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Nunes JM, Kell DB, Pretorius E. Herpesvirus Infection of Endothelial Cells as a Systemic Pathological Axis in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Viruses 2024; 16:572. [PMID: 38675914 PMCID: PMC11053605 DOI: 10.3390/v16040572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Understanding the pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is critical for advancing treatment options. This review explores the novel hypothesis that a herpesvirus infection of endothelial cells (ECs) may underlie ME/CFS symptomatology. We review evidence linking herpesviruses to persistent EC infection and the implications for endothelial dysfunction, encompassing blood flow regulation, coagulation, and cognitive impairment-symptoms consistent with ME/CFS and Long COVID. This paper provides a synthesis of current research on herpesvirus latency and reactivation, detailing the impact on ECs and subsequent systemic complications, including latent modulation and long-term maladaptation. We suggest that the chronicity of ME/CFS symptoms and the multisystemic nature of the disease may be partly attributable to herpesvirus-induced endothelial maladaptation. Our conclusions underscore the necessity for further investigation into the prevalence and load of herpesvirus infection within the ECs of ME/CFS patients. This review offers conceptual advances by proposing an endothelial infection model as a systemic mechanism contributing to ME/CFS, steering future research toward potentially unexplored avenues in understanding and treating this complex syndrome.
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Affiliation(s)
- Jean M. Nunes
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
| | - Douglas B. Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Building 220, Chemitorvet 200, 2800 Kongens Lyngby, Denmark
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK
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Nawata A, Shirayama R, Oshida K, Sato T, Ito T, Shiba E, Kusuhara K, Hisaoka M. Catastrophic antiphospholipid syndrome with Epstein-Barr virus-associated hemophagocytosis: A clinicopathological conference. Lupus 2022; 31:1385-1393. [PMID: 35938616 DOI: 10.1177/09612033221118819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a severe variant of antiphospholipid syndrome associated with multiorgan thrombosis in a short term. We present the case of a 14-year-old immunocompetent girl who developed renal, intestinal, and pulmonary infarction; thrombocytopenia; and hemolytic anemia within 1 week. She was diagnosed with thrombotic microangiopathy. Hence, plasma exchange and corticosteroid therapy were initiated, which improved thrombocytopenia. However, the patient's platelet count decreased. Her general condition gradually worsened with eventual death. An autopsy revealed multiple infarctions in the kidneys bilaterally, jejunum, ileum, and pulmonary parenchyma. Microthrombi were not detected. Massive hemophagocytosis was observed in the splenic pulp, lymph nodes, and bone marrow. Several Epstein-Barr viruses (EBVs)-encoded small ribonucleic acid (RNA)-positive lymphocytes were also found in the bone marrow. The presence of antibodies to both viral capsid antigen-immunoglobulin G and EBV nuclear antigen indicated past infection. Antiphospholipid antibody was positive after her death. The patient was finally diagnosed with CAPS and EBV-associated hemophagocytosis, possibly due to EBV reactivation. Establishing a clinical diagnosis of CAPS was relatively difficult because two different causes of thrombocytopenia, CAPS and hemophagocytosis, led to a difficulty in understanding this case's pathogenesis.
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Affiliation(s)
- Aya Nawata
- Department of Pathology and Oncology, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Rie Shirayama
- Department of Pediatrics, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Koichi Oshida
- Department of Pediatrics, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Tetsuji Sato
- Department of Pediatrics, 13780Kitakyushu City Yahata Hospital, Japan
| | - Takuma Ito
- Department of Pediatrics, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, 13137University of Occupational and Environmental Health, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, 13137University of Occupational and Environmental Health, Japan
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El Hasbani G, Taher AT, Jawad A, Uthman I. COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120978667. [PMID: 33328777 PMCID: PMC7720319 DOI: 10.1177/1179544120978667] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Ippolito Bastidas H, Márquez-Pérez T, García-Salido A, Luglietto D, García Moreno R, Martínez de Azagra-Garde A, Nieto-Moro M, Leoz-Gordillo I, Budke M, Rivero-Martín B. Cerebral Venous Sinus Thrombosis in a Pediatric Patient With COVID-19. Neurol Clin Pract 2020; 11:e208-e210. [PMID: 33842096 DOI: 10.1212/cpj.0000000000000899] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Hyaissa Ippolito Bastidas
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Trinidad Márquez-Pérez
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Alberto García-Salido
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Davide Luglietto
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Rafael García Moreno
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Amelia Martínez de Azagra-Garde
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Montserrat Nieto-Moro
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Inés Leoz-Gordillo
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Marcelo Budke
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Belén Rivero-Martín
- Department of Neurosurgery (HIB, TM-P, MB, BR-M), Hospital Infantil Universitario Niño Jesús; Department of Intensive Care (AG-S, AMA-G, MN-M, IL-G), Hospital Infantil Universitario Niño Jesús, Madrid; Department of Neurosurgery (DL), Azienda Ospedaliero Universitaria Senese Le Scotte, Siena, Italy; and Department of Neurosurgery (RGM), Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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Meng J, Chen L, Hou J, Chi H, Wang Z, Yang C, Su Y. Probable catastrophic antiphospholipid syndrome secondary to chronic myelomonocytic leukaemia in an adult patient and a mini review. Lupus 2020; 29:1287-1291. [PMID: 32605525 DOI: 10.1177/0961203320937349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a rare and life-threatening form of antiphospholipid syndrome (APS), which could be triggered by malignancy. Chronic myelomonocytic leukaemia (CMML) is an uncommon hematologic malignancy. We report a case of a 49-year-old male patient who presented multiple thromboses with a high titre of anti-β2-glycoprotein-I antibody. Unexpectedly, there was persistent monocytosis combined with <20% blasts in his bone marrow. Thus, a diagnosis of probable CAPS and CMML was made. After treatment with prednisone, hydroxychloroquine and warfarin, the thromboses dissolved, and an improved presentation of peripheral blood and bone marrow was observed. Here, we also provide a mini review of cases of APS complicated with CMML identified from searches of MEDLINE, EMBASE and Web of Science databases. The review describes the clinical characteristics, laboratory data, treatments and outcomes.
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Affiliation(s)
- Jianfen Meng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Department of Rheumatology and Immunology, The First People's Hospital of Yancheng, The Forth Affiliated Hospital of Nantong University, Yancheng, PR China
| | - Lijia Chen
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Department of Endocrinology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jiaqi Hou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhihong Wang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Investigation on Risk Factors of Ventilator-Associated Pneumonia in Acute Cerebral Hemorrhage Patients in Intensive Care Unit. Can Respir J 2017; 2017:7272080. [PMID: 29391844 PMCID: PMC5748108 DOI: 10.1155/2017/7272080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/17/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is a predominant factor of pulmonary infection. We analyzed the risk factors of VAP with acute cerebral hemorrhage in intensive care unit (ICU) by univariate and multivariate logistic regression analyses. After comparison of 197 cases of the VAP and non-VAP patients, we found that age > 65 years (P = 0.003), smoke (P = 0.003), coronary heart disease (P = 0.005), diabetes (P = 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.002), ICU and hospital stay (P = 0.01), and days on mechanical ventilation (P = 0.01) were significantly different, indicating that they are risk factors of VAP. All the age > 65 years (OR = 3.350, 95% CI = 1.936–5.796, P ≤ 0.001), smoke (OR = 3.206, 95% CI = 1.909–5.385, P ≤ 0.001), coronary heart disease (OR = 3.179, 95% CI = 1.015–4.130, P = 0.017), diabetes (OR = 5.042, 95% CI = 3.518–7.342, P ≤ 0.001), COPD (OR = 1.942, 95% CI = 1.258–2.843, P = 0.012), ICU and hospital stay (OR = 2.34, 95% CI = 1.145–3.892, P = 0.038), and days on mechanical ventilation (OR = 1.992, 95% CI = 1.107–3.287, P = 0.007) are independent risk factors of VAP. After observation of patients with 6 months of follow-up, the BI score was significantly lower in VAP than that in non-VAP, and the rebleeding rate and mortality rate were significantly higher in VAP than those in non-VAP. Thus, the prognosis of the patients with acute cerebral hemorrhage and VAP in ICU is poor.
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