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Al-Kuraishy HM, Al-Gareeb AI, El-Bouseary MM, Sonbol FI, Batiha GES. Hyperviscosity syndrome in COVID-19 and related vaccines: exploring of uncertainties. Clin Exp Med 2022:10.1007/s10238-022-00836-x. [PMID: 35608715 PMCID: PMC9128329 DOI: 10.1007/s10238-022-00836-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/26/2022] [Indexed: 12/31/2022]
Abstract
Hyperviscosity syndrome (HVS) recently emerged as a complication of coronavirus disease 2019 (COVID-19) and COVID-19 vaccines. Therefore, the objectives of this critical review are to establish the association between COVID-19 and COVID-19 vaccines with the development of HVS. HVS may develop in various viral infections due to impairment of humoral and cellular immunity with elevation of immunoglobulins. COVID-19 can increase blood viscosity (BV) through modulation of fibrinogen, albumin, lipoproteins, and red blood cell (RBC) indices. HVS can cause cardiovascular and neurological complications in COVID-19 like myocardial infarction (MI) and stroke. HVS with or without abnormal RBCs function in COVID-19 participates in the reduction of tissue oxygenation with the development of cardio-metabolic complications and long COVID-19. Besides, HVS may develop in vaccine recipients with previous COVID-19 due to higher underlying Ig concentrations and rarely without previous COVID-19. Similarly, patients with metabolic syndrome are at the highest risk for propagation of HVS after COVID-19 vaccination. In conclusion, COVID-19 and related vaccines are linked with the development of HVS, mainly in patients with previous COVID-19 and underlying metabolic derangements. The possible mechanism of HVS in COVID-19 and related vaccines is increasing levels of fibrinogen and immunoglobulins. However, dehydration, oxidative stress, and inflammatory reactions are regarded as additional contributing factors in the pathogenesis of HVS in COVID-19. However, this critical review cannot determine the final causal relationship between COVID-19 and related vaccines and the development of HVS. Prospective and retrospective studies are warranted in this field.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Maisra M El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| | - Fatma I Sonbol
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
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Li G, Lewis RD, Mishra N, Axiotis CA. A retrospective analysis of ten symptomatic multiple myeloma patients with HIV infection: a potential therapeutic effect of HAART in multiple myeloma. Leuk Res 2014; 38:1079-84. [PMID: 25064217 DOI: 10.1016/j.leukres.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/19/2014] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
Abstract
The impact of highly active anti-retroviral therapy (HAART) in multiple myeloma (MM) is unknown. Ten HIV+ and 28 HIV-negative patients were retrospectively identified out of 262 cases of MM diagnosed at Kings County Hospital Center since the introduction of HAART in 1996. The HIV+ MM patients on HAART had superior overall survival (OS) (Fisher exact, p=0.008; log-rank, p=0.012) and progression free survival (PFS) (Fisher exact, p=0.007; log-rank, p=0.009) than the HIV-negative MM patients. HAART alone blocked the production of serum M-protein. We propose that HARRT should be explored for the treatment of both HIV+ and HIV-negative MM patients.
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Affiliation(s)
- Geling Li
- Department of Pathology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Robert D Lewis
- Department of Haematology/Oncology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Nidhi Mishra
- Department of Haematology/Oncology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Constantine A Axiotis
- Department of Pathology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States.
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Abstract
Multiple sclerosis (MS) is a chronic demyelinating disorder of unknown etiology, possibly caused by a virus or virus-triggered immunopathology. The virus might reactivate after years of latency and lyse oligodendrocytes, as in progressive multifocal leukoencephalopathy, or initiate immunopathological demyelination, as in animals infected with Theiler's murine encephalomyelitis virus or coronaviruses. The argument for a viral cause of MS is supported by epidemiological analyses and studies of MS in identical twins, indicating that disease is acquired. However, the most important evidence is the presence of bands of oligoclonal IgG (OCBs) in MS brain and CSF that persist throughout the lifetime of the patient. OCBs are found almost exclusively in infectious CNS disorders, and antigenic targets of OCBs represent the agent that causes disease. Here, the authors review past attempts to identify an infectious agent in MS brain cells and discuss the promise of using recombinant antibodies generated from clonally expanded plasma cells in brain and CSF to identify disease-relevant antigens. They show how this strategy has been used successfully to analyze antigen specificity in subacute sclerosing panencephalitis, a chronic encephalitis caused by measles virus, and in neuromyelitis optica, a chronic autoimmune demyelinating disease produced by antibodies directed against the aquaporin-4 water channel.
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Affiliation(s)
- Gregory P Owens
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Abstract
Multiple sclerosis (MS) is a chronic demyelinating disorder of unknown etiology, possibly caused by a virus or virus-triggered immunopathology. The virus might reactivate after years of latency and lyse oligodendrocytes, as in progressive multifocal leukoencephalopathy, or initiate immunopathological demyelination, as in animals infected with Theiler’s murine encephalomyelitis virus or coronaviruses. The argument for a viral cause of MS is supported by epidemiological analyses and studies of MS in identical twins, indicating that disease is acquired. However, the most important evidence is the presence of bands of oligoclonal IgG (OCBs) in MS brain and CSF that persist throughout the lifetime of the patient. OCBs are found almost exclusively in infectious CNS disorders, and antigenic targets of OCBs represent the agent that causes disease. Here, the authors review past attempts to identify an infectious agent in MS brain cells and discuss the promise of using recombinant antibodies generated from clonally expanded plasma cells in brain and CSF to identify disease-relevant antigens. They show how this strategy has been used successfully to analyze antigen specificity in subacute sclerosing panencephalitis, a chronic encephalitis caused by measles virus, and in neuromyelitis optica, a chronic autoimmune demyelinating disease produced by antibodies directed against the aquaporin-4 water channel.
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Salarieh A, Rao C, Gottesman SR, Alagha O, Todor R, Axiotis CA. Plasma cell tumors in HIV-positive patients: Report of a case and review of the literature. Leuk Lymphoma 2009; 46:1067-74. [PMID: 16019560 DOI: 10.1080/10428190500054566] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Plasma cell tumors show an increased incidence in HIV-positive patients. The cases reported in the literature suggest that plasma cell tumors occur in a younger age group than that encountered in the general population. Pathologically, many of these tumors show a plasmablastic morphology. Plasma cell tumors in HIV-positive patients may present at unusual sites and progress rapidly to involve multiple sites, including the soft tissues and viscera. The prognosis is generally poor. These features may be related to a combination of factors, including immunodeficiency, oncogenic viruses, and altered cytokine milieu in these patients. A case of plasma cell tumor in an HIV-positive patient is presented.
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Affiliation(s)
- Afshin Salarieh
- Department of Pathology, State University of New York-Downstate Medical Center, and Kings County Hospital Center, Brooklyn, NY 11203, USA.
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Sompuram SR, Bastas G, Vani K, Bogen SA. Accurate identification of paraprotein antigen targets by epitope reconstruction. Blood 2007; 111:302-8. [PMID: 17878398 PMCID: PMC2200814 DOI: 10.1182/blood-2007-05-090654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the first successful clinical application of a new discovery technology, epitope-mediated antigen prediction (E-MAP), to the investigation of multiple myeloma. Until now, there has been no reliable, systematic method to identify the cognate antigens of paraproteins. E-MAP is a variation of previous efforts to reconstruct the epitopes of paraproteins, with the significant difference that it provides enough epitope sequence data so as to enable successful protein database searches. We first reconstruct the paraprotein's epitope by analyzing the peptides that strongly bind. Then, we compile the data and interrogate the nonredundant protein database, searching for a close match. As a clinical proof-of-concept, we apply this technology to uncovering the protein targets of para-proteins in multiple myeloma (MM). E-MAP analysis of 2 MM paraproteins identified human cytomegalovirus (HCMV) as a target in both. E-MAP sequence analysis determined that one para-protein binds to the AD-2S1 epitope of HCMV glycoprotein B. The other binds to the amino terminus of the HCMV UL-48 gene product. We confirmed these predictions using immunoassays and immunoblot analyses. E-MAP represents a new investigative tool for analyzing the role of chronic antigenic stimulation in B-lymphoproliferative disorders.
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Abstract
A case history of a man, who was found to have an asymptomatic lymphoplasmacytic lymphoma with an IgM paraproteinaemia and subsequently acquired HIV infection, is presented. After seroconversion there was a reduction in CD4+ cell count in the peripheral blood and bone marrow, together with an increase in CD 138+ cells in the marrow and disease progression with increasing paraprotein levels and falling haemoglobin. Following antiretroviral therapy (HAART) there was a reduction in viral titres, an increase in peripheral blood CD4+ cell counts together with a reduction in paraprotein and an improvement in haemoglobin. This case suggests that CD4+ cells play a role in controlling B cell proliferation and consequently that CD4 suppression contributes to the increased incidence of lymphoma in patients with HIV infection. We also discuss treatment options for this patient for should his LPL progress and require treatment in the future.
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MESH Headings
- Antiretroviral Therapy, Highly Active/methods
- CD4-Positive T-Lymphocytes/immunology
- Cytogenetic Analysis
- Disease Progression
- HIV Infections/complications
- HIV Infections/therapy
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/immunology
- Lymphoma, AIDS-Related/therapy
- Male
- Middle Aged
- Paraproteins/analysis
- Remission Induction
- Sensitivity and Specificity
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Affiliation(s)
- Faye Lim
- Department of Haematology St Mary's Hospital, London, UK
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Cheung MC, Pantanowitz L, Dezube BJ. AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy. Oncologist 2005; 10:412-26. [PMID: 15967835 DOI: 10.1634/theoncologist.10-6-412] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). Despite the advent of highly active anti-retroviral therapy (HAART), malignancy in this population is a leading cause of morbidity and mortality. Kaposi's sarcoma (KS) and AIDS-related non-Hodgkin's lymphoma (ARL) are the most common AIDS-defining malignancies. AIDS-related KS varies from minimal to fulminant disease. Treatment decisions for AIDS-related KS are guided largely by the presence and extent of symptomatic disease. In addition to HAART, excellent treatments exist for both localized disease (topical gel, radiotherapy, and intralesional therapy) and advanced disease (liposomal anthracyclines, paclitaxel). Novel therapies that have become available to treat AIDS-related KS include angiogenesis inhibitors and antiviral agents. ARL comprises a heterogeneous group of malignancies. With the immune restoration afforded by HAART, standard-dose chemotherapies now can be safely administered to treat ARL with curative intent. The role of analogous treatments used in HIV-negative patients, including monoclonal antibodies and autologous stem cell transplantation, requires further clarification in HIV-positive patients. HIV-infected patients also appear to be at increased risk for developing certain non-AIDS-defining cancers, such as Hodgkin's lymphoma and multiple myeloma. Although the optimal treatment of these neoplasms is at present uncertain, recent advances in chemotherapy, antiretroviral drugs, and supportive care protocols are allowing for more aggressive management of many of the AIDS-related cancers. This article provides an up-to-date review of the epidemiology, pathogenesis, clinical features, and treatment of various AIDS-related malignancies that are likely to be encountered by an oncologist practicing in the current HAART era.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Antiretroviral Therapy, Highly Active
- Education, Medical, Continuing
- Hodgkin Disease/drug therapy
- Hodgkin Disease/etiology
- Hodgkin Disease/pathology
- Humans
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/etiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/pathology
- Medical Oncology/trends
- Prognosis
- Risk Factors
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/pathology
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Affiliation(s)
- Matthew C Cheung
- Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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