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Zanini G, Selleri V, Roncati L, Coppi F, Nasi M, Farinetti A, Manenti A, Pinti M, Mattioli AV. Vascular "Long COVID": A New Vessel Disease? Angiology 2024; 75:8-14. [PMID: 36652923 PMCID: PMC9895315 DOI: 10.1177/00033197231153204] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Vascular sequelae following (SARS-CoV-2 coronavirus disease) (COVID)-19 infection are considered as "Long Covid (LC)" disease, when occurring 12 weeks after the original infection. The paucity of specific data can be obviated by translating pathophysiological elements from the original Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2) infection (In a microcirculatory system, a first "endotheliitis," is often followed by production of "Neutrophil Extracellular Trap," and can evolve into a more complex leukocytoklastic-like and hyperimmune vasculitis. In medium/large-sized vessels, this corresponds to endothelial dysfunction, leading to an accelerated progression of pre-existing atherosclerotic plaques through an increased deposition of platelets, circulating inflammatory cells and proteins. Associated dysregulated immune and pro-coagulant conditions can directly cause thrombo-embolic arterial or venous complications. In order to implement appropriate treatment, physicians need to consider vascular pathologies observed after SARS-Cov-2 infections as possible "LC" disease.
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Affiliation(s)
- Giada Zanini
- Department of Life Sciences, University of Modena and Reggio
Emilia, Modena, Italy
| | - Valentina Selleri
- Department of Life Sciences, University of Modena and Reggio
Emilia, Modena, Italy
- Istituto Nazionale per le Ricerche
Cardiovascolari, University of Modena and Reggio
Emilia, Modena, Italy
| | - Luca Roncati
- Pathology Unit, University of Modena and Reggio
Emilia. Polyclinic Hospital, Modena, Italy
| | - Francesca Coppi
- Department of Medical and Surgical
Sciences for Children and Adults, University of Modena and. Reggio
Emilia, Modena, Italy
| | - Milena Nasi
- Department of Surgical, Medical and Dental Sciences
University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Farinetti
- Department of Medical and Surgical
Sciences for Children and Adults, University of Modena and. Reggio
Emilia, Modena, Italy
| | - Antonio Manenti
- Department of Medical and Surgical
Sciences for Children and Adults, University of Modena and. Reggio
Emilia, Modena, Italy
| | - Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio
Emilia, Modena, Italy
| | - Anna Vittoria Mattioli
- Istituto Nazionale per le Ricerche
Cardiovascolari, University of Modena and Reggio
Emilia, Modena, Italy
- Department of Medical and Surgical
Sciences for Children and Adults, University of Modena and. Reggio
Emilia, Modena, Italy
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Roncati L, Manenti A. Apropos of menstrual changes and abnormal uterine bleeding after COVID-19 vaccination. BRAIN HEMORRHAGES 2022; 4:S2589-238X(22)00080-8. [PMID: 36406341 PMCID: PMC9642033 DOI: 10.1016/j.hest.2022.11.001] [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: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
It is news of 28 October 2022 that the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has recommended to add heavy menstrual bleeding among the side effects of unknown frequency inside the package insert of nucleoside-modified messenger ribonucleic acid vaccines to prevent coronavirus disease 2019 (COVID-19). The decision has been made in the light of the numerous reports of unexpected menstrual changes or abnormal uterine bleeding following COVID-19 vaccination. Here we advance a possible involvement of the particular adenohypophyseal microcirculation in these strange and still unexplained events.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Manenti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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The Use of Palmitoylethanolamide in the Treatment of Long COVID: A Real-Life Retrospective Cohort Study. Med Sci (Basel) 2022; 10:medsci10030037. [PMID: 35893119 PMCID: PMC9326613 DOI: 10.3390/medsci10030037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 can cause symptoms that last weeks or months after the infection has gone, with a significant impairment of quality of life. Palmitoylethanolamide (PEA) is a naturally occurring lipid mediator that has an entourage effect on the endocannabinoid system mitigating the cytokine storm. The aim of this retrospective study is to evaluate the potential efficacy of PEA in the treatment of long COVID. Patients attending the Neurological Out Clinic of the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy) from August 2020 to September 2021 were screened for potential inclusion in the study. We included only long COVID patients who were treated with PEA 600 mg two times daily for about 3 months. All patients performed the post-COVID-19 Functional Status (PCFS) scale. Thirty-three patients (10 males, 43.5%, mean age 47.8 ± 12.4) were enrolled in the study. Patients were divided into two groups based on hospitalization or home care observation. A substantial difference in the PCFS score between the two groups at baseline and after treatment with PEA were found. We found that smoking was a risk factor with an odds ratio of 8.13 CI 95% [0.233, 1.167]. Our findings encourage the use of PEA as a potentially effective therapy in patients with long COVID.
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An In Vivo Observational Histological Study of Peripheral Arterial Damage in Patients with Acute Limb Ischemia in SARS-CoV-2 Infection. Diagnostics (Basel) 2022; 12:diagnostics12020488. [PMID: 35204579 PMCID: PMC8871130 DOI: 10.3390/diagnostics12020488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Thromboembolic events, such as acute limb ischemia, were reported worldwide in patients with COVID-19, suggesting that SARS-CoV-2 infection acts like a redoubtable prothrombotic factor in these patients. The aim of the study was to summarize the histopathological changes found in the arterial wall, intraarterial thrombus, and adjacent skeletal muscles. Considering the lack of evidence from in vivo studies, we performed observational histological research of peripheral arterial damage in patients with acute limb ischemia and SARS-CoV-2 infection. We investigated 22 patients with acute limb ischemia and SARS and harvested histopathological samples from those who agreed to this procedure. We performed histologic tissue harvesting during the revascularization procedure from the thrombosed area of the common femoral artery. Morphologic analysis was made on the hematoxylin-eosin (HE) stain. Special stains were also used—Elastica van Gieson (EvG) and Alcian Blue—Periodic Acid—Schiff (AB-PAS) and primary antibodies—CD45 and CD61. Our patients had significant risk factors for thrombus formation, since all of them had arterial hypertension, 81% had dyslipidemia, 73% were obese, 63% suffered from diabetes mellitus, and 45% were active smokers. The histological findings using immunohistochemistry (CD45 and CD68 reactions) or special and usual stains underlined the mechanism for ischemia production in SARS-CoV-2 patients. The main histological findings in our study were endothelial destruction and inflammation that were found in all analyzed structures.
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Raciti L, Arcadi FA, Calabrò RS. Could Palmitoylethanolamide Be an Effective Treatment for Long-COVID-19? Hypothesis and Insights in Potential Mechanisms of Action and Clinical Applications. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:19-25. [PMID: 35382075 PMCID: PMC8970234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
COVID-19 is highly transmissive and contagious disease with a wide spectrum of clinicopathological issues, including respiratory, vasculo-coagulative, and immune disorders. In some cases of COVID-19, patients can be characterized by clinical sequelae with mild-to-moderate symptoms that persist long after the resolution of the acute infection, known as long-COVID, potentially affecting their quality of life. The main symptoms of long-COVID include persistent dyspnea, fatigue and weakness (that are typically out of proportion, to the degree of ongoing lung damage and gas exchange impairment), persistence of anosmia and dysgeusia, neuropsychiatric symptoms, and cognitive dysfunctions (such as brain fog or memory lapses). The appropriate management and prevention of potential long-COVID sequelae is still lacking. It is also believed that long-term symptoms of COVID-19 are related to an immunity over-response, namely a cytokine storm, involving the release of pro-inflammatory interleukins, monocyte chemoattractant proteins, and tissue necrosis factors. Palmitoylethanolamide (PEA) shows affinity for vanilloid receptor 1 and for cannabinoid-like G protein-coupled receptors, enhancing anandamide activity by means of an entourage effect. Due to its anti-inflammatory properties, PEA has been recently used as an early add-on therapy for respiratory problems in patients with COVID-19. It is believed that PEA mitigates the cytokine storm modulating cell-mediated immunity, as well as counteracts pain and oxidative stress. In this article, we theorize that PEA could be a potentially effective nutraceutical to treat long-COVID, with regard to fatigue and myalgia, where a mythocondrial dysfunction is hypothesizable.
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Affiliation(s)
- Loredana Raciti
- Drs. Raciti, Arcadi, and Calabrò are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
| | - Francesca Antonia Arcadi
- Drs. Raciti, Arcadi, and Calabrò are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
| | - Rocco Salvatore Calabrò
- Drs. Raciti, Arcadi, and Calabrò are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
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Manenti A, Roncati L, Farinetti A, Manco G, Mattioli AV. Thrombocytopenia after Thoraco-Abdominal Aortic Endografting: Pathophysiological Observations. Ann Vasc Surg 2022; 81:e1-e3. [DOI: 10.1016/j.avsg.2021.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/01/2022]
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Toward a unified pathophysiology in COVID-19 acute aortopathies. J Vasc Surg 2021; 74:1771-1772. [PMID: 34688403 PMCID: PMC8526438 DOI: 10.1016/j.jvs.2021.07.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 02/08/2023]
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Karabulut K, Kapici A, Andronikashvili A, Morgan J. A review of aortic thrombosis in COVID-19 infection. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic thrombus is a rare thrombotic event with a wide spectrum of clinical manifestations and potential catastrophic complications. This study aimed to elucidate the clinical manifestations, diagnosis and treatment dilemmas of aortic thrombus with COVID-19 infection and raise awareness among frontline medical providers. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.
Methods: Literature review was conducted between November 1, 2019, and November 14, 2020, on PubMed and Embase to identify publications regarding aortic thrombosis among COVID-19 cases.
Results: Most of the patients were male with a median age of 67 years, and had comorbidities (most commonly hypertension, dyslipidemia and diabetes mellitus). In our study, underlying atherosclerosis, a common risk factor for aortic thrombus, was identified among 56% of the patients. Aortic thrombus was symptomatic in 62% of these patients and most commonly manifested itself as acute limb ischemia (46%), whereas 30% of cases were found incidentally during the investigation of elevated inflammatory markers or increased oxygen requirement. Treatment was individualized given the lack of established guidelines for aortic thrombus, including anticoagulation, systemic and catheter directed thrombolysis, and surgical thrombectomy. Overall mortality was found to be 30% in our study.
Conclusions: Although rare, aortic thrombus has high morbidity and mortality, and can present without any symptoms or underlying aortic disease. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.
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Affiliation(s)
| | - Ahmet Kapici
- Steward Carney Hospital, Boston, MA 02124, United States
| | | | - James Morgan
- Steward Carney Hospital, Boston, MA 02124, United States
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Roncati L, Manenti A, Manco G, Farinetti A, Mattioli AV. COVID-19 thromboembolic complications: Deepening immunoinflammatory features. J Vasc Surg 2021; 74:1048-1049. [PMID: 34425948 PMCID: PMC8376811 DOI: 10.1016/j.jvs.2021.04.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Luca Roncati
- Department of Pathology, University of Modena, Modena, Italy
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Roncati L, Corsi L. Nucleoside-modified messenger RNA COVID-19 vaccine platform. J Med Virol 2021; 93:4054-4057. [PMID: 33675239 DOI: 10.1002/jmv.26924] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022]
Abstract
On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic; from that date, the vaccine race has begun, and many technology platforms to develop a specific and effective COVID-19 vaccine have been launched in several clinical trials (protein subunit, RNA-based, DNA-based, replicating viral vector, nonreplicating viral vector, inactivated virus, live attenuated virus, and virus-like particle). Among the next-generation strategies, nucleoside-modified messenger RNA vaccines appear the most attractive, not only to counteract emerging pathogens but also for the possible applications in regenerative medicine and cancer therapy. However, exactly as all innovative drugs, they deserve careful pharmacovigilance in the short and long term.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
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Roncati L, Gianotti G, Gravina D, Attolini G, Zanelli G, Rosa ND, Adani R. Carpal, cubital or tarsal tunnel syndrome after SARS-CoV-2 infection: A causal link? Med Hypotheses 2021; 153:110638. [PMID: 34217126 PMCID: PMC8223113 DOI: 10.1016/j.mehy.2021.110638] [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: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
COVID-19 is a complex disease with many clinicopathological issues, including respiratory, gastrointestinal, neurological, renal, cutaneous, and coagulative ones; in addition, reactive arthritis has been reported by different authors. Here, we hypothesize that a peripheral microangiopathy involving nerve supply, a viral demyelination, or an immune-mediated irritating antigenic stimulus on synovial sheaths after SARS-CoV-2 infection may all induce a carpal, cubital or tarsal tunnel syndrome of variable entity in genetically predisposed subjects associated with myxoid nerve degeneration.
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Affiliation(s)
- Luca Roncati
- Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy.
| | - Greta Gianotti
- Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Gravina
- Unit of Orthopedics and Traumatology, University Hospital of Modena, Modena, Italy
| | - Giovanna Attolini
- Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuliana Zanelli
- Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Norman Della Rosa
- Unit of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Unit of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Roncati L, Corsi L, Barbolini G. Abnormal immunothrombosis and lupus anticoagulant in a catastrophic COVID-19 recalling Asherson's syndrome. J Thromb Thrombolysis 2021; 52:1043-1046. [PMID: 33844151 PMCID: PMC8040358 DOI: 10.1007/s11239-021-02444-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a complex disease with many clinicopathological aspects, including abnormal immunothrombosis, and the full comprehension of its pathogenetic mechanisms is urgently required. Methods/Results By means of a multidisciplinary approach, we here report a catastrophic COVID-19 in a 44-year-old Philippine male patient, discovered lupus anticoagulant (LAC)-positive shortly before death, occurred 8 days after hospitalization in a clinical scenario refractory to standard high acuity care recalling Asherson’s syndrome (catastrophic antiphospholipid syndrome). Conclusion A parallelism between this severe form of COVID-19 and Asherson’s syndrome can be so drawn. Both the diseases in fact exhibit hypercytokinemia, thrombotic microangiopathy, disseminated intravascular coagulation and multiple organ failure, they show a relationship with viral infections, and they are burdened by a high mortality rate. A genetic predisposition to develop these two overlapping conditions may be supposed.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, Institute of Pathology, University of Modena and Reggio Emilia, Polyclinic Hospital, Largo del Pozzo 71, 41124, Modena (MO), Italy.
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Barbolini
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, Institute of Pathology, University of Modena and Reggio Emilia, Polyclinic Hospital, Largo del Pozzo 71, 41124, Modena (MO), Italy
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