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Gonzalez A, Orozco-Aguilar J, Achiardi O, Simon F, Cabello-Verrugio C. SARS-CoV-2/Renin-Angiotensin System: Deciphering the Clues for a Couple with Potentially Harmful Effects on Skeletal Muscle. Int J Mol Sci 2020; 21:ijms21217904. [PMID: 33114359 PMCID: PMC7663203 DOI: 10.3390/ijms21217904] [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] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/09/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has produced significant health emergencies worldwide, resulting in the declaration by the World Health Organization of the coronavirus disease 2019 (COVID-19) pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. A high proportion of patients require intensive care unit admission and mechanical ventilation (MV) to survive. It has been well established that angiotensin-converting enzyme type 2 (ACE2) is the primary cellular receptor for SARS-CoV-2. ACE2 belongs to the renin–angiotensin system (RAS), composed of several peptides, such as angiotensin II (Ang II) and angiotensin (1-7) (Ang-(1-7)). Both peptides regulate muscle mass and function. It has been described that SARS-CoV-2 infection, by direct and indirect mechanisms, affects a broad range of organ systems. In the skeletal muscle, through unbalanced RAS activity, SARS-CoV-2 could induce severe consequences such as loss of muscle mass, strength, and physical function, which will delay and interfere with the recovery process of patients with COVID-19. This article discusses the relationship between RAS, SARS-CoV-2, skeletal muscle, and the potentially harmful consequences for skeletal muscle in patients currently infected with and recovering from COVID-19.
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Affiliation(s)
- Andrea Gonzalez
- Laboratory of Muscle Pathology, Fragility and Aging, Department of Biological Sciences, Faculty of Life Sciences, Universidad Andres Bello, Santiago 8370146, Chile; (A.G.); (J.O.-A.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8370146, Chile;
- Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago 8350709, Chile
| | - Josué Orozco-Aguilar
- Laboratory of Muscle Pathology, Fragility and Aging, Department of Biological Sciences, Faculty of Life Sciences, Universidad Andres Bello, Santiago 8370146, Chile; (A.G.); (J.O.-A.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8370146, Chile;
- Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago 8350709, Chile
| | - Oscar Achiardi
- Escuela de Kinesiología, Facultad de Ciencias, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340025, Chile;
| | - Felipe Simon
- Millennium Institute on Immunology and Immunotherapy, Santiago 8370146, Chile;
- Laboratory of Integrative Physiopathology, Department of Biological Sciences, Faculty of Life Sciences, Universidad Andres Bello, Santiago 8370146, Chile
- Millennium Nucleus of Ion Channels-Associated Diseases (MiNICAD), Universidad de Chile, Santiago 8370146, Chile
| | - Claudio Cabello-Verrugio
- Laboratory of Muscle Pathology, Fragility and Aging, Department of Biological Sciences, Faculty of Life Sciences, Universidad Andres Bello, Santiago 8370146, Chile; (A.G.); (J.O.-A.)
- Millennium Institute on Immunology and Immunotherapy, Santiago 8370146, Chile;
- Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago 8350709, Chile
- Correspondence: ; Tel./Fax: +56-227-703-665
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52
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Zhao JV, Schooling CM, Leung GM. Using genetics to understand the role of antihypertensive drugs modulating angiotensin-converting enzyme in immune function and inflammation. Br J Clin Pharmacol 2020; 87:1839-1846. [PMID: 33025652 PMCID: PMC7675404 DOI: 10.1111/bcp.14572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Aim Angiotensin‐converting enzyme 2 (ACE 2) is the binding domain for severe acute respiratory syndrome coronavirus (SARS‐CoV) and SARSCoV‐2. Some antihypertensive drugs affect ACE2 expression or activity (ACE inhibitors and angiotensin II receptor blockers [ARBs]), suggesting use of other hypertensives might be preferable, such as calcium channel blockers (CCBs). Given the limited evidence, the International Society of Hypertension does not support such a policy. Methods We used a Mendelian randomization study to obtain unconfounded associations of antihypertensives, instrumented by published genetic variants in genes regulating target proteins of these drugs, with immune (lymphocyte and neutrophil percentage) and inflammatory (tumour necrosis factor alpha [TNF‐α]) markers in the largest available genome‐wide association studies. Results Genetically predicted effects of ACE inhibitors increased lymphocyte percentage (0.78, 95% confidence interval [CI] 0.35, 1.22), decreased neutrophil percentage (−0.64, 95% CI −1.09, −0.20) and possibly lowered TNF‐α (−4.92, 95% CI −8.50, −1.33). CCBs showed a similar pattern for immune function (lymphocyte percentage 0.21, 95% CI 0.05 to 0.36; neutrophil percentage −0.23, 95% CI −0.39 to −0.08) but had no effect on TNF‐α, as did potassium‐sparing diuretics and aldosterone antagonists, and vasodilator antihypertensives. ARBs and other classes of hypertensives had no effect on immune function or TNF‐α. Conclusion Varying effects of different classes of antihypertensives on immune and inflammatory markers do not suggest antihypertensive use based on their role in ACE2 expression, but instead suggest investigation of the role of antihypertensives in immune function and inflammation might reveal important information that could optimize their use in SARSCoV‐2.
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Affiliation(s)
- Jie V Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,School of Public Health and Health policy, City University of New York, New York, NY, USA
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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53
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Jensen MP, George M, Gilroy D, Sofat R. Beyond dexamethasone, emerging immuno-thrombotic therapies for COVID-19. Br J Clin Pharmacol 2020; 87:845-857. [PMID: 32881064 DOI: 10.1111/bcp.14540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Host immunity is required to clear SARS-CoV-2, and inability to clear the virus because of host or pathogen factors renders those infected at risk of poor outcomes. Estimates of those who are able to clear the virus with asymptomatic or paucisymptomatic COVID-19 remain unclear, and dependent on widespread testing. However, evidence is emerging that in severe cases, pathological mechanisms of hyperinflammation and coagulopathy ensue, the former supported by results from the RECOVERY trial demonstrating a reduction in mortality with dexamethasone in advanced COVID-19. It remains unclear whether these pathogenic pathways are secondary to a failure to clear the virus because of maladaptive immune responses or if these are sequential COVID-19 defining illnesses. Understanding the pathophysiological mechanisms underpinning these cascades is essential to formulating rationale therapeutic approaches beyond the use of dexamethasone. Here, we review the pathophysiology thought to underlie COVID-19 with clinical correlates and the current therapeutic approaches being investigated.
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Affiliation(s)
| | - Marc George
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK
| | - Derek Gilroy
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK
| | - Reecha Sofat
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK.,Institute of Health Informatics, 222 Euston Road, London, UK
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H. Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,*Richard H. Hunt, Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University Health Sciences Centre, Hamilton, ON L8S 4L8 (Canada),
| | - James E. East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany,Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta,Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J. Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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Abstract
Patients with cardiovascular disease have an increased risk of severe COVID‐19 disease and an increased mortality. Clinical observations have described cardiovascular complications of COVID‐19 in patients without prior cardiovascular disease, including acute cardiac injury, myocarditis, heart failure, arrhythmias, and acute coronary syndromes. These are also associated with a worse outcome from COVID‐19. Several of the potential treatments for COVID‐19 may also have cardiovascular consequences. Some of the acute cardiovascular complications resolve on recovery from the infection and it is uncertain how many people will suffer permanent cardiovascular damage. During the emergency lockdown that was introduced to deal with the pandemic it has been observed that hospital admissions with other cardiovascular conditions, such as acute coronary syndromes and heart failure, have been greatly reduced. Copyright © 2020 John Wiley & Sons.
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Affiliation(s)
- Miles Fisher
- Consultant Physician, Glasgow Royal InfirmaryGlasgowUK
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56
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Jourdes A, Lafaurie M, Martin-Blondel G, Delobel P, Faruch M, Charpentier S, Minville V, Silva S, Thalamas C, Sommet A, Moulis G. Clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 infection at Toulouse University hospital (France). Results from the Covid-clinic-Toul cohort. Rev Med Interne 2020; 41:732-740. [PMID: 33077266 PMCID: PMC7540209 DOI: 10.1016/j.revmed.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide from epicenter of Wuhan, China since December 2019. The aim of our study was to describe the clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 pneumonia at the Toulouse university hospital, France. Patients and methods We selected the patients included from March 7, 2020 to April 20, 2020 in the retrolective Covid-clinic-Toul cohort that follows all hospitalized patients with SARS-CoV-2 infection at the Toulouse Hospital. Cases were confirmed by real-time reverse transcriptase polymerase chain reaction. We report demographics, clinical, biological and radiological features, as well as unfavorable outcome at Day 14 after admission (admission in an intensive care unit, mechanical ventilation, death). Results Among 263 hospitalized patients, the median age was 65 years and 155 (58.9%) were males. Two hundred and twenty-seven patients (86.3%) had at least one comorbidity. The median time from first symptom to hospital admission was 7.0 days (interquartile range: 4–10). On day 14 after admission, 111 patients (42.2%) had been transferred to intensive care unit (ICU), including 50 (19.0%) on Day 1; 61 (23.1%) needed mechanical ventilation and 19 patients (7.2%) had died. Patients admitted to ICU at Day 1 of admission (n = 50) were more frequently men (66.0% vs 57.3%), smokers (25.0% vs 7.1%), with obesity (42.0% vs 24.7%) and had a higher mean level of C-reactive protein (median: 110.9 mg/L vs 46.2 mg/L). Conclusion This cohort provides epidemiological data on SARS-CoV-2 in hospitalized patients in a University hospital in the South of France.
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Affiliation(s)
- A Jourdes
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Lafaurie
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France.
| | - G Martin-Blondel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - P Delobel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Faruch
- Service de radiologie et imagerie médicale, CHU de Toulouse, Toulouse, France
| | - S Charpentier
- Service des urgences, CHU de Toulouse, Toulouse, France
| | - V Minville
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - S Silva
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - C Thalamas
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - A Sommet
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - G Moulis
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de médecine interne, CHU de Toulouse, Toulouse, France
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57
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Li J, Wei Q, Li WX, McCowen KC, Xiong W, Liu J, Jiang W, Marin T, Thomas RL, He M, Gongol B, Hepokoski M, Yuan JXJ, Shyy JYJ, Xiong N, Malhotra A. Metformin Use in Diabetes Prior to Hospitalization: Effects on Mortality in Covid-19. Endocr Pract 2020; 26:1166-1172. [PMID: 33471718 PMCID: PMC7834011 DOI: 10.4158/ep-2020-0466] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Although type 2 diabetes mellitus (T2DM) has been reported as a risk factor for coronavirus disease 2019 (COVID-19), the effect of pharmacologic agents used to treat T2DM, such as metformin, on COVID-19 outcomes remains unclear. Metformin increases the expression of angiotensin converting enzyme 2, a known receptor for severe acute respiratory syndrome coronavirus 2. Data from people with T2DM hospitalized for COVID-19 were used to test the hypothesis that metformin use is associated with improved survival in this population. METHODS Retrospective analyses were performed on de-identified clinical data from a major hospital in Wuhan, China, that included patients with T2DM hospitalized for COVID-19 during the recent epidemic. One hundred and thirty-one patients diagnosed with COVID-19 and T2DM were used in this study. The primary outcome was mortality. Demographic, clinical characteristics, laboratory data, diabetes medications, and respiratory therapy data were also included in the analysis. RESULTS Of these 131 patients, 37 used metformin with or without other antidiabetes medications. Among the 37 metformin-taking patients, 35 (94.6%) survived and 2 (5.4%) did not survive. The mortality rates in the metformin-taking group versus the non-metformin group were 5.4% (2/37) versus 22.3% (21/94). Using multivariate analysis, metformin was found to be an independent predictor of survival in this cohort (P = .02). CONCLUSION This study reveals a significant association between metformin use and survival in people with T2DM diagnosed with COVID-19. These clinical data are consistent with potential benefits of the use of metformin for COVID-19 patients with T2DM.
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Affiliation(s)
- Jinghong Li
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Qi Wei
- the Department of Endocrinology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Willis X Li
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Karen C McCowen
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Wei Xiong
- the Department of Endocrinology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Jiao Liu
- the Department of Endocrinology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Wenlijun Jiang
- the Department of Endocrinology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Traci Marin
- the Department of Health Sciences, Victor Valley College, Victorville, California
| | - Robert L Thomas
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Ming He
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Brendan Gongol
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Mark Hepokoski
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - Jason X-J Yuan
- From the Department of Medicine, University of California, San Diego, La Jolla, California
| | - John Y-J Shyy
- From the Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Nian Xiong
- the Department of Endocrinology, Wuhan Red Cross Hospital, Wuhan, Hubei, China; the Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China..
| | - Atul Malhotra
- From the Department of Medicine, University of California, San Diego, La Jolla, California
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58
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Hoevenaar M, Goossens D, Roorda J. Angiotensin-converting enzyme 2, the complement system, the kallikrein-kinin system, type-2 diabetes, interleukin-6, and their interactions regarding the complex COVID-19 pathophysiological crossroads. J Renin Angiotensin Aldosterone Syst 2020; 21:1470320320979097. [PMID: 33283602 PMCID: PMC7724427 DOI: 10.1177/1470320320979097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Because of the current COVID-19-pandemic, the world is currently being held hostage in various lockdowns. ACE2 facilitates SARS-CoV-2 cell-entry, and is at the very center of several pathophysiological pathways regarding the RAAS, CS, KKS, T2DM, and IL-6. Their interactions with severe COVID-19 complications (e.g. ARDS and thrombosis), and potential therapeutic targets for pharmacological intervention, will be reviewed.
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Affiliation(s)
| | | | - Janne Roorda
- Medical Doctor, General Practice
van Dijk, Oisterwijk, The Netherlands
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59
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Kawahara LT, Costa IBSDS, Barros CCS, Almeida GCD, Bittar CS, Rizk SI, Testa L, Moniz CMV, Pereira J, Oliveira GMMD, Diz MDPE, Guimarães PO, Pinto IM, Kalil R, Hajjar LA, Hoff PM. Câncer e Doenças Cardiovasculares na Pandemia de COVID-19. Arq Bras Cardiol 2020; 115:547-557. [PMID: 33027380 PMCID: PMC9363105 DOI: 10.36660/abc.20200405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
O desafio imposto ao sistema de saúde pela pandemia da COVID-19 faz com que haja uma necessidade de readequações de rotinas e serviços de saúde, com os objetivos de controlar a disseminação do vírus e preservar a saúde. Torna-se ainda mais importante o manejo seguro e correto dos pacientes dos grupos de risco, como os pacientes idosos, os portadores de doenças cardiovasculares e os pacientes com câncer. Dessa forma, a cardio-oncologia ganha novo dimensionamento, no intuito de se adequar às necessidades dos pacientes diante de uma pandemia, reestruturando o sistema de atendimento de forma a oferecer qualidade e segurança na assistência à saúde.
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Statin Use Is Associated with Decreased Risk of Invasive Mechanical Ventilation in COVID-19 Patients: A Preliminary Study. Pathogens 2020; 9:pathogens9090759. [PMID: 32957539 PMCID: PMC7559887 DOI: 10.3390/pathogens9090759] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 disproportionately affects patients with medical comorbidities such as cardiovascular disease (CVD). Patients with CVD are widely prescribed 3-hydroxy-3-methyl-glutayl-CoA (HMG-CoA) reductase inhibitors (statins), a class of lipid-lowering medications known for their pleiotropic anti-inflammatory and immunomodulatory effects. However, the relationship between statin use and COVID-19 outcomes is not fully understood. In this preliminary study, we explored the association between statin use and severe COVID-19 outcomes in hospitalized patients, including intensive care unit (ICU) admission, the need for invasive mechanical ventilation (IMV), and in-hospital death. We performed a retrospective cohort study of 249 patients hospitalized with COVID-19 from 3 March 2020 to 10 April 2020 in Rhode Island, USA. Patient demographics, past medical history, current medications, and hospital course were recorded and analyzed. A multivariate logistic regression analysis was conducted to examine associations. After adjusting for age, sex, race, cardiovascular disease, chronic pulmonary disease, diabetes, and obesity, statin use was significantly associated with decreased risk for IMV (adjusted Odds Ratio (aOR) = 0.45, 95% Confidence Interval (CI): 0.20–0.99). Our results support the continued use of statins among COVID-19 patients and could have implications for future prospective studies on the management of COVID-19.
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Samidurai A, Das A. Cardiovascular Complications Associated with COVID-19 and Potential Therapeutic~Strategies. Int J Mol Sci 2020; 21:ijms21186790. [PMID: 32947927 PMCID: PMC7554795 DOI: 10.3390/ijms21186790] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), an infectious disease with severe acute respiratory syndrome, has now become a worldwide pandemic. Despite the respiratory complication, COVID-19 is also associated with significant multiple organ dysfunction, including severe cardiac impairment. Emerging evidence reveals a direct interplay between COVID-19 and dire cardiovascular complications, including myocardial injury, heart failure, heart attack, myocarditis, arrhythmias as well as blood clots, which are accompanied with elevated risk and adverse outcome among infected patients, even sudden death. The proposed pathophysiological mechanisms of myocardial impairment include invasion of SARS-CoV-2 virus via angiotensin-converting enzyme 2 to cardiovascular cells/tissue, which leads to endothelial inflammation and dysfunction, de-stabilization of vulnerable atherosclerotic plaques, stent thrombosis, cardiac stress due to diminish oxygen supply and cardiac muscle damage, and myocardial infarction. Several promising therapeutics are under investigation to the overall prognosis of COVID-19 patients with high risk of cardiovascular impairment, nevertheless to date, none have shown proven clinical efficacy. In this comprehensive review, we aimed to highlight the current integrated therapeutic approaches for COVID-19 and we summarized the potential therapeutic options, currently under clinical trials, with their mechanisms of action and associated adverse cardiac events in highly infectious COVID-19 patients.
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Affiliation(s)
| | - Anindita Das
- Correspondence: ; Tel.: +1-804-628-5519; Fax: +1-804-828-8700
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ACE polymorphisms and COVID-19-related mortality in Europe. J Mol Med (Berl) 2020; 98:1505-1509. [PMID: 32935155 PMCID: PMC7491982 DOI: 10.1007/s00109-020-01981-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
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Zhang J, Wang M, Ding W, Wan J. The interaction of RAAS inhibitors with COVID-19: Current progress, perspective and future. Life Sci 2020; 257:118142. [PMID: 32712300 PMCID: PMC7377983 DOI: 10.1016/j.lfs.2020.118142] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently defined as the worst pandemic disease. SARS-CoV-2 infects human cells via the binding of its S protein to the receptor angiotensin-converting enzyme (ACE2). The use of ACEIs/ARBs (RAAS inhibitors) regulates the renin-angiotensin-aldosterone system (RAAS) and may increase ACE2 expression. Considering the large use of ACEIs/ARBs in hypertensive patients, some professional groups are concerned about whether the use of RAAS inhibitors affects the risk of SARS-CoV-2 infection or the risk of severe illness and mortality in COVID-19 patients. In this review, we summarize preclinical and clinical studies to investigate whether the use of ACEIs/ARBs increases ACE2 expression in animals or patients. We also analyzed whether the use of these drugs affects the risk of SARS-CoV-2 infection, severe illness or mortality based on recent studies. Finally, the review suggests that current evidence does not support the concerns.
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Affiliation(s)
| | | | | | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China.
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Di Tano G, De Maria R, Loffi M, Moschini L, Galeazzi G, Danzi GB. [Renin-angiotensin system blockers and outcomes during hydroxychloroquine treatment in patients hospitalized for COVID-19 pneumonia]. Rev Esp Cardiol 2020; 73:964-966. [PMID: 32874012 PMCID: PMC7451211 DOI: 10.1016/j.recesp.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Renata De Maria
- National Research Council, Institute of Clinical Physiology, ASST Great Metropolitan Hospital Niguarda, Milán, Italia
| | - Marco Loffi
- Cardiology Department, ASST Cremona Hospital, Cremona, Italia
| | - Luigi Moschini
- Cardiology Department, ASST Cremona Hospital, Cremona, Italia
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65
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Affiliation(s)
- Jasimuddin Ahamed
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
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66
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dos Santos WG. Natural history of COVID-19 and current knowledge on treatment therapeutic options. Biomed Pharmacother 2020; 129:110493. [PMID: 32768971 PMCID: PMC7332915 DOI: 10.1016/j.biopha.2020.110493] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023] Open
Abstract
Despite intense research there is currently no effective vaccine available against the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged in the later 2019 and responsible for the COVID-19 pandemic. This infectious and communicable disease has become one of the major public health challenges in the world. The clinical management of COVID-19 has been limited to infection prevention and control measures associated with supportive care such as supplemental oxygen and mechanical ventilation. Meanwhile efforts to find an effective treatment to inhibit virus replication, mitigate the symptoms, increase survival and decrease mortality rate are ongoing. Several classes of drugs, many of them already in use for other diseases, are being evaluated based on the body of clinical knowledge obtained from infected patients regarding to the natural history and evolution of the infection. Herein we will provide an updated overview of the natural history and current knowledge on drugs and therapeutic agents being tested for the prevention and treatment of COVID-19. These include different classes of drugs such as antiviral agents (chloroquine, ivermectin, nitazoxanide, hydroxychloroquine, lopinavir, remdesivir, tocilizumab), supporting agents (Vitamin C, Vitamin D, azithromycin, corticosteroids) and promising investigational vaccines. Considering the controversies and excessive number of compounds being tested and reported in the literature we hope that this review can provide useful and updated consolidated information on potential drugs used to prevent, control and treat COVID-19 patients worldwide.
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67
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Greco A, Buccheri S, D’Arrigo P, Calderone D, Agnello F, Monte M, Milluzzo RP, Franchina AG, Ingala S, Capodanno D. Outcomes of renin-angiotensin-aldosterone system blockers in patients with COVID-19: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 6:335-337. [PMID: 32671399 PMCID: PMC7454531 DOI: 10.1093/ehjcvp/pvaa074] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Antonio Greco
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Sergio Buccheri
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Paolo D’Arrigo
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Dario Calderone
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Federica Agnello
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Marco Monte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Rocco Paolo Milluzzo
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Antonio Gabriele Franchina
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Salvatore Ingala
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria ‘Policlinico-San Marco’, University of Catania, Catania, Italy
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68
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Lévy BI, Fauvel JP. Renin-angiotensin system blockers and severe acute respiratory syndrome coronavirus 2. Arch Cardiovasc Dis 2020; 113:572-578. [PMID: 32863157 PMCID: PMC7430243 DOI: 10.1016/j.acvd.2020.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2, which is responsible for the current coronavirus disease 2019 pandemic, uses angiotensin-converting enzyme 2 as a gateway into host cells. In this review, we summarise the biology of this enzyme, which plays a key role in cardiovascular homeostasis. Blockers of the renin–angiotensin system modify the expression and activity of angiotensin-converting enzyme 2 in different ways. The effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the expression and enzyme activity of angiotensin-converting enzyme 2 are reviewed, and the consequences of these treatments for the severity of coronavirus disease 2019 infection are discussed.
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Affiliation(s)
- Bernard I Lévy
- Inserm UMR970 (PARCC) and Hôpital Lariboisière, 75010 Paris, France.
| | - Jean-Pierre Fauvel
- Service de Néphrologie, UMR 5558, Université Claude Bernard Lyon 1, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69437 Lyon, France
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69
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Renin-angiotensin system blockers and outcomes during hydroxychloroquine treatment in patients hospitalized for COVID-19 pneumonia. ACTA ACUST UNITED AC 2020; 73:964-966. [PMID: 32792314 PMCID: PMC7346836 DOI: 10.1016/j.rec.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022]
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70
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Kussmaul WG. COVID-19 and Angiotensin-Converting Enzyme Inhibitor/Angiotensin-Receptor Blocker Therapy. Ann Intern Med 2020; 173:237-238. [PMID: 32422077 PMCID: PMC7249506 DOI: 10.7326/m20-3047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mackey and colleagues reported a systematic review that found high-certainty evidence that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers are not associated with greater illness severity in patients with COVID-19. The editorialist discusses the findings and emphasizes that, unless further data show otherwise, clinicians should continue to prescribe these drugs for their standard indications in patients with COVID-19.
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71
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Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, Pal I, Patel N, Amgai B, Ghosh RK, Fonarow GC, Lavie CJ, Naidu SS. COVID-19 Pandemic: Cardiovascular Complications and Future Implications. Am J Cardiovasc Drugs 2020; 20:311-324. [PMID: 32578167 PMCID: PMC7310596 DOI: 10.1007/s40256-020-00420-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a global pandemic with the highest number of affected individuals in the modern era. Not only is the infection inflicting significant morbidity and mortality, but there has also been a significant strain to the health care system and the economy. COVID-19 typically presents as viral pneumonia, occasionally leading to acute respiratory distress syndrome (ARDS) and death. However, emerging evidence suggests that it has a significant impact on the cardiovascular (CV) system by direct myocardial damage, severe systemic inflammatory response, hypoxia, right heart strain secondary to ARDS and lung injury, and plaque rupture secondary to inflammation. Primary cardiac manifestations include acute myocarditis, myocardial infarction, arrhythmia, and abnormal clotting. Several consensus documents have been released to help manage CV disease during this pandemic. In this review, we summarize key cardiac manifestations, their management, and future implications.
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Affiliation(s)
| | - Tauseef Akhtar
- John’s Hopkins University School of Medicine, Baltimore, MD USA
| | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY USA
| | - Manasvi Gupta
- University of Connecticut School of Medicine, Hartford, CT USA
| | - Avash Das
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Ipsita Pal
- Columbia University Irving Medical Center, New York, NY USA
| | | | | | | | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA USA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA USA
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72
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Hendry BM, Stafford N, Arnold AD, Sangwaiya A, Manglam V, Rosen SD, Arnold J. Hypothesis: Pentoxifylline is a potential cytokine modulator therapeutic in COVID-19 patients. Pharmacol Res Perspect 2020; 8:e00631. [PMID: 32715661 PMCID: PMC7383088 DOI: 10.1002/prp2.631] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
We propose a new hypothesis that the established drug pentoxifylline deserves attention as a potential repurposed therapeutic for COVID-19. Pentoxifylline is an immunomodulator with anti-inflammatory properties. It is a nonselective phosphodiesterase inhibitor and through Adenosine A2A Receptor-mediated pathways reduces tumor necrosis factor alpha, interleukin 1, interleukin 6, and interferon gamma and may act to reduce tissue damage during the cytokine storm host response to SARS-CoV-2 infection. This agent has been used clinically for many years and has a favorable profile of safety and tolerability. Pre-clinical data support pentoxifylline as effective in cytokine-driven lung damage. Clinical studies of pentoxifylline in radiation and cytokine-induced lung damage in humans are positive and consistent with anti-inflammatory efficacy. Pentoxifylline is a readily available, off-patent and inexpensive drug, suitable for large-scale use including in resource-limited countries. Current trials of therapeutics are largely focused on the inhibition of viral processes. We advocate urgent randomized trials of pentoxifylline for COVID-19 as a complementary approach to target the host responses.
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Affiliation(s)
- Bruce M. Hendry
- Renal SciencesDepartment of Inflammation BiologyKing’s College LondonLondonUK
| | - Nina Stafford
- Department of GastroenterologyEaling HospitalLondon North West University Healthcare NHS TrustSouthallUK
| | - Ahran D. Arnold
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Arvind Sangwaiya
- Department of GastroenterologyEaling HospitalLondon North West University Healthcare NHS TrustSouthallUK
| | - Vijay Manglam
- Department of GastroenterologyEaling HospitalLondon North West University Healthcare NHS TrustSouthallUK
| | - Stuart D. Rosen
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Jayantha Arnold
- Department of GastroenterologyEaling HospitalLondon North West University Healthcare NHS TrustSouthallUK
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73
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Vila-Corcoles A, Satue-Gracia E, Ochoa-Gondar O, Torrente-Fraga C, Gomez-Bertomeu F, Vila-Rovira A, Hospital-Guardiola I, de Diego-Cabanes C, Bejarano-Romero F, Rovira-Veciana D, Basora-Gallisa J. Use of distinct anti-hypertensive drugs and risk for COVID-19 among hypertensive people: A population-based cohort study in Southern Catalonia, Spain. J Clin Hypertens (Greenwich) 2020; 22:1379-1388. [PMID: 32710674 PMCID: PMC8029672 DOI: 10.1111/jch.13948] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022]
Abstract
The use of some anti-hypertensive drugs in the current COVID-19 pandemic has become controversial. This study investigated possible relationships between anti-hypertensive medications use and COVID-19 infection risk in the ambulatory hypertensive population. This is a population-based retrospective cohort study involving 34 936 hypertensive adults >50 years in Tarragona (Southern Catalonia, Spain) who were retrospectively followed through pandemic period (from 01/03/2020 to 30/04/2020). Two data sets including demographic/clinical characteristics (comorbidities and cardiovascular medications use) and laboratory PCR codes for COVID-19 were linked to construct an anonymized research database. Cox regression was used to calculate multivariable hazard ratios (HRs) and estimate the risk of suffering COVID-19 infection. Across study period, 205 PCR-confirmed COVID-19 cases were observed, which means an overall incidence of 586.8 cases per 100 000 persons-period. In multivariable analyses, only age (HR: 1.03; 95% CI: 1.02-1.05; P < .001) and nursing home residence (HR: 19.60; 95% CI: 13.80-27.84; P < .001) appeared significantly associated with increased risk of COVID-19. Considering anti-hypertensive drugs, receiving diuretics (HR: 1.22; 95% CI: 0.90-1.67; P = .205), calcium channel blockers (HR: 1.29; 95%CI: 0.91-1.82; P = .148), beta-blockers (HR: 0.97; 95% CI: 0.68-1.37; P = .844), and angiotensin-converting enzyme inhibitors (HR: 0.83; 95% CI: 0.61-1.13; P = .238) did not significantly alter the risk of PCR-confirmed COVID-19, whereas receiving angiotensin II receptor blockers was associated with an almost statistically significant reduction risk (HR: 0.67; 95% CI: 0.44-1.01; P = .054). In conclusion, our data support that receiving renin-angiotensin-aldosterone system inhibitors does not predispose for suffering COVID-19 infection in ambulatory hypertensive people. Conversely, receiving angiotensin II receptor blockers could be related with a reduced risk.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Health Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Spain
| | - Eva Satue-Gracia
- Primary Health Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Spain
| | - Olga Ochoa-Gondar
- Primary Health Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Spain
| | - Cristina Torrente-Fraga
- Department of Information and Communication Technologies, DAP Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
| | - Frederic Gomez-Bertomeu
- Department of Microbiology, Hospital Universitari Joan XXIII, Institut Catala de la Salut, Tarragona, Spain
| | - Angel Vila-Rovira
- Unitat de Suport a la Recerca Tarragona-Reus, IDIAP Jordi Gol, Barcelona, Spain
| | - Imma Hospital-Guardiola
- Primary Health Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
| | - Cinta de Diego-Cabanes
- Primary Health Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
| | - Ferran Bejarano-Romero
- Department of Farmacology, DAP Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
| | | | - Josep Basora-Gallisa
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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74
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Bharati J, Ramachandran R. Nephrology and Coronavirus Disease 2019. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2020. [DOI: 10.1055/s-0040-1714442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AbstractNovel coronavirus disease 2019 (COVID-19) has emerged as a threat to the human population worldwide. Old age and presence of comorbidities are risk factors for severe complications of the disease, as many of these patients are not able to mount effective or have an aberrant antiviral response. Patients with chronic kidney disease are at high risk of COVID-19 and its complications, especially those with end-stage renal disease (ESRD). Patients have repeated exposure to crowding in dialysis units, and face the uncertainties of health care system sustainability during periods of increasing demand and scarce supply. Acute kidney injury (AKI) is a notable complication in patients with COVID-19 with an incidence of up to 25% in specific populations. Patients with AKI have a higher mortality rate. The etiology and pathogenesis of AKI in COVID-19 are multifactorial. Direct viral invasion and cytopathic effects on renal tubular cells and indirect factors like hypovolemia, rhabdomyolysis, renal vein congestion, and hypercoagulable state play a role in causing AKI in these patients. Renal replacement therapy in the form of continuous renal replacement therapy is most widely used worldwide mostly due to hemodynamic instability of critically sick patients with COVID-19. Anticoagulation therapy is critical as most COVID-19 patients have increased clotting tendency and extracorporeal circuit thrombosis is common. ESRD patients in China had mild-to-moderate symptoms commonly. However, the data from Spain and Italy report a higher mortality rate in ESRD patients than the general population. Strict screening and uniform adherence to infection control practices have led to a decreased risk of cross-infection among other patients and dialysis personnel in dialysis units. The association between nephrology and COVID-19 is unique and focus on further research on kidney pathology along with the strengthening of existing dialysis facilities are needed.
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Affiliation(s)
- Joyita Bharati
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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75
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Pan W, Zhang J, Wang M, Ye J, Xu Y, Shen B, He H, Wang Z, Ye D, Zhao M, Luo Z, Liu M, Zhang P, Gu J, Liu M, Li D, Liu J, Wan J. Clinical Features of COVID-19 in Patients With Essential Hypertension and the Impacts of Renin-angiotensin-aldosterone System Inhibitors on the Prognosis of COVID-19 Patients. Hypertension 2020; 76:732-741. [PMID: 32654555 DOI: 10.1161/hypertensionaha.120.15289] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is one of the most common comorbidities in patients with coronavirus disease 2019 (COVID-19). This study aimed to clarify the impact of hypertension on COVID-19 and investigate whether the prior use of renin-angiotensin-aldosterone system (RAAS) inhibitors affects the prognosis of COVID-19. A total of 996 patients with COVID-19 were enrolled, including 282 patients with hypertension and 714 patients without hypertension. Propensity score-matched analysis (1:1 matching) was used to adjust the imbalanced baseline variables between the 2 groups. Patients with hypertension were further divided into the RAAS inhibitor group (n=41) and non-RAAS inhibitor group (n=241) according to their medication history. The results showed that COVID-19 patients with hypertension had more severe secondary infections, cardiac and renal dysfunction, and depletion of CD8+ cells on admission. Patients with hypertension were more likely to have comorbidities and complications and were more likely to be classified as critically ill than those without hypertension. Cox regression analysis revealed that hypertension (hazard ratio, 95% CI, unmatched cohort [1.80, 1.20-2.70]; matched cohort [2.24, 1.36-3.70]) was independently associated with all-cause mortality in patients with COVID-19. In addition, hypertensive patients with a history of RAAS inhibitor treatment had lower levels of C-reactive protein and higher levels of CD4+ cells. The mortality of patients in the RAAS inhibitor group (9.8% versus 26.1%) was significantly lower than that of patients in the non-RAAS inhibitor group. In conclusion, hypertension may be an independent risk factor for all-cause mortality in patients with COVID-19. Patients who previously used RAAS inhibitors may have a better prognosis.
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Affiliation(s)
- Wei Pan
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Jishou Zhang
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Menglong Wang
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Jing Ye
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Yao Xu
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Bo Shen
- Department of Medical Affairs (B.S., H.H.), Renmin Hospital of Wuhan University, China
| | - Hua He
- Department of Medical Affairs (B.S., H.H.), Renmin Hospital of Wuhan University, China
| | - Zhen Wang
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Di Ye
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Mengmeng Zhao
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Zhen Luo
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Mingxiao Liu
- Medical Quality Management Office (Mingxiao Liu), Renmin Hospital of Wuhan University, China
| | - Pingan Zhang
- Department of Clinical Laboratory (P.Z., J.G.), Renmin Hospital of Wuhan University, China
| | - Jian Gu
- Department of Clinical Laboratory (P.Z., J.G.), Renmin Hospital of Wuhan University, China
| | - Menglin Liu
- Department of Emergency (Menglin Liu), Renmin Hospital of Wuhan University, China
| | - Dan Li
- Department of Pediatrics (D.L.), Renmin Hospital of Wuhan University, China
| | - Jianfang Liu
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
| | - Jun Wan
- From the Department of Cardiology (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.), Renmin Hospital of Wuhan University, China.,Cardiovascular Research Institute, Wuhan University, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.).,Hubei Key Laboratory of Cardiology, Wuhan, China (W.P., J.Z., M.W., J.Y., Y.X., Z.W., D.Y., M.Z., Z.L., J.L., J.W.)
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76
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Drapkina OM, Vasilyeva LE. Debatable points of using angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in patients with COVID-19. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is a serious threat to global health. The infection mechanism is the binding of SARS-CoV-2 to angiotensin-converting enzyme 2 (ACE2) and internalization of the complex by the host cell. ACE inhibitors/angiotensin receptor antagonists (ARA) are known to increase ACE2 expression and are recommended for the treatment of many cardiovascular diseases (CVD). Thus, it has been suggested that treatment with renin-angiotensin-aldosterone system blockers (RAAS) increases the viral load and the risk of severe acute respiratory distress syndrome. However, ACE2 also converts angiotensin II into substances with cardioprotective effects. In addition, there is no evidence that RAAS inhibitors increase the severity of COVID-19 infection, while the risks of withdrawal of ACE inhibitors/ARA in patients with CVD are proven. There is also no evidence to support the idea that the administration of ACE inhibitors/ARA promotes the coronavirus’s penetration by increasing the ACE2 expression. According to the guidelines of the Russian Society of Cardiology and the consensus statements of international cardiology societies, it is necessary to continue taking RAAS inhibitors in high-risk patients with COVID-19. This review provides an analysis of foreign articles revealing the pathophysiological pathways and recommendations for using ACE inhibitors/ARA in patients with CVD and COVID-19 infection.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - L. E. Vasilyeva
- National Medical Research Center for Therapy and Preventive Medicine
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77
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Alsufyani HA, Docherty JR. The renin angiotensin aldosterone system and COVID-19. Saudi Pharm J 2020; 28:977-984. [PMID: 32788834 PMCID: PMC7332203 DOI: 10.1016/j.jsps.2020.06.019] [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: 05/20/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
The ongoing pandemic has stimulated study of the Renin Angiotensin Aldosterone System (RAAS), and how it can be manipulated to treat COVID-19. Studies are examining whether drugs that act on the RAAS system might be useful to treat COVID-19. COVID-19 and the RAAS are closely linked both in infection and in possible post-infection inflammatory cascades. We detail the Physiology and Pharmacology of the RAAS including the effects of aldosterone and atrial natriuretic peptide. It is appropriate that the theoretical benefits of modulation of the RAAS should be considered based on available knowledge of the complexity of the system. In this short review we have tried to explain the actions of the angiotensin family of peptides and produce a relatively simple model and diagrammatic summary of the RAAS and the possible sites of intervention.
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Affiliation(s)
- Hadeel A Alsufyani
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James R Docherty
- Department of Physiology, Royal College of Surgeons in Ireland, 123, St. Stephen's Green, Dublin 2, Ireland
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78
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Affiliation(s)
- Nicholas Moore
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France.
| | - Bruce Carleton
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
| | - Pauline Bosco-Levy
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
| | - Cecile Droz
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
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79
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Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings. Glob Heart 2020; 15:44. [PMID: 32923338 PMCID: PMC7413193 DOI: 10.5334/gh.823] [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] [Indexed: 02/06/2023] Open
Abstract
In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.
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80
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Sriram K, Insel PA. Assessment of ACE inhibitors/angiotensin receptor blockers in COVID-19 patients. Am J Physiol Lung Cell Mol Physiol 2020; 319:L37-L38. [PMID: 33496632 PMCID: PMC7524453 DOI: 10.1152/ajplung.00262.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Krishna Sriram
- Department of Pharmacology, University of California San Diego, La Jolla, California
| | - Paul A Insel
- Department of Pharmacology, University of California San Diego, La Jolla, California.,Department of Medicine, University of California San Diego, La Jolla, California
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81
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Magee LA, Khalil A, von Dadelszen P. Pregnancy hypertension diagnosis and care in COVID-19 era and beyond. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:7-10. [PMID: 32506723 PMCID: PMC7300934 DOI: 10.1002/uog.22115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 05/09/2023]
Affiliation(s)
- L. A. Magee
- Department of Women and Children's HealthSchool of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College LondonLondonUK
- King's Health PartnersLondonUK
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - A. Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation TrustUniversity of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
| | - P. von Dadelszen
- Department of Women and Children's HealthSchool of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College LondonLondonUK
- King's Health PartnersLondonUK
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
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82
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Fasano A, Cereda E, Barichella M, Cassani E, Ferri V, Zecchinelli AL, Pezzoli G. COVID-19 in Parkinson's Disease Patients Living in Lombardy, Italy. Mov Disord 2020; 35:1089-1093. [PMID: 32484584 PMCID: PMC7300944 DOI: 10.1002/mds.28176] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022] Open
Abstract
Background It is unknown whether patients with PD are at greater risk of COVID‐19, what their risk factors are, and whether their clinical manifestations differ from the general population. Objectives The study aimed to address all these issues. Methods In a case‐controlled survey, we interviewed 1,486 PD patients attending a single tertiary center in Lombardy, Italy and 1,207 family members (controls). Results One hundred five (7.1%) and 92 controls (7.6%) were identified as COVID‐19 cases. COVID‐19 patients were younger, more likely to suffer from chronic obstructive pulmonary disease, to be obese, and vitamin D nonsupplemented than unaffected patients. Six patients (5.7%) and 7 family members (7.6%) died from COVID‐19. Patients were less likely to report shortness of breath and require hospitalization. Conclusions In an unselected large cohort of nonadvanced PD patients, COVID‐19 risk and mortality did not differ from the general population, but symptoms appeared to be milder. The possible protective role of vitamin D supplementation warrants future studies. © 2020 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Michela Barichella
- UOS Clinical Nutrition, Pini-CTO, Milan, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Italy
| | - Erica Cassani
- Fondazione Grigioni per il Morbo di Parkinson, Italy.,Parkinson Institute, Pini-CTO, Milan, Italy
| | - Valentina Ferri
- Fondazione Grigioni per il Morbo di Parkinson, Italy.,Parkinson Institute, Pini-CTO, Milan, Italy
| | | | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Italy.,Parkinson Institute, Pini-CTO, Milan, Italy
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83
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Bravi F, Flacco ME, Carradori T, Volta CA, Cosenza G, De Togni A, Acuti Martellucci C, Parruti G, Mantovani L, Manzoli L. Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens. PLoS One 2020; 15:e0235248. [PMID: 32579597 PMCID: PMC7314008 DOI: 10.1371/journal.pone.0235248] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Aims This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). Methods and results All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. Conclusion No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.
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Affiliation(s)
| | | | | | - Carlo Alberto Volta
- "Sant'Anna" University Hospital of Ferrara, Ferrara, Italy
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | | | | | | | - Lorenzo Mantovani
- Center for Public Health Research, University of Milan—Bicocca, Milan, Italy
- IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Lamberto Manzoli
- "Sant'Anna" University Hospital of Ferrara, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- * E-mail:
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84
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Woodward B, Kermali M. COVID-19: The heart of the issue. J Card Surg 2020; 35:2112. [PMID: 32542802 PMCID: PMC7323096 DOI: 10.1111/jocs.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Beth Woodward
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Muhammed Kermali
- Faculty of Medicine, St. George's, University of London, London, UK
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85
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Tralhão A, Moita LF, Póvoa P. Potential benefit of angiotensin II in COVID-19 patients: beyond reasonable doubt? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:324. [PMID: 32517796 PMCID: PMC7282537 DOI: 10.1186/s13054-020-03027-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Affiliation(s)
- António Tralhão
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal. .,Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Avenida Professor Doutor Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Luís Ferreira Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Rua da Quinta Grande 6, 2780-156, Oeiras, Portugal
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, CHRH, New University of Lisbon, 1069-056, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, DK-5000, Odense C, Denmark
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86
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Would ACEIs/ARBs be beneficial for COVID-19 patients without hypertension? Pharmacol Res 2020; 159:104959. [PMID: 32505834 PMCID: PMC7272174 DOI: 10.1016/j.phrs.2020.104959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
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87
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Cormican DS, Winter D, McHugh S, Sonny A, Crowley J, Yu R, Barrack F, Núñez-Gil IJ, Ramakrishna H. Severe Acute Respiratory Syndrome Coronavirus-2 Cardiovascular Complications: Implications for Cardiothoracic Anesthesiology. J Cardiothorac Vasc Anesth 2020; 35:932-943. [PMID: 32601001 PMCID: PMC7836849 DOI: 10.1053/j.jvca.2020.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Daniel S Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Daniel Winter
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Northwestern Medicine, Chicago, IL
| | - Stephen McHugh
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jerome Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Raymond Yu
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Frank Barrack
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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88
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Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers with the Risk of Hospitalization and Death in Hypertensive Patients with Coronavirus Disease-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32511481 PMCID: PMC7273249 DOI: 10.1101/2020.05.17.20104943] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Whether angiotensin-converting enzyme (ACE) Inhibitors and angiotensin receptor blockers (ARBs) mitigate or exacerbate SARS-CoV-2 infection remains uncertain. In a national study, we evaluated the association of ACE inhibitors and ARB with coronavirus disease-19 (COVID-19) hospitalization and mortality among individuals with hypertension. METHODS Among Medicare Advantage and commercially insured individuals, we identified 2,263 people with hypertension, receiving ≥1 antihypertensive agents, and who had a positive outpatient SARS-CoV-2 test (outpatient cohort). In a propensity score-matched analysis, we determined the association of ACE inhibitors and ARBs with the risk of hospitalization for COVID-19. In a second study of 7,933 individuals with hypertension who were hospitalized with COVID-19 (inpatient cohort), we tested the association of these medications with in-hospital mortality. We stratified all our assessments by insurance groups. RESULTS Among individuals in the outpatient and inpatient cohorts, 31.9% and 29.8%, respectively, used ACE inhibitors and 32.3% and 28.1% used ARBs. In the outpatient study, over a median 30.0 (19.0 - 40.0) days after testing positive, 12.7% were hospitalized for COVID-19. In propensity score-matched analyses, neither ACE inhibitors (HR, 0.77 [0.53, 1.13], P = 0.18), nor ARBs (HR, 0.88 [0.61, 1.26], P = 0.48), were significantly associated with risk of hospitalization. In analyses stratified by insurance group, ACE inhibitors, but not ARBs, were associated with a significant lower risk of hospitalization in the Medicare group (HR, 0.61 [0.41, 0.93], P = 0.02), but not the commercially insured group (HR: 2.14 [0.82, 5.60], P = 0.12; P-interaction 0.09). In the inpatient study, 14.2% died, 59.5% survived to discharge, and 26.3% had an ongoing hospitalization. In propensity score-matched analyses, neither use of ACE inhibitor (0.97 [0.81, 1.16]; P = 0.74) nor ARB (1.15 [0.95, 1.38]; P = 0.15) was associated with risk of in-hospital mortality, in total or in the stratified analyses. CONCLUSIONS The use of ACE inhibitors and ARBs was not associated with the risk of hospitalization or mortality among those infected with SARS-CoV-2. However, there was a nearly 40% lower risk of hospitalization with the use of ACE inhibitors in the Medicare population. This finding merits a clinical trial to evaluate the potential role of ACE inhibitors in reducing the risk of hospitalization among older individuals, who are at an elevated risk of adverse outcomes with the infection.
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89
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Gemmati D, Bramanti B, Serino ML, Secchiero P, Zauli G, Tisato V. COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males? Int J Mol Sci 2020; 21:E3474. [PMID: 32423094 PMCID: PMC7278991 DOI: 10.3390/ijms21103474] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
In December 2019, a novel severe acute respiratory syndrome (SARS) from a new coronavirus (SARS-CoV-2) was recognized in the city of Wuhan, China. Rapidly, it became an epidemic in China and has now spread throughout the world reaching pandemic proportions. High mortality rates characterize SARS-CoV-2 disease (COVID-19), which mainly affects the elderly, causing unrestrained cytokines-storm and subsequent pulmonary shutdown, also suspected micro thromboembolism events. At the present time, no specific and dedicated treatments, nor approved vaccines, are available, though very promising data come from the use of anti-inflammatory, anti-malaria, and anti-coagulant drugs. In addition, it seems that males are more susceptible to SARS-CoV-2 than females, with males 65% more likely to die from the infection than females. Data from the World Health Organization (WHO) and Chinese scientists show that of all cases about 1.7% of women who contract the virus will die compared with 2.8% of men, and data from Hong Kong hospitals state that 32% of male and 15% of female COVID-19 patients required intensive care or died. On the other hand, the long-term fallout of coronavirus may be worse for women than for men due to social and psychosocial reasons. Regardless of sex- or gender-biased data obtained from WHO and those gathered from sometimes controversial scientific journals, some central points should be considered. Firstly, SARS-CoV-2 has a strong interaction with the human ACE2 receptor, which plays an essential role in cell entry together with transmembrane serine protease 2 (TMPRSS2); it is interesting to note that the ACE2 gene lays on the X-chromosome, thus allowing females to be potentially heterozygous and differently assorted compared to men who are definitely hemizygous. Secondly, the higher ACE2 expression rate in females, though controversial, might ascribe them the worst prognosis, in contrast with worldwide epidemiological data. Finally, several genes involved in inflammation are located on the X-chromosome, which also contains high number of immune-related genes responsible for innate and adaptive immune responses to infection. Other genes, out from the RAS-pathway, might directly or indirectly impact on the ACE1/ACE2 balance by influencing its main actors (e.g., ABO locus, SRY, SOX3, ADAM17). Unexpectedly, the higher levels of ACE2 or ACE1/ACE2 rebalancing might improve the outcome of COVID-19 in both sexes by reducing inflammation, thrombosis, and death. Moreover, X-heterozygous females might also activate a mosaic advantage and show more pronounced sex-related differences resulting in a sex dimorphism, further favoring them in counteracting the progression of the SARS-CoV-2 infection.
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Affiliation(s)
- Donato Gemmati
- Department of Morphology, Surgery and Experimental Medicine and Centre Haemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy
- University Centre for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Barbara Bramanti
- University Centre for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Biomedical & Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Luisa Serino
- Department of Medical Sciences and Centre Haemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy;
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (P.S.); (G.Z.); (V.T.)
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (P.S.); (G.Z.); (V.T.)
| | - Veronica Tisato
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (P.S.); (G.Z.); (V.T.)
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90
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Tsatsakis A, Petrakis D, Nikolouzakis TK, Docea AO, Calina D, Vinceti M, Goumenou M, Kostoff RN, Mamoulakis C, Aschner M, Hernández AF. COVID-19, an opportunity to reevaluate the correlation between long-term effects of anthropogenic pollutants on viral epidemic/pandemic events and prevalence. Food Chem Toxicol 2020; 141:111418. [PMID: 32437891 PMCID: PMC7211730 DOI: 10.1016/j.fct.2020.111418] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
Occupational, residential, dietary and environmental exposures to mixtures of synthetic anthropogenic chemicals after World War II have a strong relationship with the increase of chronic diseases, health cost and environmental pollution. The link between environment and immunity is particularly intriguing as it is known that chemicals and drugs can cause immunotoxicity (e.g., allergies and autoimmune diseases). In this review, we emphasize the relationship between long-term exposure to xenobiotic mixtures and immune deficiency inherent to chronic diseases and epidemics/pandemics. We also address the immunotoxicologic risk of vulnerable groups, taking into account biochemical and biophysical properties of SARS-CoV-2 and its immunopathological implications. We particularly underline the common mechanisms by which xenobiotics and SARS-CoV-2 act at the cellular and molecular level. We discuss how long-term exposure to thousand chemicals in mixtures, mostly fossil fuel derivatives, exposure toparticle matters, metals, ultraviolet (UV)–B radiation, ionizing radiation and lifestyle contribute to immunodeficiency observed in the contemporary pandemic, such as COVID-19, and thus threaten global public health, human prosperity and achievements, and global economy. Finally, we propose metrics which are needed to address the diverse health effects of anthropogenic COVID-19 crisis at present and those required to prevent similar future pandemics. Developmental exposure to environmental factors can disrupt the immune system. Long-term low-dose exposure to chemical mixtures is linked to imunodeficiency Immunodeficiency contributes to chronic diseases and the current Covid-19 pandemics. Environmental chemicals and microorganisms share similar molecular pathomechanisms (AhR pathway). Understanding the underlying pathomechanisms helps to improve public health.
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Affiliation(s)
- Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409 Heraklion, Crete, Greece; Department of Analytical and Forensic Medical Toxicology, Sechenov University, 2-4 Bolshaya Pirogovskaya st., 119991 Moscow, Russia; Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY 10461, USA.
| | - Demetrious Petrakis
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409 Heraklion, Crete, Greece.
| | | | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, I-41125 Modena, Italy.
| | - Marina Goumenou
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409 Heraklion, Crete, Greece
| | - Ronald N Kostoff
- School of Public Policy, Georgia Institute of Technology, Gainesville, VA, 20155, USA.
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece.
| | - Michael Aschner
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 2-4 Bolshaya Pirogovskaya st., 119991 Moscow, Russia; Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY 10461, USA.
| | - Antonio F Hernández
- Department of Legal Medicine and Toxicology, University of Granada School of Medicine, 180016 Granada, Spain.
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91
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Risk of Covid-19 with renin-angiotensin-aldosterone system medications. REACTIONS WEEKLY 2020. [PMCID: PMC7232911 DOI: 10.1007/s40278-020-78440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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92
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Molina-Carballo A, Jerez-Calero AE, Muñoz-Hoyos A. Possible Protective Role of Melatonin in Pediatric Infectious Diseases and Neurodevelopmental Pathologies. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1716713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractMelatonin, produced in every cell that possesses mitochondria, acts as an endogenous free radical scavenger, and improves energetic metabolism and immune function, by complex molecular crosstalk with other intracellular compounds. There is greatly increasing evidence regarding beneficial effects of acute and chronic administration of high melatonin doses, in infectious, developmental, and degenerative pathologies, as an endothelial cell and every cell protectant.
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Affiliation(s)
- Antonio Molina-Carballo
- Department of Pediatrics, Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, the Andalusian Health Service, School of Medicine, University of Granada, Granada, Spain
| | - Antonio Emilio Jerez-Calero
- Department of Pediatrics, Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, the Andalusian Health Service, School of Medicine, University of Granada, Granada, Spain
| | - Antonio Muñoz-Hoyos
- Department of Pediatrics, Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, the Andalusian Health Service, School of Medicine, University of Granada, Granada, Spain
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93
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Bahat G. Covid-19 and the Renin Angiotensin System: Implications for the Older Adults. J Nutr Health Aging 2020; 24:699-704. [PMID: 32744564 PMCID: PMC7271637 DOI: 10.1007/s12603-020-1403-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Affiliation(s)
- G Bahat
- Gülistan Bahat, Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Fatih 34093, Istanbul, Turkey, Telephone: +90 212 414 20 00, Fax: + 90 212 414 22 48, + 90 212 532 42 08, E-Mail Address: , ORCID ID: 0000-0001-5343-9795
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