus corona adalah: 1) menguatkan pertahanan tubuh garis depan atau innate immunity; 2) menstimulasi produksi immunoglobulin IgM dan IgG di dalam sirkulasi; 3) memblokir agar virus tidak terikat oleh receptor ACE-2; 4) menurunkan intensitas badai sitokin; 5) menurunkan kecepatan replikasi virus.
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738
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Huber W, Lorenz G, Heilmaier M, Böttcher K, Sahm P, Middelhoff M, Ritzer B, Schulz D, Bekka E, Hesse F, Poszler A, Geisler F, Spinner C, Schmid RM, Lahmer T. Extracorporeal multiorgan support including CO 2-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report. Int J Artif Organs 2020; 44:288-294. [PMID: 32985328 PMCID: PMC8041450 DOI: 10.1177/0391398820961781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- “ADVanced Organ Support” (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100–300 mL/min), dialysate flow (160–320 mL/min) and dialysate pH (7.6–9.0) were adapted to optimize arterial PaCO2 and pH. Effective CO2 removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO2 (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; p < 0.001). The CO2-elimination rate was 48 ± 23mL/min. The initial vasopressor requirement could be reduced in parallel to pH-normalization. Interruptions of ADVOS-treatment repeatedly resulted in reversible deteriorations of paCO2 and pH. After 95 h of continuous extracorporeal decarboxylating therapy the patient had markedly improved circulatory parameters compared to baseline. In the context of secondary pulmonary infection and progressive liver failure, the patient had a sudden cardiac arrest. In accordance with the presumed patient will, we decided against mechanical resuscitation. Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Georg Lorenz
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany.,Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Markus Heilmaier
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Katrin Böttcher
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Sahm
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Moritz Middelhoff
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Barbara Ritzer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Dominik Schulz
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Elias Bekka
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Felix Hesse
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Alexander Poszler
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Fabian Geisler
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Christoph Spinner
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Roland M Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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739
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Khinda J, Janjua NZ, Cheng S, van den Heuvel ER, Bhatti P, Darvishian M. Association between markers of immune response at hospital admission and COVID-19 disease severity and mortality: A meta-analysis and meta-regression. J Med Virol 2020; 93:1078-1098. [PMID: 32776551 PMCID: PMC7436507 DOI: 10.1002/jmv.26411] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 01/08/2023]
Abstract
Background To determine the utility of admission laboratory markers in the assessment and prognostication of coronavirus disease‐2019 (COVID‐19), a systematic review and meta‐analysis were conducted on the association between admission laboratory values in hospitalized COVID‐19 patients and subsequent disease severity and mortality. Material and Methods Searches were conducted in MEDLINE, Pubmed, Embase, and the WHO Global Research Database from December 1,2019 to May 1, 2020 for relevant articles. A random effects meta‐analysis was used to calculate the weighted mean difference (WMD) and 95% confidence interval (95% CI) for each of 27 laboratory markers. The impact of age and sex on WMDs was estimated using meta‐regression techniques for 11 markers. Results In total, 64 studies met the inclusion criteria. The most marked WMDs were for neutrophils (ANC) at 3.82 × 109/L (2.76, 4.87), lymphocytes (ALC) at −0.34 × 109/L (−0.45, −0.23), interleukin‐6 (IL‐6) at 32.59 pg/mL (23.99, 41.19), ferritin at 814.14 ng/mL (551.48, 1076.81), C‐reactive protein (CRP) at 66.11 mg/L (52.16, 80.06), D‐dimer at 5.74 mg/L (3.91, 7.58), LDH at 232.41 U/L (178.31, 286.52), and high sensitivity troponin I at 90.47 pg/mL (47.79, 133.14) when comparing fatal to nonfatal cases. Similar trends were observed comparing severe to non‐severe groups. There were no statistically significant associations between age or sex and WMD for any of the markers included in the meta‐regression. Conclusion The results highlight that hyper inflammation, blunted adaptive immune response, and intravascular coagulation play key roles in the pathogenesis of COVID‐19. Markers of these processes are good candidates to identify patients for early intervention and, importantly, are likely reliable regardless of age or sex in adult patients.
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Affiliation(s)
| | - Naveed Z. Janjua
- University of British ColumbiaVancouverCanada
- BC Centre for Disease ControlVancouverCanada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS)VancouverCanada
| | | | - Edwin R. van den Heuvel
- Department of Mathematics and Computer ScienceEindhoven University of TechnologyEindhovenNetherlands
- Department of Preventive Medicine and Epidemiology, School of MedicineBoston UniversityBostonMassachusetts
| | - Parveen Bhatti
- Cancer Control ResearchBC Cancer Research CentreVancouverCanada
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740
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Hellman U, Karlsson MG, Engström-Laurent A, Cajander S, Dorofte L, Ahlm C, Laurent C, Blomberg A. Presence of hyaluronan in lung alveoli in severe Covid-19: An opening for new treatment options? J Biol Chem 2020; 295:15418-15422. [PMID: 32978255 PMCID: PMC7650240 DOI: 10.1074/jbc.ac120.015967] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
Severe coronavirus disease 2019 (Covid-19) is characterized by inflammation of the lungs with increasing respiratory impairment. In fatal Covid-19, lungs at autopsy have been filled with a clear liquid jelly. However, the nature of this finding has not yet been determined. The aim of the study was to demonstrate whether the lungs of fatal Covid-19 contain hyaluronan, as it is associated with inflammation and acute respiratory distress syndrome (ARDS) and may have the appearance of liquid jelly. Lung tissue obtained at autopsy from three deceased Covid-19 patients was processed for hyaluronan histochemistry using a direct staining method and compared with staining in normal lung tissue. Stainings confirmed that hyaluronan is obstructing alveoli with presence in exudate and plugs, as well as in thickened perialveolar interstitium. In contrast, normal lungs only showed hyaluronan in intact alveolar walls and perivascular tissue. This is the first study to confirm prominent hyaluronan exudates in the alveolar spaces of Covid-19 lungs, supporting the notion that the macromolecule is involved in ARDS caused by SARS-CoV-2. The present finding may open up new treatment options in severe Covid-19, aiming at reducing the presence and production of hyaluronan in the lungs.
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Affiliation(s)
- Urban Hellman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Mats G Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Sara Cajander
- Department of Infectious diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Luiza Dorofte
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Claude Laurent
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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741
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Alberca RW, Teixeira FME, Beserra DR, de Oliveira EA, Andrade MMDS, Pietrobon AJ, Sato MN. Perspective: The Potential Effects of Naringenin in COVID-19. Front Immunol 2020; 11:570919. [PMID: 33101291 PMCID: PMC7546806 DOI: 10.3389/fimmu.2020.570919] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was declared a pandemic by the World Health Organization in March 2020. Severe COVID-19 cases develop severe acute respiratory syndrome, which can result in multiple organ failure, sepsis, and death. The higher risk group includes the elderly and subjects with pre-existing chronic illnesses such as obesity, hypertension, and diabetes. To date, no specific treatment or vaccine is available for COVID-19. Among many compounds, naringenin (NAR) a flavonoid present in citrus fruits has been investigated for antiviral and anti-inflammatory properties like reducing viral replication and cytokine production. In this perspective, we summarize NAR potential anti-inflammatory role in COVID-19 associated risk factors and SARS-CoV-2 infection.
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Affiliation(s)
- Ricardo Wesley Alberca
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Danielle Rosa Beserra
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Emily Araujo de Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Milena Mary de Souza Andrade
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Maria Notomi Sato
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
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742
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Wijeratne T, Sales C, Karimi L, Crewther SG. Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review. Front Neurol 2020; 11:1031. [PMID: 33101164 PMCID: PMC7546832 DOI: 10.3389/fneur.2020.01031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.
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Affiliation(s)
- Tissa Wijeratne
- Neurology & Stroke, Australian Institute for Musculoskeletal Science, Melbourne Medical School, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia
- Department of Medicine and Dean's Office, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Carmela Sales
- Department of Neurology, Australian Institute for Musculoskeletal Science, Level Three, Western Centre for Health Research and Education, Sunshine Hospital, Western Health & University Melbourne, St Albans, VIC, Australia
| | - Leila Karimi
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia
- Faculty of Social and Political Sciences, Tbilisi State University, Tbilisi, Georgia
| | - Sheila Gillard Crewther
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Parkville, VIC, Australia
- Department of Neurology, Australian Institute for Musculoskeletal Science, Level Three, Western Centre for Health Research and Education, Sunshine Hospital, Western Health & University Melbourne, St Albans, VIC, Australia
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743
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Kusumoputro S, Tseng S, Tse J, Au C, Lau C, Wang X, Xia T. Potential nanoparticle applications for prevention, diagnosis, and treatment of COVID‐19. VIEW 2020. [DOI: 10.1002/viw.20200105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sydney Kusumoputro
- Department of Ecology and Evolutionary Biology University of California Los Angeles California USA
| | - Shannon Tseng
- Department of Ecology and Evolutionary Biology University of California Los Angeles California USA
| | - Jonathan Tse
- Department of Integrative Biology and Physiology University of California Los Angeles California USA
| | - Christian Au
- Department of Bioengineering University of California Los Angeles California USA
| | - Candice Lau
- Department of Molecular, Cell and Developmental Biology University of California Los Angeles California USA
| | - Xiang Wang
- Division of NanoMedicine Department of Medicine University of California Los Angeles California USA
| | - Tian Xia
- Division of NanoMedicine Department of Medicine University of California Los Angeles California USA
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744
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Santos HO, Tinsley GM, da Silva GAR, Bueno AA. Pharmaconutrition in the Clinical Management of COVID-19: A Lack of Evidence-Based Research But Clues to Personalized Prescription. J Pers Med 2020; 10:E145. [PMID: 32992693 PMCID: PMC7712662 DOI: 10.3390/jpm10040145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023] Open
Abstract
A scientific interest has emerged to identify pharmaceutical and nutritional strategies in the clinical management of coronavirus disease 2019 (COVID-19). The purpose of this narrative review is to critically assess and discuss pharmaconutrition strategies that, secondary to accepted treatment methods, could be candidates in the current context of COVID-19. Oral medicinal doses of vitamin C (1-3 g/d) and zinc (80 mg/d elemental zinc) could be promising at the first signs and symptoms of COVID-19 as well as for general colds. In critical care situations requiring parenteral nutrition, vitamin C (3-10 g/d) and glutamine (0.3-0.5 g/kg/d) administration could be considered, whereas vitamin D3 administration (100,000 IU administered intramuscularly as a one-time dose) could possess benefits for patients with severe deficiency. Considering the presence of n-3 polyunsaturated fatty acids and arginine in immune-enhancing diets, their co-administration may also occur in clinical conditions where these formulations are recommended. However, despite the use of the aforementioned strategies in prior contexts, there is currently no evidence of the utility of any nutritional strategies in the management of SARS-CoV-2 infection and COVID-19. Nevertheless, ongoing and future clinical research is imperative to determine if any pharmaconutrition strategies can halt the progression of COVID-19.
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Affiliation(s)
- Heitor O. Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia 38408-100, Brazil
| | - Grant M. Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA;
| | - Guilherme A. R. da Silva
- Hospital Universitário Gaffrée e Guinle, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 21941-901, Brazil;
| | - Allain A. Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester WR2 6AJ, UK;
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745
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de la Rica R, Borges M, Gonzalez-Freire M. COVID-19: In the Eye of the Cytokine Storm. Front Immunol 2020; 11:558898. [PMID: 33072097 PMCID: PMC7541915 DOI: 10.3389/fimmu.2020.558898] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
The dysregulated release of cytokines has been identified as one of the key factors behind poorer outcomes in COVID-19. This "cytokine storm" produces an excessive inflammatory and immune response, especially in the lungs, leading to acute respiratory distress (ARDS), pulmonary edema and multi-organ failure. Alleviating this inflammatory state is crucial to improve prognosis. Pro-inflammatory factors play a central role in COVID-19 severity, especially in patients with comorbidities. In these situations, an overactive, untreated immune response can be deadly, suggesting that mortality in COVID-19 cases is likely due to this virally driven hyperinflammation. Administering immunomodulators has not yielded conclusive improvements in other pathologies characterized by dysregulated inflammation such as sepsis, SARS-CoV-1, and MERS. The success of these drugs at reducing COVID-19-driven inflammation is still anecdotal and comes with serious risks. It is also imperative to screen the elderly for risk factors that predispose them to severe COVID-19. Immunosenescence and comorbidities should be taken into consideration. In this review, we summarize the latest data available about the role of the cytokine storm in COVID-19 disease severity as well as potential therapeutic approaches to ameliorate it. We also examine the role of inflammation in other diseases and conditions often comorbid with COVID-19, such as aging, sepsis, and pulmonary disorders. Finally, we identify gaps in our knowledge and suggest priorities for future research aimed at stratifying patients according to risk as well as personalizing therapies in the context of COVID19-driven hyperinflammation.
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Affiliation(s)
- Roberto de la Rica
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Marcio Borges
- Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Marta Gonzalez-Freire
- Vascular and Metabolic Pathologies, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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746
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Cao Y, Yang R, Wang W, Lee I, Zhang R, Zhang W, Sun J, Xu B, Meng X. Computational Study of the Ion and Water Permeation and Transport Mechanisms of the SARS-CoV-2 Pentameric E Protein Channel. Front Mol Biosci 2020; 7:565797. [PMID: 33173781 PMCID: PMC7538787 DOI: 10.3389/fmolb.2020.565797] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (SARS-CoV-2) and represents the causative agent of a potentially fatal disease that is a public health emergency of international concern. Coronaviruses, including SARS-CoV-2, encode an envelope (E) protein, which is a small, hydrophobic membrane protein; the E protein of SARS-CoV-2 shares a high level of homology with severe acute respiratory syndrome coronavirus (SARS-CoV). In this study, we provide insights into the function of the SARS-CoV-2 E protein channel and the ion and water permeation mechanisms using a combination of in silico methods. Based on our results, the pentameric E protein promotes the penetration of cation ions through the channel. An analysis of the potential mean force (PMF), pore radius and diffusion coefficient reveals that Leu10 and Phe19 are the hydrophobic gates of the channel. In addition, the pore exhibits a clear wetting/dewetting transition with cation selectivity under transmembrane voltage, indicating that it is a hydrophobic voltage-dependent channel. Overall, these results provide structure-based insights and molecular dynamic information that are needed to understand the regulatory mechanisms of ion permeability in the pentameric SARS-CoV-2 E protein channel.
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Affiliation(s)
- Yipeng Cao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,National Supercomputer Center in Tianjin, TEDA - Tianjin Economic-Technological Development Area, Tianjin, China
| | - Rui Yang
- Department of Infection and Immunity, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Wei Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Imshik Lee
- College of Physics, Nankai University, Tianjin, China
| | - Ruiping Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wenwen Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jiana Sun
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bo Xu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Center for Intelligent Oncology, Chongqing University School of Medicine and Chongqing University Cancer Hospital, Chongqing, China
| | - Xiangfei Meng
- National Supercomputer Center in Tianjin, TEDA - Tianjin Economic-Technological Development Area, Tianjin, China
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747
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Lee HK, Knabl L, Pipperger L, Volland A, Furth P, Kang K, Smith H, Knabl L, Bellmann R, Bernhard C, Kaiser N, Gänzer H, Ströhle M, Walser A, Von Laer D, Hennighausen L. Immune transcriptomes of highly exposed SARS-CoV-2 asymptomatic seropositive versus seronegative individuals from the Ischgl community. RESEARCH SQUARE 2020:rs.3.rs-69657. [PMID: 32995765 PMCID: PMC7523134 DOI: 10.21203/rs.3.rs-69657/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To investigate prevalence of ongoing activation of inflammation following asymptomatic SARS-CoV-2 infection we characterized immune cell transcriptomes from 43 asymptomatic seropositive and 52 highly exposed seronegative individuals with few underlying health issues following a community superspreading event. Four mildly symptomatic seropositive individuals examined three weeks after infection as positive controls demonstrated immunological activation. Approximately four to six weeks following the event, the two asymptomatic groups showed no significant differences. Two seropositive patients with underlying genetic disease impacting immunological activation were included (Cystic Fibrosis (CF), Nuclear factor-kappa B Essential Modulator (NEMO) deficiency). CF, but not NEMO, associated with significant immune transcriptome differences including some associated with severe SARS-CoV-2 infection (IL1B, IL17A, respective receptors). All subjects remained in their usual state of health from event through five-month follow-up. Here, asymptomatic infection resolved without evidence of prolonged immunological activation. Inclusion of subjects with underlying genetic disease illustrated the pathophysiological importance of context on impact of immunological response.
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Affiliation(s)
- Hye Kyung Lee
- National Institute of Diabetes and Digestive and Kidney Diseases
| | | | | | | | | | | | - Harold Smith
- National Institute of Diabetes and Digestive and Kidney Diseases
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748
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Mustafa MI, Abdelmoneim AH, Mahmoud EM, Makhawi AM. Cytokine Storm in COVID-19 Patients, Its Impact on Organs and Potential Treatment by QTY Code-Designed Detergent-Free Chemokine Receptors. Mediators Inflamm 2020; 2020:8198963. [PMID: 33029105 PMCID: PMC7512100 DOI: 10.1155/2020/8198963] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus is not only causing respiratory problems, but it may also damage the heart, kidneys, liver, and other organs; in Wuhan, 14 to 30% of COVID-19 patients have lost their kidney function and now require either dialysis or kidney transplants. The novel coronavirus gains entry into humans by targeting the ACE2 receptor that found on lung cells, which destroy human lungs through cytokine storms, and this leads to hyperinflammation, forcing the immune cells to destroy healthy cells. This is why some COVID-19 patients need intensive care. The inflammatory chemicals released during COVID-19 infection cause the liver to produce proteins that defend the body from infections. However, these proteins can cause blood clotting, which can clog blood vessels in the heart and other organs; as a result, the organs are deprived of oxygen and nutrients which could ultimately lead to multiorgan failure and consequent progression to acute lung injury, acute respiratory distress syndrome, and often death. However, there are novel protein modification tools called the QTY code, which are similar in their structure to antibodies, which could provide a solution to excess cytokines. These synthetic proteins can be injected into the body to bind the excess cytokines created by the cytokine storm; this will eventually remove the excessive cytokines and inhibit the severe symptoms caused by the COVID-19 infection. In this review, we will focus on cytokine storm in COVID-19 patients, their impact on the body organs, and the potential treatment by QTY code-designed detergent-free chemokine receptors.
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Affiliation(s)
| | | | - Eiman M. Mahmoud
- Department of Immunology, Ahfad University for Women, Khartoum, Sudan
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749
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Optimizing the Risk-Benefit Balance of Thromboprophylaxis in Critically Ill Patients With Coronavirus Disease 2019. Crit Care Med 2020; 48:e988-e989. [PMID: 32706558 PMCID: PMC7375185 DOI: 10.1097/ccm.0000000000004509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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750
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May SARS-CoV-2 Diffusion Be Favored by Alkaline Aerosols and Ammonia Emissions? ATMOSPHERE 2020. [DOI: 10.3390/atmos11090995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ammonia is a common factor linking air in bat caves and air pollution in the proximity of agricultural fields treated with livestock farming sewage and slaughterhouses, where important clusters of COVID-19 have recently been reported all over the world. Such a commonality has a further connection with the known behavior of some viruses of the coronavirus family, such as the murine hepatitis virus, whose spike glycoprotein (S) can be triggered to a membrane-binding conformation at pH 8.0. Within the airborne route of virus transmission, with particular relevance for crowded and enclosed environments, these observations have prompted a hypothesis that may represent a contributing cause to interpret the geographical variability of the virus diffusion and the surging rise of COVID-19 cases in slaughterhouses all over the world. The hypothesis is that, in these environments, the SARS-CoV-2 S protein may find on a fraction of the airborne particles an alkaline pH, favorable to trigger the conformational changes, needed to induce the fusion of the viral envelope with the plasma membrane of the target cells.
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