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Chikopela T, Mwesigwa N, Masenga SK, Kirabo A, Shibao CA. The Interplay of HIV and Long COVID in Sub-Saharan Africa: Mechanisms of Endothelial Dysfunction. Curr Cardiol Rep 2024; 26:859-871. [PMID: 38958890 DOI: 10.1007/s11886-024-02087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Long COVID affects approximately 5 million people in Africa. This disease is characterized by persistent symptoms or new onset of symptoms after an acute SARS-CoV-2 infection. Specifically, the most common symptoms include a range of cardiovascular problems such as chest pain, orthostatic intolerance, tachycardia, syncope, and uncontrolled hypertension. Importantly, these conditions appear to have endothelial dysfunction as the common denominator, which is often due to impaired nitric oxide (NO) mechanisms. This review discusses the role of mechanisms contributing to endothelial dysfunction in Long COVID, particularly in people living with HIV. RECENT FINDINGS Recent studies have reported that increased inflammation and oxidative stress, frequently observed in Long COVID, may contribute to NO dysfunction, ultimately leading to decreased vascular reactivity. These mechanisms have also been reported in people living with HIV. In regions like Africa, where HIV infection is still a major public health challenge with a prevalence of approximately 26 million people in 2022. Specifically, endothelial dysfunction has been reported as a major mechanism that appears to contribute to cardiovascular diseases and the intersection with Long COVID mechanisms is of particular concern. Further, it is well established that this population is more likely to develop Long COVID following infection with SARS-CoV-2. Therefore, concomitant infection with SARS-CoV-2 may lead to accelerated cardiovascular disease. We outline the details of the worsening health problems caused by Long COVID, which exacerbate pre-existing conditions such as endothelial dysfunction. The overlapping mechanisms of HIV and SARS-CoV-2, particularly the prolonged inflammatory response and chronic hypoxia, may increase susceptibility to Long COVID. Addressing these overlapping health issues is critical as it provides clinical entry points for interventions that could improve and enhance outcomes and quality of life for those affected by both HIV and Long COVID in the region.
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Affiliation(s)
- Theresa Chikopela
- Department of Human Physiology, Faculty of Medicine, Lusaka Apex Medical University, Lusaka, Zambia
| | - Naome Mwesigwa
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA
| | - Sepiso K Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Annet Kirabo
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA.
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Mauro M, Cegolon L, Bestiaco N, Zulian E, Larese Filon F. Heart Rate Variability Modulation Through Slow-Paced Breathing in Health Care Workers with Long COVID: A Case-Control Study. Am J Med 2024:S0002-9343(24)00339-5. [PMID: 38795941 DOI: 10.1016/j.amjmed.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Long COVID is a syndrome persisting 12+ weeks after COVID-19 infection, impacting life and work ability. Autonomic nervous system imbalance has been hypothesized as the cause. This study aims to investigate cardiovascular autonomic function in health care workers (HCWs) with Long COVID and the effectiveness of slow-paced breathing (SPB) on autonomic modulation. METHODS From December 1, 2022 to March 31, 2023, 6655 HCWs of the University Hospitals of Trieste (Northeast Italy) were asked to participate in the study by company-email. Inclusion/exclusion criteria were assessed. Global health status and psychosomatic disorders were evaluated through validated questionnaires. Heart rate variability was assessed by finger-photoplethysmography during spontaneous breathing and SPB, which stimulate vagal response. Long COVID HCWs (G1) were contrasted with Never infected (G2) and Fully recovered COVID-19 workers (G3). RESULTS There were 126 HCWs evaluated. The 58 Long COVID were assessed at a median time because COVID-19 of 419.5 days (interquartile range 269-730) and had significantly more psychosomatic symptoms and lower detectability of spontaneous systolic pressure oscillation at 0.1 Hz (Mayer wave - baroreflex arc) during spontaneous breathing compared with 53 never-infected and 14 fully-recovered HCWs (19%, 42%, and 40%, respectively, P = .027). During SPB, the increase in this parameter was close to controls (91.2%, 100%, and 100%, respectively, P = .09). No other differences in heart rate variability parameters were found among groups. CONCLUSIONS Resting vascular modulation was reduced in Long COVID, while during SPB, baroreflex sensitivity effectively improved. Long-term studies are needed to evaluate whether multiple sessions of breathing exercises can restore basal vascular reactivity and reduce cardiovascular risk in these patients.
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Affiliation(s)
- Marcella Mauro
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Luca Cegolon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Nicoletta Bestiaco
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Elisa Zulian
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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Lin B, Jin L, Li L, Ke J, Lin J. Relationship between ultra-short heart rate variability and short-term mortality in hospitalized COVID-19 patients. J Electrocardiol 2024; 84:32-37. [PMID: 38479053 DOI: 10.1016/j.jelectrocard.2024.02.010] [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: 06/26/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To assess the association between ultra-short heart rate variability (US-HRV) and short-term mortality in patients with COVID-19 and develop prognostic prediction models to identify high-risk patients as early as possible. METHODS A retrospective cohort study was performed on 488 patients diagnosed with COVID-19 and hospitalized in the First Affiliated Hospital of Fujian Medical University from December 2022 to January 2023. 10-s electrocardiogram (ECG) data were available for these patients. The US-HRV parameters including standard deviation of all normal-to-normal R-R intervals (SDNN) and root mean square of successive differences between normal-to-normal R-R intervals (rMSSD) were calculated using Nalong ECG software. The endpoint was short-term mortality, including in-hospital mortality or mortality within 1 week after discharge. RESULTS Of the 488 patients, 76 (15.6%) died. The SDNN and rMSSD in the death group were significantly lower than those in the survival group (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for SDNN and rMSSD to predict mortality was 0.761 and 0.715, respectively. The combined use of SDNN and rMSSD had an AUC of 0.774. The mortality rate in the group with SDNN ≤7.5 ms was higher than that of SDNN >7.5 ms group (P < 0.05). With the decrease of SDNN, the mortality of patients showed an upward trend, and the mortality of patients with SDNN ≤2 ms was the highest (66.7%). Multivariate logistic regression analysis identified SDNN as an independent predictor of prognosis (odds ratio (OR) = 5.791, 95% confidential interval (CI) 1.615-20.765, P = 0.007). The AUC of Model 1 (simple model) was 0.866 (95% CI 0.826-0.905). The AUC of Model 2 (comprehensive model) was 0.914 (95% CI 0.881-0.947). CONCLUSION SDNN was associated with short-term mortality and provided the additional discriminatory power of the risk stratification model for hospitalized COVID-19 patients.
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Affiliation(s)
- Baoying Lin
- Department of Cardiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Lingdan Jin
- Department of Cardiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Lingjia Li
- Department of Cardiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jiaxing Ke
- Department of Cardiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jinxiu Lin
- Department of Cardiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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Ferreira ÁA, Abreu RMD, Teixeira RS, da Silva Neto HR, Roriz PIL, Silveira MS, de Novaes Assis Dantas FM, De Andrade AD, Schwingel PA, Neves VR. Applicability of heart rate variability for cardiac autonomic assessment in long-term COVID patients: A systematic review. J Electrocardiol 2024; 82:89-99. [PMID: 38103537 DOI: 10.1016/j.jelectrocard.2023.12.002] [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: 09/06/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To carry out a systematic review to determine the main methods used to study the heart rate variability (HRV) in individuals after the acute phase of COVID-19. METHODS The study followed the Preferred Items for Reporting for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Web of Science, Scopus and CINAHAL electronic databases were searched from the inception to November 2022. The studies were included if they used HRV assessment based on linear and non-linear methods in long-term COVID-19 patients. Review studies, theses and dissertations, conference abstracts, longitudinal studies, studies conducted on animals and studies that included individuals in the acute phase of the COVID-19 were excluded. The methodological quality of the studies was analyzed using the Joanna Briggs Institute's critical evaluation checklist for cross-sectional analytical studies. RESULTS HRV was mainly assessed using 24-h Holter monitoring in 41.6% (5/12) of the studies, and 12‑lead ECG was used in 33.3% (4/12). Regarding the type of assessment, 66.6% (8/12) of the studies only used linear analysis, where 25% (3/12) used analysis in the time domain, and 41.6% (5/12) used both types. Non-linear methods were combined with the previously cited linear method in 25% (3/12) of the studies. Moreover, 50% (6/12) of the studies demonstrated post-COVID-19 autonomic dysfunction, with an increase in the predominance of cardiac sympathetic modulation. The average score of the evaluation checklist was 6.6, characterized as having reasonable methodological quality. CONCLUSION 24-h Holter and 12‑lead ECG are considered effective tools to assess HRV in post-COVID-19 patients. Furthermore, the findings reveal diverse effects of COVID-19 on the autonomic nervous system's sympathovagal balance, which might be influenced by secondary factors such as disease severity, patients' overall health, evaluation timing, post-infection complications, ventilatory functions, and age.
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Affiliation(s)
- Ádrya Aryelle Ferreira
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Physiotherapy, University of Pernambuco (UPE), Petrolina, PE, Brazil
| | - Raphael Martins de Abreu
- LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, 50 Avenue du Parc des Sports, L-4671 Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, 50 Avenue du Parc des Sports, L-4671 Differdange, Luxembourg.
| | | | | | - Pedro Igor Lustosa Roriz
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Physiotherapy, University of Pernambuco (UPE), Petrolina, PE, Brazil
| | - Matheus Sobral Silveira
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Nutrition, University of Pernambuco (UPE), Petrolina, PE, Brazil
| | | | - Armele Dornelas De Andrade
- Postgraduation Program in Physiotherapy of the Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | - Paulo Adriano Schwingel
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Nutrition, University of Pernambuco (UPE), Petrolina, PE, Brazil
| | - Victor Ribeiro Neves
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Physiotherapy, University of Pernambuco (UPE), Petrolina, PE, Brazil
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Youssef A, Ulloa L. Ethical and Legal Debates on Vaccine Infodemics. Cureus 2024; 16:e52566. [PMID: 38371094 PMCID: PMC10874613 DOI: 10.7759/cureus.52566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Over the course of three and a half years, the global toll of coronavirus disease 2019 (COVID-19) has claimed the lives of millions of individuals. Scientific breakthroughs, exemplified by mRNA vaccines, have emerged as crucial tools in saving numerous lives and fortifying our defenses against future pandemics. However, the battle against the virus has been complicated by the dissemination of misleading political and ethical information, resulting in avoidable fatalities. Recognizing this phenomenon, the term 'infodemics' has been coined to denote the proliferation of false or misleading information that hinders effective social responses. Given the historical prevalence of infodemics surrounding vaccinations, this discussion delves into the ongoing ethical and legal deliberations concerning vaccination mandates, an indispensable health intervention in the face of pandemics. Governments bear the responsibility of safeguarding their citizens, acknowledging the social requirements imposed by the collective well-being. The protection of both citizens and healthcare workers becomes paramount, considering the potential risks of infection and mortality associated with individuals refusing vaccination. Historically, governments have played a pivotal role in eradicating pandemics through the implementation of vaccine mandates. However, the contemporary landscape is marked by the infusion of political and misleading misinformation, presenting new challenges. Governments are now confronted with an ethical duty to ensure that citizens possess the necessary information to make informed decisions and safeguard their well-being. While grappling with the realization that extraordinary circumstances demand extraordinary responses, the lessons from past pandemics underscore the imperative of prioritizing public health, especially in the context of the high numbers of casualties worldwide. This discourse explores the ethical and legal dimensions surrounding vaccine mandates, with particular emphasis on their relevance to healthcare workers.
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Affiliation(s)
- Ayman Youssef
- Anesthesiology and Perioperative Medicine, Duke University Medical Center, Durham, USA
| | - Luis Ulloa
- Anesthesiology and Perioperative Medicine, Duke University Medical Center, Durham, USA
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Boahen A, Hu D, Adams MJ, Nicholls PK, Greene WK, Ma B. Bidirectional crosstalk between the peripheral nervous system and lymphoid tissues/organs. Front Immunol 2023; 14:1254054. [PMID: 37767094 PMCID: PMC10520967 DOI: 10.3389/fimmu.2023.1254054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The central nervous system (CNS) influences the immune system generally by regulating the systemic concentration of humoral substances (e.g., cortisol and epinephrine), whereas the peripheral nervous system (PNS) communicates specifically with the immune system according to local interactions/connections. An imbalance between the components of the PNS might contribute to pathogenesis and the further development of certain diseases. In this review, we have explored the "thread" (hardwiring) of the connections between the immune system (e.g., primary/secondary/tertiary lymphoid tissues/organs) and PNS (e.g., sensory, sympathetic, parasympathetic, and enteric nervous systems (ENS)) in health and disease in vitro and in vivo. Neuroimmune cell units provide an anatomical and physiological basis for bidirectional crosstalk between the PNS and the immune system in peripheral tissues, including lymphoid tissues and organs. These neuroimmune interactions/modulation studies might greatly contribute to a better understanding of the mechanisms through which the PNS possibly affects cellular and humoral-mediated immune responses or vice versa in health and diseases. Physical, chemical, pharmacological, and other manipulations of these neuroimmune interactions should bring about the development of practical therapeutic applications for certain neurological, neuroimmunological, infectious, inflammatory, and immunological disorders/diseases.
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Affiliation(s)
- Angela Boahen
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri-Kembangan, Selangor, Malaysia
| | - Dailun Hu
- Department of Pathogenic Biology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Murray J. Adams
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
| | - Philip K. Nicholls
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
| | - Wayne K. Greene
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
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Latchman PL, Yang Q, Morgenthaler D, Kong L, Sebagisha J, Melendez L, Green CA, Bernard S, Mugno R, De Meersman R. Autonomic modulation, spontaneous baroreflex sensitivity and fatigue in young men after COVID-19. Physiol Res 2023; 72:329-336. [PMID: 37449746 PMCID: PMC10669003 DOI: 10.33549/physiolres.935051] [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: 12/12/2022] [Accepted: 03/16/2023] [Indexed: 08/26/2023] Open
Abstract
Impaired autonomic modulation and baroreflex sensitivity (BRS) have been reported during and after COVID-19. Both impairments are associated with negative cardiovascular outcomes. If these impairments were to exist undetected in young men after COVID-19, they could lead to negative cardiovascular outcomes. Fatigue is associated with autonomic dysfunction during and after COVID-19. It is unclear if fatigue can be used as an indicator of impaired autonomic modulation and BRS after COVID-19. This study aims to compare parasympathetic modulation, sympathetic modulation, and BRS between young men who had COVID-19 versus controls and to determine if fatigue is associated with impaired autonomic modulation and BRS. Parasympathetic modulation as the high-frequency power of R-R intervals (lnHFR-R), sympathetic modulation as the low-frequency power of systolic blood pressure variability (LFSBP), and BRS as the -index were measured by power spectral density analysis. These variables were compared between 20 young men who had COVID-19 and 24 controls. Independent t-tests and Mann-Whitney U tests indicated no significant difference between the COVID-19 and the control group in: lnHFR-R, P=0.20; LFSBP, P=0.11, and -index, P=0.20. Fatigue was not associated with impaired autonomic modulation or BRS. There is no difference in autonomic modulations or BRS between young men who had COVID-19 compared to controls. Fatigue did not seem to be associated with impaired autonomic modulation or impaired BRS in young men after COVID-19. Findings suggest that young men might not be at increased cardiovascular risk from COVID-19-related dysautonomia and impaired BRS.
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Affiliation(s)
- P L Latchman
- Southern Connecticut State University, New Haven, Connecticut, U.S.A.
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Shelukhina I, Siniavin A, Kasheverov I, Ojomoko L, Tsetlin V, Utkin Y. α7- and α9-Containing Nicotinic Acetylcholine Receptors in the Functioning of Immune System and in Pain. Int J Mol Sci 2023; 24:ijms24076524. [PMID: 37047495 PMCID: PMC10095066 DOI: 10.3390/ijms24076524] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Nicotinic acetylcholine receptors (nAChRs) present as many different subtypes in the nervous and immune systems, muscles and on the cells of other organs. In the immune system, inflammation is regulated via the vagus nerve through the activation of the non-neuronal α7 nAChR subtype, affecting the production of cytokines. The analgesic properties of α7 nAChR-selective compounds are mostly based on the activation of the cholinergic anti-inflammatory pathway. The molecular mechanism of neuropathic pain relief mediated by the inhibition of α9-containing nAChRs is not fully understood yet, but the role of immune factors in this process is becoming evident. To obtain appropriate drugs, a search of selective agonists, antagonists and modulators of α7- and α9-containing nAChRs is underway. The naturally occurring three-finger snake α-neurotoxins and mammalian Ly6/uPAR proteins, as well as neurotoxic peptides α-conotoxins, are not only sophisticated tools in research on nAChRs but are also considered as potential medicines. In particular, the inhibition of the α9-containing nAChRs by α-conotoxins may be a pathway to alleviate neuropathic pain. nAChRs are involved in the inflammation processes during AIDS and other viral infections; thus they can also be means used in drug design. In this review, we discuss the role of α7- and α9-containing nAChRs in the immune processes and in pain.
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Affiliation(s)
| | | | | | | | | | - Yuri Utkin
- Correspondence: or ; Tel.: +7-495-3366522
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Pinto TP, Inácio JC, de Aguiar Ferreira E, de Sá Ferreira A, Sudo FK, Tovar-Moll F, Rodrigues E. Prefrontal tDCS modulates autonomic responses in COVID-19 inpatients. Brain Stimul 2023; 16:657-666. [PMID: 36940750 PMCID: PMC10027235 DOI: 10.1016/j.brs.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND maladaptive changes in the autonomic nervous system (ANS) have been observed in short and long-term phases of COVID-19 infection. Identifying effective treatments to modulate autonomic imbalance could be a strategy for preventing and reducing disease severity and induced complications. OBJECTIVE to investigate the efficacy, safety, and feasibility of a single session of bihemispheric prefrontal tDCS on indicators of cardiac autonomic regulation and mood of COVID-19 inpatients. METHODS patients were randomized to receive a single 30-minute session of bihemispheric active tDCS over the dorsolateral prefrontal cortex (2mA; n = 20) or sham (n = 20). Changes in time [post-pre intervention] in heart rate variability (HRV), mood, heart rate, respiratory rate, and oxygen saturation were compared between groups. Additionally, clinical worsening indicators and the occurrence of falls and skin injuries were evaluated. The Brunoni Adverse Effects Questionary was employed after the intervention. RESULTS there was a large effect size (Hedges' g = 0.7) of intervention on HRV frequency parameters, suggesting alterations in cardiac autonomic regulation. An increment in oxygen saturation was observed in the active group but not in the sham after the intervention (P = 0.045). There were no group differences regarding mood, incidence and intensity of adverse effects, no occurrence of skin lesions, falls, or clinical worsening. CONCLUSIONS a single prefrontal tDCS session is safe and feasible to modulate indicators of cardiac autonomic regulation in acute COVID-19 inpatients. Further research comprising a thorough assessment of autonomic function and inflammatory biomarkers is required to verify its potential to manage autonomic dysfunctions, mitigate inflammatory responses and enhance clinical outcomes.
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Affiliation(s)
- Talita P Pinto
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro 30, Botafogo, 22281-100, Rio de Janeiro, Brazil.
| | - Jacqueline Cunha Inácio
- Programa de Pós-Graduação Em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Erivelton de Aguiar Ferreira
- Programa de Pós-Graduação Em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Arthur de Sá Ferreira
- Programa de Pós-Graduação Em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Felipe Kenji Sudo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro 30, Botafogo, 22281-100, Rio de Janeiro, Brazil.
| | - Fernanda Tovar-Moll
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro 30, Botafogo, 22281-100, Rio de Janeiro, Brazil.
| | - Erika Rodrigues
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro 30, Botafogo, 22281-100, Rio de Janeiro, Brazil; Programa de Pós-Graduação Em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
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Hassan L, Ahsan Z, Bint E Riaz H. An Unusual Case of Blackout in a COVID-19 Patient: COVID-19 Brain Fog. Cureus 2023; 15:e36273. [PMID: 37073192 PMCID: PMC10105897 DOI: 10.7759/cureus.36273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature. COVID-19 is associated with a long-COVID syndrome that presents with cognitive decline and fatigue. Recent studies show the emergence of a novel syndrome known as post-acute COVID syndrome or long COVID, which constitutes a variety of symptoms that continue for four weeks following the onset of a COVID-19 diagnosis. Numerous post-COVID patients experience both short and long-lasting symptoms affecting several organs, including the brain, which includes being unconscious, bradyphrenia, or amnesia. This long COVID status comprises of "brain fog", which, coupled with neuro-cognitive effects, has a significant role in prolonging the recovery phase. The pathogenesis of brain fog is currently unknown. One of the leading causes might be the involvement of neuroinflammation due to mast cells stimulated by pathogenic and stress stimuli. This in turn, triggers the release of mediators that activate microglia, causing inflammation in the hypothalamus. Its ability to invade the nervous system through trans-neural or hematogenous mechanisms is possibly the chief cause behind the presenting symptoms. This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature and how it may lead to neurologic complications such as meningitis, encephalitis, and Guillain-Barré syndrome.
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Cabral-Marques O, Moll G, Catar R, Preuß B, Bankamp L, Pecher AC, Henes J, Klein R, Kamalanathan AS, Akbarzadeh R, van Oostveen W, Hohberger B, Endres M, Koolmoes B, Levarht N, Postma R, van Duinen V, van Zonneveld AJ, de Vries-Bouwstra J, Fehres C, Tran F, do Vale FYN, da Silva Souza KB, Filgueiras IS, Schimke LF, Baiocchi GC, de Miranda GC, da Fonseca DLM, Freire PP, Hackel AM, Grasshoff H, Stähle A, Müller A, Dechend R, Yu X, Petersen F, Sotzny F, Sakmar TP, Ochs HD, Schulze-Forster K, Heidecke H, Scheibenbogen C, Shoenfeld Y, Riemekasten G. Autoantibodies targeting G protein-coupled receptors: An evolving history in autoimmunity. Report of the 4th international symposium. Autoimmun Rev 2023; 22:103310. [PMID: 36906052 DOI: 10.1016/j.autrev.2023.103310] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
G protein-coupled receptors (GPCR) are involved in various physiological and pathophysiological processes. Functional autoantibodies targeting GPCRs have been associated with multiple disease manifestations in this context. Here we summarize and discuss the relevant findings and concepts presented in the biennial International Meeting on autoantibodies targeting GPCRs (the 4th Symposium), held in Lübeck, Germany, 15-16 September 2022. The symposium focused on the current knowledge of these autoantibodies' role in various diseases, such as cardiovascular, renal, infectious (COVID-19), and autoimmune diseases (e.g., systemic sclerosis and systemic lupus erythematosus). Beyond their association with disease phenotypes, intense research related to the mechanistic action of these autoantibodies on immune regulation and pathogenesis has been developed, underscoring the role of autoantibodies targeting GPCRs on disease outcomes and etiopathogenesis. The observation repeatedly highlighted that autoantibodies targeting GPCRs could also be present in healthy individuals, suggesting that anti-GPCR autoantibodies play a physiologic role in modeling the course of diseases. Since numerous therapies targeting GPCRs have been developed, including small molecules and monoclonal antibodies designed for treating cancer, infections, metabolic disorders, or inflammatory conditions, anti-GPCR autoantibodies themselves can serve as therapeutic targets to reduce patients' morbidity and mortality, representing a new area for the development of novel therapeutic interventions.
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Affiliation(s)
- Otávio Cabral-Marques
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil; Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil; Department of Pharmacy and Postgraduate Program of Health and Science, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil.
| | - Guido Moll
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany; BIH Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), all Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Rusan Catar
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Beate Preuß
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Lukas Bankamp
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Ann-Christin Pecher
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Joerg Henes
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Reinhild Klein
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - A S Kamalanathan
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Reza Akbarzadeh
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Wieke van Oostveen
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Bettina Hohberger
- Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Bryan Koolmoes
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Nivine Levarht
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Rudmer Postma
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Vincent van Duinen
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Anton Jan van Zonneveld
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Jeska de Vries-Bouwstra
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Cynthia Fehres
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Fernando Yuri Nery do Vale
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Igor Salerno Filgueiras
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lena F Schimke
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gabriela Crispim Baiocchi
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gustavo Cabral de Miranda
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Dennyson Leandro Mathias da Fonseca
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Paula Paccielli Freire
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Alexander M Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Stähle
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Antje Müller
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, A collaboration of Max Delbruck Center for Molecular Medicine and Charité Universitätsmedizin, and HELIOS Clinic, Department of Cardiology and Nephrology, Berlin 13125, Germany
| | - Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Franziska Sotzny
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Thomas P Sakmar
- Laboratory of Chemical Biology and Signal Transduction, The Rockefeller University, New York, NY, USA
| | - Hans D Ochs
- University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.
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12
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Tillman TS, Chen Q, Bondarenko V, Coleman JA, Xu Y, Tang P. SARS-CoV-2 Spike Protein Downregulates Cell Surface α7nAChR through a Helical Motif in the Spike Neck. ACS Chem Neurosci 2023; 14:689-698. [PMID: 36745901 PMCID: PMC9923440 DOI: 10.1021/acschemneuro.2c00610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A deficiency of the functional α7 nicotinic acetylcholine receptor (α7nAChR) impairs neuronal and immune systems. The SARS-CoV-2 spike protein (S12) facilitates virus cell entry during COVID-19 infection and can also independently disrupt cellular functions. Here, we found that S12 expression significantly downregulated surface expression of α7nAChR in mammalian cells. A helical segment of S12 (L1145-L1152) in the spike neck was identified to be responsible for the downregulation of α7nAChR, as the mutant S12AAA (L1145A-F1148A-L1152A) had minimal effects on surface α7nAChR expression. This S12 segment is homologous to the α7nAChR intracellular helical motif known for binding chaperone proteins RIC3 and Bcl-2 to promote α7nAChR surface expression. Competition from S12 for binding these proteins likely underlies suppression of surface α7nAChR. Considering the critical roles of α7nAChR in cellular functions, these findings provide a new perspective for improving mRNA vaccines and developing treatment options for certain symptoms related to long COVID.
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Affiliation(s)
- Tommy S Tillman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Qiang Chen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Vasyl Bondarenko
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Jonathan A Coleman
- Department of Structural Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Yan Xu
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Structural Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Pei Tang
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
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13
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Kwon CY. The Impact of SARS-CoV-2 Infection on Heart Rate Variability: A Systematic Review of Observational Studies with Control Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:909. [PMID: 36673664 PMCID: PMC9859268 DOI: 10.3390/ijerph20020909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 05/13/2023]
Abstract
Autonomic nervous system (ANS) dysfunction can arise after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and heart rate variability (HRV) tests can assess its integrity. This review investigated the relationship between the impact of SARS-CoV-2 infection on HRV parameters. Comprehensive searches were conducted in four electronic databases. Observational studies with a control group reporting the direct impact of SARS-CoV-2 infection on the HRV parameters in July 2022 were included. A total of 17 observational studies were included in this review. The square root of the mean squared differences of successive NN intervals (RMSSD) was the most frequently investigated. Some studies found that decreases in RMSSD and high frequency (HF) power were associated with SARS-CoV-2 infection or the poor prognosis of COVID-19. Also, decreases in RMSSD and increases in the normalized unit of HF power were related to death in critically ill COVID-19 patients. The findings showed that SARS-CoV-2 infection, and the severity and prognosis of COVID-19, are likely to be reflected in some HRV-related parameters. However, the considerable heterogeneity of the included studies was highlighted. The methodological quality of the included observational studies was not optimal. The findings suggest rigorous and accurate measurements of HRV parameters are highly needed on this topic.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dongeui University, 52-57, Yangjeong-ro, Busanjin-gu, Busan 47227, Republic of Korea
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14
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Kaniusas E, Fudim M, Czura CJ, Panetsos F. Editorial: Neuromodulation in COVID-19: From basic research to clinical applications. Front Physiol 2023; 14:1148819. [PMID: 36875048 PMCID: PMC9978783 DOI: 10.3389/fphys.2023.1148819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Eugenijus Kaniusas
- Instutute of Biomedical Electronics, Faculty of Electrical Engineering and Information Technology, Vienna University of Technology (TU Wien), Vienna, Austria
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, United States.,Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | | | - Fivos Panetsos
- Neurocomputing and Neurorobotics Research Group, Universidad Complutense de Madrid, Madrid, Spain.,Institute for Health Research (IdISSC), San Carlos Clinical Hospital, Madrid, Spain.,Silk Biomed SL, Madrid, Spain
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15
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Province VM, Szeghy RE, Stute NL, Augenreich MA, Behrens CE, Stickford JL, Stickford ASL, Ratchford S. Tracking peripheral vascular function for six months in young adults following SARS-CoV-2 infection. Physiol Rep 2022; 10:e15552. [PMID: 36541342 PMCID: PMC9768737 DOI: 10.14814/phy2.15552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023] Open
Abstract
SARS-CoV-2 infection is known to instigate a range of physiologic perturbations, including vascular dysfunction. However, little work has concluded how long these effects may last, especially among young adults with mild symptoms. To determine potential recovery from acute vascular dysfunction in young adults (8 M/8F, 21 ± 1 yr, 23.5 ± 3.1 kg⋅m-2 ), we longitudinally tracked brachial artery flow-mediated dilation (FMD) and reactive hyperemia (RH) in the arm and hyperemic response to passive limb movement (PLM) in the leg, with Doppler ultrasound, as well as circulating biomarkers of inflammation (interleukin-6, C-reactive protein), oxidative stress (thiobarbituric acid reactive substances, protein carbonyl), antioxidant capacity (superoxide dismutase), and nitric oxide bioavailability (nitrite) monthly for a 6-month period post-SARS-CoV-2 infection. FMD, as a marker of macrovascular function, improved from month 1 (3.06 ± 1.39%) to month 6 (6.60 ± 2.07%; p < 0.001). FMD/Shear improved from month one (0.10 ± 0.06 AU) to month six (0.18 ± 0.70 AU; p = 0.002). RH in the arm and PLM in the leg, as markers of microvascular function, did not change during the 6 months (p > 0.05). Circulating markers of inflammation, oxidative stress, antioxidant capacity, and nitric oxide bioavailability did not change during the 6 months (p > 0.05). Together, these results suggest some improvements in macrovascular, but not microvascular function, over 6 months following SARS-CoV-2 infection. The data also suggest persistent ramifications for cardiovascular health among those recovering from mild illness and among young, otherwise healthy adults with SARS-CoV-2.
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Affiliation(s)
- Valesha M. Province
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Rachel E. Szeghy
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Nina L. Stute
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Marc A. Augenreich
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Christian E. Behrens
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Jonathon L. Stickford
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | | | - Stephen M. Ratchford
- Department of Health & Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
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16
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DePace NL, Colombo J. Long-COVID Syndrome and the Cardiovascular System: A Review of Neurocardiologic Effects on Multiple Systems. Curr Cardiol Rep 2022; 24:1711-1726. [PMID: 36178611 PMCID: PMC9524329 DOI: 10.1007/s11886-022-01786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of (1) angiotensin-converting enzyme 2 receptors (the entry points for the virus), (2) inflammation, and (3) oxidative stress (the resultant effects of the virus). RECENT FINDINGS These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology. Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).
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Affiliation(s)
- Nicholas L. DePace
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
| | - Joe Colombo
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
- CTO and Sr. Medical Director, Physio PS, Inc, Atlanta, GA USA
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17
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Eldokla AM, Ali ST. Autonomic function testing in long-COVID syndrome patients with orthostatic intolerance. Auton Neurosci 2022; 241:102997. [DOI: 10.1016/j.autneu.2022.102997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/08/2022] [Accepted: 05/30/2022] [Indexed: 12/26/2022]
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18
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Czura CJ, Bikson M, Charvet L, Chen JDZ, Franke M, Fudim M, Grigsby E, Hamner S, Huston JM, Khodaparast N, Krames E, Simon BJ, Staats P, Vonck K. Neuromodulation Strategies to Reduce Inflammation and Improve Lung Complications in COVID-19 Patients. Front Neurol 2022; 13:897124. [PMID: 35911909 PMCID: PMC9329660 DOI: 10.3389/fneur.2022.897124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiated to identify and develop disease modifying or preventative therapeutic strategies has been initiated. The primary focus has been on pharmacological treatment of the immune and respiratory system and the development of a vaccine. The hyperinflammatory state ("cytokine storm") observed in many cases of COVID-19 indicates a prognostically negative disease progression that may lead to respiratory distress, multiple organ failure, shock, and death. Many critically ill patients continue to be at risk for significant, long-lasting morbidity or mortality. The human immune and respiratory systems are heavily regulated by the central nervous system, and intervention in the signaling of these neural pathways may permit targeted therapeutic control of excessive inflammation and pulmonary bronchoconstriction. Several technologies, both invasive and non-invasive, are available and approved for clinical use, but have not been extensively studied in treatment of the cytokine storm in COVID-19 patients. This manuscript provides an overview of the role of the nervous system in inflammation and respiration, the current understanding of neuromodulatory techniques from preclinical and clinical studies and provides a rationale for testing non-invasive neuromodulation to modulate acute systemic inflammation and respiratory dysfunction caused by SARS-CoV-2 and potentially other pathogens. The authors of this manuscript have co-founded the International Consortium on Neuromodulation for COVID-19 to advocate for and support studies of these technologies in the current coronavirus pandemic.
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Affiliation(s)
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Jiande D. Z. Chen
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | | | - Marat Fudim
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | | | - Sam Hamner
- Cala Health, Burlingame, CA, United States
| | - Jared M. Huston
- Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | | | - Elliot Krames
- Pacific Pain Treatment Center, Napa, CA, United States
| | | | - Peter Staats
- National Spine and Pain, ElectroCore, Inc., Jacksonville, FL, United States
| | - Kristl Vonck
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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19
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Ahmed U, Chang YC, Zafeiropoulos S, Nassrallah Z, Miller L, Zanos S. Strategies for precision vagus neuromodulation. Bioelectron Med 2022; 8:9. [PMID: 35637543 PMCID: PMC9150383 DOI: 10.1186/s42234-022-00091-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022] Open
Abstract
The vagus nerve is involved in the autonomic regulation of physiological homeostasis, through vast innervation of cervical, thoracic and abdominal visceral organs. Stimulation of the vagus with bioelectronic devices represents a therapeutic opportunity for several disorders implicating the autonomic nervous system and affecting different organs. During clinical translation, vagus stimulation therapies may benefit from a precision medicine approach, in which stimulation accommodates individual variability due to nerve anatomy, nerve-electrode interface or disease state and aims at eliciting therapeutic effects in targeted organs, while minimally affecting non-targeted organs. In this review, we discuss the anatomical and physiological basis for precision neuromodulation of the vagus at the level of nerve fibers, fascicles, branches and innervated organs. We then discuss different strategies for precision vagus neuromodulation, including fascicle- or fiber-selective cervical vagus nerve stimulation, stimulation of vagal branches near the end-organs, and ultrasound stimulation of vagus terminals at the end-organs themselves. Finally, we summarize targets for vagus neuromodulation in neurological, cardiovascular and gastrointestinal disorders and suggest potential precision neuromodulation strategies that could form the basis for effective and safe therapies.
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Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Stefanos Zafeiropoulos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Zeinab Nassrallah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Larry Miller
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
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20
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Lv ZY, Shi YL, Bassi GS, Chen YJ, Yin LM, Wang Y, Ulloa L, Yang YQ, Xu YD. Electroacupuncture at ST36 ( Zusanli) Prevents T-Cell Lymphopenia and Improves Survival in Septic Mice. J Inflamm Res 2022; 15:2819-2833. [PMID: 35535053 PMCID: PMC9078867 DOI: 10.2147/jir.s361466] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Sepsis is the main cause of death in intensive care unit. Maladaptive cytokine storm and T-cell lymphopenia are critical prognosis predictors of sepsis. Electroacupuncture (EA) is expected to be an effective intervention to prevent sepsis. This study aims to determine the potential of EA at ST36 (Zusanli) to prevent experimental septic mice. Methods Mice were randomly assigned into PBS, LPS, or EA+LPS group. EA (0.1 mA, continuous wave, 10 Hz) was performed stimulating the ST36 for 30 min, once a day for 3 days. After the third day, all mice were challenged with PBS or LPS (4 mg/kg) simultaneously. Mice were evaluated for survival, ear temperature, and other clinical symptoms. Lung and small intestine tissue injuries were analyzed by hematoxylin and eosin staining. Bio-Plex cytokine assay was used to analyze the concentration of cytokines. T lymphocytes were analyzed by flow cytometry and Western blot assays. The role of T cells in preventing sepsis by EA was analyzed by using nude mice lacking T lymphocytes. Results EA at ST36 improved survival, symptom scores, and ear temperature of endotoxemic mice. EA also improved dramatically pulmonary and intestinal injury by over 50% as compared to untreated mice. EA blunted the inflammatory cytokine storm by inducing a lasting inhibition of the production of major inflammatory factors (TNF-α, IL-1β, IL-5, IL-6, IL-10, IL-17A, eotaxin, IFN-γ, MIP-1β and KC). Flow cytometry and Western blot analyses showed EA significantly reduced T-lymphocyte apoptosis and pyroptosis. Furthermore, T lymphocytes were critical for the effects of EA at ST36 stimulation blunted serum TNF-α levels in wild-type but not in nude mice. Conclusion EA halted systemic inflammation and improved survival in endotoxemic mice. These effects are associated with the protective effect of EA on T lymphocytes, and T cells are required in the anti-inflammatory effects of EA in sepsis.
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Affiliation(s)
- Zhi-Ying Lv
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yang-Lin Shi
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Gabriel Shimizu Bassi
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yan-Jiao Chen
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Lei-Miao Yin
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yu Wang
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Luis Ulloa
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Yong-Qing Yang
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yu-Dong Xu
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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21
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Tornero C, Pastor E, Garzando MDM, Orduña J, Forner MJ, Bocigas I, Cedeño DL, Vallejo R, McClure CK, Czura CJ, Liebler EJ, Staats P. Non-invasive Vagus Nerve Stimulation for COVID-19: Results From a Randomized Controlled Trial (SAVIOR I). Front Neurol 2022; 13:820864. [PMID: 35463130 PMCID: PMC9028764 DOI: 10.3389/fneur.2022.820864] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Severe coronavirus disease 2019 (COVID-19) is characterized, in part, by an excessive inflammatory response. Evidence from animal and human studies suggests that vagus nerve stimulation can lead to reduced levels of various biomarkers of inflammation. We conducted a prospective randomized controlled study (SAVIOR-I) to assess the feasibility, efficacy, and safety of non-invasive vagus nerve stimulation (nVNS) for the treatment of respiratory symptoms and inflammatory markers among patients who were hospitalized for COVID-19 (ClinicalTrials.gov identifier: NCT04368156). Methods Participants were randomly assigned in a 1:1 allocation to receive either the standard of care (SoC) alone or nVNS therapy plus the SoC. The nVNS group received 2 consecutive 2-min doses of nVNS 3 times daily as prophylaxis. Efficacy and safety were evaluated via the incidence of specific clinical events, inflammatory biomarker levels, and the occurrence of adverse events. Results Of the 110 participants who were enrolled and randomly assigned, 97 (nVNS, n = 47; SoC, n = 50) had sufficient available data and comprised the evaluable population. C-reactive protein (CRP) levels decreased from baseline to a significantly greater degree in the nVNS group than in the SoC group at day 5 and overall (i.e., all postbaseline data points collected through day 5, combined). Procalcitonin level also showed significantly greater decreases from baseline to day 5 in the nVNS group than in the SoC group. D-dimer levels were decreased from baseline for the nVNS group and increased from baseline for the SoC group at day 5 and overall, although the difference between the treatment groups did not reach statistical significance. No significant treatment differences were seen for clinical respiratory outcomes or any of the other biochemical markers evaluated. No serious nVNS-related adverse events occurred during the study. Conclusions nVNS therapy led to significant reductions in levels of inflammatory markers, specifically CRP and procalcitonin. Because nVNS has multiple mechanisms of action that may be relevant to COVID-19, additional research into its potential use earlier in the course of COVID-19 and its potential to mitigate some of the symptoms associated with post-acute sequelae of COVID-19 is warranted.
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Affiliation(s)
- Carlos Tornero
- Hospital Clínico Universitario de Valencia, Anesthesia, Critical Care and Pain Management Unit, Valencia, Spain
- Cátedra Dolor, UFV-Fundación Vithas, Madrid, Spain
| | - Ernesto Pastor
- Hospital Clínico Universitario de Valencia, Anesthesia, Critical Care and Pain Management Unit, Valencia, Spain
| | - María del Mar Garzando
- Hospital Clínico Universitario de Valencia, Anesthesia, Critical Care and Pain Management Unit, Valencia, Spain
| | - Jorge Orduña
- Hospital Clínico Universitario de Valencia, Anesthesia, Critical Care and Pain Management Unit, Valencia, Spain
| | - Maria J. Forner
- Hospital Clínico Universitario de Valencia, Internal Medicine Department, Valencia, Spain
| | - Irene Bocigas
- Hospital Clínico Universitario de Valencia, Pulmonary Department, Valencia, Spain
| | - David L. Cedeño
- Department of Basic Science, Millennium Pain Center, Bloomington, IL, United States
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, United States
| | - Ricardo Vallejo
- Department of Basic Science, Millennium Pain Center, Bloomington, IL, United States
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, United States
| | | | | | | | - Peter Staats
- electroCore, Inc., Rockaway, NJ, United States
- *Correspondence: Peter Staats
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22
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Eldokla AM, Mohamed-Hussein AA, Fouad AM, Abdelnaser MG, Ali ST, Makhlouf NA, Sayed IG, Makhlouf HA, Shah J, Aiash H. Prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome: A cross-sectional study. Ann Clin Transl Neurol 2022; 9:778-785. [PMID: 35393771 PMCID: PMC9110879 DOI: 10.1002/acn3.51557] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The association between autonomic dysfunction and long-COVID syndrome is established. However, the prevalence and patterns of symptoms of dysautonomia in long-COVID syndrome in a large population are lacking. OBJECTIVE To evaluate the prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome. METHODS We administered the Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire to a sample of post-COVID-19 patients who were referred to post-COVID clinic in Assiut University Hospitals, Egypt for symptoms concerning for long-COVID syndrome. Participants were asked to complete the COMPASS-31 questionnaire referring to the period of more than 4 weeks after acute COVID-19. RESULTS We included 320 patients (35.92 ± 11.92 years, 73% females). The median COMPASS-31 score was 26.29 (0-76.73). The most affected domains of dysautonomia were gastrointestinal, secretomotor, and orthostatic intolerance with 91.6%, 76.4%, and 73.6%, respectively. There was a positive correlation between COMPASS-31 score and long-COVID duration (p < 0.001) and a positive correlation between orthostatic intolerance domain score and post-COVID duration (p < 0.001). There was a positive correlation between orthostatic intolerance domain score and age of participants (p = 0.004). Two hundred forty-seven patients (76.7%) had a high score of COMPASS-31 >16.4. Patients with COMPASS-31 >16.4 had a longer duration of long-COVID syndrome than those with score <16.4 (46.2 vs. 26.8 weeks, p < 0.001). CONCLUSIONS Symptoms of dysautonomia are common in long-COVID syndrome. The most common COMPASS-31 affected domains of dysautonomia are gastrointestinal, secretomotor, and orthostatic intolerance. There is a positive correlation between orthostatic intolerance domain score and patients' age.
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Affiliation(s)
- Ahmed M Eldokla
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, New York, 13210, USA.,Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York, 13210, USA
| | | | - Ahmed M Fouad
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Sara T Ali
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, New York, 13210, USA
| | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam G Sayed
- Chest Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Hoda A Makhlouf
- Chest Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Jaffer Shah
- New York State Department of Health, Albany, New York, USA
| | - Hani Aiash
- Department of Family Medicine, Suez Canal University, Ismailia, Egypt.,Department of Cardiovascular Perfusion, State University of New York, Upstate Medical University, Syracuse, New York, 13210, USA
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23
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Kopańska M, Batoryna M, Bartman P, Szczygielski J, Banaś-Ząbczyk A. Disorders of the Cholinergic System in COVID-19 Era-A Review of the Latest Research. Int J Mol Sci 2022; 23:ijms23020672. [PMID: 35054856 PMCID: PMC8775685 DOI: 10.3390/ijms23020672] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
The appearance of the SARS-CoV-2 virus initiated many studies on the effects of the virus on the human body. So far, its negative influence on the functioning of many morphological and physiological units, including the nervous system, has been demonstrated. Consequently, research has been conducted on the changes that SARS-CoV-2 may cause in the cholinergic system. The aim of this study is to review the latest research from the years 2020/2021 regarding disorders in the cholinergic system caused by the SARS-CoV-2 virus. As a result of the research, it was found that the presence of the COVID-19 virus disrupts the activity of the cholinergic system, for example, causing the development of myasthenia gravis or a change in acetylcholine activity. The SARS-CoV-2 spike protein has a sequence similar to neurotoxins, capable of binding nicotinic acetylcholine receptors (nAChR). This may be proof that SARS-CoV-2 can bind nAChR. Nicotine and caffeine have similar structures to antiviral drugs, capable of binding angiotensin-converting enzyme 2 (ACE 2) epitopes that are recognized by SARS-CoV-2, with the potential to inhibit the formation of the ACE 2/SARS-CoV-2 complex. The blocking is enhanced when nicotine and caffeine are used together with antiviral drugs. This is proof that nAChR agonists can be used along with antiviral drugs in COVID-19 therapy. As a result, it is possible to develop COVID-19 therapies that use these compounds to reduce cytokine production. Another promising therapy is non-invasive stimulation of the vagus nerve, which soothes the body’s cytokine storm. Research on the influence of COVID-19 on the cholinergic system is an area that should continue to be developed as there is a need for further research. It can be firmly stated that COVID-19 causes a dysregulation of the cholinergic system, which leads to a need for further research, because there are many promising therapies that will prevent the SARS-CoV-2 virus from binding to the nicotinic receptor. There is a need for further research, both in vitro and in vivo. It should be noted that in the functioning of the cholinergic system and its connection with the activity of the COVID-19 virus, there might be many promising dependencies and solutions.
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Affiliation(s)
- Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- Correspondence:
| | - Marta Batoryna
- Sensusmed, Psychotherapy and Neurorehabilitation Center, 30-084 Cracow, Poland;
| | - Paulina Bartman
- Students Science Club “Reh-Tech”, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Jacek Szczygielski
- Department of Neurosurgery, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
- Department of Neurosurgery, Faculty of Medicine, Saarland University, 66424 Homburg, Germany
| | - Agnieszka Banaś-Ząbczyk
- Departament of Biology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
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24
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Beil J, Gatti A, Leonhard B, Schroer H. A case report of severe cardioinhibitory reflex syncope associated with coronavirus disease 2019. Eur Heart J Case Rep 2022; 6:ytab524. [PMID: 35098018 PMCID: PMC8780476 DOI: 10.1093/ehjcr/ytab524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been recognized as a disease with a broad spectrum of clinical manifestations. In this report, we illustrate an extraordinary case of severe cardioinhibitory reflex syncope with prolonged asystole associated with COVID-19. CASE SUMMARY A 35-year-old male patient presented to the emergency department with a 10-day history of postural syncope and fever. Electrocardiogram monitoring during positional change revealed reflex syncope with cardioinhibitory response, exhibiting sinus bradycardia, subsequent asystole, and syncope. The patient tested positive for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and was admitted to the intensive care unit where temporary transvenous pacing was necessary because of prolonged episodes of asystole. Work-up included extensive cardiac and neurological diagnostic testing, but did not yield any structural abnormalities. Although temporary pacing was able to abort syncope, a decision was made to hold off on permanent pacing as the most likely aetiology was felt to be temporary cardioinhibitory reflex syncope associated with COVID-19. The patient was discharged with mild symptoms of orthostatic intolerance and responded well to education and lifestyle modification. Outpatient follow-up with repeat tilt testing after 3 and 6 months initially showed residual inducible syncope but was eventually normal and the patient remained asymptomatic. DISCUSSION We believe that autonomic imbalance with a strong vagal activation due to acute SARS-CoV-2 infection played a pivotal role in the occurrence of transient syncope in this patient's condition. Although pacemaker implantation would have been a reasonable alternative, a watch-and-wait approach should be considered in similar instances.
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Affiliation(s)
- Johannes Beil
- Department of Internal Medicine/Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | - Alessia Gatti
- Department of Internal Medicine/Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | - Bruch Leonhard
- Department of Internal Medicine/Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | - Hinrich Schroer
- Department of Internal Medicine/Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
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25
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Shah B, Kunal S, Bansal A, Jain J, Poundrik S, Shetty MK, Batra V, Chaturvedi V, Yusuf J, Mukhopadhyay S, Tyagi S, Meenahalli Palleda G, Gupta A, Gupta MD. Heart rate variability as a marker of cardiovascular dysautonomia in post-COVID-19 syndrome using artificial intelligence. Indian Pacing Electrophysiol J 2022; 22:70-76. [PMID: 35101582 PMCID: PMC8800539 DOI: 10.1016/j.ipej.2022.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Cardiovascular dysautonomia comprising postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH) is one of the presentations in COVID-19 recovered subjects. We aim to determine the prevalence of cardiovascular dysautonomia in post COVID-19 patients and to evaluate an Artificial Intelligence (AI) model to identify time domain heart rate variability (HRV) measures most suitable for short term ECG in these subjects. Methods This observational study enrolled 92 recently COVID-19 recovered subjects who underwent measurement of heart rate and blood pressure response to standing up from supine position and a 12-lead ECG recording for 60 s period during supine paced breathing. Using feature extraction, ECG features including those of HRV (RMSSD and SDNN) were obtained. An AI model was constructed with ShAP AI interpretability to determine time domain HRV features representing post COVID-19 recovered state. In addition, 120 healthy volunteers were enrolled as controls. Results Cardiovascular dysautonomia was present in 15.21% (OH:13.04%; POTS:2.17%). Patients with OH had significantly lower HRV and higher inflammatory markers. HRV (RMSSD) was significantly lower in post COVID-19 patients compared to healthy controls (13.9 ± 11.8 ms vs 19.9 ± 19.5 ms; P = 0.01) with inverse correlation between HRV and inflammatory markers. Multiple perceptron was best performing AI model with HRV(RMSSD) being the top time domain HRV feature distinguishing between COVID-19 recovered patients and healthy controls. Conclusion Present study showed that cardiovascular dysautonomia is common in COVID-19 recovered subjects with a significantly lower HRV compared to healthy controls. The AI model was able to distinguish between COVID-19 recovered patients and healthy controls.
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Affiliation(s)
- Bhushan Shah
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Shekhar Kunal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Jayant Jain
- SBILab, Department of ECE, IIIT, Delhi, India
| | | | - Manu Kumar Shetty
- Department of Pharmacology, Maulana Azad Medical College, Delhi, India
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Vivek Chaturvedi
- Senior Consultant Cardiologist and Director Cardiac Electrophysiology, Narayana Superspeciality Hospital, Gurugram, India
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Sanjay Tyagi
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Girish Meenahalli Palleda
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | | | - Mohit Dayal Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
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26
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Skazkina VV, Popov KA, Krasikova NS. Spectral analysis of signals of autonomic regulation of blood circulation in patients with COVID-19 and arterial hypertension. CARDIO-IT 2021. [DOI: 10.15275/cardioit.2021.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The work aims to carry out a comparative analysis of the spectral indices of the photoplethysmogram signals and RR-intervals of healthy volunteers, patients with COVID-19, as well as patients with COVID-19 and chronic arterial hypertension of 1-2 degrees. The study included 45 records of pairs of electrocardiogram and photoplethysmogram signals. Each sample included 15 pairs of 20-minute experimental signals. The study revealed an increase in the integrated power of the low-frequency (LF) band over the integrated power of the high-frequency (HF) band in the photoplethysmogram signals in patients with COVID-19, burdened with hypertension. In the signals of the RR-intervals, the largest values of the ratio of the LF to HF indices are associated with patients without cardiovascular diseases. In turn, this may be an indicator of the different effects of viral infection and arterial hypertension on the loops of autonomic control of heart rate and vascular tone.
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27
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Hassani M, Fathi Jouzdani A, Motarjem S, Ranjbar A, Khansari N. How COVID-19 can cause autonomic dysfunctions and postural orthostatic syndrome? A Review of mechanisms and evidence. NEUROLOGY AND CLINICAL NEUROSCIENCE 2021; 9:434-442. [PMID: 34909198 PMCID: PMC8661735 DOI: 10.1111/ncn3.12548] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 04/14/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a viral disease spread by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because the recent pandemic has resulted in significant morbidity and mortality, understanding various aspects of this disease has become critical. SARS-CoV-2 can affect a variety of organs and systems in the body. The autonomic nervous system plays an important role in regulating body functions, and its dysfunction can cause a great deal of discomfort for patients. In this study, we focused on the effect of COVID-19 on the autonomic system and syndromes associated with it, such as postural orthostatic syndrome (POTS).
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Affiliation(s)
- Mehran Hassani
- Neurosurgery Research Group (NRG)Student Research CommitteeHamadan University of Medical SciencesHamadanIran
| | - Ali Fathi Jouzdani
- Neurosurgery Research Group (NRG)Student Research CommitteeHamadan University of Medical SciencesHamadanIran
| | - Sara Motarjem
- Neurosurgery Research Group (NRG)Student Research CommitteeHamadan University of Medical SciencesHamadanIran
| | - Akram Ranjbar
- Department of Pharmacology and ToxicologySchool of PharmacyHamadan University of Medical SciencesHamadanIran
| | - Nakisa Khansari
- Department of CardiologySchool of MedicineHamadan University of Medical SciencesHamadanIran
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28
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Skazkina VV, Krasikova NS, Borovkova EI, Ishbulatov YM, Gorshkov AY, Korolev AI, Dadaeva VA, Fedorovich AA, Kuligin AV, Drapkina OM, Karavaev AS, Kiselev AR. Synchronization Of Autonomic Control Loops Of Blood Circulation In Patients With COVID-19. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study aims to investigate the strength of synchronization between the autonomic control loops of the cardiovascular system (CVS) in patients with COronaVIrus Disease 2019 (COVID-19). Methods — We calculated the total percent of phase synchronization index (S index) between the loops of autonomic control of heart rate and vascular tone in two sample groups: healthy individuals and COVID-19 patients. Results — The group-average value of the S index in COVID-19 patients is lower comparing to healthy individuals, the Mann-Whitney U-test confirmed that the differences are statistically significant. Conclusion — Obtained results suggest that the decreased value of the S index reflects the presence of a viral disease, and the S index is a promising basis for non-invasive screening diagnostics of viral diseases, particularly of COVID-19.
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Affiliation(s)
- Viktoriia V. Skazkina
- Saratov State University, Saratov, Russia; Lappeenranta University of Technology, Finland
| | | | - Ekaterina I. Borovkova
- Saratov Branch of the Institute of RadioEngineering and Electronics of Russian Academy of Sciences, Saratov, Russia; Saratov State Medical University, Saratov, Russia; Saratov State University, Saratov, Russia
| | - Yurii M. Ishbulatov
- Saratov State Medical University, Saratov, Russia; Saratov State University, Saratov, Russia
| | | | - Andrei I. Korolev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Valida A. Dadaeva
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Andrei A. Fedorovich
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia; Research Center – Institute of Biomedical Problems of the Russian Academy of Sciences (IBMP), Moscow, Russia
| | | | - Oxana M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Anatoly S. Karavaev
- Saratov State University, Saratov, Russia; Saratov State Medical University, Saratov, Russia; Saratov Branch of the Institute of RadioEngineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - Anton R. Kiselev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia; Saratov State Medical University, Saratov, Russia; Saratov State University, Saratov, Russia
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29
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Picano E, Ciampi Q, Cortigiani L, Arruda-Olson AM, Borguezan-Daros C, de Castro e Silva Pretto JL, Cocchia R, Bossone E, Merli E, Kane GC, Varga A, Agoston G, Scali MC, Morrone D, Simova I, Samardjieva M, Boshchenko A, Ryabova T, Vrublevsky A, Palinkas A, Palinkas ED, Sepp R, Torres MAR, Villarraga HR, Preradović TK, Citro R, Amor M, Mosto H, Salamè M, Leeson P, Mangia C, Gaibazzi N, Tuttolomondo D, Prota C, Peteiro J, Van De Heyning CM, D’Andrea A, Rigo F, Nikolic A, Ostojic M, Lowenstein J, Arbucci R, Haber DML, Merlo PM, Wierzbowska-Drabik K, Kasprzak JD, Haberka M, Camarozano AC, Ratanasit N, Mori F, D’Alfonso MG, Tassetti L, Milazzo A, Olivotto I, Marchi A, Rodriguez-Zanella H, Zagatina A, Padang R, Dekleva M, Djordievic-Dikic A, Boskovic N, Tesic M, Giga V, Beleslin B, Di Salvo G, Lorenzoni V, Cameli M, Mandoli GE, Bombardini T, Caso P, Celutkiene J, Barbieri A, Benfari G, Bartolacelli Y, Malagoli A, Bursi F, Mantovani F, Villari B, Russo A, De Nes M, Carpeggiani C, Monte I, Re F, Cotrim C, Bilardo G, Saad AK, Karuzas A, Matuliauskas D, Colonna P, Antonini-Canterin F, Pepi M, Pellikka PA. Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging. J Clin Med 2021; 10:3641. [PMID: 34441937 PMCID: PMC8397117 DOI: 10.3390/jcm10163641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021-2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
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Affiliation(s)
- Eugenio Picano
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | | | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | | | | | - Rosangela Cocchia
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Eduardo Bossone
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, 48100 Ravenna, Italy;
| | - Garvan C. Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Albert Varga
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | - Gergely Agoston
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | | | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy;
| | - Iana Simova
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Martina Samardjieva
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Alexander Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Attila Palinkas
- Internal Medicine Department, Elisabeth Hospital, 6800 Hódmezővásárhely, Hungary;
| | - Eszter D. Palinkas
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | - Robert Sepp
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | | | - Hector R. Villarraga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Tamara Kovačević Preradović
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84100 Salerno, Italy;
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Michael Salamè
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Paul Leeson
- RDM Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford OX3 9DU, UK;
| | - Cristina Mangia
- CNR, ISAC-Institute of Sciences of Atmosphere and Climate, 73100 Lecce, Italy;
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Domenico Tuttolomondo
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Costantina Prota
- Cardiology Department, Vallo della Lucania Hospital, 84100 Salerno, Italy;
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain;
| | | | - Antonello D’Andrea
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, 30031 Venice, Italy;
| | - Aleksandra Nikolic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Miodrag Ostojic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Diego M. Lowenstein Haber
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Pablo M. Merlo
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Ana Cristina Camarozano
- Medicine Department, Hospital de Clinicas UFPR, Federal University of Paranà, Curitiba 80000-000, Brazil;
| | - Nithima Ratanasit
- Department of Medicine, Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Maria Grazia D’Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Luigi Tassetti
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alessandra Milazzo
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Iacopo Olivotto
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alberto Marchi
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | | | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, 199034 Saint Petersburg, Russia;
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade 11000, Serbia;
| | - Ana Djordievic-Dikic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Nikola Boskovic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Milorad Tesic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Vojislav Giga
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Branko Beleslin
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Giovanni Di Salvo
- Division of Pediatric Cardiology, University Hospital, 35100 Padua, Italy;
| | | | - Matteo Cameli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Giulia Elena Mandoli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Tonino Bombardini
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Pio Caso
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Andrea Barbieri
- Noninvasive Cardiology, University Hospital, 43100 Parma, Italy;
| | - Giovanni Benfari
- Cardiology Department, University of Verona, 37121 Verona, Italy;
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, S. Orsola-Malpighi Hospital, 40100 Bologna, Italy;
| | - Alessandro Malagoli
- Nephro-Cardiovascular Department, Division of Cardiology, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Francesca Bursi
- ASST Santi Paolo e Carlo, Presidio Ospedale San Paolo, 20100 Milano, Italy;
| | - Francesca Mantovani
- Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Cardiology, 42100 Reggio Emilia, Italy;
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | - Antonello Russo
- Association for Public Health “Salute Pubblica”, 72100 Brindisi, Italy;
| | - Michele De Nes
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Clara Carpeggiani
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Ines Monte
- Echocardiography Laboratory, Cardio-Thorax-Vascular Department, “ Policlinico Vittorio Emanuele”, Catania University, 95100 Catania, Italy;
| | - Federica Re
- Ospedale San Camillo, Cardiology Division, 00100 Rome, Italy;
| | - Carlos Cotrim
- Heart Center, Hospital da Cruz Vermelha, Lisbon, and Medical School of University of Algarve, 1549-008 Lisbon, Portugal;
| | - Giuseppe Bilardo
- UOC di Cardiologia, ULSS1 DOLOMITI, Presidio Ospedaliero di Feltre, 32032 Belluno, Italy;
| | - Ariel K. Saad
- División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires C1120, Argentina;
| | - Arnas Karuzas
- Ligence Medical Solutions, 49206 Vilnius, Lithuania; (A.K.); (D.M.)
| | | | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, 70100 Bari, Italy;
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
| | - Francesco Antonini-Canterin
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta di Livenza, Motta di Livenza, 31045 Treviso, Italy
| | - Mauro Pepi
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
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Buoite Stella A, Furlanis G, Frezza NA, Valentinotti R, Ajcevic M, Manganotti P. Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study. J Neurol 2021; 269:587-596. [PMID: 34386903 PMCID: PMC8359764 DOI: 10.1007/s00415-021-10735-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9-31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Nicolò Arjuna Frezza
- School of Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Romina Valentinotti
- Infectious Diseases, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Milos Ajcevic
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.
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Trinity JD, Craig JC, Fermoyle CC, McKenzie AI, Lewis MT, Park SH, Rondina MT, Richardson RS. Impact of presymptomatic COVID-19 on vascular and skeletal muscle function: a case study. J Appl Physiol (1985) 2021; 130:1961-1970. [PMID: 34002634 PMCID: PMC8213510 DOI: 10.1152/japplphysiol.00236.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The impact of COVID-19 has been largely described after symptom development. Although the SARS-CoV-2 virus elevates heart rate (HR) prior to symptom onset, whether this virus evokes other presymptomatic alterations is unknown. This case study details the presymptomatic impact of COVID-19 on vascular and skeletal muscle function in a young woman [24 yr, 173.5 cm, 89 kg, body mass index (BMI): 29.6 kg·m-2]. Vascular and skeletal muscle function were assessed as part of a separate study with the first and second visits separated by 2 wk. On the evening following the second visit, the participant developed a fever and a rapid antigen test confirmed a positive COVID-19 diagnosis. Compared with the first visit, the participant presented with a markedly elevated HR (∼30 beats/min) and a lower mean blood pressure (∼8 mmHg) at the second visit. Vascular function measured by brachial artery flow-mediated dilation, reactive hyperemia, and passive leg movement were all noticeably attenuated (25%-65%) as was leg blood flow during knee extension exercise. Muscle strength was diminished as was ADP-stimulated respiration (30%), assessed in vitro, whereas there was a 25% increase in the apparent Km. Lastly, an elevation in IL-10 was observed prior to symptom onset. Notably, 2.5 mo after diagnosis symptoms of fatigue and cough were still present. Together, these findings provide unique insight into the physiological responses immediately prior to onset of COVID-19 symptoms; they suggest that SARS-CoV-2 negatively impacts vascular and skeletal muscle function prior to the onset of common symptoms and may set the stage for the widespread sequelae observed following COVID-19 diagnosis.NEW & NOTEWORTHY This unique case study details the impact of SARS-CoV-2 infection on vascular and skeletal muscle function in a young predominantly presymptomatic woman. Prior to COVID-19 diagnosis, substantial reductions in vascular, skeletal muscle, and mitochondrial function were observed along with an elevation in IL-10. This integrative case study indicates that the presymptomatic impact of COVID-19 is widespread and may help elucidate the acute and long-term sequelae of this disease.
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Affiliation(s)
- Joel D. Trinity
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah,3Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Jesse C. Craig
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah
| | - Caitlin C. Fermoyle
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah
| | - Alec I. McKenzie
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah
| | - Matthew T. Lewis
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah
| | - Soung Hun Park
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,3Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Matthew T. Rondina
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah,4Molecular Medicine Program, Division of General Internal Medicine, Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, Utah
| | - Russell S. Richardson
- 1Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah,2Division of Geriatrics, Department of Internal Medicine, grid.223827.eUniversity of Utah, Salt Lake City, Utah,3Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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Di Maro M, Cataldi M, Santillo M, Chiurazzi M, Damiano S, De Conno B, Colantuoni A, Guida B. The Cholinergic and ACE-2-Dependent Anti-Inflammatory Systems in the Lung: New Scenarios Emerging From COVID-19. Front Physiol 2021; 12:653985. [PMID: 34054572 PMCID: PMC8155253 DOI: 10.3389/fphys.2021.653985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
The renin angiotensin system and the cholinergic anti-inflammatory pathway have been recently shown to modulate lung inflammation in patients with COVID-19. We will show how studies performed on this disease are starting to provide evidence that these two anti-inflammatory systems may functionally interact with each other, a mechanism that could have a more general physiological relevance than only COVID-19 infection.
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Affiliation(s)
- Martina Di Maro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, University of Naples Federico II, Naples, Italy
| | - Mariarosaria Santillo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Martina Chiurazzi
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Simona Damiano
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Barbara De Conno
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Antonio Colantuoni
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
| | - Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University of Naples Federico II, Naples, Italy
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Borges U, Lobinger B, Javelle F, Watson M, Mosley E, Laborde S. Using Slow-Paced Breathing to Foster Endurance, Well-Being, and Sleep Quality in Athletes During the COVID-19 Pandemic. Front Psychol 2021; 12:624655. [PMID: 34054642 PMCID: PMC8155704 DOI: 10.3389/fpsyg.2021.624655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has been causing major disruptions in the sporting world. Negative physiological and psychological effects on athletes have been reported, such as respiratory issues and increased stress. Therefore, it is timely to support this population by presenting cost-effective and accessible intervention techniques to reduce this impact. Slow-paced breathing (SPB) has the potential to counteract many of the detrimental effects of COVID-19 that can directly affect sports performance. In this article, we present and justify the use of SPB in athletes by focusing on three key outcomes, namely aerobic endurance performance, emotional well-being, and sleep quality. We examine the physiological mechanisms that underpin these three outcomes and review literature showing that SPB can activate anti-inflammatory pathways, increase lung capacity and, in turn, improve aerobic endurance, emotional well-being, and sleep quality. We conclude that interventions using SPB can have preventive and rehabilitative properties for athletes. Future studies should empirically test the potential of SPB to help this specific population.
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Affiliation(s)
- Uirassu Borges
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
- Department of Social and Health Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Babett Lobinger
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Florian Javelle
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Matthew Watson
- Department of Social and Health Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Emma Mosley
- Department of Sport Science and Performance, Solent University, Southampton, United Kingdom
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
- UFR STAPS, Université de Caen Normandie, Caen, France
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34
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Azabou E, Bao G, Bounab R, Heming N, Annane D. Vagus Nerve Stimulation: A Potential Adjunct Therapy for COVID-19. Front Med (Lausanne) 2021; 8:625836. [PMID: 34026778 PMCID: PMC8137825 DOI: 10.3389/fmed.2021.625836] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) through excessive end organ inflammation. Despite improved understanding of the pathophysiology, management, and the great efforts worldwide to produce effective drugs, death rates of COVID-19 patients remain unacceptably high, and effective treatment is unfortunately lacking. Pharmacological strategies aimed at modulating inflammation in COVID-19 are being evaluated worldwide. Several drug therapies targeting this excessive inflammation, such as tocilizumab, an interleukin (IL)-6 inhibitor, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, and intravenous immunoglobulin have been identified as potentially useful and reliable approaches to counteract the cytokine storm. However, little attention is currently paid for non-drug therapeutic strategies targeting inflammatory and immunological processes that may be useful for reducing COVID-19-induced complications and improving patient outcome. Vagus nerve stimulation attenuates inflammation both in experimental models and preliminary data in human. Modulating the activity of cholinergic anti-inflammatory pathways (CAPs) described by the group of KJ Tracey has indeed become an important target of therapeutic research strategies for inflammatory diseases and sepsis. Non-invasive transcutaneous vagal nerve stimulation (t-VNS), as a non-pharmacological adjuvant, may help reduce the burden of COVID-19 and deserve to be investigated. VNS as an adjunct therapy in COVID-19 patients should be investigated in clinical trials. Two clinical trials on this topic are currently underway (NCT04382391 and NCT04368156). The results of these trials will be informative, but additional larger studies are needed.
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Affiliation(s)
- Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Guillaume Bao
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Rania Bounab
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Djillali Annane
- General Intensive Care Unit - Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique- Hôpitaux de Paris, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
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35
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Derakhshan N, Yaghmaei S, Keshavarz P. Vagal nerve stimulation for the treatment of male factor infertility. Andrologia 2021; 53:e14043. [PMID: 33929756 DOI: 10.1111/and.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nima Derakhshan
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Pedram Keshavarz
- Department of Diagnostic & Interventional Radiology of New Hospitals LTD, Tbilisi, Georgia
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36
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Reyes-Lagos JJ, Abarca-Castro EA, Echeverría JC, Mendieta-Zerón H, Vargas-Caraveo A, Pacheco-López G. A Translational Perspective of Maternal Immune Activation by SARS-CoV-2 on the Potential Prenatal Origin of Neurodevelopmental Disorders: The Role of the Cholinergic Anti-inflammatory Pathway. Front Psychol 2021; 12:614451. [PMID: 33868085 PMCID: PMC8044741 DOI: 10.3389/fpsyg.2021.614451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
The emergent Coronavirus Disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) could produce a maternal immune activation (MIA) via the inflammatory response during gestation that may impair fetal neurodevelopment and lead to postnatal and adulthood mental illness and behavioral dysfunctions. However, so far, limited evidence exists regarding long-term physiological, immunological, and neurodevelopmental modifications produced by the SARS-CoV-2 in the human maternal-fetal binomial and, particularly, in the offspring. Relevant findings derived from epidemiological and preclinical models show that a MIA is indeed linked to an increased risk of neurodevelopmental disorders in the offspring. We hypothesize that a gestational infection triggered by SARS-CoV-2 increases the risks leading to neurodevelopmental disorders of the newborn, which can affect childhood and the long-term quality of life. In particular, disruption of either the maternal or the fetal cholinergic anti-inflammatory pathway (CAP) could cause or exacerbate the severity of COVID-19 in the maternal-fetal binomial. From a translational perspective, in this paper, we discuss the possible manifestation of a MIA by SARS-CoV-2 and the subsequent neurodevelopmental disorders considering the role of the fetal-maternal cytokine cross-talk and the CAP. Specifically, we highlight the urgent need of preclinical studies as well as multicenter and international databanks of maternal-fetal psychophysiological data obtained pre-, during, and post-infection by SARS-CoV-2 from pregnant women and their offspring.
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Affiliation(s)
| | - Eric Alonso Abarca-Castro
- Multidisciplinary Research Center in Education (CIME), Autonomous University of the State of Mexico (UAEMex), Toluca, Mexico
| | - Juan Carlos Echeverría
- Basic Sciences and Engineering Division, Campus Iztapalapa, Metropolitan Autonomous University (UAM), Mexico City, Mexico
| | - Hugo Mendieta-Zerón
- Faculty of Medicine, Autonomous University of the State of Mexico (UAEMex), Toluca, Mexico
- Health Institute of the State of Mexico (ISEM), “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital, Toluca, Mexico
| | - Alejandra Vargas-Caraveo
- Biological and Health Sciences Division, Campus Lerma, Metropolitan Autonomous University (UAM), Lerma, Mexico
| | - Gustavo Pacheco-López
- Biological and Health Sciences Division, Campus Lerma, Metropolitan Autonomous University (UAM), Lerma, Mexico
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37
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Guo ZP, Sörös P, Zhang ZQ, Yang MH, Liao D, Liu CH. Use of Transcutaneous Auricular Vagus Nerve Stimulation as an Adjuvant Therapy for the Depressive Symptoms of COVID-19: A Literature Review. Front Psychiatry 2021; 12:765106. [PMID: 34975571 PMCID: PMC8714783 DOI: 10.3389/fpsyt.2021.765106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) comprises more than just severe acute respiratory syndrome. It also interacts with the cardiovascular, nervous, renal, and immune systems at multiple levels, increasing morbidity in patients with underlying cardiometabolic conditions and inducing myocardial injury or dysfunction. Transcutaneous auricular vagus nerve stimulation (taVNS), which is derived from auricular acupuncture, has become a popular therapy that is increasingly accessible to the general public in modern China. Here, we begin by outlining the historical background of taVNS, and then describe important links between dysfunction in proinflammatory cytokine release and related multiorgan damage in COVID-19. Furthermore, we emphasize the important relationships between proinflammatory cytokines and depressive symptoms. Finally, we discuss how taVNS improves immune function via the cholinergic anti-inflammatory pathway and modulates brain circuits via the hypothalamic-pituitary-adrenal axis, making taVNS an important treatment for depressive symptoms on post-COVID-19 sequelae. Our review suggests that the link between anti-inflammatory processes and brain circuits could be a potential target for treating COVID-19-related multiorgan damage, as well as depressive symptoms using taVNS.
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Affiliation(s)
- Zhi-Peng Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Peter Sörös
- Research Center Neurosensory Science, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Zhu-Qing Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Ming-Hao Yang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Dan Liao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Institute of Traditional Chinese Medicine, Beijing, China
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38
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Rangon CM, Krantic S, Moyse E, Fougère B. The Vagal Autonomic Pathway of COVID-19 at the Crossroad of Alzheimer's Disease and Aging: A Review of Knowledge. J Alzheimers Dis Rep 2020; 4:537-551. [PMID: 33532701 PMCID: PMC7835993 DOI: 10.3233/adr-200273] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer's disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an inflammatory "storm". The lethal outcomes of COVID-19, like in AD and unhealthy aging, likely rely on a critical hypoactivity of the efferent vagus nerve cholinergic pathway, which is involved in lowering cardiovascular pressure and systemic inflammation tone. We further discuss the emerging evidence supporting the use of 1) the non-invasive stimulation of vagus nerve as an additional therapeutic approach for severe COVID-19, and 2) the demonstrated vagal tone index, i.e., heart rate variability, via smartphone-based applications as a non-serological low-cost diagnostic of COVID-19. These two well-known medical approaches are already available and now deserve large-scale testing on human cohorts in the context of both AD and COVID-19.
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Affiliation(s)
- Claire-Marie Rangon
- Pain and Neuromodulation Unit, Division of Neurosurgery, Hôpital Fondation Ophtalmologique A. De Rothschild, Paris, France
| | - Slavica Krantic
- Sorbonne Université, St. Antoine Research Center (CRSA), Inserm UMRS-938, Hopital St-Antoine, Paris, France
| | - Emmanuel Moyse
- INRAE Centre Val-de-Loire, Physiology of Reproduction and Behavior Unit (PRC, UMR-85), Team ER2, Nouzilly, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
- Education, Ethics, Health (EA 7505), Tours University, Tours, France
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39
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Horkowitz AP, Schwartz AV, Alvarez CA, Herrera EB, Thoman ML, Chatfield DA, Osborn KG, Feuer R, George UZ, Phillips JA. Acetylcholine Regulates Pulmonary Pathology During Viral Infection and Recovery. Immunotargets Ther 2020; 9:333-350. [PMID: 33365281 PMCID: PMC7751717 DOI: 10.2147/itt.s279228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction This study was designed to explore the role of acetylcholine (ACh) in pulmonary viral infection and recovery. Inflammatory control is critical to recovery from respiratory viral infection. ACh secreted from non-neuronal sources, including lymphocytes, plays an important, albeit underappreciated, role in regulating immune-mediated inflammation. Methods ACh and lymphocyte cholinergic status in the lungs were measured over the course of influenza infection and recovery. The role of ACh was examined by inhibiting ACh synthesis in vivo. Pulmonary inflammation was monitored by Iba1 immunofluorescence, using a novel automated algorithm. Tissue repair was monitored histologically. Results Pulmonary ACh remained constant through the early stage of infection and increased during the peak of the acquired immune response. As the concentration of ACh increased, cholinergic lymphocytes appeared in the BAL and lungs. Cholinergic capacity was found primarily in CD4 T cells, but also in B cells and CD8 T cells. The cholinergic CD4+ T cells bound to influenza-specific tetramers and were retained in the resident memory regions of the lung up to 2 months after infection. Histologically, cholinergic lymphocytes were found in direct physical contact with activated macrophages throughout the lung. Inflammation was monitored by ionized calcium-binding adapter molecule 1 (Iba1) immunofluorescence, using a novel automated algorithm. When ACh production was inhibited, mice exhibited increased tissue inflammation and delayed recovery. Histologic examination revealed abnormal tissue repair when ACh was limited. Conclusion These findings point to a previously unrecognized role for ACh in the transition from active immunity to recovery and pulmonary repair following respiratory viral infection.
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Affiliation(s)
- Alexander P Horkowitz
- Donald P. Shiley Biosciences Center, San Diego State University, San Diego, California, USA.,Department of Biology, San Diego State University, San Diego, California, USA
| | - Ashley V Schwartz
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Carlos A Alvarez
- Donald P. Shiley Biosciences Center, San Diego State University, San Diego, California, USA.,Department of Biology, San Diego State University, San Diego, California, USA
| | - Edgar B Herrera
- Donald P. Shiley Biosciences Center, San Diego State University, San Diego, California, USA
| | - Marilyn L Thoman
- Donald P. Shiley Biosciences Center, San Diego State University, San Diego, California, USA
| | - Dale A Chatfield
- Department of Chemistry, San Diego State University, San Diego, California, USA
| | - Kent G Osborn
- Office of Animal Research, University of California San Diego, San Diego, California, USA
| | - Ralph Feuer
- Department of Biology, San Diego State University, San Diego, California, USA
| | - Uduak Z George
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Joy A Phillips
- Donald P. Shiley Biosciences Center, San Diego State University, San Diego, California, USA
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40
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Monteonofrio L, Florio MC, AlGhatrif M, Lakatta EG, Capogrossi MC. Aging- and gender-related modulation of RAAS: potential implications in COVID-19 disease. VASCULAR BIOLOGY 2020; 3:R1-R14. [PMID: 33537555 PMCID: PMC7849461 DOI: 10.1530/vb-20-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a new infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is frequently characterized by a marked inflammatory response with severe pneumonia and respiratory failure associated with multiorgan involvement. Some risk factors predispose patients to develop a more severe infection and to an increased mortality; among them, advanced age and male gender have been identified as major and independent risk factors for COVID-19 poor outcome. The renin-angiotensin-aldosterone system (RAAS) is strictly involved in COVID-19 because angiotensin converting enzyme 2 (ACE2) is the host receptor for SARS-CoV-2 and also converts pro-inflammatory angiotensin (Ang) II into anti-inflammatory Ang(1–7). In this review, we have addressed the effect of aging and gender on RAAS with emphasis on ACE2, pro-inflammatory Ang II/Ang II receptor 1 axis and anti-inflammatory Ang(1–7)/Mas receptor axis.
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Affiliation(s)
- Laura Monteonofrio
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Maria Cristina Florio
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Majd AlGhatrif
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Longitudinal Study Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Maurizio C Capogrossi
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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41
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Lee SK, Jeakins GS, Tukiainen A, Hewage E, Armitage OE. Next-Generation Bioelectric Medicine: Harnessing the Therapeutic Potential of Neural Implants. Bioelectricity 2020; 2:321-327. [PMID: 34476364 DOI: 10.1089/bioe.2020.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bioelectric medicine leverages natural signaling pathways in the nervous system to counteract organ dysfunction. This novel approach has potential to address conditions with unmet needs, including heart failure, hypertension, inflammation, arthritis, asthma, Alzheimer's disease, and diabetes. Neural therapies, which target the brain, spinal cord, or peripheral nerves, are already being applied to conditions such as epilepsy, Parkinson's, and chronic pain. While today's therapies have made exciting advancements, their open-loop design-where stimulation is administered without collecting feedback-means that results can be variable and devices do not work for everyone. Stimulation effects are sensitive to changes in neural tissue, nerve excitability, patient position, and more. Closing the loop by providing neural or non-neural biomarkers to the system can guide therapy by providing additional insights into stimulation effects and overall patient condition. Devices currently on the market use recorded biomarkers to close the loop and improve therapy. The future of bioelectric medicine is more holistically personalized. Collected data will be used for increasingly precise application of neural stimulations to achieve therapeutic effects. To achieve this future, advances are needed in device design, implanted and computational technologies, and scientific/medical interpretation of neural activity. Research and commercial devices are enabling the development of multiple levels of responsiveness to neural, physiological, and environmental changes. This includes developing suitable implanted technologies for high bandwidth brain/machine interfaces and addressing the challenge of neural or state biomarker decoding. Consistent progress is being made in these challenges toward the long-term vision of automatically and holistically personalized care for chronic health conditions.
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Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, Lim PB. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond) 2020; 21:e63-e67. [PMID: 33243837 DOI: 10.7861/clinmed.2020-0896] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. 'Post-acute COVID' (known colloquially as 'long COVID') is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness. We describe a series of individuals with symptoms of 'long COVID', and we posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. We suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. We present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.
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Affiliation(s)
- Melanie Dani
- Hammersmith Hospital, London, UK and Imperial College London, London, UK
| | | | | | | | | | - Richard Sutton
- National Heart and Lung Institute, Imperial College London, London, UK
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43
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Pilloni G, Bikson M, Badran BW, George MS, Kautz SA, Okano AH, Baptista AF, Charvet LE. Update on the Use of Transcranial Electrical Brain Stimulation to Manage Acute and Chronic COVID-19 Symptoms. Front Hum Neurosci 2020; 14:595567. [PMID: 33281589 PMCID: PMC7689057 DOI: 10.3389/fnhum.2020.595567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, United States
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
| | - Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigation 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Leigh E. Charvet
- Department of Neurology, NYU Langone Health, New York, NY, United States
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Manolis AS, Manolis AA, Manolis TA, Apostolopoulos EJ, Papatheou D, Melita H. COVID-19 infection and cardiac arrhythmias. Trends Cardiovasc Med 2020; 30:451-460. [PMID: 32814095 PMCID: PMC7429078 DOI: 10.1016/j.tcm.2020.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
As the coronavirus 2019 (COVID-19) pandemic marches unrelentingly, more patients with cardiac arrhythmias are emerging due to the effects of the virus on the respiratory and cardiovascular (CV) systems and the systemic inflammation that it incurs, and also as a result of the proarrhythmic effects of COVID-19 pharmacotherapies and other drug interactions and the associated autonomic imbalance that enhance arrhythmogenicity. The most worrisome of all arrhythmogenic mechanisms is the QT prolonging effect of various anti-COVID pharmacotherapies that can lead to polymorphic ventricular tachycardia in the form of torsade des pointes and sudden cardiac death. It is therefore imperative to monitor the QT interval during treatment; however, conventional approaches to such monitoring increase the transmission risk for the staff and strain the health system. Hence, there is dire need for contactless monitoring and telemetry for inpatients, especially those admitted to the intensive care unit, as well as for outpatients needing continued management. In this context, recent technological advances have ushered in a new era in implementing digital health monitoring tools that circumvent these obstacles. All these issues are herein discussed and a large body of recent relevant data are reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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45
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ten Hove AS, Brinkman DJ, Li Yim AYF, Verseijden C, Hakvoort TBM, Admiraal I, Welting O, van Hamersveld PHP, Sinniger V, Bonaz B, Luyer MD, de Jonge WJ. The role of nicotinic receptors in SARS-CoV-2 receptor ACE2 expression in intestinal epithelia. Bioelectron Med 2020; 6:20. [PMID: 33123616 PMCID: PMC7592135 DOI: 10.1186/s42234-020-00057-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent evidence demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) propagates in intestinal epithelial cells expressing Angiotensin-Converting Enzyme 2 (ACE2), implying that these cells represent an important entry site for the viral infection. Nicotinic receptors (nAChRs) have been put forward as potential regulators of inflammation and of ACE2 expression. As vagus nerve stimulation (VNS) activates nAChRs, we aimed to investigate whether VNS can be instrumental in affecting intestinal epithelial ACE2 expression. METHODS By using publicly available datasets we qualified epithelial ACE2 expression in human intestine, and assessed gene co-expression of ACE2 and SARS-CoV-2 priming Transmembrane Serine Protease 2 (TMPRSS2) with nAChRs in intestinal epithelial cells. Next, we investigated mouse and human ACE2 expression in intestinal tissues after chronic VNS via implanted devices. RESULTS We show co-expression of ACE2 and TMPRSS2 with nAChRs and α7 nAChR in particular in intestinal stem cells, goblet cells, and enterocytes. However, VNS did not affect ACE2 expression in murine or human intestinal tissue, albeit in colitis setting. CONCLUSIONS ACE2 and TMPRSS2 are specifically expressed in epithelial cells of human intestine, and both are co-expressed with nAChRs. However, no evidence for regulation of ACE2 expression through VNS could be found. Hence, a therapeutic value of VNS with respect to SARS-CoV-2 infection risk through ACE2 receptor modulation in intestinal epithelia could not be established.
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Affiliation(s)
- Anne S. ten Hove
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - David J. Brinkman
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, the Netherlands
| | - Andrew Y. F. Li Yim
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, 1105 AZ the Netherlands
| | - Caroline Verseijden
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Theo B. M. Hakvoort
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Iris Admiraal
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Olaf Welting
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Patricia H. P. van Hamersveld
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Valérie Sinniger
- Grenoble Institute of Neurosciences, Division of Hepato-Gastroenterology, University Grenoble Alpes, Inserm U1216, 38000 Grenoble, France
| | - Bruno Bonaz
- Grenoble Institute of Neurosciences, Division of Hepato-Gastroenterology, University Grenoble Alpes, Inserm U1216, 38000 Grenoble, France
| | - Misha D. Luyer
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, the Netherlands
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany
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Babelyuk VY, Popovych IL, Babelyuk NV, Korolyshyn TA, Dubkova GI, Kovbasnyuk MM, Hubyts’kyi VY, Kikhtan VV, Musiyenko VY, Kyrylenko IG, Dobrovolsky YG, Korsunskyi IH, Muszkieta R, Zukow W, Gozhenko AI. Perspectives on the use of electrostimulation with the device “VEB”® in the management of disorders related to COVID-19. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. One of the symptoms of COVID-19 is the so-called "cytokine storm". Its pathogenesis is that the initial release by lymphocytes and macrophages of proinflammatory cytokines in the classical immune response to SARS-CoV-2 is significantly enhanced and maintained due to excessive adrenergic stimulation of the immune cells. The proinflammatory adrenergic mechanism of the "cytokine storm" can be offset by the activation of the anti-inflammatory cholinergic mechanism by non-invasive stimulation of the vagus nerve. In 2015, a generator for electrotherapy and stimulation oh human nerve centers was created, called “VEB-1”®. Preliminary observation of volunteers revealed a modulating effect of a four-day course of electrical stimulation on the parameters of electroencephalogram, metabolism, as well as gas-discharge visualization (GDV). We hypothesized that changes in EEG parameters may be accompanied by a vagotonic shift of the sympatho-vagus balance, favorable for calming the “cytokine storm”. The main purpose of this study was to find out. In addition, concomitant changes in EEG, immunity, GDV, etc. due to the use of the devices "VEB-1"® and recently designed "VEB-2" had to be detected. Material and research methods. The object of observation were 18 volunteers: 11 women 33-62 y and 7 men 29-62 y (Mean±SD: 51±12 y) without clinical diagnose but with dysfunction of neuro-endocrine-immune complex and metabolism. In the morning registered HRV (“CardioLab+HRV”, “KhAI-Medica”, Kharkiv, UA), EEG (“NeuroCom Standard”, “KhAI-Medica”, Kharkiv, UA), kirlianogram by the method of GDV (“GDV Chamber”, “Biotechprogress”, SPb, RF), electroconductivity of skin in three pairs of points of acupuncture (“Medissa”), electrokinetic index of buccal epithelium ("Biotest", Kharkiv State University), as well as some parameters of immunity and metabolism. After the initial testing, an electrical stimulation session was performed with a “VEB-1”® or a “VEB-2” devices. The next morning after completing the four-day course, retesting was performed. Results. The effects of electrical stimulation can be divided into the following networks. Regarding EEG, this is a leveling of right-hand lateralization and normalizing decrease in the increased of the amplitude of the θ-rhythm and its spectral power density (SPD) at the loci F3, F7, F8, T3, T4, T6, P3, O1 and O2; further increase of SPD of δ-rhythm in loci F3, F4, T6, P3 and O1 as well as further decrease of SPD F4-α; reversion of the increased level of entropy in loci Fp1, F4, C3 and P3 to the lowered level. Regarding HRV, it is a vagotonic shift of sympatho-vagus balance due to a decrease in elevated levels of sympathetic tone markers and an increase in decreased levels of vagus tone markers, but without normalization. Neurotropic effects are accompanied by favorable changes in a number of immune parameters and a tendency to decrease the level of C-Reactive Protein. Regarding GDV, it is almost complete normalization of the initially increased GDI Area in the frontal projection and third Chakra Energy; normalizing decrease in the initially increased Energy of second and seventh Chakras; normalizing right-hand shift of more or less pronounced left-sided Asymmetry of first and third Chakra. These effects should be clearly interpreted as physiologically beneficial. The effects on these parameters are almost equally pronounced in people of both sexes when using both devices. Conclusion. Vagotonic and immunotropic effects of our device give us a reason to offer it for further research on the leveling of “cytokine storm” in patients with COVID-19.
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Affiliation(s)
- Valeriy Ye. Babelyuk
- 1. Clinical Sanatorium “Moldova”, Truskavets’, Ukraine 2. State Enterprise Ukrainian Research Institute for Medicine of Transport, Ministry of Health of Ukraine, Odesa, Ukraine
| | - Igor L. Popovych
- 2. State Enterprise Ukrainian Research Institute for Medicine of Transport, Ministry of Health of Ukraine, Odesa, Ukraine 3. Bohomolets’ Institute of Physiology of NAS, Kyїv, Ukraine
| | - Nazariy V. Babelyuk
- 1. Clinical Sanatorium “Moldova”, Truskavets’, Ukraine 2. State Enterprise Ukrainian Research Institute for Medicine of Transport, Ministry of Health of Ukraine, Odesa, Ukraine
| | | | | | | | | | | | | | - Iryna G. Kyrylenko
- 2. State Enterprise Ukrainian Research Institute for Medicine of Transport, Ministry of Health of Ukraine, Odesa, Ukraine
| | | | | | | | - Walery Zukow
- 5. Nicolaus Copernicus University, Torun, Poland
| | - Anatoliy I. Gozhenko
- 2. State Enterprise Ukrainian Research Institute for Medicine of Transport, Ministry of Health of Ukraine, Odesa, Ukraine
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Boutou AK, Pitsiou G, Kontakiotis T, Kioumis I. Nicotine treatment and smoking cessation in the era of COVID-19 pandemic: an interesting alliance. ERJ Open Res 2020; 6:00306-2020. [PMID: 32802824 PMCID: PMC7418819 DOI: 10.1183/23120541.00306-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Since the declaration of the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, the worldwide medical community has been racing against time to identify effective therapeutic agents to constrain the disease and reduce the effects of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Recently, the nicotinic hypothesis has been proposed; according to this, the acetylcholine receptor (nAChR) might play a key role in the pathophysiology of COVID-19 and, thus, should be a potential therapeutic target to reduce COVID-19 burden and its complications [1]. Since nicotine replacement therapy has long been used to treat tobacco dependence, this is an interesting hypothesis with important implications. In the era of this pandemic, the role of medicinal nicotine in the prevention and treatment of #COVID19 disease should be evaluated in placebo-controlled trials, while smoking cessation should be further promoted as a general public health measurehttps://bit.ly/3fpsBdq
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Affiliation(s)
- Afroditi K Boutou
- Dept of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Georgia Pitsiou
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodore Kontakiotis
- Dept of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
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48
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Kaniusas E, Szeles JC, Kampusch S, Alfageme-Lopez N, Yucuma-Conde D, Li X, Mayol J, Neumayer C, Papa M, Panetsos F. Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome. Front Physiol 2020; 11:890. [PMID: 32848845 PMCID: PMC7399203 DOI: 10.3389/fphys.2020.00890] [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: 05/17/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Covid-19 is an infectious disease caused by an invasion of the alveolar epithelial cells by coronavirus 19. The most severe outcome of the disease is the Acute Respiratory Distress Syndrome (ARDS) combined with hypoxemia and cardiovascular damage. ARDS and co-morbidities are associated with inflammatory cytokine storms, sympathetic hyperactivity, and respiratory dysfunction. Hypothesis: In the present paper, we present and justify a novel potential treatment for Covid19-originated ARDS and associated co-morbidities, based on the non-invasive stimulation of the auricular branch of the vagus nerve. Methods: Auricular vagus nerve stimulation activates the parasympathetic system including anti-inflammatory pathways (the cholinergic anti-inflammatory pathway and the hypothalamic pituitary adrenal axis) while regulating the abnormal sympatho-vagal balance and improving respiratory control. Results: Along the paper (1) we expose the role of the parasympathetic system and the vagus nerve in the control of inflammatory processes (2) we formulate our physiological and methodological hypotheses (3) we provide a large body of clinical and preclinical data that support the favorable effects of auricular vagus nerve stimulation in inflammation, sympatho-vagal balance as well as in respiratory and cardiac ailments, and (4) we list the (few) possible collateral effects of the treatment. Finally, we discuss auricular vagus nerve stimulation protective potential, especially in the elderly and co-morbid population with already reduced parasympathetic response. Conclusions: Auricular vagus nerve stimulation is a safe clinical procedure and it could be either an effective treatment for ARDS originated by Covid-19 and similar viruses or a supplementary treatment to actual ARDS therapeutic approaches.
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Affiliation(s)
- Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Jozsef C. Szeles
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Nuria Alfageme-Lopez
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
| | - Daniela Yucuma-Conde
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Xie Li
- The Pediatric Department, Women and Children's Hospital of Hunan, Changsha, China
| | - Julio Mayol
- San Carlos Clinical Hospital, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Christoph Neumayer
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michele Papa
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fivos Panetsos
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
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