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García-García I, Seco-Meseguer E, Ruiz-Seco P, Navarro-Jimenez G, Martínez-Porqueras R, Espinosa-Díaz M, Ortega-Albás JJ, Sagastagoitia I, García-Morales MT, Jiménez-González M, Martínez de Soto L, Bajo-Martínez AI, del Palacio-Tamarit M, López-García R, Díaz-García L, Queiruga-Parada J, Giesen C, Pérez-Villena A, de Castro-Martínez M, González-García JJ, Rodriguez-Rubio M, de la Oliva P, Arribas JR, Carcas AJ, Borobia AM. Melatonin in the Prophylaxis of SARS-CoV-2 Infection in Healthcare Workers (MeCOVID): A Randomised Clinical Trial. J Clin Med 2022; 11:jcm11041139. [PMID: 35207411 PMCID: PMC8876218 DOI: 10.3390/jcm11041139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
We evaluated in this randomised, double-blind clinical trial the efficacy of melatonin as a prophylactic treatment for prevention of SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomised 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. The main outcome was the number of SARS-CoV-2 infections. A total of 344 volunteers were screened, and 314 were randomised: 151 to placebo and 163 to melatonin; 308 received the study treatment (148 placebo; 160 melatonin). We detected 13 SARS-CoV-2 infections, 2.6% in the placebo arm and 5.5% in the melatonin arm (p = 0.200). A total of 294 adverse events were detected in 127 participants (139 in placebo; 155 in melatonin). We found a statistically significant difference in the incidence of adverse events related to treatment: 43 in the placebo arm and 67 in the melatonin arm (p = 0.040), and in the number of participants suffering from somnolence related to treatment: 8.8% (n = 14) in the melatonin versus 1.4% (n = 2) in the placebo arm (p = 0.008). No severe adverse events related to treatment were reported. We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in healthcare workers.
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Affiliation(s)
- Irene García-García
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
| | - Enrique Seco-Meseguer
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
| | - Pilar Ruiz-Seco
- Internal Medicine Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain; (P.R.-S.); (G.N.-J.)
| | - Gema Navarro-Jimenez
- Internal Medicine Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain; (P.R.-S.); (G.N.-J.)
| | - Raúl Martínez-Porqueras
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - María Espinosa-Díaz
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Juan José Ortega-Albás
- Sleep Unit, Hospital General Universitario de Castellón, 12004 Castellón de la Plana, Spain; (J.J.O.-A.); (R.L.-G.)
| | - Iñigo Sagastagoitia
- Internal Medicine/Infectious Diseases Department, Hospital Clínico San Carlos, IdiSSC, 28040 Madrid, Spain;
| | - María Teresa García-Morales
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - María Jiménez-González
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
| | - Lucía Martínez de Soto
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
| | - Ana Isabel Bajo-Martínez
- Emergency Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - María del Palacio-Tamarit
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Raquel López-García
- Sleep Unit, Hospital General Universitario de Castellón, 12004 Castellón de la Plana, Spain; (J.J.O.-A.); (R.L.-G.)
| | - Lucía Díaz-García
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
| | - Javier Queiruga-Parada
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
| | - Christine Giesen
- Preventive Medicine Unit, Infanta Sofia University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - Ana Pérez-Villena
- Pediatric Department, Infanta Sofia University Hospital, 28702 San Sebastián de los Reyes, Spain;
| | - Marta de Castro-Martínez
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (R.M.-P.); (M.E.-D.); (M.d.P.-T.); (M.d.C.-M.)
| | - Juan J. González-García
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Miguel Rodriguez-Rubio
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Pediatric Intensive Care Department, La Paz University Hospital-IdiPAZ, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Pedro de la Oliva
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Pediatric Intensive Care Department, La Paz University Hospital-IdiPAZ, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José R. Arribas
- Infectious Diseases Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.J.G.-G.); (J.R.A.)
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Antonio J. Carcas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Correspondence: (A.J.C.); (A.M.B.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (I.G.-G.); (E.S.-M.); (M.J.-G.); (L.M.d.S.); (L.D.-G.); (J.Q.-P.)
- Spanish Clinical Research Network (SCReN), 28046 Madrid, Spain;
- School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (M.R.-R.); (P.d.l.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Correspondence: (A.J.C.); (A.M.B.)
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Dioguardi M, Cazzolla AP, Arena C, Sovereto D, Caloro GA, Dioguardi A, Crincoli V, Laino L, Troiano G, Lo Muzio L. Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection. Pediatr Rep 2021; 13:363-382. [PMID: 34287338 PMCID: PMC8293341 DOI: 10.3390/pediatric13030045] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 (Coronavirus Disease 2019) is an emerging viral disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which leads to severe respiratory infections in humans. The first reports came in December 2019 from the city of Wuhan in the province of Hubei in China. It was immediately clear that children developed a milder disease than adults. The reasons for the milder course of the disease were attributed to several factors: innate immunity, difference in ACE2 (angiotensin-converting enzyme II) receptor expression, and previous infections with other common coronaviruses (CovH). This literature review aims to summarize aspects of innate immunity by focusing on the role of ACE2 expression and viral infections in children in modulating the antibody response to SARS-CoV-2 infection. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles deemed potentially eligible were considered, including those dealing with COVID-19 in children and providing more up-to-date and significant data in terms of epidemiology, prognosis, course, and symptoms, focusing on the etiopathogenesis of SARS-CoV-2 disease in children. The bibliographic search was conducted using the search engines PubMed and Scopus. The following search terms were entered in PubMed and Scopus: COVID-19 AND ACE2 AND Children; COVID-19 AND Immunity innate AND children. The search identified 857 records, and 18 studies were applicable based on inclusion and exclusion criteria that addressed the issues of COVID-19 concerning the role of ACE2 expression in children. The scientific literature agrees that children develop milder COVID-19 disease than adults. Milder symptomatology could be attributed to innate immunity or previous CovH virus infections, while it is not yet fully understood how the differential expression of ACE2 in children could contribute to milder disease.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
| | - Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
| | - Claudia Arena
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
| | - Giorgia Apollonia Caloro
- Unità Operativa Nefrologia e Dialisi, Presidio Ospedaliero Scorrano, ASL (Azienda Sanitaria Locale) Lecce, Via Giuseppina Delli Ponti, 73020 Scorrano, Italy;
| | - Antonio Dioguardi
- U.S.C.A. “Unità Speciali di Continuità Assistenziale” Troia 2, ASL “Azienda Sanitaria Locale” Foggia Contrada Fontanelle, 71029 Troia, Italy;
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Division of Complex Operating Unit of Dentistry, “Aldo Moro” University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy;
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (A.P.C.); (C.A.); (D.S.); (G.T.); (L.L.M.)
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