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Pulito-Cueto V, Sebastián Mora-Gil M, Ferrer-Pargada D, Remuzgo-Martínez S, Genre F, Lera-Gómez L, Alonso-Lecue P, Batista-Liz JC, Tello-Mena S, Abascal-Bolado B, Izquierdo S, Ruiz-Cubillán JJ, Armiñanzas-Castillo C, Blanco R, González-Gay MA, López-Mejías R, Cifrián JM. Inflammasome-Related Genetic Polymorphisms as Severity Biomarkers of COVID-19. Int J Mol Sci 2024; 25:3731. [PMID: 38612539 PMCID: PMC11011752 DOI: 10.3390/ijms25073731] [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: 02/15/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The most critical forms of coronavirus disease 2019 (COVID-19) are associated with excessive activation of the inflammasome. Despite the COVID-19 impact on public health, we still do not fully understand the mechanisms by which the inflammatory response influences disease prognosis. Accordingly, we aimed to elucidate the role of polymorphisms in the key genes of the formation and signaling of the inflammasome as biomarkers of COVID-19 severity. For this purpose, a large and well-defined cohort of 377 COVID-19 patients with mild (n = 72), moderate (n = 84), severe (n = 100), and critical (n = 121) infections were included. A total of 24 polymorphisms located in inflammasome-related genes (NLRP3, NLRC4, NLRP1, CARD8, CASP1, IL1B, IL18, NFKB1, ATG16L1, and MIF) were genotyped in all of the patients and in the 192 healthy controls (HCs) (who were without COVID-19 at the time of and before the study) by RT-qPCR. Our results showed that patients with mild, moderate, severe, and critical COVID-19 presented similar allelic and genotypic distribution in all the variants studied. No statistically significant differences in the haplotypic distribution of NLRP3, NLRC4, NLRP1, CARD8, CASP1, IL1B, and ATG16L1 were observed between COVID-19 patients, who were stratified by disease severity. Each stratified group of patients presented a similar genetic distribution to the HCs. In conclusion, our results suggest that the inflammasome polymorphisms studied are not associated with the worsening of COVID-19.
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Affiliation(s)
- Verónica Pulito-Cueto
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - María Sebastián Mora-Gil
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Diego Ferrer-Pargada
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | | | - Fernanda Genre
- Valdecilla Research Institute (IDIVAL), 39011 Santander, Spain; (S.R.-M.); (F.G.)
| | - Leticia Lera-Gómez
- Department of Microbiology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Pilar Alonso-Lecue
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | - Joao Carlos Batista-Liz
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Sandra Tello-Mena
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | - Beatriz Abascal-Bolado
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | - Sheila Izquierdo
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | - Juan José Ruiz-Cubillán
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
| | | | - Ricardo Blanco
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Miguel A. González-Gay
- School of Medicine, University of Cantabria, 39011 Santander, Spain;
- Department of Rheumatology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Raquel López-Mejías
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - José M. Cifrián
- Immunopathology Group, Marqués de Valdecilla University Hospital-Valdecilla Research Institute (IDIVAL), 39008 Santander, Spain; (M.S.M.-G.); (P.A.-L.); (J.C.B.-L.); (R.B.); (R.L.-M.); (J.M.C.)
- Department of Pneumology, Marqués de Valdecilla University Hospital, 39008 Santander, Spain; (D.F.-P.); (S.T.-M.); (B.A.-B.); (S.I.); (J.J.R.-C.)
- School of Medicine, University of Cantabria, 39011 Santander, Spain;
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Jukic I, Heffernan A, Schelling AF, Kokic Males V, Savicevic NJ, Kovacic V. Association between COVID-19 Infection or Vaccination Outcomes and Methylenetetrahydrofolate Reductase Gene Polymorphism: A Systematic Review of the Literature. J Pers Med 2023; 13:1687. [PMID: 38138914 PMCID: PMC10744904 DOI: 10.3390/jpm13121687] [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: 11/02/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Thrombosis is a detrimental sequala of COVID-19 infection; thus, prophylactic anti-coagulant therapy has been deemed mandatory in treatment unless serious contraindications are present. Susceptibility to thromboembolic events in COVID-19, or following COVID-19 vaccination, is likely attributable to an interplay of factors, including a patient's baseline clinical status and comorbidities, alongside genetic risk factors. In Europe, 8-20% of the population are homozygous for the MTHFR (methylene tetrahydrofolate reductase) variant, which compromises folate metabolism and elevates homocysteine levels. While heightened homocysteine levels are considered a risk factor for thromboembolic events, the precise clinical significance remains a contentious issue. However, recent research suggests elevated homocysteine levels may predict the course and severity of COVID-19 infection. Given the lack of reliable biomarkers predictive of COVID-19 thrombotic risk existing in practice, and the accessibility of MTHFR screening, we established two main outcomes for this study: (1) to determine the association between hereditary MTHFR mutations and COVID-19 severity and thromboembolic events and (2) to determine the link between MTHFR variants and adverse thrombotic events following COVID-19 vaccination. METHODS The review was conducted in accordance with PRISMA guidelines. Medline, Scopus, and Web of Science databases were searched from pandemic inception (11 March 2020) to 30 October 2023. Eligibility criteria were applied, and data extraction performed. RESULTS From 63 citations identified, a total of 14 articles met the full inclusion criteria (8 of which were cross-sectional or observational studies, and 6 were case studies or reports). Among the eight observational and cross-sectional studies evaluating the relationship between MTHFR variants (C667T; A1298C) and thromboembolic events in COVID-19 infection, four studies established a connection (n = 2200), while the remaining four studies failed to demonstrate any significant association (n = 38). CONCLUSIONS This systematic review demonstrated a possible association between the MTHFR gene variants and COVID-19 severity, thromboembolic events, and adverse events following vaccination. However, the paucity of robust data precluded any firm conclusions being drawn. Further prospective trials are required to determine the connection between the MTHFR gene variant and COVID-19 infection and vaccination outcomes.
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Affiliation(s)
- Ivana Jukic
- Internal Medicine Department, Gastroenterology Division, University Hospital of Split, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Aisling Heffernan
- School of Medicine, University of Split, 21000 Split, Croatia; (A.H.); (A.F.S.); (N.J.S.); (V.K.)
| | | | - Visnja Kokic Males
- Department of Health Studies, University of Split, 21000 Split, Croatia;
- Internal Medicine Department, Endocrinology Division, University Hospital of Split, 21000 Split, Croatia
| | - Nora Josipa Savicevic
- School of Medicine, University of Split, 21000 Split, Croatia; (A.H.); (A.F.S.); (N.J.S.); (V.K.)
| | - Vedran Kovacic
- School of Medicine, University of Split, 21000 Split, Croatia; (A.H.); (A.F.S.); (N.J.S.); (V.K.)
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
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