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Abstract
There is an urgent need to develop drugs and vaccines to counteract the effects of the new coronavirus SARS-CoV-2 and adequately treat the corona virus disease (COVID-19). As these drugs are still under investigation, research also focuses on existing medication with proven effectiveness in other coronaviral diseases. The advantages of existing therapeutic drugs that are currently approved (for other indications) are the known safety profile, general availability and relatively lower costs involved in extending the purpose to a new disease. Calcineurin inhibitors (CNI) are drugs that have shown effectiveness in several coronaviral diseases, and are well-known and widely used drugs in transplant medicine. The aim of this narrative review is to present the current evidence of CNI in coronaviral diseases, the biophysiology of CNI and to suggest possible ways to study CNI as a new treatment option for COVID-19. We searched original papers, observational studies, case reports, and meta-analyses published between 2000 and 2020 in English in the PubMed database and Google Scholar using the keywords: (coronavirus), (treatment), (MERS), (SARS), (COVID-19), (tacrolimus), (ciclosporin), (cyclosporin) AND (calcineurin inhibitor). We excluded studies in patients with clear indications for immunosuppressive therapy. Additionally, we searched in the preprint servers and the World Health Organization bulletin. Ten studies were identified and included. Calcineurin inhibitor therapy has been suggested to be effective for coronaviral diseases in different settings. The results are summarized in a table. CNI should be investigated as a first treatment option based on evidence of direct antiviral effects and its properties preventing severe systemic hyperinflammation, as has been observed in COVID-19 with predominantly pulmonary immunopathological changes.
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102
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García-Juárez I, Campos-Murguía A, Tovar-Méndez V, Gabutti A, Ruiz I. Unexpected better outcome in a liver transplant recipient with COVID-19: a beneficial effect of tacrolimus? REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [PMCID: PMC7547645 DOI: 10.1016/j.rgmxen.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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103
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Tschopp J, L’Huillier AG, Mombelli M, Mueller NJ, Khanna N, Garzoni C, Meloni D, Papadimitriou-Olivgeris M, Neofytos D, Hirsch HH, Schuurmans MM, Müller T, Berney T, Steiger J, Pascual M, Manuel O, van Delden C. First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study. Am J Transplant 2020; 20:2876-2882. [PMID: 32412159 PMCID: PMC7272999 DOI: 10.1111/ajt.16062] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/25/2023]
Abstract
Immunocompromised patients may be at increased risk for complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, comprehensive data of SARS-CoV-2 infection in solid organ transplant (SOT) recipients are still lacking. We performed a multicenter nationwide observational study within the Swiss Transplant Cohort Study (STCS) to describe the epidemiology, clinical presentation, treatment and outcomes of the first microbiologically documented SARS-CoV-2 infection among SOT recipients. Overall, 21 patients were included with a median age of 56 years (10 kidney, 5 liver, 1 pancreas, 1 lung, 1 heart and 3 combined transplantations). The most common presenting symptoms were fever (76%), dry cough (57%), nausea (33%), and diarrhea (33%). Ninety-five percent and 24% of patients required hospital and ICU admission, respectively, and 19% were intubated. After a median of 33 days of follow-up, 16 patients were discharged, 3 were still hospitalized and 2 patients died. These data suggest that clinical manifestations of SARS-CoV-2 infection in middle-aged SOT recipients appear to be similar to the general population without an apparent higher rate of complications. These results need to be confirmed in larger cohorts.
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Affiliation(s)
- Jonathan Tschopp
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Matteo Mombelli
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas J. Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zürich, Switzerland
| | - Nina Khanna
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Christian Garzoni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Dario Meloni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
| | | | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Hans H. Hirsch
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland,Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | | | - Thomas Müller
- Nephrology clinic, University Hospital Zurich, Zürich, Switzerland
| | - Thierry Berney
- Service of Transplantation, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Jürg Steiger
- Department for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland,Correspondence Christian van Delden
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104
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Ghaffari Rahbar M, Nafar M, Khoshdel A, Dalili N, Abrishami A, Firouzan A, Poorrezagholi F, Samadian F, Ziaie S, Fatemizadeh S, Samavat S. Low rate of COVID-19 pneumonia in kidney transplant recipients-A battle between infection and immune response? Transpl Infect Dis 2020; 22:e13406. [PMID: 32654357 PMCID: PMC7404525 DOI: 10.1111/tid.13406] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND With COVID-19 pandemic, concerns about kidney transplant recipients are rising. However, the incidence, clinical course, outcome, and predictive factors of disease severity are obscured. METHODS We describe clinical and laboratory manifestations, radiologic findings, clinical course, and finally outcome of kidney transplant recipients with COVID-19 pneumonia. RESULTS Of 2493 kidney transplant recipients under follow-up in our clinic, 19 cases (4 cases diagnosed based on radiologic findings) were admitted. The mean age of patients was 47.6 ± 12.4 years, and the mean time from transplantation was 115.6 ± 70.3 months. Lymphopenia and eosinopenia were 84.2% and 78.9%, respectively. Nine patients did not survive the hospital course. History of acute rejection during the past 12 months, diabetes, higher N/L ratio, lower platelet count, elevated N/L x CRP, higher levels of LDH, positive D-dimer, higher troponin, and prolonged PT were associated with mortality. Among patients with positive COVID-19 test, history of acute rejection, low platelet count, and positive D-dimer were associated with poor outcome. Treatment with cyclosporine was associated with better clinical outcome. CONCLUSIONS Low rate of admission in transplant recipients specially in the very first years of transplantation might be due to protective effects of immunosuppressive agents against cytokine storm or modification of immunity function. We suggest evaluation of T-cell number, function, and cytokine profile as a guide to manage COVID-19 mainly in patients with higher risk of mortality.
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Affiliation(s)
- Maryam Ghaffari Rahbar
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen Nafar
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Nooshin Dalili
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Alireza Abrishami
- Department of RadiologyShahid Labbafinejad HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Ahmad Firouzan
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Fatemeh Poorrezagholi
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Fariba Samadian
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Shadi Ziaie
- Clinical Pharmacy DepartmentFaculty of PharmacyShahid Beheshti University of medical sciencesTehranIran
| | - Somayeh Fatemizadeh
- Department of Internal MedicineShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Shiva Samavat
- Department of NephrologyShahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
- Chronic Kidney Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
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105
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Koczulla RA, Sczepanski B, Koteczki A, Kuhnert S, Hecker M, Askevold I, Schneider C, Michel S, Kneidinger N. SARS-CoV-2 infection in two patients following recent lung transplantation. Am J Transplant 2020; 20:2928-2932. [PMID: 32400084 PMCID: PMC7272871 DOI: 10.1111/ajt.15998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/25/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has become a global health problem with pandemic character. Lung transplant recipients may be particularly at risk due to the high degree of immunosuppression and the lung being the organ primarily affected by COVID-19. We describe a 16-year-old male and a 64-year-old female recently lung transplanted patients with COVID-19 during inpatient rehabilitation. Both patients were receiving triple immunosuppressive therapy and had no signs of allograft dysfunction. Both patients had close contact with a person who developed COVID-19 and were tested positive for SARS-CoV-2. Subsequently, both patients underwent systematic screening and SARS-CoV-2 was ultimately detected. Although the 16-year-old boy was completely asymptomatic, the 64-year-old woman developed only mild COVID-19. Immunosuppressive therapy was unchanged and no experimental treatment was initiated. No signs of graft involvement or dysfunction were noticed. In conclusion, our report of patients with asymptomatic SARS-CoV-2 infection and mild COVID-19, respectively, may indicate that lung transplant recipients are not per se at risk for severe COVID-19. Further observations and controlled trials are urgently needed to study SARS-CoV-2 infection in lung transplant recipients.
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Affiliation(s)
- Rembert A. Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany,Department of Pulmonary Rehabilitation, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany,Department of Internal Medicine, Division of Pulmonary Diseases, Philipps-University Marburg, Marburg, Germany,Teaching Hospital, Paracelsus Medical University, Salzburg, Austria,Correspondence Rembert A. Koczulla
| | - Bernd Sczepanski
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg and Schönau Königssee, Germany
| | - Adam Koteczki
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg and Schönau Königssee, Germany
| | - Stefan Kuhnert
- Department of Pulmonary Medicine, University of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Matthias Hecker
- Department of Pulmonary Medicine, University of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Ingolf Askevold
- Department of General and Thoracic Surgery, University Hospital of Giessen, Justus-Liebig-University of Giessen, Giessen, Germany
| | | | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University of Munich, LMU, Comprehensive Pneumology Center, (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany,Nikolaus Kneidinger
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106
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Li Q, Cheng Q, Zhao Z, Dai N, Zeng L, Zhu L, Guo W, Li C, Wang J, Li S, Shen N, Ge Q. Novel coronavirus infection and acute kidney injury in two renal transplant recipients: a case report. J Int Med Res 2020; 48:300060520964009. [PMID: 33100064 PMCID: PMC7588709 DOI: 10.1177/0300060520964009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The causative virus of coronavirus disease 2019 (COVID-19) may cause severe fatal pneumonia. The clinical presentation includes asymptomatic infection, severe pneumonia, and acute respiratory failure. Data pertaining to acute renal injury due to COVID-19 in patients who have undergone renal transplantation are scarce. We herein report two cases of COVID-19 along with acute kidney injury following kidney transplantation.Case presentation: Two patients with COVID-19 underwent renal transplantation and were subsequently diagnosed with acute kidney injury. The first patient presented with progressive respiratory symptoms and acute renal injury. He was treated with diuretics and suspension of immunosuppressive therapy; however, the patient died. The second patient presented with respiratory tract symptoms, hypoxemia, and progressive deterioration of renal function followed by improvement. Her mycophenolate mofetil was stopped after admission, and tacrolimus was discontinued 10 days later. Moxifloxacin and methylprednisolone were continued in combination with albumin and gamma globulin infusion. A diuretic was administered, and prednisone was gradually reduced along with tacrolimus. The patient exhibited a satisfactory clinical recovery. CONCLUSION Patients who develop COVID-19 after kidney transplantation are at risk of acute kidney injury, and their prednisone, immunosuppressant, and gamma globulin treatment must be adjusted according to their condition.
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Affiliation(s)
- Qiuyu Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Qin Cheng
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Zhiling Zhao
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Nini Dai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, PR China
| | - Lan Zhu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wei Guo
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Chao Li
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Junhong Wang
- Department of Emergency, Peking University Third Hospital, Beijing, PR China
| | - Shu Li
- Department of Emergency, Peking University Third Hospital, Beijing, PR China
| | - Ning Shen
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Qinggang Ge
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
- Qinggang Ge, Department of Critical Care Medicine, Peking University Third Hospital, No. 49 Huayuanbeilu Road, Haidian District, Beijing 100191, P.R. China.
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107
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Abstract
Management of kidney transplant recipients requires a sustainable infrastructure that can provide reliable medical care both before and after transplantation. The COVID-19 pandemic has disrupted transplant referral and listing processes, led to decreases in the numbers of transplant procedures and resulted in changes in practice for pre- and post-transplantation management and follow-up.
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108
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Ma BM, Hung IFN, Chan GCW, Tam AR, Chan SSK, Wong BCK, Fukuda K, Ohno T, Yuen KY, Chan TM. Case of "relapsing" COVID-19 in a kidney transplant recipient. Nephrology (Carlton) 2020; 25:933-936. [PMID: 32951300 PMCID: PMC7536982 DOI: 10.1111/nep.13786] [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: 06/04/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
Clinical outcomes of COVID‐19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS‐CoV‐2. We report a kidney transplant recipient with COVID‐19 who presented with pneumonitis and acute kidney injury (AKI). She improved after reduction of immunosuppressive treatment and had two consecutive negative reverse transcription polymerase chain reaction (RT‐PCR) tests. Her respiratory tract samples turned positive again afterwards, and she was treated with lopinavir‐ritonavir. She had satisfactory virological and clinical response after a prolonged disease course. This case illustrates the risk of relapse or persisting shedding of SARS‐CoV‐2 in immunosuppressed patients, the important role of viral load monitoring in management, the challenges in balancing the risks of COVID‐19 progression and transplant rejection, and the pharmacokinetic interaction between immunosuppressive and antiviral medications.
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Affiliation(s)
- Becky Mingyao Ma
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ivan Fan Ngai Hung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gary Chi Wang Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Anthony Raymond Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | | | - Takanori Ohno
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kwok Yung Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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109
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Favorable Outcome of COVID-19 Pneumonia in a Kidney Transplant Recipient Treated with Tocilizumab. Case Rep Infect Dis 2020; 2020:8830626. [PMID: 32963854 PMCID: PMC7495166 DOI: 10.1155/2020/8830626] [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: 06/05/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
The presentation of COVID-19 pneumonia in kidney transplant recipients is similar to that of the general population. However, in the former, it may have a worse clinical course. We report a kidney transplant patient affected by COVID-19 pneumonia whose condition worsened 9 days after the initial presentation. As no therapeutic guidelines on the subject are currently available, here we share our approach in the management of the immunosuppressive medications and the antiviral therapy and compare them to the scarce available data. We also expose the use of tocilizumab in our patient with excellent results.
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110
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Giannini M, Ohana M, Nespola B, Zanframundo G, Geny B, Meyer A. Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care? Eur Respir J 2020; 56:13993003.01618-2020. [PMID: 32631836 PMCID: PMC7338399 DOI: 10.1183/13993003.01618-2020] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 01/21/2023]
Abstract
As yet, no direct-acting antiviral drugs have demonstrated efficacy in the disease. In contrast, increasing evidence indicates an immune-mediated pathophysiology that is paving the way for the evaluation of immunomodulation strategies [2]. In support of this view, we would like to highlight the striking similarities between COVID-19 and a rare autoimmune disease: the anti-MDA5-syndrome. Similarities between COVID-19 and anti-MDA5 syndrome support further evaluation of employing an immunomodulatory strategy in COVID-19https://bit.ly/3dN6lJ8
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Affiliation(s)
- Margherita Giannini
- Physiology and Functional Explorations Dept, University Hospitals of Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Radiology Dept, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
| | - Benoit Nespola
- Laboratory of Immunology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
| | - Giovanni Zanframundo
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Dept of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Bernard Geny
- Physiology and Functional Explorations Dept, University Hospitals of Strasbourg, Strasbourg, France.,Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Alain Meyer
- Physiology and Functional Explorations Dept, University Hospitals of Strasbourg, Strasbourg, France .,Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France.,Rheumatology Dept, National Centre for Rare Systemic Autoimmune Diseases, University Hospitals of Strasbourg, Strasbourg, France
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111
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Onorati F, Myers P, Bajona P, Perrotti A, Mestres CA, Quintana E. Effects of COVID-19 pandemic on cardiac surgery practice in 61 Hospitals worldwide: results of a survey. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:763-768. [PMID: 32964896 DOI: 10.23736/s0021-9509.20.11556-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the impact of COVID-19 infection on cardiac surgery community and practice. METHODS A 43-question survey was sent to cardiac surgery centers worldwide. The survey analyzed the prepandemic organization of the center, the center's response to Covid-19 in terms of re-organization pathways, surveillance methods, personal-protective equipment (PPE), and allowed surgical practice with results. RESULTS Sixty-one out of 64 centers (95.3%) fulfilled the survey. One third of ICUs were transformed into COVID-19 dedicated-ICUs and one-third moved to another location inside the hospital. Negative-pressure rooms were available in 60.6% centers. Informative measures from hospital administration were received after the first COVID-19 admitted case in 36.1% and during the spread of the infection inside the hospital in 19.6%. Inadequate supply of PPE was common, with no COVID-surveillance of the medical personnel in 4.9% of centers. COVID-19 infected 7.4% of staff surgeons, 8.3% of residents and 9.5% of anesthetists. Cardiac surgery caseload declined in 93.4% centers. COVID-19 infection in patients receiving cardiac surgery resulted in 41-50% mortality in 9.5% centers, and 91-100% mortality in 4.7% centers. Successful weaning with survival from veno-venous extra corporeal membrane oxygenation (ECMO) and veno-arterial ECMO was <50% in 79.2% and 80.0% centers respectively. COVID-19 infection in transplanted patients was rare, with a reported mortality of 0.5% and 1% in one center each. CONCLUSIONS There is room for improvement in hospital surveillance, informative measures and PPE to the personnel. These measurements will reduce current spread of COVID-19 infection among medical personnel and patients, helping the rump up of cardiac surgical practice.
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Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, University Hospital of Verona, Verona, Italy -
| | - Patrick Myers
- CHUV Cardiovascular Surgery Hospital, Lausanne, Switzerland
| | - Pietro Bajona
- Allegheny Health Network, Drexel University Hospital, Pittsburgh, PA, USA
| | - Andrea Perrotti
- Department of Cardio-Thoracic Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital of Zürich, Zürich, Switzerland
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112
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Hage R, Schuurmans MM. Calcineurin Inhibitors and COVID-19. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30223-0. [PMID: 33069616 PMCID: PMC7513811 DOI: 10.1016/j.reuma.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023]
Affiliation(s)
- René Hage
- University Hospital Zurich, Division of Pulmonology, Raemistrasse 100, 8091 Zurich, Switzerland; University of Zurich, Faculty of Medicine, Raemistrasse 71, 8006 Zurich, Switzerland.
| | - Macé M Schuurmans
- University Hospital Zurich, Division of Pulmonology, Raemistrasse 100, 8091 Zurich, Switzerland; University of Zurich, Faculty of Medicine, Raemistrasse 71, 8006 Zurich, Switzerland
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113
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NasrAllah MM, Osman NA, Elalfy M, Malvezzi P, Rostaing L. Transplantation in the era of the Covid-19 pandemic: How should transplant patients and programs be handled? Rev Med Virol 2020; 31:1-9. [PMID: 32954602 PMCID: PMC7537021 DOI: 10.1002/rmv.2149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Due to the Covid‐19 pandemic caused by SARS‐CoV‐2, transplant programs worldwide have been severely impacted with dwindling numbers of transplantations performed and a complete halt in several areas. In this review we examine whether SARS‐CoV‐2 infection presents differently in transplant recipients, whom and how we should test, how susceptible the transplant population is to overt infection and describe the range of outcomes. From retrieved published reports on SARS‐CoV‐2infections in 389solid organ transplant recipients reported in the literature, the overall mortality rate was 16.7% (n = 65); however for those with mild or moderate Covid‐19 disease this was 2.9% and 2.3% respectively; conversely, for those with severe infection the mortality rate was 52.2%.We then address questions regarding halting transplantation programs during this pandemic, whether all human tissues being considered for transplantation are capable of transmitting the infection, and if we should alter immunosuppressive medications during the pandemic.
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Affiliation(s)
- Mohamed M NasrAllah
- Department of Nephrology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Misr International Hospital, Cairo, Egypt
| | - Noha A Osman
- Department of Nephrology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Misr International Hospital, Cairo, Egypt
| | - Mahmoud Elalfy
- Misr International Hospital, Cairo, Egypt.,Cairo University Student's Hospital, Cairo, Egypt
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèseset Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèseset Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
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Imam A, Tzukert K, Merhav H, Imam R, Abu-Gazala S, Abel R, Elhalel MD, Khalaileh A. Practical recommendations for kidney transplantation in the COVID-19 pandemic. World J Transplant 2020; 10:223-229. [PMID: 32995318 PMCID: PMC7504192 DOI: 10.5500/wjt.v10.i9.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/23/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation at the time of a global viral pandemic has become challenging in many aspects. Firstly, we must reassess deceased donor safety (for the recipient) especially in communities with a relatively high incidence of coronavirus disease 19 (COVID-19). With respect to elective live donors, if one decides to do them at all, similar considerations must be made that may impose undue hardship on the donor. Recipient selection is also problematic since there is clear evidence of a much higher morbidity and mortality from COVID-19 for patients older than 60 and those with comorbidities such as hypertension, diabetes, obesity and lung disease. Unfortunately, many, if not most of dialysis patients fit that mold. We may and indeed must reassess our allocation policies, but this must be done based on data rather than conjecture. Follow-up routines must be re-engineered to minimize patient travel and exposure. Reliance on technology and telemedicine is paramount. Making this technology available to patients is extremely important. Modifying or changing immunosuppression protocols is controversial and not based on clinical studies. Nevertheless, we should reassess the need for induction therapy across the board for ordinary patients and the more liberal use of mammalian target of rapamycin inhibitors in transplant patients with proven infection.
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Affiliation(s)
- Ashraf Imam
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Keren Tzukert
- Department of Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Hadar Merhav
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Riham Imam
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Samir Abu-Gazala
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Roy Abel
- Department of Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | | | - Abed Khalaileh
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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Rammohan A. Post-transplant immunosuppression and COVID-19: From a double whammy to a mixed blessing. World J Transplant 2020; 10:267-276. [PMID: 32995321 PMCID: PMC7504191 DOI: 10.5500/wjt.v10.i9.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 08/15/2020] [Indexed: 02/05/2023] Open
Abstract
The coronavirus pandemic (COVID-19) has had an unprecedented effect on various disease processes and their management. COVID-19 is likely to have a complex pathophysiological interplay with the post-transplant patients; one affecting the clinical course and outcome of the other. In the absence of validated data from trials, there is strong dependence on experience based on previous similar epidemics (SARS/MERS), and from consensus based on expert opinions. Despite the fact that our knowledge is rapidly evolving with time, there still is relatively limited objective data on the effect of COVID-19 on the human body. Numerous questions remain unanswered, one of which involves the management of immunosuppression in the post-transplant recipient during this contagion. The core tenet of which continues to be that of establishing an equipoise between infection and rejection. This review summarises the current knowledge on immune interactions of the virus, the immunomodulatory effects that may be at play, and its relation to the art of immunosuppression.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
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116
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Campbell CM, Guha A, Haque T, Neilan TG, Addison D. Repurposing Immunomodulatory Therapies against Coronavirus Disease 2019 (COVID-19) in the Era of Cardiac Vigilance: A Systematic Review. J Clin Med 2020; 9:E2935. [PMID: 32932930 PMCID: PMC7565788 DOI: 10.3390/jcm9092935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in efforts to identify therapies to ameliorate adverse clinical outcomes. The recognition of the key role for increased inflammation in COVID-19 has led to a proliferation of clinical trials targeting inflammation. The purpose of this review is to characterize the current state of immunotherapy trials in COVID-19, and focuses on associated cardiotoxicities, given the importance of pharmacovigilance. The search terms related to COVID-19 were queried in ClinicalTrials.gov. A total of 1621 trials were identified and screened for interventional trials directed at inflammation. Trials (n = 226) were fully assessed for the use of a repurposed drug, identifying a total of 141 therapeutic trials using a repurposed drug to target inflammation in COVID-19 infection. Building on the results of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial demonstrating the benefit of low dose dexamethasone in COVID-19, repurposed drugs targeting inflammation are promising. Repurposed drugs directed at inflammation in COVID-19 primarily have been drawn from cancer therapies and immunomodulatory therapies, specifically targeted anti-inflammatory, anti-complement, and anti-rejection agents. The proposed mechanisms for many cytokine-directed and anti-rejection drugs are focused on evidence of efficacy in cytokine release syndromes in humans or animal models. Anti-complement-based therapies have the potential to decrease both inflammation and microvascular thrombosis. Cancer therapies are hypothesized to decrease vascular permeability and inflammation. Few publications to date describe using these drugs in COVID-19. Early COVID-19 intervention trials have re-emphasized the subtle, but important cardiotoxic sequelae of potential therapies on outcomes. The volume of trials targeting the COVID-19 hyper-inflammatory phase continues to grow rapidly with the evaluation of repurposed drugs and late-stage investigational agents. Leveraging known clinical safety profiles and pharmacodynamics allows swift investigation in clinical trials for a novel indication. Physicians should remain vigilant for cardiotoxicity, often not fully appreciated in small trials or in short time frames.
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Affiliation(s)
- Courtney M. Campbell
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA;
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Tamanna Haque
- Division of Hematology/Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA;
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA 02144, USA;
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA;
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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117
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Michel S, Witt C, Gottlieb J, Aigner C. Impact of COVID-19 on Lung Transplant Activity in Germany-A Cross-Sectional Survey. Thorac Cardiovasc Surg 2020; 69:92-94. [PMID: 32898894 DOI: 10.1055/s-0040-1715436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The current COVID-19 pandemia affects health care systems worldwide, however, to a variable extent depending on the caseload in each country. We aimed to provide a cross-sectional overview of current limitations or adaptions in lung transplant programs in Germany in from January to May 2020 due to the COVID-19 pandemia caused by severe acute respiratory syndrome coronavirus 2. A cross-sectional survey assessing various aspects of lung transplant activity was sent to all active lung transplant programs (n = 12) in Germany. Eight centers (66%) responded to the survey within the requested time frame. Four centers (50%) reported their activity is not restricted at all and four centers (50%) reported on moderate general limitations. The overall lung transplant activity in Germany from January to May 2020 contains 128 bilateral and 11 single lung transplantations, which is similar to the same period in the year 2019 (126 bilateral transplantations and 12 single lung transplantations). The results suggest that the influence of the COVID-19 pandemia on lung transplantation activity in Germany has been moderate so far. Nevertheless, adaptions such as extensive testing of donors and recipients were introduced to reduce the likelihood of infections and increase patient safety. Alertness to changes in COVID-19 reproduction rates might be required until effective antiviral therapy or vaccination is available.
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Affiliation(s)
- Sebastian Michel
- Department of Cardiac Surgery, LMU München, Munchen, Bayern, Germany
| | - Christian Witt
- Department of Respiratory Medicine, Charite University Hospital Berlin, Berlin, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine and German Center of Lung Research, MHH, Hannover, Niedersachsen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Universitat Duisburg-Essen Medizinische Fakultat, Essen, Germany
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118
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Adrogué AH, Mithani F, Ibrahim HN, Schwartz MR, Gaber L, Hebert SA, Adrogué HE. A Kidney Transplant Recipient With Coronavirus Disease 2019: Utility of a Prognostication Score. Transplant Proc 2020; 52:2688-2692. [PMID: 32980137 PMCID: PMC7470815 DOI: 10.1016/j.transproceed.2020.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 01/20/2023]
Abstract
Background Cytokine release storm (CRS) is a potentially fatal, hyperinflammatory condition common to both coronavirus disease 2019 (COVID-19) and reactive hemophagocytic lymphohistiocytosis (rHLH). We present our experience with the use of a diagnostic score, developed for rHLH, in a kidney transplant recipient hospitalized with COVID-19. Methods We applied the H-Score to risk-stratify our patient to help predict his hospital course. This study was exempt from requiring specific Institutional Review Board approval, but met all the criteria required by our institution for this type of study and report including consent from the patient. Results The calculated H-Score for our patient fell below the diagnostic cut-off value for rHLH. Because rHLH is characterized by CRS, we expected him to have a milder hospital course with COVID-19. Correlating with his below cut-off H-score, the patient had a more benign than expected hospital course. Conclusions Because this is only a single case, we plan to retrospectively review a series of patients to validate our initial experience—that a low H-Score may correlate with a milder hospital course in kidney transplant patients with COVID-19.
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Affiliation(s)
| | - F Mithani
- Texas A&M University College of Medicine, College Station, Texas
| | - H N Ibrahim
- Texas A&M University College of Medicine, College Station, Texas; Houston Methodist Hospital, Houston, Texas; Weill Cornell Medicine, New York, New York
| | | | - L Gaber
- Houston Methodist Hospital, Houston, Texas; Weill Cornell Medicine, New York, New York
| | - S A Hebert
- Texas A&M University College of Medicine, College Station, Texas; Houston Methodist Hospital, Houston, Texas
| | - H E Adrogué
- Texas A&M University College of Medicine, College Station, Texas; Houston Methodist Hospital, Houston, Texas.
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119
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Abu Jawdeh BG. COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges. Adv Chronic Kidney Dis 2020; 27:383-389. [PMID: 33308503 PMCID: PMC7366980 DOI: 10.1053/j.ackd.2020.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.
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Affiliation(s)
- Bassam G Abu Jawdeh
- Division of Nephrology & Hypertension, University of Cincinnati, Kidney C.A.R.E. Program, Cincinnati, OH.
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120
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Singhvi A, Barghash M, Lala A, Mitter SS, Parikh A, Oliveros E, Rollins BM, Brunjes DL, Alvarez-Garcia J, Johnston E, Ryan K, Itagaki S, Moss N, Pinney SP, Anyanwu A, Mancini D. Challenges in heart transplantation during COVID-19: A single-center experience. J Heart Lung Transplant 2020; 39:894-903. [PMID: 32891266 PMCID: PMC7316040 DOI: 10.1016/j.healun.2020.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease 2019 (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety. METHODS Chart review was performed for consecutive OHT recipients with COVID-19 and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020. RESULTS Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (range, 49-71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5-20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%), and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% of patients. Most (n = 16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. Five patients underwent OHT during the pandemic. They were all males, ranging from 30 to 59 years of age. Two were transplanted at United Network of Organ Sharing Status 1 or 2, 1 at Status 3, and 2 at Status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization. CONCLUSION OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19.
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Affiliation(s)
- Aditi Singhvi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maya Barghash
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Sumeet S Mitter
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aditya Parikh
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Estefania Oliveros
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett M Rollins
- Department of Pharmacy, The Mount Sinai Hospital, New York, New York
| | - Danielle L Brunjes
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jesus Alvarez-Garcia
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erika Johnston
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kieran Ryan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean P Pinney
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York
| | - Donna Mancini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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121
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Schoot TS, Kerckhoffs APM, Hilbrands LB, van Marum RJ. Immunosuppressive Drugs and COVID-19: A Review. Front Pharmacol 2020; 11:1333. [PMID: 32982743 PMCID: PMC7485413 DOI: 10.3389/fphar.2020.01333] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is currently unknown whether immunosuppressive drugs are advantageous or detrimental in patients with COVID-19. Immunosuppressive drugs could be harmful in the initial phase of COVID-19. In this phase, the host immune response is necessary to inhibit viral replication. However, immunosuppressive drugs might have a beneficial effect in the later, more severe phase of COVID-19. In this phase, an overshoot of the host immune response (the "cytokine storm") can cause ARDS, multiorgan failure and mortality. AIM To summarize the available evidence on the effect of immunosuppressive drugs on infection with SARS-CoV-2. The effects of immunosuppressive drugs on similar pandemic coronaviruses may resemble the effects on SARS-CoV-2. Thus, we also included studies on the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). METHODS The study protocol was registered in PROSPERO (registration number CRD42020181137). We included randomized controlled trials (RCTs), cohort studies with a control group and case-control studies concerning humans ≥ 18 years old. We also included in-vitro studies and animal studies with a control group. RESULTS AND CONCLUSION Sixty-nine studies were included. Interestingly, MPA inhibits SARS-CoV-2 replication in-vitro. Clinical studies are needed to confirm the inhibitory effect of MPA on SARS-CoV-2 replication in-vivo. There are indications that corticosteroids and IL-6 inhibitors, like tocilizumab, can reduce mortality and prevent mechanical ventilation in patients with COVID-19. However, observational studies have contradictory results and the risk of bias is high. Thus, these results have to be confirmed in high-quality clinical trials before these drugs can be implemented as standard care. Based on the positive results of CNIs, mTOR inhibitors and thiopurine analogues in in-vitro studies with SARS-CoV and MERS-CoV, it would be interesting to investigate their effects on SARS-CoV-2 replication.
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Affiliation(s)
- Tessa S. Schoot
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Nephrology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
| | - Angèle P. M. Kerckhoffs
- Department of Nephrology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
- Department of Geriatric Medicine Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
| | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rob J. van Marum
- Department of Geriatric Medicine Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
- Department of Clinical Pharmacology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
- Department of Medicine for Older People, VU University Medical Center, Amsterdam, Netherlands
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122
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Sanclemente-Alaman I, Moreno-Jiménez L, Benito-Martín MS, Canales-Aguirre A, Matías-Guiu JA, Matías-Guiu J, Gómez-Pinedo U. Experimental Models for the Study of Central Nervous System Infection by SARS-CoV-2. Front Immunol 2020; 11:2163. [PMID: 32983181 PMCID: PMC7485091 DOI: 10.3389/fimmu.2020.02163] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The response to the SARS-CoV-2 coronavirus epidemic requires increased research efforts to expand our knowledge of the disease. Questions related to infection rates and mechanisms, the possibility of reinfection, and potential therapeutic approaches require us not only to use the experimental models previously employed for the SARS-CoV and MERS-CoV coronaviruses but also to generate new models to respond to urgent questions. DEVELOPMENT We reviewed the different experimental models used in the study of central nervous system (CNS) involvement in COVID-19 both in different cell lines that have enabled identification of the virus' action mechanisms and in animal models (mice, rats, hamsters, ferrets, and primates) inoculated with the virus. Specifically, we reviewed models used to assess the presence and effects of SARS-CoV-2 on the CNS, including neural cell lines, animal models such as mouse hepatitis virus CoV (especially the 59 strain), and the use of brain organoids. CONCLUSION Given the clear need to increase our understanding of SARS-CoV-2, as well as its potential effects on the CNS, we must endeavor to obtain new information with cellular or animal models, with an appropriate resemblance between models and human patients.
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Affiliation(s)
- Inmaculada Sanclemente-Alaman
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
| | - Lidia Moreno-Jiménez
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
| | - María Soledad Benito-Martín
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Canales-Aguirre
- Preclinical Evaluation Unit, Medical and Pharmaceutical Biotechnology, CIATEJ-CONACYT, Guadalajara, Mexico
| | - Jordi A. Matías-Guiu
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matías-Guiu
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
| | - Ulises Gómez-Pinedo
- Laboratory of Neurobiology, Department of Neurology, Institute of Neurosciences, San Carlos Institute for Health Research, Universidad Complutense de Madrid, Madrid, Spain
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An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Kidney Int 2020; 98:1549-1558. [PMID: 32853631 PMCID: PMC7444636 DOI: 10.1016/j.kint.2020.08.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day mortality 22.8%). Multivariable analysis identified overweight, fever, and dyspnea as independent risk factors for severe disease, whereas age over 60 years, cardiovascular disease, and dyspnea were independently associated with mortality. Thus, Covid-19 in recipients of kidney transplants portends a high mortality rate. Proper management of immunosuppression and tailored treatment of this population remain challenging.
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124
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Adapa S, Konala VM, Naramala S, Daggubati SR, Koduri NM, Gayam V, Chenna A. COVID-19 in Renal Transplant Patient Presenting With Active Typical Symptoms and Resolved Atypical Symptoms. J Investig Med High Impact Case Rep 2020; 8:2324709620949307. [PMID: 32779481 PMCID: PMC7424610 DOI: 10.1177/2324709620949307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.
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Affiliation(s)
| | | | | | | | | | - Vijay Gayam
- Interfaith Medical Center, Brooklyn, NY, USA
| | - Avantika Chenna
- Phoebe Putney Memorial Hospital, Albany, GA, USA.,Medical College of Georgia, Augusta, GA, USA
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125
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Rivinius R, Kaya Z, Schramm R, Boeken U, Provaznik Z, Heim C, Knosalla C, Schoenrath F, Rieth A, Berchtold-Herz M, Barten MJ, Rauschning D, Mücke VT, Heyl S, Pistulli R, Grinninger C, Hagl C, Gummert JF, Warnecke G, Schulze PC, Katus HA, Kreusser MM, Raake PW. COVID-19 among heart transplant recipients in Germany: a multicenter survey. Clin Res Cardiol 2020; 109:1531-1539. [PMID: 32783099 PMCID: PMC7418884 DOI: 10.1007/s00392-020-01722-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023]
Abstract
Aims Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. Methods and results A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). Conclusion Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.
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Affiliation(s)
- Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ziya Kaya
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - René Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Zdenek Provaznik
- Department of Cardiovascular Surgery, Regensburg University Hospital, Regensburg, Germany
| | - Christian Heim
- Department of Cardiovascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Dominic Rauschning
- Department of Internal Medicine, Bundeswehr Central Hospital, Koblenz, Germany
| | - Victoria T Mücke
- Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany
| | - Stephan Heyl
- Department of Internal Medicine III, Frankfurt University Hospital, Frankfurt, Germany
| | - Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Münster University Hospital, Münster, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Gregor Warnecke
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P Christian Schulze
- Department of Cardiology, Angiology and Pneumology, Jena University Hospital, Jena, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
- German Center for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany.
| | - Philip W Raake
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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126
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Wang AX, Quintero Cardona O, Ho DY, Busque S, Lenihan CR. Influence of immunosuppression on seroconversion against SARS-CoV-2 in two kidney transplant recipients. Transpl Infect Dis 2020; 23:e13423. [PMID: 32701196 PMCID: PMC7404350 DOI: 10.1111/tid.13423] [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: 04/29/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022]
Abstract
Solid organ transplant recipients are at risk for infectious complications due to chronic immunosuppression. The outbreak of coronavirus disease 2019 (COVID‐19) in the United States has raised growing concerns for the transplant patient population. We seek to add to the current limited literature on COVID‐19 in transplant recipients by describing the clinical course of two kidney transplant recipients with SARS‐CoV‐2 infection monitored by both RT‐PCR and serology. Through careful adjustment of their immunosuppression regimen, both patients had excellent recovery with intact graft function and development of anti‐SARS‐CoV‐2 antibodies.
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Affiliation(s)
- Aileen X Wang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Orlando Quintero Cardona
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephan Busque
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Colin R Lenihan
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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127
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Verma A, Khorsandi SE, Dolcet A, Prachalias A, Suddle A, Heaton N, Jassem W. Low prevalence and disease severity of COVID-19 in post-liver transplant recipients-A single centre experience. Liver Int 2020; 40:1972-1976. [PMID: 32471013 PMCID: PMC7300707 DOI: 10.1111/liv.14552] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is driving a present day global pandemic. Immunosuppressed patients are regarded as a high-risk cohort. The following is a short report on COVID-19 in liver transplant recipients (n = 5) from a high volume UK liver transplant unit with a large follow-up cohort (n = 4500). Based on this limited data, liver transplant recipients appear to have a low incidence of COVID-19, with less severe symptoms than expected, when compared with the general population and other solid organ recipients. This possibly could be related to self-isolation adherence and/or the 'ideal' level of immunosuppression that favourably modulates the immune response to COVID-19.
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Affiliation(s)
- Anita Verma
- Institute of Liver StudiesKing's College HospitalLondonUK
| | | | | | | | - Abid Suddle
- Institute of Liver StudiesKing's College HospitalLondonUK
| | - Nigel Heaton
- Institute of Liver StudiesKing's College HospitalLondonUK
| | - Wayel Jassem
- Institute of Liver StudiesKing's College HospitalLondonUK
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128
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Hammami MB, Garibaldi B, Shah P, Liu G, Jain T, Chen PH, Kim AK, Avdic E, Petty B, Strout S, Fine DM, Niranjan-Azadi A, Garneau WM, Cameron AM, Monroy Trujillo JM, Gurakar A, Avery R. Clinical course of COVID-19 in a liver transplant recipient on hemodialysis and response to tocilizumab therapy: A case report. Am J Transplant 2020; 20:2254-2259. [PMID: 32359210 PMCID: PMC7267667 DOI: 10.1111/ajt.15985] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/25/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) is a highly infectious and rapidly spreading disease. There are limited published data on the epidemiology and outcomes of COVID-19 infection among organ transplant recipients. After initial flulike symptoms, progression to an inflammatory phase may occur, characterized by cytokine release rapidly leading to respiratory and multiorgan failure. We report the clinical course and management of a liver transplant recipient on hemodialysis, who presented with COVID-19 pneumonia, and despite completing a 5-day course of hydroxychloroquine, later developed marked inflammatory manifestations with rapid improvement after administration of off-label, single-dose tocilizumab. We also highlight the role of lung ultrasonography in early diagnosis of the inflammatory phase of COVID-19. Future investigation of the effects of immunomodulators among transplant recipients with COVID-19 infection will be important.
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Affiliation(s)
- Muhammad Baraa Hammami
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian Garibaldi
- Division of Pulmonology and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pali Shah
- Division of Pulmonology and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gigi Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tania Jain
- Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy K. Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edina Avdic
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brent Petty
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara Strout
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Derek M. Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashwini Niranjan-Azadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William M. Garneau
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew M. Cameron
- Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jose M. Monroy Trujillo
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin Avery
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Correspondence Robin Avery
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129
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Parente A, Manzia TM, Angelico R, Tirotta F, Muiesan P, Tisone G, Framarino Dei Malatesta M. COVID-19, liver transplant, and immunosuppression: Allies or foes? Transpl Infect Dis 2020; 23:e13417. [PMID: 32666588 PMCID: PMC7404415 DOI: 10.1111/tid.13417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 12/15/2022]
Abstract
Liver transplant (LT) recipients are considered at a particularly high risk for developing critical COVID‐19 infection. To date, available data are heterogeneous and scarce and mortality in LT recipients seems to be higher compared to normal population, but whether this is caused by altered immunological status, immunosuppression (IS), or underlying comorbidities has not yet been fully clarified. Some evidences show that IS might play a role in the pathophysiology of this new disease. We searched all available data regarding LT recipients infected by COVID‐19, focusing on the role of IS. To date, 244 LT recipients have been reported as COVID‐19‐positive. Trends among transplant physicians are to reduce overall IS, especially antimetabolite drugs, but the current available observations are still not enough to build strong evidences for recommendation and IS should be meticulously tailored case by case.
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Affiliation(s)
- Alessandro Parente
- Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Hepatobiliary Surgery and Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Tommaso Maria Manzia
- Department of Hepatobiliary Surgery and Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Roberta Angelico
- Department of Hepatobiliary Surgery and Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Fabio Tirotta
- Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paolo Muiesan
- Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Giuseppe Tisone
- Department of Hepatobiliary Surgery and Transplant Unit, Tor Vergata University of Rome, Rome, Italy
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130
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Desmazes-Dufeu N, Coltey B, Amari L, Gouitaa M, Touzery C, Reynaud-Gaubert M, Chanez P, Cassir N. Discordant courses of COVID-19 in a cohabiting couple of lung transplant recipients. Transpl Infect Dis 2020; 23:e13410. [PMID: 32654244 PMCID: PMC7404422 DOI: 10.1111/tid.13410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 12/23/2022]
Abstract
COVID-19 is a novel infectious disease caused by SARS-CoV-2 that emerged in late 2019 and which is now a pandemic. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 due to their chronic use of immunosuppressive drugs (ISDs) and to their associated conditions. Scarce data are available on the optimized management of ISDs in these patients and on its impact on presentation, clinical course, viral shedding, and outcome. We report here two cases of COVID-19 in a cohabiting couple of lung transplant recipients for cystic fibrosis, who had different ISDs management and who developed discordant courses of their disease. Our findings suggest that the degree of their immunosuppression might be a reason for their different course and that ISDs might prove partially protective.
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Affiliation(s)
- Nadine Desmazes-Dufeu
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Hôpital Nord, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - Bérengère Coltey
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Hôpital Nord, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - Lyria Amari
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Hôpital Nord, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - Marion Gouitaa
- Clinique des Bronches, Allergie et Sommeil/APHM, Marseille C2VN Center INSERM INRAE UMR1062, Aix-Marseille Université, Marseille, France
| | - Camille Touzery
- Service de Radiologie, Hôpital Nord, APHM, Marseille, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Hôpital Nord, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France.,Microbes, Evolution, Phylogeny and Infection (MEΦI), Aix-Marseille Université UM63, Institut de Recherche pour le Développement IRD 198, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pascal Chanez
- Clinique des Bronches, Allergie et Sommeil/APHM, Marseille C2VN Center INSERM INRAE UMR1062, Aix-Marseille Université, Marseille, France
| | - Nadim Cassir
- Microbes, Evolution, Phylogeny and Infection (MEΦI), Aix-Marseille Université UM63, Institut de Recherche pour le Développement IRD 198, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
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131
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Bösch F, Börner N, Kemmner S, Lampert C, Jacob S, Koliogiannis D, Stangl M, Michel S, Kneidinger N, Schneider C, Fischereder M, Irlbeck M, Denk G, Werner J, Angele MK, Guba MO. Attenuated early inflammatory response in solid organ recipients with COVID-19. Clin Transplant 2020; 34:e14027. [PMID: 32589760 PMCID: PMC7361260 DOI: 10.1111/ctr.14027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS‐CoV‐2) infection. The specific features of coronavirus disease 2019 (COVID‐19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Seven transplanted patients (two liver, three kidneys, one double lung, one heart) admitted to the Ludwig‐Maximilians‐University Munich because of COVID‐19 and tested positive for SARS‐CoV‐2 were included. The clinical course and the clinical findings were extracted from the medical record. The two liver transplant patients and the heart transplant patient had an uncomplicated course and were discharged after 14, 18, and 12 days, respectively. Two kidney transplant recipients were intubated within 48 hours. One kidney and the lung transplant recipients were required to intubate after 10 and 15 days, respectively. Immunosuppression was adapted in five patients, but continued in all patients. Compared to non‐transplanted patients at the ICU (n = 19) the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL‐6 blood values. This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS‐CoV‐2, their clinical course seems to be similar to immunocompetent patients.
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Affiliation(s)
- Florian Bösch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nikolaus Börner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Kemmner
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christopher Lampert
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sven Jacob
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Manfred Stangl
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Michel
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Clinic of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Christian Schneider
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Fischereder
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Renal Division, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerald Denk
- Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus O Guba
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.,Transplantation Center Munich, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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132
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Lai Q, Spoletini G, Bianco G, Graceffa D, Agnes S, Rossi M, Lerut J. SARS-CoV2 and immunosuppression: A double-edged sword. Transpl Infect Dis 2020; 22:e13404. [PMID: 32639598 PMCID: PMC7361075 DOI: 10.1111/tid.13404] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome Coronavirus 2 (SARS‐Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. This impact in the specific setting of transplantation and immunosuppression has been poorly explored to date. Discordant data exist on the impact of previous coronavirus outbreaks on immunosuppressed patients. Overall, only a very limited number of cases have been reported in literature, suggesting that transplanted patients not necessarily present an increased risk of severe SARS‐Cov2‐related disease compared to the general population. We conducted a literature review related to the impact of immunosuppression on coronavirus infections including case reports and series describing immunosuppression management in transplant recipients. The role of steroids, calcineurin inhibitors, and mycophenolic acid has been explored more in detail. A point‐in‐time snapshot of the yet released literature and some considerations in relation to the use of immunosuppression in SARS‐Cov2 infected transplant recipients are provided here for the physicians dealing with immunocompromised patients.
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Affiliation(s)
- Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Rossi
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jan Lerut
- Institute for Experimental and Clinical Research *IREC - Université catholique de Louvain - UCL, Brussels, Belgium
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133
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Silva F, Cipriano A, Cruz H, Tavares J, Fragoso J, Malheiro J, Almeida M, Martins LS, Abreu M, Pedroso S, Dias L, Henriques AC. SARS-CoV-2 infection in kidney transplant recipients: Early report of five cases. Transpl Infect Dis 2020; 23:e13394. [PMID: 32597550 PMCID: PMC7361202 DOI: 10.1111/tid.13394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
From December 2019 to March 2020, China was the epicenter of the SARS‐CoV‐2 infection pandemic, but from that moment on, Europe surpassed China in the number of new cases and deaths related to this novel viral respiratory infection. The emergence of this world pandemic is particularly important for solid organ transplant recipients, who might have an increased risk of mortality, not only due to their chronic immunosuppression status, but also to the cardiovascular risk that correlates with several years of chronic kidney disease. To the extent that there is still a lack of knowledge about the clinical characteristics, evolution, and prognosis of SARS‐CoV‐2 infection in kidney transplant recipients, we will report the first 5 cases diagnosed and followed in our transplant unit, as well as share the therapeutic strategies adopted.
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Affiliation(s)
- Filipa Silva
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Cipriano
- Infectious Diseases Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Hugo Cruz
- Microbiology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Joana Tavares
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Joana Fragoso
- Infectious Diseases Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Manuela Almeida
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - La Salete Martins
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Miguel Abreu
- Infectious Diseases Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Sofia Pedroso
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Leonídio Dias
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - António Castro Henriques
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Immunopathology of SARS-CoV-2 Infection: Immune Cells and Mediators, Prognostic Factors, and Immune-Therapeutic Implications. Int J Mol Sci 2020; 21:ijms21134782. [PMID: 32640747 PMCID: PMC7370171 DOI: 10.3390/ijms21134782] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
The present is a comprehensive review of the immunopathology of Covid-19. The immune reaction to SARS-CoV-2 infection is characterized by differentiation and proliferation of a variety of immune cells with immune mediator production and release, and activation of other pathogen resistance mechanisms. We fully address the humoral and cellular immune changes induced by the virus, with particular emphasis on the role of the “cytokine storm” in the evolution of the disease. Moreover, we also propose some immune alterations (i.e., inflammatory parameters, cytokines, leukocytes and lymphocyte subpopulations) as prognostic markers of the disease. Furthermore, we discuss how immune modifying drugs, such as tocilizumab, chloroquine, glucocorticoids and immunoglobulins, and blood purification therapy, can constitute a fundamental moment in the therapy of the infection. Finally, we made a critical analysis of a number of substances, not yet utilized, but potentially useful in SARS-CoV-2 patients, such as IFN lambda, TNF blockers, ulinastatin, siponimod, tacrolimus, mesenchymal stem cells, inhibitors of mononuclear macrophage recruitment, IL-1 family antagonists, JAK-2 or STAT-3 inhibitors.
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135
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Fishman JA, Grossi PA. Novel Coronavirus-19 (COVID-19) in the immunocompromised transplant recipient: #Flatteningthecurve. Am J Transplant 2020; 20:1765-1767. [PMID: 32233057 PMCID: PMC7228206 DOI: 10.1111/ajt.15890] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/25/2023]
Abstract
Worldwide collaboration will be required to define viral pathogenesis, correlates of immunity, and biomarkers for progressive infection to optimize clinical care and to interrupt pandemic spread of SARS-CoV-2.
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Affiliation(s)
- Jay A. Fishman
- Transplant Infectious Disease Program, Infectious Disease Division, and MGH Transplantation Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Correspondence Jay A. Fishman
| | - Paolo A. Grossi
- Infectious Diseases Department, University of Insubria, Varese, Italy,National Centre for Transplantation, Rome, Italy
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136
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Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology 2020; 159:350-357. [PMID: 32283100 PMCID: PMC7151253 DOI: 10.1053/j.gastro.2020.04.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update was to rapidly review the emerging evidence and provide timely expert recommendations regarding the management of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic. This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely perspective on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
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Affiliation(s)
- David T. Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois,Correspondence Address correspondence to: David T. Rubin, MD, Inflammatory Bowel Disease Center, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4076, Chicago, Illinois 60637
| | - Joseph D. Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Russell D. Cohen
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
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137
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Cavagna L, Seminari E, Zanframundo G, Gregorini M, Di Matteo A, Rampino T, Montecucco C, Pelenghi S, Cattadori B, Pattonieri EF, Vitulo P, Bertani A, Sambataro G, Vancheri C, Biglia A, Bozzalla-Cassione E, Bonetto V, Monti MC, Ticozzelli E, Turco A, Oggionni T, Corsico A, Bertuccio F, Zuccaro V, Codullo V, Morosini M, Marena C, Gnecchi M, Pellegrini C, Meloni F. Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy. Microorganisms 2020; 8:E977. [PMID: 32629788 PMCID: PMC7409165 DOI: 10.3390/microorganisms8070977] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/23/2022] Open
Abstract
The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to April 28th 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48-69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Elena Seminari
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Giovanni Zanframundo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Marilena Gregorini
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Angela Di Matteo
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Teresa Rampino
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Carlomaurizio Montecucco
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Barbara Cattadori
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Eleonora Francesca Pattonieri
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Patrizio Vitulo
- Pulmonology Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Alessandro Bertani
- Thoracic Surgery Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Alessandro Biglia
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Emanuele Bozzalla-Cassione
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Valentina Bonetto
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Maria Cristina Monti
- Department of Public Health, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy;
| | - Elena Ticozzelli
- General Surgery Unit, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Annalisa Turco
- Cardiology Department, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Tiberio Oggionni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Angelo Corsico
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Francesco Bertuccio
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Valentina Zuccaro
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Veronica Codullo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Monica Morosini
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Carlo Marena
- SC Direzione Medica di Presidio, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, 27100 Pavia, Italy
| | - Carlo Pellegrini
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Federica Meloni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
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138
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Hage R, Steinack C, Schuurmans MM. Calcineurin inhibitors revisited: A new paradigm for COVID-19? Braz J Infect Dis 2020; 24:365-367. [PMID: 32603679 PMCID: PMC7320855 DOI: 10.1016/j.bjid.2020.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can cause mild, moderate or severe disease (COVID-19). In severe disease, there is hyperinflammation causing severe symptoms. Severe COVID-19 is an immunological phenomenon, rather than a direct viral damage disease. Therapies for COVID-19 are all investigational therapies. In case of severe disease, treatment with a calcineurin inhibitor could be promising. In this article we explain the mechanisms of calcineurin inhibitor treatment for COVID-19, based on experiences seen in solid organ transplant recipients who suffered from COVID-19.
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Affiliation(s)
- René Hage
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland; University of Zurich, Faculty of Medicine, Zurich, Switzerland.
| | - Carolin Steinack
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland; University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Macé M Schuurmans
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland; University of Zurich, Faculty of Medicine, Zurich, Switzerland
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139
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Hoek RAS, Manintveld OC, Betjes MGH, Hellemons ME, Seghers L, Van Kampen JAA, Caliskan K, van de Wetering J, van den Hoogen M, Metselaar HJ, Hesselink DA. COVID-19 in solid organ transplant recipients: a single-center experience. Transpl Int 2020; 33:1099-1105. [PMID: 32460390 PMCID: PMC7283727 DOI: 10.1111/tri.13662] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022]
Abstract
Solid organ transplant (SOT) recipients may be at risk for severe COVID‐19. Data on the clinical course of COVID‐19 in immunosuppressed patients are limited, and the effective treatment strategy for these patients is unknown. We describe our institutional experience with COVID‐19 in SOT. Demographic, clinical, and treatment data were extracted from the electronic patient files. A total of 23 SOT transplant recipients suffering from COVID‐19 were identified (n = 3 heart; n = 15 kidney; n = 1 kidney‐after‐heart; n = 3 lung, and n = 1 liver transplant recipient). The presenting symptoms were similar to nonimmunocompromised patients. Eighty‐three percent (19/23) of the patients required hospitalization, but only two of these were transferred to the intensive care unit. Five patients died from COVID‐19; all had high Clinical Frailty Scores. In four of these patients, mechanical ventilation was deemed futile. In 57% of patients, the immunosuppressive therapy was not changed and only three patients were treated with chloroquine. Most patients recovered without experimental antiviral therapy. Modification of the immunosuppressive regimen alone could be a therapeutic option for SOT recipients suffering from moderate to severe COVID‐19. Pre‐existent frailty is associated with death from COVID‐19.
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Affiliation(s)
- Rogier A S Hoek
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Merel E Hellemons
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Leonard Seghers
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jeroen A A Van Kampen
- Department of Viroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Martijn van den Hoogen
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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140
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Morlacchi LC, Rossetti V, Gigli L, Amati F, Rosso L, Aliberti S, Nosotti M, Blasi F. COVID‐19 in lung transplant recipients: A case series from Milan, Italy. Transpl Infect Dis 2020; 22:e13356. [DOI: 10.1111/tid.13356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Letizia Corinna Morlacchi
- Respiratory Unit and Adult Cystic Fibrosis Centre Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
| | - Valeria Rossetti
- Respiratory Unit and Adult Cystic Fibrosis Centre Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
| | - Lorenzo Gigli
- Cardiovascular Disease Unit Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Francesco Amati
- Respiratory Unit and Adult Cystic Fibrosis Centre Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
| | - Lorenzo Rosso
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
- Thoracic Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Centre Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
| | - Mario Nosotti
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
- Thoracic Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Centre Internal Medicine Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milano Italy
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141
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Tepasse PR, Hafezi W, Lutz M, Kühn J, Wilms C, Wiewrodt R, Sackarnd J, Keller M, Schmidt HH, Vollenberg R. Persisting SARS-CoV-2 viraemia after rituximab therapy: two cases with fatal outcome and a review of the literature. Br J Haematol 2020; 190:185-188. [PMID: 32557623 PMCID: PMC7300950 DOI: 10.1111/bjh.16896] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 infection can cause severe pneumonia (COVID-19). There is evidence that patients with comorbidities are at higher risk of a severe disease course. The role of immunosuppression in the disease course is not clear. In the present report, we first describe two cases of persisting SARS-CoV-2 viraemia with fatal outcome in patients after rituximab therapy.
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Affiliation(s)
- Phil-Robin Tepasse
- Department of Gastroenterology and Hepatology, Section for Infectious Diseases, University Hospital Muenster, Muenster, Germany
| | - Wali Hafezi
- Institute of Virology, University Hospital Muenster, Muenster, Germany
| | - Mathias Lutz
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Joachim Kühn
- Institute of Virology, University Hospital Muenster, Muenster, Germany
| | - Christian Wilms
- Department of Gastroenterology and Hepatology, Section for Infectious Diseases, University Hospital Muenster, Muenster, Germany
| | - Rainer Wiewrodt
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Martin Keller
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology and Hepatology, Section for Infectious Diseases, University Hospital Muenster, Muenster, Germany
| | - Richard Vollenberg
- Department of Gastroenterology and Hepatology, Section for Infectious Diseases, University Hospital Muenster, Muenster, Germany
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142
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Sebastian S, Gonzalez HA, Peyrin-Biroulet L. Safety of Drugs During Previous and Current Coronavirus Pandemics: Lessons for Inflammatory Bowel Disease. J Crohns Colitis 2020; 14:1632-1643. [PMID: 32520312 PMCID: PMC7314090 DOI: 10.1093/ecco-jcc/jjaa120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus 2019 [COVID-19] pandemic has posed challenges in the routine care of patients with inflammatory bowel disease [IBD]. One of the key challenges is quantification of the risks of immunosuppressive and biological therapies in IBD patients during the pandemic. The similarities and differences between previous coronavirus outbreaks and the pathobiology of the infections can give useful information in understanding the risks, and perhaps potential beneficial aspects of drugs used in IBD. Although clinical, immunological and pharmacological data from the experience with previous coronavirus outbreaks cannot be automatically translated to predict the safety of IBD therapies during the COVID-19 pandemic, the signals so far from these outbreaks on IBD patients who are on immunomodulators and biologics are reassuring to patients and clinicians alike.
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Affiliation(s)
- S Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, Hull, UK
- Corresponding author: Prof S Sebastian MD FRCP, IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, e-mail:
| | - H A Gonzalez
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-Les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-Les-Nancy, France
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143
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Vistoli F, Furian L, Maggiore U, Caldara R, Cantaluppi V, Ferraresso M, Zaza G, Cardillo M, Biancofiore G, Menichetti F, Russo A, Turillazzi E, Di Paolo M, Grandaliano G, Boggi U. COVID-19 and kidney transplantation: an Italian Survey and Consensus. J Nephrol 2020; 33:667-680. [PMID: 32495231 PMCID: PMC7268183 DOI: 10.1007/s40620-020-00755-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 12/21/2022]
Abstract
Italy was the first Western country to face the COVID-19 pandemic. Here we report the results of a national survey on kidney transplantation activity in February and March 2020, and the results of a three-round Delphi consensus promoted by four scientific societies: the Italian Society of Organ Transplantation, the Italian Society of Nephrology, the Italian Society of Anesthesia and Intensive Care, and the Italian Group on Antimicrobial Stewardship. All 41 Italian transplant centers were invited to express their opinion in the Delphi rounds along with a group of seven experts. The survey revealed that, starting from March 2020, there was a decline in kidney transplantation activity in Italy, especially for living-related transplants. Overall, 60 recipients tested positive for SARS-CoV2 infection, 57 required hospitalization, 17 were admitted to the ICU, and 11 died. The online consensus had high response rates at each round (95.8%, 95.8%, and 89.5%, respectively). Eventually, 27 of 31 proposed statements were approved (87.1%), 12 at the first or second round (38.7%), and 3 at the third (9.7%). Based on the Italian experience, we discuss the reasons for the changes in kidney transplantation activity during the COVID-19 pandemic in Western countries. We also provide working recommendations for the organization and management of kidney transplantation under these conditions.
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Affiliation(s)
- Fabio Vistoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Umberto Maggiore
- Kidney and Kidney-Pancreas Transplant Unit, Department of Nephrology, Parma University Hospital, Parma, Italy
| | - Rossana Caldara
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale (UPO), Novara, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy.
| | - Massimo Cardillo
- Italian National Transplant Center, Italian National Institute of Health, Rome, Italy
| | | | | | - Alessandro Russo
- Division of Infectious Disease Control, University of Pisa, Pisa, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Marco Di Paolo
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
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144
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Zhang H, Chen Y, Yuan Q, Xia QX, Zeng XP, Peng JT, Liu J, Xiao XY, Jiang GS, Xiao HY, Xie LB, Chen J, Liu JL, Xiao X, Su H, Zhang C, Zhang XP, Yang H, Li H, Wang ZD. Identification of Kidney Transplant Recipients with Coronavirus Disease 2019. Eur Urol 2020; 77:742-747. [PMID: 32249089 PMCID: PMC7270372 DOI: 10.1016/j.eururo.2020.03.030] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel and lethal infectious disease, posing a threat to global health security. The number of cases has increased rapidly, but no data concerning kidney transplant (KTx) recipients infected with COVID-19 are available. To present the epidemiological, clinical, and therapeutic characteristics of KTx recipients infected with COVID-19, we report on a case series of five patients who were confirmed as having COVID-19 through nucleic acid testing (NAT) from January 1, 2020 to February 28, 2020. The most common symptoms on admission to hospital were fever (five patients, 100%), cough (five patients, 100%), myalgia or fatigue (three patients, 60%), and sputum production (three patients, 60%); serum creatinine or urea nitrogen levels were slightly higher than those before symptom onset. Four patients received a reduced dose of maintenance immunosuppressive therapy during hospitalization. As of March 4, 2020 NAT was negative for COVID-19 in three patients twice in succession, and their computed tomography scans showed improved images. Although greater patient numbers and long-term follow-up data are needed, our series demonstrates that mild COVID-19 infection in KTx recipients can be managed using symptomatic support therapy combined with adjusted maintenance immunosuppressive therapy.
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Affiliation(s)
- Hui Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; These authors contributed equally to this work and share first authorship
| | - Yan Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; These authors contributed equally to this work and share first authorship
| | - Quan Yuan
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; These authors contributed equally to this work and share first authorship
| | - Qiu-Xiang Xia
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Peng Zeng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Tao Peng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-Yuan Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo-Song Jiang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han-Yu Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang-Bo Xie
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Li Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Xiao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Yang
- Department of Organ Transplantation, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Heng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Di Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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145
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Maggiore U, Abramowicz D, Crespo M, Mariat C, Mjoen G, Peruzzi L, Sever MS, Oniscu GC, Hilbrands L, Watschinger B. How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion. Nephrol Dial Transplant 2020; 35:899-904. [PMID: 32441741 PMCID: PMC7313836 DOI: 10.1093/ndt/gfaa130] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Umberto Maggiore
- Dipartimento di Medicina e Chrurgia, Università d Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp University, Antwerp, Belgium
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | - Christophe Mariat
- Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, Turin, Italy
| | - Mehmet Sükrü Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
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146
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Willicombe M, Thomas D, McAdoo S. COVID-19 and Calcineurin Inhibitors: Should They Get Left Out in the Storm? J Am Soc Nephrol 2020; 31:1145-1146. [PMID: 32312797 PMCID: PMC7269341 DOI: 10.1681/asn.2020030348] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michelle Willicombe
- Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
- Renal and Transplant Centre, Imperial College Healthcare National Health Service Trust, Hammersmith Hospital, London, United Kingdom
| | - David Thomas
- Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
- Renal and Transplant Centre, Imperial College Healthcare National Health Service Trust, Hammersmith Hospital, London, United Kingdom
| | - Stephen McAdoo
- Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
- Renal and Transplant Centre, Imperial College Healthcare National Health Service Trust, Hammersmith Hospital, London, United Kingdom
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147
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Aigner C, Dittmer U, Kamler M, Collaud S, Taube C. COVID-19 in a lung transplant recipient. J Heart Lung Transplant 2020; 39:610-611. [PMID: 32340870 PMCID: PMC7152862 DOI: 10.1016/j.healun.2020.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany; West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany.
| | - Ulf Dittmer
- Institute for Virology, University Medicine Essen - University Clinic, Essen, Germany
| | - Markus Kamler
- West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany; Department of Thoracic Transplantation, University Medicine Essen - University Clinic, Essen, Germany
| | - Stephane Collaud
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany; West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Christian Taube
- West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany; Department of Pulmonary Medicine, University Medicine Essen - Ruhrlandklinik, Essen, Germany
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148
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Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is spreading as a pandemic in 2020. Few reports on infections in thoracic transplantation have been published so far. We present a case of COVID-19 in a 55-year old female lung transplant recipient infected 5 months posttransplant, who additionally was co-infected with a Norovirus. Respiratory and gastrointestinal symptoms were observed without need of therapeutic escalation except for antibiotic therapy. We observed a moderate disease evolution likely due to triple immunosuppression.
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149
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Machado DJDB, Ianhez LE. COVID-19 pneumonia in kidney transplant recipients-Where we are? Transpl Infect Dis 2020; 22:e13306. [PMID: 32364677 PMCID: PMC7261981 DOI: 10.1111/tid.13306] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022]
Abstract
In late December 2019, China reported cases of respiratory illness in humans that involved a novel coronavirus SARS-CoV-2. On March 20, 2020, the first coronavirus disease 2019 (COVID-19) in Brazil was diagnosed, and by now, we present the report on the first case of COVID among transplant recipients in our country. A liver and kidney transplant patient with SARS-CoV-2 pneumonia without respiratory failure was treated in a clinical multimodal strategy consisting of symptomatic support therapy, immunosuppression reduction, use of anti-coronavirus drugs and heparin leading to a progressive improvement of patient symptoms till discharge. The authors also present a comprehensive review of published cases.
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Affiliation(s)
- David José de Barros Machado
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.,Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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150
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Banerjee A, Czinn SJ, Reiter RJ, Blanchard TG. Crosstalk between endoplasmic reticulum stress and anti-viral activities: A novel therapeutic target for COVID-19. Life Sci 2020; 255:117842. [PMID: 32454157 PMCID: PMC7245231 DOI: 10.1016/j.lfs.2020.117842] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
The outbreak of COVID-19 caused by 2019–nCov/SARS-CoV-2 has become a pandemic with an urgent need for understanding the mechanisms and identifying a treatment. Viral infections including SARS-CoV are associated with increased levels of reactive oxygen species, disturbances of Ca++ caused by unfolded protein response (UPR) mediated by endoplasmic reticulum (ER) stress and is due to the exploitation of virus's own protein i.e., viroporins into the host cells. Several clinical trials are on-going including testing Remdesivir (anti-viral), Chloroquine and Hydroxychloroquine derivatives (anti-malarial drugs) etc. Unfortunately, each drug has specific limitations. Herein, we review the viral protein involvement to activate ER stress transducers (IRE-1, PERK, ATF-6) and their downstream signals; and evaluate combination therapies for COVID-19 mediated ER stress alterations. Melatonin is an immunoregulator, anti-pyretic, antioxidant, anti-inflammatory and ER stress modulator during viral infections. It enhances protective mechanisms for respiratory tract disorders. Andrographolide, isolated from Andrographis paniculata, has versatile biological activities including immunomodulation and determining SARS-CoV-2 binding site. Considering the properties of both compounds in terms of anti-inflammatory, antioxidant, anti-pyrogenic, anti-viral and ER stress modulation and computational approaches revealing andrographolide docks with the SARS-CoV2 binding site, we predict that this combination therapy may have potential utility against COVID-19.
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Affiliation(s)
- Aditi Banerjee
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Steven J Czinn
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Thomas G Blanchard
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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