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Ridgway H, Moore GJ, Gadanec LK, Zulli A, Apostolopoulos V, Hoffmann W, Węgrzyn K, Vassilaki N, Mpekoulis G, Zouridakis M, Giastas P, Vidali VP, Kelaidonis K, Matsoukas MT, Dimitriou M, Mavromoustakos T, Tsiodras S, Gorgoulis VG, Karakasiliotis I, Chasapis CT, Matsoukas JM. Novel benzimidazole angiotensin receptor blockers with anti-SARS-CoV-2 activity equipotent to that of nirmatrelvir: computational and enzymatic studies. Expert Opin Ther Targets 2024; 28:437-459. [PMID: 38828744 DOI: 10.1080/14728222.2024.2362675] [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: 02/13/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Hypertension worsens outcomes in SARS-CoV-2 patients. Sartans, a type of antihypertensive angiotensin receptor blocker-(ARB), reduce COVID-19 morbidity and mortality by targeting angiotensin-converting enzyme-2 (ACE2). This study aimed to evaluate the antiviral and antihypertensive effects of nirmatrelvir, commercial sartans (candesartan, losartan, and losartan carboxylic (Exp3174)), and newly synthesized sartans (benzimidazole-N-biphenyl carboxyl (ACC519C) and benzimidazole-N-biphenyl tetrazole (ACC519T)), compared to nirmatrelvir, the antiviral component of Paxlovid. RESEARCH DESIGN AND METHODS Surface plasmon resonance (SPR) and enzymatic studies assessed drug effects on ACE2. Antiviral abilities were tested with SARS-CoV-2-infected Vero E6 cells, and antihypertensive effects were evaluated using angiotensin II-contracted rabbit iliac arteries. RESULTS Benzimidazole-based candesartan and ACC519C showed antiviral activity comparable to nirmatrelvir (95% inhibition). Imidazole-based losartan, Exp3174, and ACC519T were less potent (75%-80% and 50%, respectively), with Exp3174 being the least effective. SPR analysis indicated high sartans-ACE2 binding affinity. Candesartan and nirmatrelvir combined had greater inhibitory and cytopathic effects (3.96%) than individually (6.10% and 5.08%). ACE2 enzymatic assays showed varying effects of novel sartans on ACE2. ACC519T significantly reduced angiotensin II-mediated contraction, unlike nirmatrelvir and ACC519T(2). CONCLUSION This study reports the discovery of a new class of benzimidazole-based sartans that significantly inhibit SARS-CoV-2, likely due to their interaction with ACE2.
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Affiliation(s)
- Harry Ridgway
- Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, Australia
- AquaMem Consultants, Rodeo, NM, USA
| | - Graham J Moore
- Pepmetics Inc, 772 Murphy Place, Victoria, BC, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura Kate Gadanec
- Institute for Health and Sport, Immunology and Translational Research, Victoria University, Melbourne, Australia
| | - Anthony Zulli
- Institute for Health and Sport, Immunology and Translational Research, Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Immunology and Translational Research, Victoria University, Melbourne, Australia
- Immunology Program, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Weronika Hoffmann
- Laboratory of Molecular Biology, Intercollegiate Faculty of Biotechnology of University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Węgrzyn
- Laboratory of Molecular Biology, Intercollegiate Faculty of Biotechnology of University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Niki Vassilaki
- Laboratory of Molecular Virology, Hellenic Pasteur Institute, Athens, Greece
| | - George Mpekoulis
- Laboratory of Molecular Virology, Hellenic Pasteur Institute, Athens, Greece
| | - Marios Zouridakis
- Structural Neurobiology Research Group, Laboratory of Molecular Neurobiology and Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Petros Giastas
- Structural Neurobiology Research Group, Laboratory of Molecular Neurobiology and Immunology, Hellenic Pasteur Institute, Athens, Greece
- Department of Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Veroniki P Vidali
- Natural Products and Bioorganic Chemistry Laboratory, Institute of Nanoscience & Nanotechnology, NCSR "Demokritos", Athens, Greece
| | | | | | - Marios Dimitriou
- Laboratory of Biology, Department of Medicine, Democritus University of Thrace, Xanthi, Greece
| | - Thomas Mavromoustakos
- Department of Chemistry, Laboratory of Organic Chemistry, National Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Faculty of Medicine, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilis G Gorgoulis
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
- Department of Histology and Embryology, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece
- Faculty Institute for Cancer Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Ioannis Karakasiliotis
- Laboratory of Biology, Department of Medicine, Democritus University of Thrace, Xanthi, Greece
| | - Christos T Chasapis
- Institute of Chemical Biology, National Hellenic Research Foundation, Athens, Greece
| | - John M Matsoukas
- Institute for Health and Sport, Immunology and Translational Research, Victoria University, Melbourne, Australia
- NewDrug PC, Patras Science Park, Patras, Greece
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Chemistry, University of Patras, Patras, Greece
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ACE2-Inhibitory Effects of Bromelain and Ficin in Colon Cancer Cells. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020301. [PMID: 36837502 PMCID: PMC9962737 DOI: 10.3390/medicina59020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: Bromelain and ficin are aqueous extracts from fruits of Ananas comosus and Ficus carcia plants, used widely for medical applications. Angiotensin-converting enzyme 2 (ACE2) is a homolog of ACE, degrading Ang II to angiotensin 1-7 and decreasing the cellular concentration of Ang II. Materials and Methods: In this study, we investigated the ACE2-inhibitory, antiproliferative, and apoptosis-inducing effects of ficin and bromelain on caco-2 cells. Results: We found that bromelain and ficin significantly reduced the viability of human colon cancer cells with IC50 value concentrations of 8.8 and 4.2 mg/mL for bromelain after 24 and 48 h treatments, and 8.8 and 4.2 mg/mL for ficin after 24 and 48 h treatments, respectively. The apoptosis of the caco-2 cell line treated with bromelain was 81.04% and 56.70%, observed after 24 and 48 h. Total apoptotic proportions in caco-2 cells treated with ficin after 24 and 48 h were 83.7% and 73.0%. An amount of 1.6 mg/mL of bromelain and ficin treatments on caco-2 cells after 24 h revealed a higher decrease than that of other concentrations in the expression of ACE2 protein. Conclusions: In conclusion, bromelain and ficin can dose-dependently decrease the expression of ACE2 protein in caco-2 cells.
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Wang L, Wang Z, Yang Z, Wang X, Yan L, Wu J, Liu Y, Fu B, Yang H. Potential common mechanism of four Chinese patent medicines recommended by diagnosis and treatment protocol for COVID-19 in medical observation period. Front Med (Lausanne) 2022; 9:874611. [PMID: 36388945 PMCID: PMC9643314 DOI: 10.3389/fmed.2022.874611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
The global epidemic has been controlled to some extent, while sporadic outbreaks still occur in some places. It is essential to summarize the successful experience and promote the development of new drugs. This study aimed to explore the common mechanism of action of the four Chinese patent medicine (CPMs) recommended in the Medical Observation Period COVID-19 Diagnostic and Treatment Protocol and to accelerate the new drug development process. Firstly, the active ingredients and targets of the four CPMs were obtained by the Chinese medicine composition database (TCMSP, TCMID) and related literature, and the common action targets of the four TCMs were sorted out. Secondly, the targets of COVID-19 were obtained through the gene-disease database (GeneCards, NCBI). Then the Venn diagram was used to intersect the common drug targets with the disease targets. And GO and KEGG pathway functional enrichment analysis was performed on the intersected targets with the help of the R package. Finally, the results were further validated by molecular docking and molecular dynamics analysis. As a result, a total of 101 common active ingredients and 21 key active ingredients of four CPMs were obtained, including quercetin, luteolin, acacetin, kaempferol, baicalein, naringenin, artemisinin, aloe-emodin, which might be medicinal substances for the treatment of COVID-19. TNF, IL6, IL1B, CXCL8, CCL2, IL2, IL4, ICAM1, IFNG, and IL10 has been predicted as key targets. 397 GO biological functions and 166 KEGG signaling pathways were obtained. The former was mainly enriched in regulating apoptosis, inflammatory response, and T cell activation. The latter, with 92 entries related to COVID-19, was mainly enriched to signaling pathways such as Coronavirus disease-COVID-19, Cytokine-cytokine receptor interaction, IL-17 signaling pathway, and Toll-like receptor signaling pathway. Molecular docking results showed that 19/21 of key active ingredients exhibited strong binding activity to recognized COVID-19-related targets (3CL of SARS-CoV-2, ACE2, and S protein), even better than one of these four antiviral drugs. Among them, shinflavanone had better affinity to 3CL, ACE2, and S protein of SARS-CoV-2 than these four antiviral drugs. In summary, the four CPMs may play a role in the treatment of COVID-19 by binding flavonoids such as quercetin, luteolin, and acacetin to target proteins such as ACE2, 3CLpro, and S protein and acting on TNF, IL6, IL1B, CXCL8, and other targets to participate in broad-spectrum antiviral, immunomodulatory and inflammatory responses.
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Affiliation(s)
- Lin Wang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zheyi Wang
- Qilu Hospital, Shandong University, Shandong, China
| | - Zhihua Yang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xingwang Wang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangzhou, Guangdong, China
| | - Liping Yan
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jianxiong Wu
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yue Liu
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Baohui Fu
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hongtao Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Possible Beneficial Effects of Fresh Pomegranate Juice in SARS-CoV-2 Infection Conditions. J Nutr Metab 2022; 2022:5134560. [PMID: 35287379 PMCID: PMC8917946 DOI: 10.1155/2022/5134560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Rather than the prophylactic vaccination, any effective synthetic, natural, or nutritional therapy or regimen that may cure or remedy, albeit partially, the complications of SARS-CoV-2 should be highly acknowledged. Here, we reviewed and discussed possible beneficial biological effects of pomegranate juice in such diseased condition of viral infection based on the current published evidence (direct and indirect) and owing to the robust evidence that fresh pomegranate juice is highly rich with unique bioactive compounds that are approved in various occasions to be effective in several chronic diseased conditions. All related references that serve our aim are accessed through available electronic databases, particularly PubMed and Scopus. In summary, there is accepted evidence that pomegranate juice may be beneficial in SARS-CoV-2 infection conditions, especially for patients with the clinical history of chronic diseases such as hypertension, cardiovascular disease, diabetes, and cancer. However, the interventional studies that directly probe and confirm the effectiveness of fresh pomegranate juice in the management of SARS-CoV-2 infection are mandatory.
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Babajani F, Kakavand A, Mohammadi H, Sharifi A, Zakeri S, Asadi S, Afshar ZM, Rahimi Z, Sayad B. COVID-19 and renin angiotensin aldosterone system: Pathogenesis and therapy. Health Sci Rep 2021; 4:e440. [PMID: 34869917 PMCID: PMC8596942 DOI: 10.1002/hsr2.440] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the ACE2 component of the renin-angiotensin aldosterone system (RAAS) and infects the human cells. The aims of the present review were to look at the role and alteration of the RAAS components in SARS-CoV-2 infection, therapeutic approaches, and clinical trials in this field. METHODS We surveyed the literature (PubMed, Web of Science, and Scopus) till August 18, 2021, and 59 published papers regarding the components of the RAAS and their role and alterations in SARS-CoV-2 infection along with various COVID-19 therapies based on the RASS components were included in the study. RESULTS ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor inhibitors are agents that significantly enhance the ACE2 and Ang-(1-7) levels, which can be suggestive for their role as therapeutics against SARS-CoV-2 infection. Beta-adrenergic blockers, which negatively regulate renin release from juxtaglomerular cells, and vitamin D, as a regulator of the RAAS and renin expression, are proposed therapeutics in the treatment of COVID-19. Some antihyperglycemic agents could be potentially protective against COVID-19-induced lung injury. Also, the inhibition of the Janus kinase/signal transducer and activator of the transcription pathway as a potential treatment for COVID-19 has been suggested. Finally, resveratrol, an antioxidant that can suppress Ang II, has been suggested as an adjunct to other therapies. CONCLUSION Regarding the suggested potential therapies for COVID-19, there are many clinical trials whose results might change the treatment strategies of SARS-CoV-2 infection. So, the results of well-organized clinical trials on the efficacy and safety of the mentioned agents in the treatment of COVID-19 will be useful in the management and therapy of the disease.
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Affiliation(s)
- Fatemeh Babajani
- Students Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Atefeh Kakavand
- Students Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Hossien Mohammadi
- Students Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Armin Sharifi
- Students Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Saba Zakeri
- Students Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Soheila Asadi
- Department of Clinical BiochemistryKermanshah University of Medical SciencesKermanshahIran
| | - Zeinab Mohseni Afshar
- Infectious Diseases Research CenterKermanshah University of Medical SciencesKermanshahIran
| | - Zohreh Rahimi
- Department of Clinical BiochemistryKermanshah University of Medical SciencesKermanshahIran
- Behavioral Research CenterKermanshah University of Medical SciencesKermanshahIran
| | - Babak Sayad
- Infectious Diseases Research CenterKermanshah University of Medical SciencesKermanshahIran
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Westheim AJF, Bitorina AV, Theys J, Shiri-Sverdlov R. COVID-19 infection, progression, and vaccination: Focus on obesity and related metabolic disturbances. Obes Rev 2021; 22:e13313. [PMID: 34269511 PMCID: PMC8420274 DOI: 10.1111/obr.13313] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023]
Abstract
Coronaviruses are constantly circulating in humans, causing common colds and mild respiratory infections. In contrast, infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease-2019 (COVID-19), can cause additional severe complications, particularly in patients with obesity and associated metabolic disturbances. Obesity is a principal causative factor in the development of the metabolic syndrome; a series of physiological, biochemical, clinical, and metabolic factors that increase the risk of obesity-associated diseases. "Metabolically unhealthy" obesity is, in addition to metabolic disturbances, also associated with immunological disturbances. As such, patients with obesity are more prone to develop serious complications from infections, including those from SARS-CoV-2. In this review, we first describe how obesity and related metabolic disturbances increase the risk of SARS-CoV-2 infection. Then, mechanisms contributing to COVID-19 complications and poor prognosis in these patients are discussed. Finally, we discuss how obesity potentially reduces long-term COVID-19 vaccination efficacy. Despite encouraging COVID-19 vaccination results in patients with obesity and related metabolic disturbances in the short-term, it is becoming increasingly evident that long-term COVID-19 vaccination efficacy should be closely monitored in this vulnerable group.
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Affiliation(s)
- Annemarie J F Westheim
- Department of Precision Medicine, GROW-Research School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Albert V Bitorina
- Department of Molecular Genetics, NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan Theys
- Department of Precision Medicine, GROW-Research School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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7
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Mali SN, Thorat BR, Chopade AR. A Viewpoint on Angiotensin-Converting Enzyme 2, Anti-Hypertensives and Coronavirus Disease 2019 (COVID-19). Infect Disord Drug Targets 2021; 21:311-313. [PMID: 32389117 DOI: 10.2174/1871526520666200511005546] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Suraj N Mali
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Matunga, Mumbai- 400019, India
| | - Bapu R Thorat
- Department of Chemistry, Government of Maharashtra's Ismail Yusuf College of Arts, Science and Commerce, Mumbai 60, India
| | - Atul R Chopade
- Department of Pharmacology, Rajarambapu College of Pharmacy, Kasegaon, Maharashtra, India
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COVID-19: imbalance of multiple systems during infection and importance of therapeutic choice and dosing of cardiac and anti-coagulant therapies. Mol Biol Rep 2021; 48:2917-2928. [PMID: 33837899 PMCID: PMC8035598 DOI: 10.1007/s11033-021-06333-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
The renin-angiotensin-aldosterone system and its metabolites play an important role in homeostasis of body, especially the cardiovascular system. In this study, we discuss the imbalance of multiple systems during the infection and the importance of therapeutic choice, dosing, and laboratory monitoring of cardiac and anti-coagulant therapies in COVID-19 patients. The crosstalk between angiotensin, kinin-kallikrein system, as well as inflammatory and coagulation systems plays an essential role in COVID-19. Cardiac complications and coagulopathies imply the crosstalks between the mentioned systems. We believe that the blockage of bradykinin can be a good option in the management of COVID-19 and CVD in patients and that supportive treatment of respiratory and cardiologic complications is needed in COVID-19 patients. Ninety-one percent of COVID-19 patients who were admitted to hospital with a prolonged aPTT were positive for lupus anticoagulant, which increases the risk of thrombosis and prolonged aPTT. Therefore, the question that is posed at this juncture is whether it is safe to use the prophylactic dose of heparin particularly in those with elevated D-dimer levels. It should be noted that timing is of high importance in anti-coagulant therapy; therefore, we should consider the level of D-dimer, fibrinogen, drug-drug interactions, and risk factors during thromboprophylaxis administration. Fibrinogen is an independent predictor of resistance to heparin and should be considered before thromboprophylaxis. Alteplase and Futhan might be a good choice to assess the condition of heparin resistance. Finally, the treatment option, dosing, and laboratory monitoring of anticoagulant therapy are critical decisions in COVID-19 patients.
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9
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Khan S, Rasool ST, Ahmed SI. Role of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us? Curr Probl Cardiol 2021; 46:100842. [PMID: 33994028 PMCID: PMC7977033 DOI: 10.1016/j.cpcardiol.2021.100842] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
Purpose of review: Although the respiratory system is the main target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is evident from recent data that other systems, especially cardiovascular and hematological, are also significantly affected. In fact, in severe form, COVID-19 causes a systemic illness with widespread inflammation and cytokine flood, resulting in severe cardiovascular injury. Therefore, we reviewed cardiac injury biomarkers' role in various cardiovascular complications of COVID 19 in recent studies. Recent findings: Cardiac injury biomarkers were elevated in most of the complicated cases of COVID-19, and their elevation is directly proportional to the worst outcome. Evaluation of cardiac biomarkers with markers of other organ damage gives a more reliable tool for case fatalities and future outcome. Summary: Significant association of cardiac biomarkers in COVID-19 cases helps disease management and prognosis, especially in severely ill patients.
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Affiliation(s)
- Shahzad Khan
- Department of Pathophysiology, Wuhan University School of Medicine, Hubei, Wuhan, China.
| | | | - Syed Imran Ahmed
- College of Science, School of Pharmacy, University of Lincoln, Lincoln, United Kingdom.
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Lotfi F, Akbarzadeh-Khiavi M, Lotfi Z, Rahbarnia L, Safary A, Zarredar H, Baghbanzadeh A, Naghili B, Baradaran B. Micronutrient therapy and effective immune response: a promising approach for management of COVID-19. Infection 2021; 49:1133-1147. [PMID: 34160789 PMCID: PMC8220424 DOI: 10.1007/s15010-021-01644-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
The escalating prevalence of coronavirus disease 2019 (COVID-19) worldwide, with an increased rate of morbidity and mortality, highlights an urgent need to develop more effective therapeutic interventions. Despite the authorized treatment against COVID-19 by the European Union (EU), the safety and effectiveness of this therapeutic strategy for a wide variety of patients have remained a significant challenge. In this respect, micronutrients such as vitamins and minerals, as essential factors, can be considered for improving the function of the immune system and accelerating the treatment procedure. Dietary supplements can attenuate vascular and inflammatory manifestations related to infectious diseases in large part due to their anti-inflammatory and antioxidant properties. Recently, it has been revealed that poor nutritional status may be one of the notable risk factors in severe COVID-19 infections. In the current review, we focus on the micronutrient therapy of COVID-19 patients and provide a comprehensive insight into the essential vitamins/minerals and their role in controlling the severity of the COVID-19 infection. We also discuss the recent advancements, challenges, negative and positive outcomes in relevance to this approach.
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Affiliation(s)
- Fariba Lotfi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Mostafa Akbarzadeh-Khiavi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, P.O. Box 5165665811, Tabriz, Iran
| | - Ziba Lotfi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Rahbarnia
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Azam Safary
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Habib Zarredar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Amir Baghbanzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Lin M, Dong HY, Xie HZ, Li YM, Jia L. Why do we lack a specific magic anti-COVID-19 drug? Analyses and solutions. Drug Discov Today 2020; 26:631-636. [PMID: 33385574 PMCID: PMC7771376 DOI: 10.1016/j.drudis.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic represents the greatest worldwide public health crisis of recent times. The lack of proven effective therapies means that COVID-19 rages relatively unchecked. Current anti-COVID-19 pharmacotherapies are drugs originally designed for other diseases, and administered orally or intravascularly. Thus, they can have various adverse effects. A specific anti-Coronavirus drug should not only target the virus per se, but also treat the related respiratory and cardiovascular symptoms. Here, we examine the advantages and disadvantages of current anti-COVID-19 pharmacotherapies, and analyze the reasons why in the era of big data we have not yet established specific coronavirus therapies and related technical bottlenecks. Finally, we present our design of a novel nebulized S-nitrosocaptopril that is under development for targeting both coronaviruses and their related symptoms.
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Affiliation(s)
- Min Lin
- Cancer Metastasis Alert and Prevention Center, College of Chemistry, Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy, Fuzhou University, Fuzhou, Fujian 350116, China; Institute of Oceanography, Minjiang University, Fuzhou, Fujian 350108, China
| | - Hai-Yan Dong
- Fujian Key Laboratory for Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, Fujian Medical University, Fuzhou, Fujian 350108, China
| | - Huan-Zhang Xie
- Institute of Oceanography, Minjiang University, Fuzhou, Fujian 350108, China
| | - Yu-Mei Li
- Cancer Metastasis Alert and Prevention Center, College of Chemistry, Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy, Fuzhou University, Fuzhou, Fujian 350116, China; Institute of Oceanography, Minjiang University, Fuzhou, Fujian 350108, China
| | - Lee Jia
- Institute of Oceanography, Minjiang University, Fuzhou, Fujian 350108, China.
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12
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Gencer S, Lacy M, Atzler D, van der Vorst EPC, Döring Y, Weber C. Immunoinflammatory, Thrombohaemostatic, and Cardiovascular Mechanisms in COVID-19. Thromb Haemost 2020; 120:1629-1641. [PMID: 33124029 PMCID: PMC7869061 DOI: 10.1055/s-0040-1718735] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has deranged the recent history of humankind, afflicting more than 27 million individuals to date. While the majority of COVID-19 patients recuperate, a considerable number of patients develop severe complications. Bilateral pneumonia constitutes the hallmark of severe COVID-19 disease but an involvement of other organ systems, namely the cardiovascular system, kidneys, liver, and central nervous system, occurs in at least half of the fatal COVID-19 cases. Besides respiratory failure requiring ventilation, patients with severe COVID-19 often display manifestations of systemic inflammation and thrombosis as well as diffuse microvascular injury observed postmortem. In this review, we survey the mechanisms that may explain how viral entry and activation of endothelial cells by severe acute respiratory syndrome coronavirus 2 can give rise to a series of events including systemic inflammation, thrombosis, and microvascular dysfunction. This pathophysiological scenario may be particularly harmful in patients with overt cardiovascular disease and may drive the fatal aspects of COVID-19. We further shed light on the role of the renin-angiotensin aldosterone system and its inhibitors in the context of COVID-19 and discuss the potential impact of antiviral and anti-inflammatory treatment options. Acknowledging the comorbidities and potential organ injuries throughout the course of severe COVID-19 is crucial in the clinical management of patients affecting treatment approaches and recovery rate.
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Affiliation(s)
- Selin Gencer
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
| | - Michael Lacy
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dorothee Atzler
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Walther Straub Institute for Pharmacology and Toxicology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Emiel P. C. van der Vorst
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Interdisciplinary Center for Clinical Research (IZKF), Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Yvonne Döring
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Divison of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Weber
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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13
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Affiliation(s)
- Carlos M Ferrario
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA. .,Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA.
| | - Sarfaraz Ahmad
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Leanne Groban
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, USA
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14
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Ferrario CM, Ahmad S, Groban L. Twenty years of progress in angiotensin converting enzyme 2 and its link to SARS-CoV-2 disease. Clin Sci (Lond) 2020; 134:2645-2664. [PMID: 33063823 PMCID: PMC9055624 DOI: 10.1042/cs20200901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
The virulence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the aggressive nature of the disease has transformed the universal pace of research in the desperate attempt to seek effective therapies to halt the morbidity and mortality of this pandemic. The rapid sequencing of the SARS-CoV-2 virus facilitated identification of the receptor for angiotensin converting enzyme 2 (ACE2) as the high affinity binding site that allows virus endocytosis. Parallel evidence that coronavirus disease 2019 (COVID-19) disease evolution shows greater lethality in patients with antecedent cardiovascular disease, diabetes, or even obesity questioned the potential unfavorable contribution of angiotensin converting enzyme (ACE) inhibitors or angiotensin II (Ang II) receptor blockers as facilitators of adverse outcomes due to the ability of these therapies to augment the transcription of Ace2 with consequent increase in protein formation and enzymatic activity. We review, here, the specific studies that support a role of these agents in altering the expression and activity of ACE2 and underscore that the robustness of the experimental data is associated with weak clinical long-term studies of the existence of a similar regulation of tissue or plasma ACE2 in human subjects.
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Affiliation(s)
- Carlos M. Ferrario
- Departments of Surgery and Physiology-Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, U.S.A
| | - Sarfaraz Ahmad
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, U.S.A
| | - Leanne Groban
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, U.S.A
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15
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Senger MR, Evangelista TCS, Dantas RF, Santana MVDS, Gonçalves LCS, de Souza Neto LR, Ferreira SB, Silva-Junior FP. COVID-19: molecular targets, drug repurposing and new avenues for drug discovery. Mem Inst Oswaldo Cruz 2020; 115:e200254. [PMID: 33027420 PMCID: PMC7534958 DOI: 10.1590/0074-02760200254] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious infection that may break the healthcare system of several countries. Here, we aimed at presenting a critical view of ongoing drug repurposing efforts for COVID-19 as well as discussing opportunities for development of new treatments based on current knowledge of the mechanism of infection and potential targets within. Finally, we also discuss patent protection issues, cost effectiveness and scalability of synthetic routes for some of the most studied repurposing candidates since these are key aspects to meet global demand for COVID-19 treatment.
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Affiliation(s)
- Mario Roberto Senger
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Tereza Cristina Santos Evangelista
- Universidade Federal do Rio de Janeiro, Instituto de Química,
Laboratório de Síntese Orgânica e Prospecção Biológica, Rio de Janeiro, RJ,
Brasil
| | - Rafael Ferreira Dantas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Marcos Vinicius da Silva Santana
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Luiz Carlos Saramago Gonçalves
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Lauro Ribeiro de Souza Neto
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
| | - Sabrina Baptista Ferreira
- Universidade Federal do Rio de Janeiro, Instituto de Química,
Laboratório de Síntese Orgânica e Prospecção Biológica, Rio de Janeiro, RJ,
Brasil
| | - Floriano Paes Silva-Junior
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório
de Bioquímica Experimental e Computacional de Fármacos, Rio de Janeiro, RJ,
Brasil
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16
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Qin JJ, Cheng X, Zhou F, Lei F, Akolkar G, Cai J, Zhang XJ, Blet A, Xie J, Zhang P, Liu YM, Huang Z, Zhao LP, Lin L, Xia M, Chen MM, Song X, Bai L, Chen Z, Zhang X, Xiang D, Chen J, Xu Q, Ma X, Touyz RM, Gao C, Wang H, Liu L, Mao W, Luo P, Yan Y, Ye P, Chen M, Chen G, Zhu L, She ZG, Huang X, Yuan Y, Zhang BH, Wang Y, Liu PP, Li H. Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19. Hypertension 2020; 76:1104-1112. [PMID: 32673499 PMCID: PMC7375179 DOI: 10.1161/hypertensionaha.120.15528] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60–11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50–7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33–7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18–6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53–5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%–50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19–associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.
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Affiliation(s)
- Juan-Juan Qin
- From the Department of Cardiology (J.-J.Q.), Zhongnan Hospital of Wuhan University, China.,Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Xu Cheng
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Feng Zhou
- Medical Science Research Center (F.Z., P.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Fang Lei
- Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Gauri Akolkar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (G.A., A.B., P.P.L.)
| | | | - Xiao-Jing Zhang
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Alice Blet
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (G.A., A.B., P.P.L.)
| | - Jing Xie
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (G.A., A.B., P.P.L.)
| | - Peng Zhang
- Medical Science Research Center (F.Z., P.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.).,Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (G.A., A.B., P.P.L.)
| | - Ye-Mao Liu
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Zizhen Huang
- Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Ling-Ping Zhao
- Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Lijin Lin
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Meng Xia
- Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Ming-Ming Chen
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Xiaohui Song
- Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Liangjie Bai
- Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Ze Chen
- Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Xingyuan Zhang
- Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Da Xiang
- Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Jing Chen
- Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Qingbo Xu
- Centre for Clinic Pharmacology, The William Harvey Research Institute, Queen Mary University of London, United Kingdom (Q.X.)
| | - Xinliang Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania (X.M.)
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.)
| | - Chen Gao
- Department of Anesthesiology, Cardiovascular Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles (C.G., Y.W.)
| | - Haitao Wang
- Department of Hepatobiliary and Pancreatic Surgery (H.W., Y. Yuan), Zhongnan Hospital of Wuhan University, China
| | - Liming Liu
- Department of General Surgery, Ezhou Central Hospital, Wuhan, China (L.L.)
| | - Weiming Mao
- Department of General Surgery, Huanggang Central Hospital, Wuhan, China (W.M.)
| | - Pengcheng Luo
- Department of Urology (P.L.), Wuhan Third Hospital and Tongren Hospital of Wuhan University, China
| | | | - Ping Ye
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, China (P.Y., M.C.)
| | - Manhua Chen
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, China (P.Y., M.C.)
| | - Guohua Chen
- Department of Neurology, Wuhan First Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine, Hubei, China (G.C.)
| | - Lihua Zhu
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Zhi-Gang She
- Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
| | - Xiaodong Huang
- Department of Gastroenterology (X.H.), Wuhan Third Hospital and Tongren Hospital of Wuhan University, China
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery (H.W., Y. Yuan), Zhongnan Hospital of Wuhan University, China
| | - Bing-Hong Zhang
- Department of Neonatology (B.-H.Z.), Renmin Hospital of Wuhan University, China
| | - Yibin Wang
- Department of Anesthesiology, Cardiovascular Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles (C.G., Y.W.)
| | | | - Hongliang Li
- Medical Science Research Center (F.Z., P.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Basic Medical School, Wuhan University, China (F.L., Z.H., X.S., Z.C., X.Z., H.L.).,Department of Cardiology (J.-J.Q., X.C., X.-J.Z., J.X., Y.-M.L., L.L., M.-M.C., L.Z., Z.-G.S., H.L.), Renmin Hospital of Wuhan University, China.,Institute of Model Animal of Wuhan University, China (J.-J.Q., X.C., F.Z., F.L., X.-J.Z., P.Z., Y.-M.L., Z.H., L.-P.Z., L.L., M.X., M.-M.C., X.S., L.B., Z.C., X.Z., D.X., J. Chen, L.Z., Z.-G.S., H.L.)
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17
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Ranard LS, Fried JA, Abdalla M, Anstey DE, Givens RC, Kumaraiah D, Kodali SK, Takeda K, Karmpaliotis D, Rabbani LE, Sayer G, Kirtane AJ, Leon MB, Schwartz A, Uriel N, Masoumi A. Approach to Acute Cardiovascular Complications in COVID-19 Infection. Circ Heart Fail 2020; 13:e007220. [PMID: 32500721 PMCID: PMC8126417 DOI: 10.1161/circheartfailure.120.007220] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.
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Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Justin A Fried
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - D Edmund Anstey
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Raymond C Givens
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Deepa Kumaraiah
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Koji Takeda
- Department of Surgery (K.T.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Dimitrios Karmpaliotis
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - LeRoy E Rabbani
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Martin B Leon
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (S.K.K., D. Karmpaliotis, A.J.K., M.B.L.)
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Nir Uriel
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine (L.S.R., J.A.F., M.A., D.E.A., R.C.G., D. Kumaraiah, S.K.K., D. Karmpaliotis, L.E.R., G.S., A.J.K., M.B.L., A.S., N.U., A.M.), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
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18
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Lanza K, Perez LG, Costa LB, Cordeiro TM, Palmeira VA, Ribeiro VT, Simões e Silva AC. Covid-19: the renin-angiotensin system imbalance hypothesis. Clin Sci (Lond) 2020; 134:1259-1264. [PMID: 32507883 PMCID: PMC7276636 DOI: 10.1042/cs20200492] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
The emergency of SARS-CoV-2 in China started a novel challenge to the scientific community. As the virus turns pandemic, scientists try to map the cellular mechanisms and pathways of SARS-CoV-2 related to the pathogenesis of Coronavirus Disease 2019 (Covid-19). After transmembrane angiotensin-converting enzyme 2 (ACE2) has been found to be SARS-CoV-2 receptor, we hypothesized an immune-hematological mechanism for Covid-19 based on renin-angiotensin system (RAS) imbalance to explain clinical, laboratory and imaging findings on disease course. We believe that exaggerated activation of ACE/Angiotensin II (Ang II)/Angiotensin Type 1 (AT1) receptor RAS axis in line with reduction of ACE2/Angiotensin-(1-7)/Mas receptor may exert a pivotal role in the pathogenesis of Covid-19. In this perspective, we discuss potential mechanisms and evidence on this hypothesis.
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Affiliation(s)
- Katharina Lanza
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lucas G. Perez
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Larissa B. Costa
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thiago M. Cordeiro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Vitria A. Palmeira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Victor T. Ribeiro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões e Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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19
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Luetkens JA, Isaak A, Zimmer S, Nattermann J, Sprinkart AM, Boesecke C, Rieke GJ, Zachoval C, Heine A, Velten M, Duerr GD. Diffuse Myocardial Inflammation in COVID-19 Associated Myocarditis Detected by Multiparametric Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2020; 13:e010897. [PMID: 32397816 DOI: 10.1161/circimaging.120.010897] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Julian Alexander Luetkens
- Department of Radiology (J.A.L., A.I., A.M.S.), University Hospital Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., A.M.S.)
| | - Alexander Isaak
- Department of Radiology (J.A.L., A.I., A.M.S.), University Hospital Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., A.M.S.)
| | - Sebastian Zimmer
- Department of Internal Medicine II - Cardiology (S.Z., C.Z.), University Hospital Bonn, Germany.,German Centre for Infection Research (DZIF), partner-site Cologne-Bonn (J.N., C.B., G.J.R.), University Hospital Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine II - Cardiology (S.Z., C.Z.), University Hospital Bonn, Germany
| | - Alois Martin Sprinkart
- Department of Radiology (J.A.L., A.I., A.M.S.), University Hospital Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., A.M.S.)
| | - Christoph Boesecke
- Department of Internal Medicine I (J.N., C.B., G.J.R.), University Hospital Bonn, Germany.,German Centre for Infection Research (DZIF), partner-site Cologne-Bonn (J.N., C.B., G.J.R.), University Hospital Bonn, Germany
| | - Gereon Jonas Rieke
- Department of Internal Medicine I (J.N., C.B., G.J.R.), University Hospital Bonn, Germany.,German Centre for Infection Research (DZIF), partner-site Cologne-Bonn (J.N., C.B., G.J.R.), University Hospital Bonn, Germany
| | - Christian Zachoval
- Department of Internal Medicine II - Cardiology (S.Z., C.Z.), University Hospital Bonn, Germany
| | - Annkristin Heine
- Department of Internal Medicine III - Oncology, Hematology, Rheumatology and Immune-Oncology (A.H.), University Hospital Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology (M.V.), University Hospital Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery (G.D.D.), University Hospital Bonn, Germany
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20
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Lamas-Barreiro JM, Alonso-Suárez M, Fernández-Martín JJ, Saavedra-Alonso JA. [Angiotensin II suppression in SARS-CoV-2 infection: a therapeutic approach]. Nefrologia 2020; 40:213-216. [PMID: 32456945 PMCID: PMC7190491 DOI: 10.1016/j.nefro.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Mario Alonso-Suárez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Vigo, Vigo, España
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21
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Affiliation(s)
- Jean-Jacques Mourad
- ESH Excellence Centre, Internal Medicine, Groupe hospitalier Paris Saint-Joseph, Paris, France.
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22
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23
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Lamas-Barreiro JM, Alonso-Suárez M, Fernández-Martín JJ, Saavedra-Alonso JA. Angiotensin II suppression in SARS-CoV-2 infection: a therapeutic approach ☆. NEFROLOGÍA (ENGLISH EDITION) 2020; 40. [PMCID: PMC7323640 DOI: 10.1016/j.nefroe.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- José María Lamas-Barreiro
- Servicio de Nefrología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
- Corresponding author.
| | - Mario Alonso-Suárez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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