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Baksh M, Ravat V, Zaidi A, Patel RS. A Systematic Review of Cases of Acute Respiratory Distress Syndrome in the Coronavirus Disease 2019 Pandemic. Cureus 2020; 12:e8188. [PMID: 32566429 PMCID: PMC7301420 DOI: 10.7759/cureus.8188] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) was declared a global pandemic after it spread to 213 countries and has the highest total number of cases worldwide. About 80% of COVID-19 infections are mild or asymptomatic and never require hospitalization but about 5% of patients become critically ill and develop acute respiratory distress syndrome (ARDS). The widely used management for ARDS in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation. Treatment options for this widespread disease are limited and there are no definitive therapies or vaccines until now. Although some antimalarial and antiviral drugs may prove effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their safety and efficacy are still under clinical trials. We conducted a systematic review of case reports on ARDS in SARS-CoV-2 infection to summarize the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. We need more data and established studies for the effective management of the novel SARS-CoV-2 and to reduce mortality in high-risk patients.
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Affiliation(s)
- Mizba Baksh
- Internal Medicine, Dr. Nandamuri Taraka Rama Rao University of Health Sciences, Vijayawada, IND
| | | | - Annam Zaidi
- Medicine, Dow University of Health Sciences, Karachi, PAK
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Zhao R, Ali G, Nie HG, Chang Y, Bhattarai D, Su X, Zhao X, Matthay MA, Ji HL. Plasmin improves blood-gas barrier function in oedematous lungs by cleaving epithelial sodium channels. Br J Pharmacol 2020; 177:3091-3106. [PMID: 32133621 DOI: 10.1111/bph.15038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Lung oedema in association with suppressed fibrinolysis is a hallmark of lung injury. Here, we have tested whether plasmin cleaves epithelial sodium channels (ENaC) to resolve lung oedema fluid. EXPERIMENTAL APPROACH Human lungs and airway acid-instilled mice were used for analysing fluid resolution. In silico prediction, mutagenesis, Xenopus oocytes, immunoblotting, voltage clamp, mass spectrometry, and protein docking were combined for identifying plasmin cleavage sites. KEY RESULTS Plasmin improved lung fluid resolution in both human lungs ex vivo and injured mice. Plasmin activated αβγENaC channels in oocytes in a time-dependent manner. Deletion of four consensus proteolysis tracts (αΔ432-444, γΔ131-138, γΔ178-193, and γΔ410-422) eliminated plasmin-induced activation significantly. Further, immunoblotting assays identified 7 cleavage sites (K126, R135, K136, R153, K168, R178, K179) for plasmin to trim both furin-cleaved C-terminal fragments and full-length human γENaC proteins. In addition, 9 new sites (R122, R137, R138, K150, K170, R172, R180, K181, K189) in synthesized peptides were found to be cleaved by plasmin. These cleavage sites were located in the finger and the thumb, particularly the GRIP domain of human ENaC 3D model composed of two proteolytic centres for plasmin. Novel uncleaved sites beyond the GRIP domain in both α and γ subunits were identified to interrupt the plasmin cleavage-induced conformational change in ENaC channel complexes. Additionally, plasmin could regulate ENaC activity via the G protein signal. CONCLUSION AND IMPLICATIONS Plasmin can cleave ENaC to improve blood-gas exchange by resolving oedema fluid and could be a potent therapy for oedematous lungs.
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Affiliation(s)
- Runzhen Zhao
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas
| | - Gibran Ali
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas
| | - Hong-Guang Nie
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas.,College of Basic Medical Science, China Medical University, Shenyang, Liaoning, China
| | - Yongchang Chang
- Division of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona
| | - Deepa Bhattarai
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas
| | - Xuefeng Su
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas
| | - Xiaoli Zhao
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Michael A Matthay
- Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
| | - Hong-Long Ji
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas.,Texas Lung Injury Institute, University of Texas Health Science Centre at Tyler, Tyler, Texas
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53
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Arutyunov GP, Koziolova NA, Tarlovskaya EI, Arutyunov AG, Grigorjeva NY, Dzhunusbekova GA, Malchikova SV, Mitkovskaya NP, Orlova YA, Petrova MM, Rebrov AP, Sisakyan AS, Skibitsky VV, Sugraliev AB, Fomin IV, Chesnikova AI, Shaposhnik II. [The Agreed Experts' Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange]. ACTA ACUST UNITED AC 2020; 60:9-19. [PMID: 32515699 DOI: 10.18087/cardio.2020.5.n1132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
The article discusses pathogenesis and treatment of COVID-19. The authors presented state-of-the-art insight into hemostatic disorders in patients with COVID-19 and clinical recommendations on prevention of thrombosis and thromboembolism in patients infected with SARS-CoV-2. The article discussed in detail a new hypothesis proposed by Chinese physicians about a new component in the pathogenesis of COVID-19, namely, about the effect of SARS-CoV-2 virus on the hemoglobin beta-chain and the formation of a complex with porphyrin, which results in displacement of the iron ion. Thus, hemoglobin loses the capability for transporting oxygen, which aggravates hypoxia and worsens the prognosis. The article stated rules of hemotransfusion safety in the conditions of COVID-19 pandemic.
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Affiliation(s)
- G P Arutyunov
- N. I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - N A Koziolova
- Academician E. A. Vagner Perm State Medical University, Perm, Russia
| | - E I Tarlovskaya
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - A G Arutyunov
- N. I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - N Yu Grigorjeva
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - G A Dzhunusbekova
- Kazakh Medical University of Postgraduate Education, Almaty, Republic of Kazakhstan
| | | | - N P Mitkovskaya
- Belorussian State Medical University, Minsk, Republic of Belarus
| | - Ya A Orlova
- M. V. Lomonosov Moscow State University, Moscow, Russia
| | - M M Petrova
- V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - A P Rebrov
- V. I. Razumovsky Saratov State Medical University, Saratov, Russia
| | - A S Sisakyan
- M. Geratsi Erevan State Medical University, Erevan, Armenia
| | | | - A B Sugraliev
- S. D. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - I V Fomin
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | | | - I I Shaposhnik
- South Ural State Medical University, Chelyabinsk, Russia
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54
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Barrett CD, Moore HB, Moore EE, McIntyre RC, Moore PK, Burke J, Hua F, Apgar J, Talmor DS, Sauaia A, Liptzin DR, Veress LA, Yaffe MB. Fibrinolytic therapy for refractory COVID-19 acute respiratory distress syndrome: Scientific rationale and review. Res Pract Thromb Haemost 2020; 4:524-531. [PMID: 32542213 PMCID: PMC7267116 DOI: 10.1002/rth2.12357] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three quarters of patients with COVID-19 admitted to the intensive care unit, and both the clinical picture and pathologic findings are consistent with microvascular occlusive phenomena being a major contributor to their unique form of respiratory failure. Numerous studies are ongoing focusing on anticytokine therapies, antibiotics, and antiviral agents, but none to date have focused on treating the underlying thrombotic coagulopathy in an effort to improve respiratory failure in COVID-19. There are animal data and a previous human trial demonstrating a survival advantage with fibrinolytic therapy to treat acute respiratory distress syndrome. Here, we review the extant and emerging literature on the relationship between thrombotic coagulopathy and pulmonary failure in the context of COVID-19 and present the scientific rationale for consideration of targeting the coagulation and fibrinolytic systems to improve pulmonary function in these patients.
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Affiliation(s)
- Christopher D. Barrett
- Center for Precision Cancer MedicineDepartments of Biological Engineering and BiologyKoch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMAUSA
- Division of Acute Care Surgery, Trauma and Surgical Critical CareDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
| | - Hunter B. Moore
- Colorado School of Public Health and Department of SurgeryUniversity of Colorado DenverDenverCOUSA
| | - Ernest E. Moore
- Colorado School of Public Health and Department of SurgeryUniversity of Colorado DenverDenverCOUSA
- Department of SurgeryErnest E Moore Shock Trauma Center at Denver HealthDenverCOUSA
| | - Robert C. McIntyre
- Colorado School of Public Health and Department of SurgeryUniversity of Colorado DenverDenverCOUSA
| | - Peter K. Moore
- Department of MedicineUniversity of Colorado Denver, School of MedicineAuroraCOUSA
| | | | - Fei Hua
- Applied BioMath, LLCConcordMAUSA
| | | | - Daniel S. Talmor
- Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
| | - Angela Sauaia
- Colorado School of Public Health and Department of SurgeryUniversity of Colorado DenverDenverCOUSA
| | - Deborah R. Liptzin
- Department of Pediatrics, Pulmonary MedicineUniversity of Colorado DenverAuroraCOUSA
| | - Livia A. Veress
- Department of Pediatrics, Pulmonary MedicineUniversity of Colorado DenverAuroraCOUSA
| | - Michael B. Yaffe
- Center for Precision Cancer MedicineDepartments of Biological Engineering and BiologyKoch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMAUSA
- Division of Acute Care Surgery, Trauma and Surgical Critical CareDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
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55
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Lu X, Wang C, Wu D, Zhang C, Xiao C, Xu F. Quantitative proteomics reveals the mechanisms of hydrogen-conferred protection against hyperoxia-induced injury in type II alveolar epithelial cells. Exp Lung Res 2019; 44:464-475. [PMID: 30973277 DOI: 10.1080/01902148.2019.1601296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose/Aim: Exposure to hyperoxia leads to lung injury both in vivo and in vitro, molecular hydrogen has been reported to protect against hyperoxia-induced lung injury; however, the underlying molecular mechanisms remain largely unknown. The objective of this study was to characterize differentially regulated proteins and biological processes in hydrogen-treated hyperoxic primary type II alveolar epithelial cells (AECIIs) to elucidate the protective mechanism of hydrogen using quantitative proteomics. Materials and Methods: AECIIs were divided into three groups that were cultured for 24 h in three different conditions: control (21% oxygen), hyperoxia (95% oxygen), and hyperoxia + hydrogen. Morphologic examination, flow cytometric analysis, cell viability assessment and analysis of the expression of apoptosis-associated proteins Bax and Bcl-2 as well as AECI markers (AQP5, T1α) and an AECII marker (SP-C) were performed for each group. The TMT labeling quantitative proteome technique was used to detect changes in the protein expression profile, and bioinformatics analysis was performed. Results: Hydrogen plays a protective role in hyperoxia-induced damage in AECIIs, as evidenced by reduced apoptosis, increased viability and survival, improved morphology, and enhanced transdifferentiation of AECIIs into AECIs. A total of 5782 proteins were identified in our study, of which 162 were significantly altered in abundance after hyperoxia exposure, and 97 were significantly altered in abundance in response to hydrogen treatment. The Gene Ontology and KEGG enrichment analyses identified a large number of proteins and biological processes that may responsible for the protective effect of hydrogen, including VEGFA, PDGFB, IGFBP3, EDN1, NADPH oxidase, the coagulation cascade, etc. Conclusions: Molecular hydrogen protects AECIIs from hyperoxic injury by complex mechanisms involving a variety of proteins and biological processes, such as VEGFA, PDGFB, IGFBP3, EDN1, NADPH oxidase and the coagulation cascade. These findings suggest novel pathways that need to be investigated as possible therapeutic targets for hyperoxia-induced lung injury.
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Affiliation(s)
- Xue Lu
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
| | - Chao Wang
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
| | - Dan Wu
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
| | - Chao Zhang
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
| | - Changxue Xiao
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
| | - Feng Xu
- a Department of Pediatric Intensive Care Unit , Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders , Chongqing , China.,b China International Science and Technology Cooperation Base of Child Development and Critical Disorders , Chongqing , China.,c Chongqing Key Laboratory of Pediatrics , Chongqing , China
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