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Lockwood TD. Coordination chemistry suggests that independently observed benefits of metformin and Zn 2+ against COVID-19 are not independent. Biometals 2024; 37:983-1022. [PMID: 38578560 PMCID: PMC11255062 DOI: 10.1007/s10534-024-00590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/12/2024] [Indexed: 04/06/2024]
Abstract
Independent trials indicate that either oral Zn2+ or metformin can separately improve COVID-19 outcomes by approximately 40%. Coordination chemistry predicts a mechanistic relationship and therapeutic synergy. Zn2+ deficit is a known risk factor for both COVID-19 and non-infectious inflammation. Most dietary Zn2+ is not absorbed. Metformin is a naked ligand that presumably increases intestinal Zn2+ bioavailability and active absorption by cation transporters known to transport metformin. Intracellular Zn2+ provides a natural buffer of many protease reactions; the variable "set point" is determined by Zn2+ regulation or availability. A Zn2+-interactive protease network is suggested here. The two viral cysteine proteases are therapeutic targets against COVID-19. Viral and many host proteases are submaximally inhibited by exchangeable cell Zn2+. Inhibition of cysteine proteases can improve COVID-19 outcomes and non-infectious inflammation. Metformin reportedly enhances the natural moderating effect of Zn2+ on bioassayed proteome degradation. Firstly, the dissociable metformin-Zn2+ complex could be actively transported by intestinal cation transporters; thereby creating artificial pathways of absorption and increased body Zn2+ content. Secondly, metformin Zn2+ coordination can create a non-natural protease inhibitor independent of cell Zn2+ content. Moderation of peptidolytic reactions by either or both mechanisms could slow (a) viral multiplication (b) viral invasion and (c) the pathogenic host inflammatory response. These combined actions could allow development of acquired immunity to clear the infection before life-threatening inflammation. Nirmatrelvir (Paxlovid®) opposes COVID-19 by selective inhibition the viral main protease by a Zn2+-independent mechanism. Pending safety evaluation, predictable synergistic benefits of metformin and Zn2+, and perhaps metformin/Zn2+/Paxlovid® co-administration should be investigated.
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Affiliation(s)
- Thomas D Lockwood
- Department Pharmacology and Toxicology, School of Medicine, Wright State University, Dayton, OH, 45435, USA.
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2
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Schneider A, Sadhana J, Menindez MD, Jeevaratnam S, Balistreri L, Thomas C, Chirila R, Berianu F. Hydroxychloroquine Induced Cardiotoxicity: A Case Series. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:210-215. [PMID: 38377065 DOI: 10.2478/rjim-2024-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 02/22/2024]
Abstract
Hydroxychloroquine (HCQ) induced cardiotoxicity is a rare diagnosis and is often associated with chronic use of the medication. It has been shown that chronic HCQ use is associated with a drug-induced cardiomyopathy mainly driven by acquired lysosomal storage defects leading to hypertrophy and conduction abnormalities. As the only proven treatment is the discontinuation of the offending agent, prompt recognition is required to avoid further exposure to the drug and potential progression of disease. History, physical examination and advanced imaging modalities are useful diagnostic tools, but more invasive testing with an endomyocardial biopsy is required for definitive diagnosis. We present a descriptive case series of ten patients that were diagnosed with biopsy proven HCQ cardiotoxicity.
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Affiliation(s)
- Artur Schneider
- 1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jonna Sadhana
- 2Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Suren Jeevaratnam
- 1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Lisa Balistreri
- 3Department of Rheumatology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Colleen Thomas
- 4Department of Quantitative Health Science, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Razvan Chirila
- 1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
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3
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Brown B, Joseph C, Talanki V, Budzikowski AS, McFarlane SI, John S. Severe Hypertrophic Cardiomyopathy Associated With Hydroxychloroquine in a Young Woman With Systemic Lupus Erythematosus: A Case Report and Review of the Literature. Cureus 2024; 16:e61452. [PMID: 38947707 PMCID: PMC11214841 DOI: 10.7759/cureus.61452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
The use of the antimalarial drug hydroxychloroquine is a standard treatment in patients with systemic lupus erythematosus. It helps reduce disease-associated damage, prevents disease flare, and improves overall survival. The mechanism of action of hydroxychloroquine includes interference with lysosomal degradation of cells leading to the accumulation of vacuoles. Retinopathy is a well-described adverse effect of hydroxychloroquine, thus requiring screening with an ophthalmologist after prolonged use. Although rarely reported, cardiac adverse effects of hydroxychloroquine can also occur. In this report, we present a case of a 23-year-old woman with systemic lupus erythematosus on hydroxychloroquine who presented with stroke possibly due to Libman-Sacks endocarditis and was found to have severe hypertrophic cardiomyopathy on transthoracic echocardiogram.
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Affiliation(s)
- Bernard Brown
- Internal Medicine, Downstate-Health Science University, Brooklyn, USA
| | - Christy Joseph
- Cardiology, Downstate-Health Science University, Brooklyn, USA
| | - Varsha Talanki
- Cardiology, Downstate-Health Science University, Brooklyn, USA
| | - Adam S Budzikowski
- Cardiovascular Medicine - Electrophysiology (EP) Section, Downstate-Health Science University, Brooklyn, USA
| | - Samy I McFarlane
- Internal Medicine, Downstate-Health Science University, Brooklyn, USA
| | - Sabu John
- Cardiology, Downstate-Health Science University, Brooklyn, USA
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4
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Souza KBDE, Wyse EL, Nasre-Nasser RG, Veber AP, Muccillo-Baisch AL, Arbo BD, Silva Júnior FMRDA, Hort MA. Prevalence and predictors of self-medication to prevent or treat COVID-19 among undergraduate students in Southern Brazil. AN ACAD BRAS CIENC 2024; 96:e20230114. [PMID: 38808811 DOI: 10.1590/0001-3765202420230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/05/2023] [Indexed: 05/30/2024] Open
Abstract
Self-medication (SM) is the practice of consuming medicines without a prescription. Despite being a potentially dangerous action, SM is practiced globally and has been highlighted during the COVID-19 pandemic. The aim of this study was to evaluate SM for the prevention or treatment of COVID-19 and the factors associated with this practice among undergraduate students in Southern Brazil. A cross-sectional study was conducted between July and November 2020 using an electronic questionnaire to collect information about the practice of SM and the associated sociodemographic characteristics, health perception, and lifestyle. We collected 1,553 responses and identified a prevalence of 14.9% for SM. The risk factors for SM were earning between BRL 2,101 and BRL 5,250, studying at a public university, and studying a distance undergraduate course. The protective factors were age above 30 years, female sex, working or participating in internships, occasionally recommending their own medications to other people, and worsening health during the pandemic. The main drugs or products used were ivermectin, vitamins C and D, tea, azithromycin, zinc, and propolis. Our data could help in the development of health education measures to reduce SM among undergraduate students and guide the population regarding the risks of this practice.
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Affiliation(s)
- Karoline B DE Souza
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Faculdade de Medicina, Rua Visconde de Paranaguá, 102, 96203-900 Rio Grande, RS, Brazil
| | - Eduarda L Wyse
- Universidade Federal do Rio Grande (FURG), Instituto de Ciências Biológicas, Campus Carreiros, Avenida Itália, s/n, Km 8, 96203-900 Rio Grande, RS, Brazil
| | - Raif Gregorio Nasre-Nasser
- Programa de Pós-Graduação em Ciências Médicas (Endocrinologia), Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcellos, 2400, 2º andar, 90035-003 Porto Alegre, RS, Brazil
| | - Ana Paula Veber
- Universidade Estadual de Ponta Grossa (UEPG), Setor de Ciências Biológicas e da Saúde, Departamento de Ciências Farmacêuticas, Avenida Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, PR, Brazil
| | - Ana Luiza Muccillo-Baisch
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Faculdade de Medicina, Rua Visconde de Paranaguá, 102, 96203-900 Rio Grande, RS, Brazil
- Universidade Federal do Rio Grande (FURG), Instituto de Ciências Biológicas, Campus Carreiros, Avenida Itália, s/n, Km 8, 96203-900 Rio Grande, RS, Brazil
| | - Bruno D Arbo
- Universidade Federal do Rio Grande do Sul (UFRGS), Instituto de Ciências Básicas e da Saúde, Departamento de Farmacologia, Rua Ramiro Barcellos, 2600, 90035-003 Porto Alegre, RS, Brazil
| | - Flávio Manoel R DA Silva Júnior
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Faculdade de Medicina, Rua Visconde de Paranaguá, 102, 96203-900 Rio Grande, RS, Brazil
- Universidade Federal do Rio Grande (FURG), Instituto de Ciências Biológicas, Campus Carreiros, Avenida Itália, s/n, Km 8, 96203-900 Rio Grande, RS, Brazil
| | - Mariana A Hort
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Faculdade de Medicina, Rua Visconde de Paranaguá, 102, 96203-900 Rio Grande, RS, Brazil
- Universidade Federal do Rio Grande (FURG), Instituto de Ciências Biológicas, Campus Carreiros, Avenida Itália, s/n, Km 8, 96203-900 Rio Grande, RS, Brazil
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Farhat H, Kassab CJ, Tlaiss Y, Gutlapalli SD, Ganipineni VDP, Paramsothy J, Tedesco S, Kailayanathan T, Abdulaal R, Otterbeck P. Hydroxychloroquine and the associated risk of arrhythmias. Glob Cardiol Sci Pract 2024; 2024:e202417. [PMID: 38746066 PMCID: PMC11090172 DOI: 10.21542/gcsp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.
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Affiliation(s)
- Hadi Farhat
- Internal Medicine, University of Balamand, Beirut, Lebanon
| | - Celine J. Kassab
- Pharmacy, Lebanese American University School of Pharmacy, Beirut, Lebanon
| | - Yehya Tlaiss
- Internal Medicine, University of Balamand, Beirut, Lebanon
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | | | - Jananthan Paramsothy
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | - Sarah Tedesco
- Psychiatry, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | - Tharunjan Kailayanathan
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | | | - Philip Otterbeck
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
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Dey S, Lee KI, Subhan S, Ash JY, Wasserman A, Frishman WH, Aronow WS. Hydroxychloroquine and Cardiotoxicity. Cardiol Rev 2023:00045415-990000000-00086. [PMID: 36946912 DOI: 10.1097/crd.0000000000000547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Hydroxychloroquine (HCQ) has been used for rheumatological diseases such as systemic lupus erythematous and rheumatoid arthritis and demonstrated to improve clinical symptoms and reduce long-term sequelae. The drug is metabolized in the liver, is primarily excreted through the kidney, and works by modulating major histocompatibility complex (MHC) and various cytokines, suppressing the immune system in the process. Prolonged administration and high dosages of HCQ have been associate with cardiotoxic effects such as bradycardia, tachycardia, QT prolongation, atrioventricular block, and cardiomyopathy. Common cardiac biopsy findings of HCQ-induced toxicity are enlarged and vacuolated cells on light microscopy along with the presence of myelinoid and curvilinear bodies on transmission electron microscopy. HCQ cardiotoxicity is not very well recognized, and there are no current guidelines for routine cardiac function monitoring from either rheumatology or cardiology societies.
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Affiliation(s)
- Subo Dey
- From the Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Kyu-In Lee
- Departments of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Sarah Subhan
- From the Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Julia Yegudin Ash
- Departments of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Amy Wasserman
- Departments of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- From the Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
- Departments of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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7
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Clinical Features Related to Severity and Mortality among COVID-19 Patients in a Pre-Vaccine Period in Luanda, Angola. Trop Med Infect Dis 2022; 7:tropicalmed7110338. [PMID: 36355881 PMCID: PMC9693333 DOI: 10.3390/tropicalmed7110338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with clinical features of diverse severity. Few studies investigated the severity and mortality predictors of coronavirus disease 2019 (COVID-19) in Africa. Herein, we investigated the clinical features of severity and mortality among COVID-19 patients in Luanda, Angola. Methods: This multicenter cohort study involved 101 COVID-19 patients, between December 2020 and April 2021, with clinical and laboratory data collected. Analysis was done using independent-sample t-tests and Chi-square tests. The results were deemed significant when p < 0.05. Results: The mean age of patients was 51 years (ranging from 18 to 80 years) and 60.4% were male. Fever (46%), cough (47%), gastrointestinal symptoms (26.7%), and asthenia (26.7%), were the most common symptoms. About 64.4% of the patients presented coexistent disorders, including hypertension (42%), diabetes (17%), and chronic renal diseases (6%). About 23% were non-severe, 77% were severe, and 10% died during hospitalization. Variations in the concentration of neutrophil, urea, creatinine, c-reactive protein, sodium, creatine kinase, and chloride were independently associated with severity and/or mortality (p < 0.05). Conclusion: Several factors contributed to the severity and mortality among COVID-19 patients in Angola. Further studies related to clinical features should be carried out to help clinical decision-making and follow-up of COVID-19 patients in Angola.
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