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Umadevi K, Sundeep D, Varadharaj EK, Sastry CC, Shankaralingappa A, Chary RN, Vighnesh AR. Precision Detection of Fungal Co-Infections for Enhanced COVID-19 Treatment Strategies Using FESEM Imaging. Indian J Microbiol 2024; 64:1084-1098. [PMID: 39282206 PMCID: PMC11399527 DOI: 10.1007/s12088-024-01246-1] [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: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 09/18/2024] Open
Abstract
The treatment of fungal infections presents significant challenges due to the lack of standardized diagnostic procedures, a restricted range of antifungal treatments, and the risk of harmful interactions between antifungal medications and the immunosuppressive drugs used in anti-inflammatory treatment for critically ill patients with COVID-19. Mucormycosis and aspergillosis are the primary invasive fungal infections in patients with severe COVID-19, occurring singly or in combination. Histopathological examination is a vital diagnostic technique that details the presence and invasion of fungi within tissues and blood vessels, and the body's response to the infection. However, the pathology report omits information on the most common fungi associated with the observed morphology, as well as other potential fungi and parasites that ought to be included in the differential diagnosis. This research marks significance in diagnosing fungal infections, such as mucormycosis and aspergillosis associated to COVID-19 by field emission scanning electron microscopy (FESEM) imaging to examine unstained histopathology slides, allowing for a detailed morphological analysis of the fungus. FESEM provides an unprecedented resolution and detail, surpassing traditional Hematoxylin & Eosin (H&E) and Grocott's Methenamine Silver (GMS) staining methods in identifying and differentiating dual fungal infections and diverse fungal species. The findings underscore the critical need for individualized treatment plans for patients severely affected by COVID-19 and compounded by secondary fungal infections. The high-magnification micrographs reveal specific fungal morphology and reproductive patterns. Current treatment protocols largely depend on broad-spectrum antifungal therapies. However this FESEM guided diagnostic approach can help in targeted patient specific anti fungal therapies. Such precision could lead to more effective early interventions, addressing the complex management required for severe COVID-19 cases with coexisting fungal infections. This approach significantly advances disease management and patient recovery, advocating for personalized, precision medicine in tackling this multifaceted clinical challenge. Graphical Abstract
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Affiliation(s)
- Kovuri Umadevi
- Department of Pathology, Government Medical College and Hospital, Khaleelwadi, Nizamabad, Telangana 503001 India
| | - Dola Sundeep
- Biomedical Research Laboratory, Department of Electronics and Communication Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | - Eswaramoorthy K Varadharaj
- Biomedical Research Laboratory, Department of Electronics and Communication Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | - Chebbiyam Chandrasekhara Sastry
- Biomedical Research Laboratory, Department of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | | | - Rajarikam Nagarjuna Chary
- Department of Pathology, Government Medical College and Hospital, Khaleelwadi, Nizamabad, Telangana 503001 India
| | - Alluru Raghavendra Vighnesh
- Department of Mechanical Engineering, Indian Institute of Technology (IIT-BHU), Varanasi, Uttar Pradesh 221005 India
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Velikova T, Valkov H, Aleksandrova A, Peshevska-Sekulovska M, Sekulovski M, Shumnalieva R. Harnessing immunity: Immunomodulatory therapies in COVID-19. World J Virol 2024; 13:92521. [PMID: 38984079 PMCID: PMC11229839 DOI: 10.5501/wjv.v13.i2.92521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 06/24/2024] Open
Abstract
An overly exuberant immune response, characterized by a cytokine storm and uncontrolled inflammation, has been identified as a significant driver of severe coronavirus disease 2019 (COVID-19) cases. Consequently, deciphering the intricacies of immune dysregulation in COVID-19 is imperative to identify specific targets for intervention and modulation. With these delicate dynamics in mind, immunomodulatory therapies have emerged as a promising avenue for mitigating the challenges posed by COVID-19. Precision in manipulating immune pathways presents an opportunity to alter the host response, optimizing antiviral defenses while curbing deleterious inflammation. This review article comprehensively analyzes immunomodulatory interventions in managing COVID-19. We explore diverse approaches to mitigating the hyperactive immune response and its impact, from corticosteroids and non-steroidal drugs to targeted biologics, including anti-viral drugs, cytokine inhibitors, JAK inhibitors, convalescent plasma, monoclonal antibodies (mAbs) to severe acute respiratory syndrome coronavirus 2, cell-based therapies (i.e., CAR T, etc.). By summarizing the current evidence, we aim to provide a clear roadmap for clinicians and researchers navigating the complex landscape of immunomodulation in COVID-19 treatment.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Hristo Valkov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna-ISUL”, Medical University of Sofia, Sofia 1527, Bulgaria
| | | | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Russka Shumnalieva
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia 1612, Bulgaria
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Aljabr W, Dandachi I, Abbas B, Karkashan A, Al-Amari A, AlShahrani D. Metagenomic next-generation sequencing of nasopharyngeal microbiota in COVID-19 patients with different disease severities. Microbiol Spectr 2024; 12:e0416623. [PMID: 38557102 PMCID: PMC11237758 DOI: 10.1128/spectrum.04166-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
Throughout the COVID-19 pandemic, extensive research has been conducted on SARS-COV-2 to elucidate its genome, prognosis, and possible treatments. However, few looked at the microbial markers that could be explored in infected patients and that could predict possible disease severity. The aim of this study is to compare the nasopharyngeal microbiota of healthy subjects, moderate, under medication, and recovered SARS-COV-2 patients. In 2020, 38 nasopharyngeal swabs were collected from 6 healthy subjects, 14 moderates, 10 under medication and 8 recovered SARS-COV-2 patients at the Prince Mohammed Bin Abdulaziz Hospital Riyadh. Metatranscriptomic sequencing was performed using Minion Oxford nanopore sequencing. No significant difference in alpha as well as beta diversity was observed among all four categories. Nevertheless, we have found that Streptococcus spp including Streptococcus pneumoniae and Streptococcus thermophilus were among the top 15 most abundant species detected in COVID-19 patients but not in healthy subjects. The genus Staphylococcus was found to be associated with COVID-19 patients compared to healthy subjects. Furthermore, the abundance of Leptotrichia was significantly higher in healthy subjects compared to recovered patients. Corynebacterium on the other hand, was associated with under-medication patients. Taken together, our study revealed no differences in the overall microbial composition between healthy subjects and COVID-19 patients. Significant differences were seen only at specific taxonomic level. Future studies should explore the nasopharyngeal microbiota between controls and COVID-19 patients while controlling for confounders including age, gender, and comorbidities; since these latter could affect the results and accordingly the interpretation.IMPORTANCEIn this work, no significant difference in the microbial diversity was seen between healthy subjects and COVID-19 patients. Changes in specific taxa including Leptotrichia, Staphylococcus, and Corynebacterium were only observed. Leptotrichia was significantly higher in healthy subjects, whereas Staphylococcus and Corynebacterium were mostly associated with COVID-19, and specifically with under-medication SARS-COV-2 patients, respectively. Although the COVID-19 pandemic has ended, the SARS-COV-2 virus is continuously evolving and the emergence of new variants causing more severe disease should be always kept in mind. Microbial markers in SARS-COV-2 infected patients can be useful in the early suspicion of the disease, predicting clinical outcomes, framing hospital and intensive care unit admission as well as, risk stratification. Data on which microbial marker to tackle is still controversial and more work is needed, hence the importance of this study.
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Affiliation(s)
- Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Iman Dandachi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Basma Abbas
- Department of Biological Sciences, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Alaa Karkashan
- Department of Biological Sciences, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Ahod Al-Amari
- Department of Basic Medical Sciences, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Dayel AlShahrani
- Pediatric infectious diseases, King Fahad Medical City, Riyadh, Saudi Arabia
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Wu N, Chen Z, Zha G, Deng Z, Huang W, Cai D, Peng M, Hu P, Tang L, Ren H. Clinical and immunological features of COVID-19 in patients with anti-MDA5 dermatomyositis during the omicron wave in Chongqing, China. J Med Virol 2024; 96:e29493. [PMID: 38436114 DOI: 10.1002/jmv.29493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Patients with anti-melanoma differentiation-associated gene 5 (anti-MDA5) dermatomyositis (DM) have a higher risk of coronavirus disease 2019 (COVID-19) infection. In this longitudinal observational study, we aimed to investigate the clinical and immunological features of these patients after COVID-19 infection. A total of 73 patients with anti-MDA5 DM were recruited from the Second Affiliated Hospital of Chongqing Medical University during the Omicron wave epidemic. Clinical data were collected by questionnaire survey and electronic medical records. Blood samples were used to determine the immunity responses. From December 9, 2022 to March 31, 2023, 67 patients were eligible for final analysis; 68.7% of them were infected with COVID-19. The most common symptoms observed in COVID-19 were upper respiratory symptoms, most cases were mild or moderate (97.8%). The clinical laboratory indexes were relativity stable in patients after infection (all p > 0.05). Vaccination is not a protective factor against the Omicron infection (odds ratio: 2.69, 95% confidence interval: 0.81-8.93, p = 0.105). Both wildtype (WT) neutralizing antibodies titer and BA.5-specific immunoglobulin G titer were significantly enhanced after infection (all p < 0.01), which was as high as healthy controls (HCs). The memory B-cell responses were similar between the patients with anti-MDA5 DM and HCs (p > 0.05). However, both the WT-specific CD8+ T cells and CD4+ T cells were reduced in patients with anti-MDA5 DM (all p < 0.05). In conclusion, patients with anti-MDA5 DM did not deteriorate the COVID-19, in turn, COVID-19 infection did not increase the risk of anti-MDA5 DM exacerbation. The humoral responses were robust but the cellular responses were weakened after COVID-19 infection.
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Affiliation(s)
- Na Wu
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiwei Chen
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guanhua Zha
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiling Deng
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhan Huang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dachuan Cai
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingli Peng
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Hu
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Tang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Ren
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Adhikary S, Pathak S, Palani V, Acar A, Banerjee A, Al-Dewik NI, Essa MM, Mohammed SGAA, Qoronfleh MW. Current Technologies and Future Perspectives in Immunotherapy towards a Clinical Oncology Approach. Biomedicines 2024; 12:217. [PMID: 38255322 PMCID: PMC10813720 DOI: 10.3390/biomedicines12010217] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Immunotherapy is now established as a potent therapeutic paradigm engendering antitumor immune response against a wide range of malignancies and other diseases by modulating the immune system either through the stimulation or suppression of immune components such as CD4+ T cells, CD8+ T cells, B cells, monocytes, macrophages, dendritic cells, and natural killer cells. By targeting several immune checkpoint inhibitors or blockers (e.g., PD-1, PD-L1, PD-L2, CTLA-4, LAG3, and TIM-3) expressed on the surface of immune cells, several monoclonal antibodies and polyclonal antibodies have been developed and already translated clinically. In addition, natural killer cell-based, dendritic cell-based, and CAR T cell therapies have been also shown to be promising and effective immunotherapeutic approaches. In particular, CAR T cell therapy has benefited from advancements in CRISPR-Cas9 genome editing technology, allowing the generation of several modified CAR T cells with enhanced antitumor immunity. However, the emerging SARS-CoV-2 infection could hijack a patient's immune system by releasing pro-inflammatory interleukins and cytokines such as IL-1β, IL-2, IL-6, and IL-10, and IFN-γ and TNF-α, respectively, which can further promote neutrophil extravasation and the vasodilation of blood vessels. Despite the significant development of advanced immunotherapeutic technologies, after a certain period of treatment, cancer relapses due to the development of resistance to immunotherapy. Resistance may be primary (where tumor cells do not respond to the treatment), or secondary or acquired immune resistance (where tumor cells develop resistance gradually to ICIs therapy). In this context, this review aims to address the existing immunotherapeutic technologies against cancer and the resistance mechanisms against immunotherapeutic drugs, and explain the impact of COVID-19 on cancer treatment. In addition, we will discuss what will be the future implementation of these strategies against cancer drug resistance. Finally, we will emphasize the practical steps to lay the groundwork for enlightened policy for intervention and resource allocation to care for cancer patients.
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Affiliation(s)
- Subhamay Adhikary
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Surajit Pathak
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Vignesh Palani
- Faculty of Medicine, Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Ahmet Acar
- Department of Biological Sciences, Middle East Technical University, 06800 Ankara, Türkiye;
| | - Antara Banerjee
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Nader I. Al-Dewik
- Department of Pediatrics, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 00974, Qatar;
| | - Musthafa Mohamed Essa
- College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat 123, Oman
| | | | - M. Walid Qoronfleh
- Research & Policy Division, Q3 Research Institute (QRI), Ypsilanti, MI 48917, USA
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Yilmazer A, Alagarsamy KN, Gokce C, Summak GY, Rafieerad A, Bayrakdar F, Ozturk BI, Aktuna S, Delogu LG, Unal MA, Dhingra S. Low Dose of Ti 3 C 2 MXene Quantum Dots Mitigate SARS-CoV-2 Infection. SMALL METHODS 2023; 7:e2300044. [PMID: 37075731 DOI: 10.1002/smtd.202300044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/21/2023] [Indexed: 05/03/2023]
Abstract
MXene QDs (MQDs) have been effectively used in several fields of biomedical research. Considering the role of hyperactivation of immune system in infectious diseases, especially in COVID-19, MQDs stand as a potential candidate as a nanotherapeutic against viral infections. However, the efficacy of MQDs against SARS-CoV-2 infection has not been tested yet. In this study, Ti3 C2 MQDs are synthesized and their potential in mitigating SARS-CoV-2 infection is investigated. Physicochemical characterization suggests that MQDs are enriched with abundance of bioactive functional groups such as oxygen, hydrogen, fluorine, and chlorine groups as well as surface titanium oxides. The efficacy of MQDs is tested in VeroE6 cells infected with SARS-CoV-2. These data demonstrate that the treatment with MQDs is able to mitigate multiplication of virus particles, only at very low doses such as 0,15 µg mL-1 . Furthermore, to understand the mechanisms of MQD-mediated anti-COVID properties, global proteomics analysis are performed and determined differentially expressed proteins between MQD-treated and untreated cells. Data reveal that MQDs interfere with the viral life cycle through different mechanisms including the Ca2 + signaling pathway, IFN-α response, virus internalization, replication, and translation. These findings suggest that MQDs can be employed to develop future immunoengineering-based nanotherapeutics strategies against SARS-CoV-2 and other viral infections.
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Affiliation(s)
- Açelya Yilmazer
- Department of Biomedical Engineering, Ankara University, Golbasi, Ankara, 06830, Turkey
- Stem Cell Institute, Ankara University, Balgat, Ankara, 06520, Turkey
| | - Keshav Narayan Alagarsamy
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, R3T 2N2, Canada
| | - Cemile Gokce
- Department of Biomedical Engineering, Ankara University, Golbasi, Ankara, 06830, Turkey
| | | | - Alireza Rafieerad
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, R3T 2N2, Canada
| | - Fatma Bayrakdar
- Microbiology References Laboratory, Ministry of Health General Directorate of Public Health, Ankara, 06100, Turkey
| | - Berfin Ilayda Ozturk
- Department of Biomedical Engineering, Ankara University, Golbasi, Ankara, 06830, Turkey
| | - Suleyman Aktuna
- Department of Medical Genetics, Faculty of Medicine, Yuksek Ihtisas University, Ankara, 06530, Turkey
| | - Lucia Gemma Delogu
- Department of Biomedical Sciences, University of Padua, Padua, 35122, Italy
- New York University Abu Dhabi, Abu Dhabi, 129188, United Arab Emirates
| | - Mehmet Altay Unal
- Stem Cell Institute, Ankara University, Balgat, Ankara, 06520, Turkey
| | - Sanjiv Dhingra
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, R3T 2N2, Canada
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Paine R, Chasse R, Halstead ES, Nfonoyim J, Park DJ, Byun T, Patel B, Molina-Pallete G, Harris ES, Garner F, Simms L, Ahuja S, McManus JL, Roychowdhury DF. Inhaled Sargramostim (Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor) for COVID-19-Associated Acute Hypoxemia: Results of the Phase 2, Randomized, Open-Label Trial (iLeukPulm). Mil Med 2023; 188:e2629-e2638. [PMID: 36458916 PMCID: PMC10363010 DOI: 10.1093/milmed/usac362] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Granulocyte-macrophage colony-stimulating factor (GM-CSF), a protein produced in the lung, is essential for pulmonary host defense and alveolar integrity. Prior studies suggest potential benefits in several pulmonary conditions, including acute respiratory distress syndrome and viral infections. This trial evaluated the effect of the addition of inhaled sargramostim (yeast-derived, glycosylated recombinant human GM-CSF) to standard of care (SOC) on oxygenation and clinical outcomes in patients with COVID-19-associated acute hypoxemia. MATERIALS AND METHODS A randomized, controlled, open-label trial of hospitalized adults with COVID-19-associated hypoxemia (oxygen saturation <93% on ≥2 L/min oxygen supplementation and/or PaO2/FiO2 <350) randomized 2:1 to inhaled sargramostim (125 mcg twice daily for 5 days) plus SOC versus SOC alone. Institutional SOC before and during the study was not limited. Primary outcomes were change in the alveolar-arterial oxygen gradient (P(A-a)O2) by day 6 and the percentage of patients intubated within 14 days. Safety evaluations included treatment-emergent adverse events. Efficacy analyses were based on the modified intent-to-treat population, the subset of the intent-to-treat population that received ≥1 dose of any study treatment (sargramostim and/or SOC). An analysis of covariance approach was used to analyze changes in oxygenation measures. The intubation rate was analyzed using the chi-squared test. All analyses are considered descriptive. The study was institutional review board approved. RESULTS In total, 122 patients were treated (sargramostim, n = 78; SOC, n = 44). The sargramostim arm experienced greater improvement in P(A-a)O2 by day 6 compared to SOC alone (least squares [LS] mean change from baseline [SE]: -102.3 [19.4] versus -30.5 [26.9] mmHg; LS mean difference: -71.7 [SE 33.2, 95% CI -137.7 to -5.8]; P = .033; n = 96). By day 14, 11.5% (9/78) of sargramostim and 15.9% (7/44) of SOC arms required intubation (P = .49). The 28-day mortality was 11.5% (9/78) and 13.6% (6/44) in the sargramostim and SOC arms, respectively (hazard ratio 0.85; P = .76). Treatment-emergent adverse events occurred in 67.9% (53/78) and 70.5% (31/44) on the sargramostim and SOC arms, respectively. CONCLUSIONS The addition of inhaled sargramostim to SOC improved P(A-a)O2, a measure of oxygenation, by day 6 in hospitalized patients with COVID-19-associated acute hypoxemia and was well tolerated. Inhaled sargramostim is delivered directly to the lung, minimizing systemic effects, and is simple to administer making it a feasible treatment option in patients in settings where other therapy routes may be difficult. Although proportionally lower rates of intubation and mortality were observed in sargramostim-treated patients, this study was insufficiently powered to demonstrate significant changes in these outcomes. However, the significant improvement in gas exchange with sargramostim shows this inhalational treatment enhances pulmonary efficiency in this severe respiratory illness. These data provide strong support for further evaluation of sargramostim in high-risk patients with COVID-19.
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Affiliation(s)
- Robert Paine
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Robert Chasse
- Department of Pulmonary and Critical Care, TidalHealth Peninsula Regional Medical Center, Salisbury, MD 21801, USA
| | - E Scott Halstead
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State University, Hershey, PA 17033, USA
| | - Jay Nfonoyim
- Department of Medicine and Critical Care, Richmond University Medical Center, Staten Island, NY 10310, USA
| | - David J Park
- Department of Hematology and Oncology, Providence St. Jude Medical Center, Fullerton, CA 92835, USA
| | - Timothy Byun
- Department of Hematology and Medical Oncology, Providence St. Joseph Hospital, Orange, CA 92868, USA
| | - Bela Patel
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center, Houston, TX 77030, USA
| | - Guido Molina-Pallete
- Department of Pulmonary and Critical Care, Great Plains Health, North Platte, NE 69101, USA
| | - Estelle S Harris
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Fiona Garner
- Partner Therapeutics, Inc., Lexington, MA 02421, USA
| | - Lorinda Simms
- Partner Therapeutics, Inc., Lexington, MA 02421, USA
| | - Sanjeev Ahuja
- Partner Therapeutics, Inc., Lexington, MA 02421, USA
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Kushch AA, Ivanov AV. [Exosomes in the life cycle of viruses and the pathogenesis of viral infections]. Vopr Virusol 2023; 68:181-197. [PMID: 37436410 DOI: 10.36233/0507-4088-173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 07/13/2023]
Abstract
Exosomes are extracellular vesicles of endosomal origin, with a bilayer membrane, 30160 nm in diameter. Exosomes are released from cells of different origins and are detected in various body fluids. They contain nucleic acids, proteins, lipids, metabolites and can transfer the contents to recipient cells. Exosome biogenesis involves cellular proteins of the Rab GTPase family and the ESCRT system, which regulate budding, vesicle transport, molecule sorting, membrane fusion, formation of multivesicular bodies and exosome secretion. Exosomes are released from cells infected with viruses and may contain viral DNA and RNA, as well as mRNA, microRNA, other types of RNA, proteins and virions. Exosomes are capable of transferring viral components into uninfected cells of various organs and tissues. This review analyzes the impact of exosomes on the life cycle of widespread viruses that cause serious human diseases: human immunodeficiency virus (HIV-1), hepatitis B virus, hepatitis C virus, SARS-CoV-2. Viruses are able to enter cells by endocytosis, use molecular and cellular pathways involving Rab and ESCRT proteins to release exosomes and spread viral infections. It has been shown that exosomes can have multidirectional effects on the pathogenesis of viral infections, suppressing or enhancing the course of diseases. Exosomes can potentially be used in noninvasive diagnostics as biomarkers of the stage of infection, and exosomes loaded with biomolecules and drugs - as therapeutic agents. Genetically modified exosomes are promising candidates for new antiviral vaccines.
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Affiliation(s)
- A A Kushch
- National Research Center for Epidemiology and Microbiology named after Honorary Academician N.F. Gamaleya of the Ministry of Health of the Russian Federation
| | - A V Ivanov
- Institute of Molecular Biology named after V.A. Engelhardt of Russian Academy of Sciences
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Lassan S, Tesar T, Tisonova J, Lassanova M. Pharmacological approaches to pulmonary fibrosis following COVID-19. Front Pharmacol 2023; 14:1143158. [PMID: 37397477 PMCID: PMC10308083 DOI: 10.3389/fphar.2023.1143158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background: In the past few years, COVID-19 became the leading cause of morbidity and mortality worldwide. Although the World Health Organization has declared an end to COVID-19 as a public health emergency, it can be expected, that the emerging new cases at the top of previous ones will result in an increasing number of patients with post-COVID-19 sequelae. Despite the fact that the majority of patients recover, severe acute lung tissue injury can in susceptible individuals progress to interstitial pulmonary involvement. Our goal is to provide an overview of various aspects associated with the Post-COVID-19 pulmonary fibrosis with a focus on its potential pharmacological treatment options. Areas covered: We discuss epidemiology, underlying pathobiological mechanisms, and possible risk and predictive factors that were found to be associated with the development of fibrotic lung tissue remodelling. Several pharmacotherapeutic approaches are currently being applied and include anti-fibrotic drugs, prolonged use or pulses of systemic corticosteroids and non-steroidal anti-inflammatory and immunosuppressive drugs. In addition, several repurposed or novel compounds are being investigated. Fortunately, clinical trials focused on pharmacological treatment regimens for post-COVID-19 pulmonary fibrosis have been either designed, completed or are already in progress. However, the results are contrasting so far. High quality randomised clinical trials are urgently needed with respect to the heterogeneity of disease behaviour, patient characteristics and treatable traits. Conclusion: The Post-COVID-19 pulmonary fibrosis contributes to the burden of chronic respiratory consequences among survivors. Currently available pharmacotherapeutic approaches mostly comprise repurposed drugs with a proven efficacy and safety profile, namely, corticosteroids, immunosuppressants and antifibrotics. The role of nintedanib and pirfenidone is promising in this area. However, we still need to verify conditions under which the potential to prevent, slow or stop progression of lung damage will be fulfilled.
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Affiliation(s)
- Stefan Lassan
- Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jana Tisonova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Lassanova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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10
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Afewerki S, Stocco TD, Rosa da Silva AD, Aguiar Furtado AS, Fernandes de Sousa G, Ruiz-Esparza GU, Webster TJ, Marciano FR, Strømme M, Zhang YS, Lobo AO. In vitro high-content tissue models to address precision medicine challenges. Mol Aspects Med 2023; 91:101108. [PMID: 35987701 PMCID: PMC9384546 DOI: 10.1016/j.mam.2022.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 01/18/2023]
Abstract
The field of precision medicine allows for tailor-made treatments specific to a patient and thereby improve the efficiency and accuracy of disease prevention, diagnosis, and treatment and at the same time would reduce the cost, redundant treatment, and side effects of current treatments. Here, the combination of organ-on-a-chip and bioprinting into engineering high-content in vitro tissue models is envisioned to address some precision medicine challenges. This strategy could be employed to tackle the current coronavirus disease 2019 (COVID-19), which has made a significant impact and paradigm shift in our society. Nevertheless, despite that vaccines against COVID-19 have been successfully developed and vaccination programs are already being deployed worldwide, it will likely require some time before it is available to everyone. Furthermore, there are still some uncertainties and lack of a full understanding of the virus as demonstrated in the high number new mutations arising worldwide and reinfections of already vaccinated individuals. To this end, efficient diagnostic tools and treatments are still urgently needed. In this context, the convergence of bioprinting and organ-on-a-chip technologies, either used alone or in combination, could possibly function as a prominent tool in addressing the current pandemic. This could enable facile advances of important tools, diagnostics, and better physiologically representative in vitro models specific to individuals allowing for faster and more accurate screening of therapeutics evaluating their efficacy and toxicity. This review will cover such technological advances and highlight what is needed for the field to mature for tackling the various needs for current and future pandemics as well as their relevancy towards precision medicine.
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Affiliation(s)
- Samson Afewerki
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, BOX 35, 751 03, Uppsala, Sweden
| | - Thiago Domingues Stocco
- Bioengineering Program, Technological and Scientific Institute, Brazil University, 08230-030, São Paulo, SP, Brazil; Faculty of Medical Sciences, Unicamp - State University of Campinas, 13083-877, Campinas, SP, Brazil
| | | | - André Sales Aguiar Furtado
- Interdisciplinary Laboratory for Advanced Materials, BioMatLab, Department of Materials Engineering, Federal University of Piauí (UFPI), Teresina, PI, Brazil
| | - Gustavo Fernandes de Sousa
- Interdisciplinary Laboratory for Advanced Materials, BioMatLab, Department of Materials Engineering, Federal University of Piauí (UFPI), Teresina, PI, Brazil
| | - Guillermo U Ruiz-Esparza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA; Division of Health Sciences and Technology, Harvard University ‑ Massachusetts Institute of Technology, Boston, MA, 02115, USA
| | - Thomas J Webster
- Interdisciplinary Laboratory for Advanced Materials, BioMatLab, Department of Materials Engineering, Federal University of Piauí (UFPI), Teresina, PI, Brazil; Hebei University of Technology, Tianjin, China
| | - Fernanda R Marciano
- Department of Physics, Federal University of Piauí (UFPI), Teresina, PI, Brazil
| | - Maria Strømme
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, BOX 35, 751 03, Uppsala, Sweden
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA; Division of Health Sciences and Technology, Harvard University ‑ Massachusetts Institute of Technology, Boston, MA, 02115, USA.
| | - Anderson Oliveira Lobo
- Interdisciplinary Laboratory for Advanced Materials, BioMatLab, Department of Materials Engineering, Federal University of Piauí (UFPI), Teresina, PI, Brazil.
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11
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Valenzuela G, Alarcón‐Andrade G, Schulze‐Schiapacasse C, Rodríguez R, García‐Salum T, Pardo‐Roa C, Levican J, Serrano E, Avendaño MJ, Gutiérrez M, Godoy L, Céspedes P, Bermudez S, Aravena J, Nicolaides I, Martínez E, Gómez‐Canobbio C, Jofré M, Salinas A, Depaoli D, Loza C, Muñoz A, Ormazábal N, Manzur D, Barriga J, Almonacid LI, Poblete‐Cárdenas E, Salinas E, Muñoz‐Marcos A, Barja S, Medina RA. Short-term complications and post-acute sequelae in hospitalized paediatric patients with COVID-19 and obesity: A multicenter cohort study. Pediatr Obes 2023; 18:e12980. [PMID: 36222077 PMCID: PMC9874399 DOI: 10.1111/ijpo.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short-term complications and post-acute sequelae in children is not well defined. OBJECTIVE To evaluate the relationship between obesity and short-term complications and post-acute sequelae of SARS-CoV-2 infection in hospitalized paediatric patients. METHODS An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS-CoV-2 RT-PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0-2 years) and CDC 2000 (2-20 years) growth references. Short-term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms were considered as post-acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. RESULTS A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90-10.94), oxygen requirement (aOR = 2.77, CI95% 1.36-5.63), non-invasive ventilatory support (aOR = 6.81, CI95% 2.11-22.04), overall superinfections (aOR = 3.02 CI95% 1.45-6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44-6.23). For post-acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92-51.10) and muscle weakness (aOR = 20.04 CI95% 2.50-160.65). CONCLUSIONS In paediatric hospitalized patients with COVID-19, severe short-term outcomes and post-acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID-19 complications in children.
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Affiliation(s)
- Gonzalo Valenzuela
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID‐19 Working Group, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Gonzalo Alarcón‐Andrade
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Clara Schulze‐Schiapacasse
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Rocío Rodríguez
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Clínico Red Salud UC‐ChristusSantiagoChile
| | - Tamara García‐Salum
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID‐19 Working Group, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Catalina Pardo‐Roa
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID‐19 Working Group, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Jorge Levican
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Eileen Serrano
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - María José Avendaño
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Monserrat Gutiérrez
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Dr. Sótero del RíoSantiagoChile
| | - Loreto Godoy
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Dr. Sótero del RíoSantiagoChile
| | - Pamela Céspedes
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Dr. Sótero del RíoSantiagoChile
| | - Sandra Bermudez
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Dr. Sótero del RíoSantiagoChile
| | - Javiera Aravena
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Irini Nicolaides
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Eliana Martínez
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Constanza Gómez‐Canobbio
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Macarena Jofré
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Andrea Salinas
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Daniela Depaoli
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Carolina Loza
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Andrés Muñoz
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Natalia Ormazábal
- Centro de Responsabilidad de PeditaríaHospital Clínico La FloridaSantiagoChile
| | - Diana Manzur
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Clínico Red Salud UC‐ChristusSantiagoChile
| | - José Barriga
- Division of Pediatrics, Pontificia Universidad Católica de ChileHospital Clínico Red Salud UC‐ChristusSantiagoChile
| | - Leonardo I. Almonacid
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Estefany Poblete‐Cárdenas
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Erick Salinas
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID‐19 Working Group, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Andrés Muñoz‐Marcos
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Salesa Barja
- Department of Pediatrics, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Department of Pediatric Gastroenterology and Nutrition, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Catolica de ChileHospital Josefina MartínezSantiagoChile
| | - Rafael A. Medina
- Department of Pediatric Infectious Diseases and Immunology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID‐19 Working Group, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
- Department of MicrobiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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12
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Ahuja P, Ujjain SK, Kukobat R, Urita K, Moriguchi I, Furuse A, Hattori Y, Fujimoto K, Rao G, Ge X, Wright T, Kaneko K. Air-permeable redox mediated transcutaneous CO 2 sensor. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2023; 457:141260. [PMID: 36620723 PMCID: PMC9804966 DOI: 10.1016/j.cej.2022.141260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Standard clinical care of neonates and the ventilation status of human patients affected with coronavirus disease involves continuous CO2 monitoring. However, existing noninvasive methods are inadequate owing to the rigidity of hard-wired devices, insubstantial gas permeability and high operating temperature. Here, we report a cost-effective transcutaneous CO2 sensing device comprising elastomeric sponges impregnated with oxidized single-walled carbon nanotubes (oxSWCNTs)-based composites. The proposed device features a highly selective CO2 sensing response (detection limit 155 ± 15 ppb), excellent permeability and reliability under a large deformation. A follow-up prospective study not only offers measurement equivalency to existing clinical standards of CO2 monitoring but also provides important additional features. This new modality allowed for skin-to-skin care in neonates and room-temperature CO2 monitoring as compared with clinical standard monitoring system operating at high temperature to substantially enhance the quality for futuristic applications.
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Affiliation(s)
- Preety Ahuja
- Research Initiative for Supra-Material, Shinshu University, Nagano 380-8553, Japan
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Sanjeev Kumar Ujjain
- Research Initiative for Supra-Material, Shinshu University, Nagano 380-8553, Japan
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Radovan Kukobat
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Bosnia and Herzegovina
| | - Koki Urita
- Graduate School of Engineering, Nagasaki University, Nagasaki 852-8521, Japan
| | - Isamu Moriguchi
- Graduate School of Engineering, Nagasaki University, Nagasaki 852-8521, Japan
| | - Ayumi Furuse
- Research Initiative for Supra-Material, Shinshu University, Nagano 380-8553, Japan
| | - Yoshiyuki Hattori
- Division of Chemistry and Materials, Faculty of Textile Science and Technology, Shinshu University, Ueda 386-8567, Japan
| | - Keisaku Fujimoto
- Omachi Municipal General Hospital, Omachi 398-0002, Japan
- School of Medicine, Shinshu University, Matsumoto 390-8621, Japan
| | - Govind Rao
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Xudong Ge
- Center for Advanced Sensor Technology and Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Thelma Wright
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Katsumi Kaneko
- Research Initiative for Supra-Material, Shinshu University, Nagano 380-8553, Japan
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13
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Mouliou DS. The Deceptive COVID-19: Lessons from Common Molecular Diagnostics and a Novel Plan for the Prevention of the Next Pandemic. Diseases 2023; 11:diseases11010020. [PMID: 36810534 PMCID: PMC9944891 DOI: 10.3390/diseases11010020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The COVID-19 pandemic took place during the years 2020-2022 and the virus, named SARS-CoV-2, seems likely to have resulted in an endemic disease. Nevertheless, widespread COVID-19 has given rise to several major molecular diagnostics' facts and concerns that have emerged during the overall management of this disease and the subsequent pandemic. These concerns and lessons are undeniably critical for the prevention and control of future infectious agents. Furthermore, most populaces were introduced to several new public health maintenance strategies, and again, some critical events arose. The purpose of this perspective is to thoroughly analyze all these issues and the concerns, such as the molecular diagnostics' terminologies, their role, as well as the quantity and quality issues with a molecular diagnostics' test result. Furthermore, it is speculated that society will be more vulnerable in the future and prone to emerging infectious diseases; thus, a novel preventive medicine's plan for the prevention and control of future (re)emerging infectious diseases is presented, so as to aid the early prevention of future epidemics and pandemics.
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14
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Lazarus HM, Pitts K, Wang T, Lee E, Buchbinder E, Dougan M, Armstrong DG, Paine R, Ragsdale CE, Boyd T, Rock EP, Gale RP. Recombinant GM-CSF for diseases of GM-CSF insufficiency: Correcting dysfunctional mononuclear phagocyte disorders. Front Immunol 2023; 13:1069444. [PMID: 36685591 PMCID: PMC9850113 DOI: 10.3389/fimmu.2022.1069444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Endogenous granulocyte-macrophage colony-stimulating factor (GM-CSF), identified by its ability to support differentiation of hematopoietic cells into several types of myeloid cells, is now known to support maturation and maintain the metabolic capacity of mononuclear phagocytes including monocytes, macrophages, and dendritic cells. These cells sense and attack potential pathogens, present antigens to adaptive immune cells, and recruit other immune cells. Recombinant human (rhu) GM-CSF (e.g., sargramostim [glycosylated, yeast-derived rhu GM-CSF]) has immune modulating properties and can restore the normal function of mononuclear phagocytes rendered dysfunctional by deficient or insufficient endogenous GM-CSF. Methods We reviewed the emerging biologic and cellular effects of GM-CSF. Experts in clinical disease areas caused by deficient or insufficient endogenous GM-CSF examined the role of GM-CSF in mononuclear phagocyte disorders including autoimmune pulmonary alveolar proteinosis (aPAP), diverse infections (including COVID-19), wound healing, and anti-cancer immune checkpoint inhibitor therapy. Results We discuss emerging data for GM-CSF biology including the positive effects on mitochondrial function and cell metabolism, augmentation of phagocytosis and efferocytosis, and immune cell modulation. We further address how giving exogenous rhu GM-CSF may control or treat mononuclear phagocyte dysfunction disorders caused or exacerbated by GM-CSF deficiency or insufficiency. We discuss how rhu GM-CSF may augment the anti-cancer effects of immune checkpoint inhibitor immunotherapy as well as ameliorate immune-related adverse events. Discussion We identify research gaps, opportunities, and the concept that rhu GM-CSF, by supporting and restoring the metabolic capacity and function of mononuclear phagocytes, can have significant therapeutic effects. rhu GM-CSF (e.g., sargramostim) might ameliorate multiple diseases of GM-CSF deficiency or insufficiency and address a high unmet medical need.
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Affiliation(s)
- Hillard M. Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - Katherine Pitts
- Medical Affairs, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Tisha Wang
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Elinor Lee
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Elizabeth Buchbinder
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Michael Dougan
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Timothy Boyd
- Clinical Development, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Edwin P. Rock
- Clinical Development, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Robert Peter Gale
- Hematology Centre, Department of Immunology and Inflammation, Imperial College, London, United Kingdom
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15
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Gragueb-Chatti I, Hyvernat H, Leone M, Agard G, Peres N, Guervilly C, Boucekine M, Hamidi D, Papazian L, Dellamonica J, Lopez A, Hraiech S. Incidence, Outcomes and Risk Factors of Recurrent Ventilator Associated Pneumonia in COVID-19 Patients: A Retrospective Multicenter Study. J Clin Med 2022; 11:7097. [PMID: 36498679 PMCID: PMC9738672 DOI: 10.3390/jcm11237097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French intensive care units (ICUs). Patients admitted for a documented COVID-19 from March 2020 to May 2021 and requiring mechanical ventilation (MV) for ≥48 h were included. The study main outcome was the incidence of VAP recurrences. Secondary outcomes were the duration of MV, ICU and hospital length of stay and mortality according to VAP and recurrences. We also assessed the factors associated with VAP recurrences. Results: During the study period, 398 patients met the inclusion criteria. A total of 236 (59%) of them had at least one VAP episode during their ICU stay and 109 (46%) of these patients developed at least one recurrence. The incidence of VAP recurrence considering death and extubation as competing events was 29.6% (IC = [0.250−0.343]). Seventy-eight percent of recurrences were due to the same bacteria (relapses). Patients with a VAP recurrence had a longer duration of MV as compared with one VAP and no VAP patients (41 (25−56) vs. 16 (8−30) and 10 (5−18) days; p < 0.001) and a longer ICU length of stay (46 (29−66) vs. 22 (12−36) and 14 (9−25) days; p < 0.001). The 90-day mortality was higher in the recurrence group as compared with the no VAP group only (31.2 vs. 21.0% (p = 0.021)). In a multivariate analysis including bacterial co-infection at admission, the use of immunosuppressive therapies and the bacteria responsible for the first VAP episode, the duration of MV was the only factor independently associated with VAP recurrence. Conclusion: In COVID-19 associated respiratory failure, recurrences affected 46% of patients with a first episode of VAP. VAP recurrences were mainly relapses and were associated with a prolonged duration of MV and ICU length of stay but not with a higher mortality. MV duration was the only factor associated with recurrences.
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Affiliation(s)
- Ines Gragueb-Chatti
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France
| | - Hervé Hyvernat
- Service de Médecine Intensive-Réanimation, CHU Nice, 06202 Nice, France
| | - Marc Leone
- Service d’Anesthésie et de Réanimation, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
| | - Geoffray Agard
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France
| | - Noémie Peres
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon—La Seyne sur Mer, 83056 Toulon, France
| | - Christophe Guervilly
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005 Marseille, France
| | - Mohamed Boucekine
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005 Marseille, France
| | - Dany Hamidi
- Service de Médecine Intensive-Réanimation, CHU Nice, 06202 Nice, France
| | - Laurent Papazian
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005 Marseille, France
| | - Jean Dellamonica
- Service de Médecine Intensive-Réanimation, CHU Nice, 06202 Nice, France
| | - Alexandre Lopez
- Service d’Anesthésie et de Réanimation, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
| | - Sami Hraiech
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005 Marseille, France
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16
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Esposito R, Mirra D, Sportiello L, Spaziano G, D’Agostino B. Overview of Antiviral Drug Therapy for COVID-19: Where Do We Stand? Biomedicines 2022; 10:2815. [PMID: 36359334 PMCID: PMC9687182 DOI: 10.3390/biomedicines10112815] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 09/08/2024] Open
Abstract
The vaccine weapon has resulted in being essential in fighting the COVID-19 outbreak, but it is not fully preventing infection due to an alarming spreading of several identified variants of concern. In fact, the recent emergence of variants has pointed out how the SARS-CoV-2 pandemic still represents a global health threat. Moreover, oral antivirals also develop resistance, supporting the need to find new targets as therapeutic tools. However, cocktail therapy is useful to reduce drug resistance and maximize vaccination efficacy. Natural products and metal-drug-based treatments have also shown interesting antiviral activity, representing a valid contribution to counter COVID-19 outbreak. This report summarizes the available evidence which supports the use of approved drugs and further focuses on significant clinical trials that have investigated the safety and efficacy of repurposing drugs and new molecules in different COVID-19 phenotypes. To date, there are many individuals vulnerable to COVID-19 exhibiting severe symptoms, thus characterizing valid therapeutic strategies for better management of the disease is still a challenge.
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Affiliation(s)
- Renata Esposito
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Davida Mirra
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giuseppe Spaziano
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Bruno D’Agostino
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
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17
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Wang Y, Du G, Zhang G, Matucci-Cerinic M, Furst DE. Similarities and differences between severe COVID-19 pneumonia and anti-MDA-5-positive dermatomyositis-associated rapidly progressive interstitial lung diseases: a challenge for the future. Ann Rheum Dis 2022; 81:e192. [PMID: 32759260 DOI: 10.1136/annrheumdis-2020-218594] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Yukai Wang
- Department of Rheumatology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Guangzhou Du
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Toscana, Italy
| | - Daniel E Furst
- Department of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
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18
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Cluck D, Covert KL, Wagner JL, Chastain DB. A primer on Post-COVID-19 conditions and implications for clinical pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:716-724. [PMID: 35942184 PMCID: PMC9347933 DOI: 10.1002/jac5.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and is largely viewed as an acute illness involving multiple organ systems. In the wake of the acute illness, many survivors fully recover and return to baseline, while others suffer from a wide range of lingering symptoms collectively known as "post-COVID conditions". The recognition of these conditions as a clinical entity represents the first step in developing a targeted plan for recovery and symptom mitigation. While interventions to directly minimize or reduce new, recurrent, or persistent symptoms are currently unknown, pharmacists can play a key role in optimizing management of these patients.
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Affiliation(s)
- David Cluck
- Department of Pharmacy PracticeBill Gatton College of Pharmacy East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Kelly L. Covert
- Department of Pharmacy PracticeBill Gatton College of Pharmacy East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Jamie L. Wagner
- Department of Pharmacy PracticeUniversity of Mississippi School of PharmacyJacksonMississippiUSA
| | - Daniel B. Chastain
- Department of Clinical and Administrative PharmacyUniversity of Georgia College of PharmacyAlbanyGeorgiaUSA
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19
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Forouzani-Haghighi B, Rezvani A, Vazin A. Immune Targeted Therapies for COVID-19 Infection: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:291-299. [PMID: 35919074 PMCID: PMC9339106 DOI: 10.30476/ijms.2021.91614.2277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
In December 2019, the coronavirus disease-2019 (COVID-19) outbreak emerged in Wuhan, China. The World Health Organization officially declared it a pandemic on March 11, 2020. Reports indicated that the associated mortality of the infection is quite higher in the elderly, individuals with specific comorbidities (such as diabetes mellitus), and generally the ones with a compromised immune system. A cohort study in Wuhan, China, reported a dysregulated immune response in 452 patients with laboratory-confirmed COVID-19. As a result of this suppressed immune response, an increase in neutrophil to lymphocyte ratio, T lymphopenia, and a decrease in CD4+ T cells were all common laboratory findings, especially in severe cases. On the other hand, there is substantial evidence of T cell exhaustion in critically ill patients. Accordingly, the immune system seems to play an important role in the prognosis and pathogenesis of the disease. Therefore, this study aims to review the evidence on the immune response dysregulation in COVID-19 infection and the potential role of immunoregulatory treatments such as immune checkpoint inhibitors, interferons, and CD200 inhibitors in altering disease prognosis, especially in critically ill patients.
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Affiliation(s)
- Bahareh Forouzani-Haghighi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Department of Hematology and Medical Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,
Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Jude EB, Tentolouris N, Rastogi A, Yap MH, Pedrosa HC, Ling SF. Vitamin D prescribing practices among clinical practitioners during the COVID-19 pandemic. Health Sci Rep 2022; 5:e691. [PMID: 35844828 PMCID: PMC9273939 DOI: 10.1002/hsr2.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims COVID-19 has caused devastation globally. Low vitamin D status, particularly during the winter months, remains commonplace around the world, and it is thought to be one of the contributing factors toward causation and severity of COVID-19. Many guidelines do not recommend vitamin D for the treatment or prevention of the disease. Hence, we set out to conduct a global survey to understand the use and prescribing habits of vitamin D among clinicians for COVID-19. Methods An online anonymous questionnaire was sent to clinicians enquiring about their prescribing habits of vitamin D and personal use of vitamin D. Data of the survey were collected between January 15, 2021, and February 13, 2021. Results Four thousand four hundred forty practicing clinicians were included in the analysis, with the majority of those responding from Asia, followed by Europe. 82.9% prescribed vitamin D before COVID-19, more commonly among general practitioners (GPs) in comparison with medical specialists, and Asian clinicians were more likely to prescribe vitamin D in comparison with Caucasian physicians (p < 0.01). GPs were also more likely to prescribe vitamin D prophylactically to prevent COVID-19 in comparison with medical specialists (OR 1.47, p < 0.01). Most GPs (72.8%) would also prescribe vitamin D to treat COVID-19 in comparison with medical specialists (OR 1.81, p < 0.01), as well as more Asian in comparison with Caucasian physicians (OR 4.57, p < 0.01). 80.4% of respondents were taking vitamin D, more so in the 45-54 and 65-74 age groups in comparison with the 18-24 years category (OR 2.15 and 2.40, respectively, both p < 0.05), many of whom did so before COVID-19 (72.1%). Conclusion This survey has shown that many clinicians would prescribe vitamin D for the prevention and treatment of COVID-19. The majority would also recommend measuring vitamin D levels, but not so in patients with COVID-19.
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Affiliation(s)
- Edward B. Jude
- Department of Diabetes and EndocrinologyTameside and Glossop Integrated Care NHS Foundation TrustAshton‐under‐LyneUK
- Department of Diabetes and EndocrinologyThe University of ManchesterManchesterUK
- Department of Diabetes and EndocrinologyManchester Metropolitan UniversityManchesterUK
| | - Nikolaos Tentolouris
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of AthensLaiko General HospitalAthensGreece
| | - Ashu Rastogi
- Department of Diabetes and EndocrinologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Moi H. Yap
- Department of Diabetes and EndocrinologyManchester Metropolitan UniversityManchesterUK
| | - Hermelinda C. Pedrosa
- Department of Diabetes and Endocrinology, Endocrinology Unit, Research Centre, Taguatinga Regional HospitalSecretariat of HealthBrasilia‐DFBrazil
| | - Stephanie F. Ling
- Department of Diabetes and EndocrinologyThe University of ManchesterManchesterUK
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21
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Gioia F, Albasata H, Hosseini-Moghaddam SM. Concurrent Infection with SARS-CoV-2 and Pneumocystis jirovecii in Immunocompromised and Immunocompetent Individuals. J Fungi (Basel) 2022; 8:585. [PMID: 35736068 PMCID: PMC9225243 DOI: 10.3390/jof8060585] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) may occur with concurrent infections caused by bacterial and fungal microorganisms. This systematic review evaluated studies reporting concomitant COVID-19 and Pneumocystis jirovecii pneumonia (PJP). We found 39 patients (74% male, median age: 56.8 (range: 11-83) years), including 66% immunosuppressed individuals (23% HIV-infected and 41% on long-term corticosteroid therapy). Patients were characteristically severely ill (mechanical ventilation: 70%), associated with 41% mortality. The median lymphocyte count was 527 cells/mm3 (range: 110-2200), and the median CD4+ T cell count was 206 cells/mm3 (range: 8-1021). We identified three patterns of concurrent COVID-19 and P. jirovecii infection. The first pattern (airway colonization with a low burden of P. jirovecii) does not seem to modify the COVID-19 course of illness. However, P. jirovecii superinfection, typically occurring weeks after COVID-19 diagnosis as a biphasic illness, and P. jirovecii coinfection characteristically results in progressive multilobar pneumonia, which is associated with poor outcomes. To support this categorization, we reported three patients with concurrent PJP and COVID-19 identified in our institution, presenting these clinical scenarios. The diagnosis of PJP requires a high index of suspicion, since clinical and radiological characteristics overlap with COVID-19. Observational studies are necessary to determine the PJP burden in patients with COVID-19 requiring hospitalization.
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Affiliation(s)
| | | | - Seyed M. Hosseini-Moghaddam
- Transplant Infectious Diseases Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada; (F.G.); (H.A.)
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22
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Dadashi M, Dadashi A, Sameni F, Sayadi S, Goudarzi M, Nasiri MJ, Yaslianifard S, Ghazi M, Arjmand R, Hajikhani B. SARS-CoV-2 and HIV co-infection; clinical features, diagnosis, and treatment strategies: A systematic review and meta-analysis. GENE REPORTS 2022; 27:101624. [PMID: 35607389 PMCID: PMC9117161 DOI: 10.1016/j.genrep.2022.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 12/15/2022]
Abstract
Background and aim Coronavirus disease 2019 (COVID-19) in people living with human immunodeficiency virus (HIV) who has a compromised immune system can be associated with more significant risks for severe complications. To date, no comprehensive study has been performed to evaluate HIV in patients with COVID-19. In the present study, we assessed the status of patients co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV as a systematic review and meta-analysis. Methods A systematic literature search strategy was conducted via reviewing original research articles published in Medline, Web of Science, and Embase databases in 2019 and 2020. Statistical analysis was performed using STATA software, version 14.0 (Stata Corporation, College Station, Texas, USA), to report the prevalence of HIV among patients with COVID-19. Case reports/case series were also evaluated as a systematic review. Results Sixty-three studies (53 case reports/case series and ten prevalence studies) were included in our study. A meta-analysis of prevalence studies showed that HIV infection among patients with COVID-19 was reported in 6 countries (Uganda, China, Iran, USA, Italy, and Spain) with an overall frequency of 1.2% [(95% CI) 0.8–1.7] among 14,424 COVID-19 patients. According to the case reports and case series, 111 patients with HIV have been reported among 113 patients with COVID-19 from 19 countries. Most of the cases were in the USA, China, Italy, and Spain. Conclusion The small number of SARS-CoV-2-HIV co-infected patients reported in the literature makes it difficult to draw precise conclusions. However, since people with HIV are more likely to develop more severe complications of COVID-19, targeted policies to address this raised risk in the current pandemic should be considered. Our findings highlight the importance of identifying underlying diseases, co-infections, co-morbidities, laboratory findings, and beneficial treatment strategies for HIV patients during the COVID-19 pandemic.
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23
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McCormick TS, Hejal RB, Leal LO, Ghannoum MA. GM-CSF: Orchestrating the Pulmonary Response to Infection. Front Pharmacol 2022; 12:735443. [PMID: 35111042 PMCID: PMC8803133 DOI: 10.3389/fphar.2021.735443] [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: 07/02/2021] [Accepted: 12/13/2021] [Indexed: 01/18/2023] Open
Abstract
This review summarizes the structure and function of the alveolar unit, comprised of alveolar macrophage and epithelial cell types that work in tandem to respond to infection. Granulocyte-macrophage colony-stimulating factor (GM-CSF) helps to maintain the alveolar epithelium and pulmonary immune system under physiological conditions and plays a critical role in restoring homeostasis under pathologic conditions, including infection. Given the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and global spread of coronavirus disease 2019 (COVID-19), with subsequent acute respiratory distress syndrome, understanding basic lung physiology in infectious diseases is especially warranted. This review summarizes clinical and preclinical data for GM-CSF in respiratory infections, and the rationale for sargramostim (yeast-derived recombinant human [rhu] GM-CSF) as adjunctive treatment for COVID-19 and other pulmonary infectious diseases.
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Affiliation(s)
- Thomas S. McCormick
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Rana B. Hejal
- Medical Intensive Care Unit, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Pulmonary and Critical Care Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Luis O. Leal
- Partner Therapeutics, Lexington, MA, United States
| | - Mahmoud A. Ghannoum
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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24
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Zakariaei Z, Sharifpour A, Fakhar M, Soleymani M, Banimostafavi ES, Taheri A. Detection of Lophomonas in pericardial effusion sample in a COVID-19 patient with systemic sclerosis: An unusual case report. SAGE Open Med Case Rep 2022; 10:2050313X221102021. [PMID: 35651516 PMCID: PMC9149606 DOI: 10.1177/2050313x221102021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis is a connective tissue disorder that involves the skin and
many other organs, such as the heart, skin, and gastrointestinal tract. Cardiac
involvement is in the form of pericarditis, pericardial effusion, and pulmonary
hypertension. Several complications and super infections post-COVID-19 have been
reported, such as fungal, bacterial infections, and Lophomonas
blattarum. Lophomoniasis is an emerging pulmonary infection that
mainly involves the lower respiratory tract. Herein, we present an ectopic
Lophomonas infection in an unusual location (pericardial
effusion) in a COVID-19 patient who had systemic sclerosis.
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Affiliation(s)
- Zakaria Zakariaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Department of Radiology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirmasoud Taheri
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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25
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Chastain DB, Henao-Martínez AF, Dykes AC, Steele GM, Stoudenmire LL, Thomas GM, Kung V, Franco-Paredes C. Missed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review. Ther Adv Infect Dis 2022; 9:20499361211066363. [PMID: 35070297 PMCID: PMC8771738 DOI: 10.1177/20499361211066363] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.
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Affiliation(s)
- Daniel B. Chastain
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, 1000 Jefferson Street, Albany, GA 31701, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Austin C. Dykes
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, Albany, GA, USA
| | - Gregory M. Steele
- Infectious Diseases, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | | | - Geren M. Thomas
- Department of Pharmacy, John D. Archbold Memorial Hospital, Thomasville, GA, USA
| | - Vanessa Kung
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USAHospital Infantil de México, Federico Gómez, México City, México
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26
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Zahedipour F, Guest PC, Majeed M, Moallem SA, Kesharwani P, Jamialahmadi T, Sahebkar A. Evaluating the Effects of Curcumin on the Cytokine Storm in COVID-19 Using a Chip-Based Multiplex Analysis. Methods Mol Biol 2022; 2511:285-295. [PMID: 35838968 DOI: 10.1007/978-1-0716-2395-4_21] [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] [Indexed: 06/15/2023]
Abstract
SARS-CoV-2 can stimulate the expression of various inflammatory cytokines and induce the cytokine storm in COVID-19 patients leading to multiple organ failure and death. Curcumin as a polyphenolic compound has been shown to have anti-inflammatory properties and inhibit the release of numerous pro-inflammatory cytokines. We present multiplex analysis using the Evidence Investigator biochip system to determine the effect of curcumin on serum level of cytokines which are typically elevated in cytokine storm events, including tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and IL-10.
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Affiliation(s)
- Fatemeh Zahedipour
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Seyed Adel Moallem
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Tannaz Jamialahmadi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomeical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- School of Medicine, The University of Western Australia, Perth, Australia.
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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27
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An Overview of COVID-19 and Its Vaccines. BIOLOGY BULLETIN REVIEWS 2021. [PMCID: PMC8762443 DOI: 10.1134/s2079086421070069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronavirus pandemic, is a continuing catastrophe (COVID-19) triggered by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The virus passes into the target cells by attaching itself to a receptor i.e., Human Angiotensin-converting enzyme 2 (hACE2). It consists of Spike structures created from glycoproteins that promote the virus entry into the target cells of host. The RBD of the S1 subunit on Spike proteins binds to the hACE2 receptor, which is mostly found in the lungs, particularly type-2 pneumocytes, causing human ACE2 receptors to be downregulated. Apart from nausea, vomiting, and chest tightness, which are unusual symptoms of COVID-19, the most common causes of death and severity are respiratory failure (69.5%), sepsis or multi-organ failure (28%), cardiac failure (14.6%), and renal failure (14.6%). Viral antigen-based or viral nucleic acid-based real-time RT-PCR is recommended for the diagnosis of COVID-19 suspects. Vaccination is essential for antiviral treatment. The study was conducted on viruses based on live-attenuated or non-activated viruses, recombinant viral vectors, DNA, VLPs and soluble proteins. Vaccine from Pfizer and BioNTech was the first that showed promising data on effectiveness. 90% efficacy of the vaccine was reported. BNT-162b2 (Pfizer, BioNTech) & mRNA-1273 (Moderna) are mRNA based; AZD-1222 Ad5‑CoV (AstraZeneca; Oxford University); Ad26.COV2.S (Johnson & Johnson) are viral vector based and other vaccines have been granted emergency use authorization by FDA. Since RNA viruses are able to mutate readily and quickly the mutation in the existing strain can be Variants of concern (VOCs) that might diminish vaccine effectiveness. The latest Delta variant (B.1.671.2) has rapidly spread in India is emerging in the United States in mid-2021. It turns out to be the chief which is 6–8 fold more resistant to neutralization by sera from COVID-19 convalescent and mRNA vaccinated individuals.
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28
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Gupta A, Pradhan A, Maurya VK, Kumar S, Theengh A, Puri B, Saxena SK. Therapeutic approaches for SARS-CoV-2 infection. Methods 2021; 195:29-43. [PMID: 33962011 PMCID: PMC8096528 DOI: 10.1016/j.ymeth.2021.04.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/30/2021] [Indexed: 01/18/2023] Open
Abstract
Therapeutic approaches to COVID-19 treatment require appropriate inhibitors to target crucial proteins of SARS-CoV-2 replication machinery. It's been approximately 12 months since the pandemic started, yet no known specific drugs are available. However, research progresses with time in terms of high throughput virtual screening (HTVS) and rational design of repurposed, novel synthetic and natural products discovery by understanding the viral life cycle, immuno-pathological and clinical outcomes in patients based on host's nutritional, metabolic, and lifestyle status. Further, complementary and alternative medicine (CAM) approaches have also improved resiliency and immune responses. In this article, we summarize all the therapeutic antiviral strategies for COVID-19 drug discovery including computer aided virtual screening, repurposed drugs, immunomodulators, vaccines, plasma therapy, various adjunct therapies, and phage technology to unravel insightful mechanistic pathways of targeting SARS-CoV-2 and host's intrinsic, innate immunity at multiple checkpoints that aid in the containment of the disease.
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Affiliation(s)
- Ankur Gupta
- Government Pharmacy College, Sajong, Rumtek, Gangtok 737135, India
| | - Anish Pradhan
- Government Pharmacy College, Sajong, Rumtek, Gangtok 737135, India
| | - Vimal K Maurya
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow 226003, India
| | - Swatantra Kumar
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow 226003, India
| | - Angila Theengh
- Government Pharmacy College, Sajong, Rumtek, Gangtok 737135, India
| | - Bipin Puri
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow 226003, India
| | - Shailendra K Saxena
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow 226003, India.
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Lazarus HM, Ragsdale CE, Gale RP, Lyman GH. Sargramostim (rhu GM-CSF) as Cancer Therapy (Systematic Review) and An Immunomodulator. A Drug Before Its Time? Front Immunol 2021; 12:706186. [PMID: 34484202 PMCID: PMC8416151 DOI: 10.3389/fimmu.2021.706186] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sargramostim [recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF)] was approved by US FDA in 1991 to accelerate bone marrow recovery in diverse settings of bone marrow failure and is designated on the list of FDA Essential Medicines, Medical Countermeasures, and Critical Inputs. Other important biological activities including accelerating tissue repair and modulating host immunity to infection and cancer via the innate and adaptive immune systems are reported in pre-clinical models but incompletely studied in humans. OBJECTIVE Assess safety and efficacy of sargramostim in cancer and other diverse experimental and clinical settings. METHODS AND RESULTS We systematically reviewed PubMed, Cochrane and TRIP databases for clinical data on sargramostim in cancer. In a variety of settings, sargramostim after exposure to bone marrow-suppressing agents accelerated hematologic recovery resulting in fewer infections, less therapy-related toxicity and sometimes improved survival. As an immune modulator, sargramostim also enhanced anti-cancer responses in solid cancers when combined with conventional therapies, for example with immune checkpoint inhibitors and monoclonal antibodies. CONCLUSIONS Sargramostim accelerates hematologic recovery in diverse clinical settings and enhances anti-cancer responses with a favorable safety profile. Uses other than in hematologic recovery are less-well studied; more data are needed on immune-enhancing benefits. We envision significantly expanded use of sargramostim in varied immune settings. Sargramostim has the potential to reverse the immune suppression associated with sepsis, trauma, acute respiratory distress syndrome (ARDS) and COVID-19. Further, sargramostim therapy has been promising in the adjuvant setting with vaccines and for anti-microbial-resistant infections and treating autoimmune pulmonary alveolar proteinosis and gastrointestinal, peripheral arterial and neuro-inflammatory diseases. It also may be useful as an adjuvant in anti-cancer immunotherapy.
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Affiliation(s)
- Hillard M. Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | | | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Gary H. Lyman
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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30
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Gragueb-Chatti I, Lopez A, Hamidi D, Guervilly C, Loundou A, Daviet F, Cassir N, Papazian L, Forel JM, Leone M, Dellamonica J, Hraiech S. Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study. Ann Intensive Care 2021; 11:87. [PMID: 34057642 PMCID: PMC8165680 DOI: 10.1186/s13613-021-00876-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00876-8.
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Affiliation(s)
- Ines Gragueb-Chatti
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Alexandre Lopez
- Service d'Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Dany Hamidi
- Service de Médecine Intensive Réanimation CHU de Nice et UR2CA, Université Cote d'Azur, Nice, France
| | - Christophe Guervilly
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Anderson Loundou
- Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Florence Daviet
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Nadim Cassir
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation CHU de Nice et UR2CA, Université Cote d'Azur, Nice, France
| | - Sami Hraiech
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France. .,Centre d'Études et de Recherches sur les Services de Santé et qualite de vie EA 3279, 13005, Marseille, France. .,Service de Médecine Intensive Réanimation, APHM, CHU Nord, 13015, Marseille, France.
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31
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Jindal A, Sarkar S, Alam A. Nanomaterials-Mediated Immunomodulation for Cancer Therapeutics. Front Chem 2021; 9:629635. [PMID: 33708759 PMCID: PMC7940769 DOI: 10.3389/fchem.2021.629635] [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: 11/15/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Immunotherapy holds great promise in overcoming the limitations of conventional regimens for cancer therapeutics. There is growing interest among researchers and clinicians to develop novel immune-strategies for cancer diagnosis and treatment with better specificity and lesser adversity. Immunomodulation-based cancer therapies are rapidly emerging as an alternative approach that employs the host's own defense mechanisms to recognize and selectively eliminate cancerous cells. Recent advances in nanotechnology have pioneered a revolution in the field of cancer therapy. Several nanomaterials (NMs) have been utilized to surmount the challenges of conventional anti-cancer treatments like cytotoxic chemotherapy, radiation, and surgery. NMs offer a plethora of exceptional features such as a large surface area to volume ratio, effective loading, and controlled release of active drugs, tunable dimensions, and high stability. Moreover, they also possess the inherent property of interacting with living cells and altering the immune responses. However, the interaction between NMs and the immune system can give rise to unanticipated adverse reactions such as inflammation, necrosis, and hypersensitivity. Therefore, to ensure a successful and safe clinical application of immunomodulatory nanomaterials, it is imperative to acquire in-depth knowledge and a clear understanding of the complex nature of the interactions between NMs and the immune system. This review is aimed at providing an overview of the recent developments, achievements, and challenges in the application of immunomodulatory nanomaterials (iNMs) for cancer therapeutics with a focus on elucidating the mechanisms involved in the interplay between NMs and the host's immune system.
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Affiliation(s)
- Ajita Jindal
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Sounik Sarkar
- Flowcytometry Facility, Modern Biology Department, University of Calcutta, Kolkata, India
| | - Aftab Alam
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Clare Hall, University of Cambridge, Cambridge, United Kingdom
- Charles River Laboratories, Cambridge Biomedical Campus, Cambridge, United Kingdom
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32
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Liu BM, Martins TB, Peterson LK, Hill HR. Clinical significance of measuring serum cytokine levels as inflammatory biomarkers in adult and pediatric COVID-19 cases: A review. Cytokine 2021; 142:155478. [PMID: 33667962 PMCID: PMC7901304 DOI: 10.1016/j.cyto.2021.155478] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/29/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly evolving infectious/inflammatory disorder which has turned into a global pandemic. With severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as its etiologic agent, severe COVID-19 cases usually develop uncontrolled inflammatory responses and cytokine storm-like syndromes. Measuring serum levels of pro-inflammatory cytokines (e.g., IL-6 and others) as inflammatory biomarkers may have several potential applications in the management of COVID-19, including risk assessment, monitoring of disease progression, determination of prognosis, selection of therapy and prediction of response to treatment. This is especially true for pediatric patients with COVID-19 associated Kawasaki-like disease and similar syndromes. In this report, we review the current knowledge of COVID-19 associated cytokines, their roles in host immune and inflammatory responses, the clinical significance and utility of cytokine immunoassays in adult and pediatric COVID-19 patients, as well as the challenges and pitfalls in implementation and interpretation of cytokine immunoassays. Given that cytokines are implicated in different immunological disorders and diseases, it is challenging to interpret the multiplex cytokine data for COVID-19 patients. Also, it should be taken into consideration that biological and technical variables may affect the commutability of cytokine immunoassays and enhance complexity of cytokine immunoassay interpretation. It is recommended that the same method, platform and laboratory should be used when monitoring differences in cytokine levels between groups of individuals or for the same individual over time. It may be important to correlate cytokine profiling data with the SARS-CoV-2 nucleic acid amplification testing and imaging observations to make an accurate interpretation of the inflammatory status and disease progression in COVID-19 patients.
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Affiliation(s)
- Benjamin M Liu
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Thomas B Martins
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Lisa K Peterson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Harry R Hill
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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33
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Rodriguez-Guerra M, Jadhav P, Vittorio TJ. Current treatment in COVID-19 disease: a rapid review. Drugs Context 2021; 10:2020-10-3. [PMID: 33569082 PMCID: PMC7850293 DOI: 10.7573/dic.2020-10-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
The world has faced the most challenging pandemic of the modern era, that of severe acute respiratory syndrome coronavirus 2 infection, causing coronavirus disease and affecting over 35 million people globally. The wide range of clinical manifestations associated with this viral disease is thought to be related to the overexpression of inflammatory markers. Due to a dysregulated host response, the most severe form involves multi-organ failure and thromboembolic complications. Immunomodulatory therapies may help prevent its progression and anticoagulation has been shown to reduce the risk of thrombotic complications. As this is a new entity for the medical world, there are no known therapeutic options nor has the prevention of complications been established. Anti-inflammatory agents, antimicrobial therapy, and vitamin supplements are short of clear benefits, but there is limited data to review. Other agents, such as convalescent plasma, eculizumab, immunoglobulins, neutralizing IgG1 monoclonal antibodies, remdesivir, steroids, and tocilizumab, have shown a possible impact on inpatient length of stay and mortality rate. This review aims to assess the efficacy and safety of these available therapies in light of current evidence. We compare these treatment options based on their impact on symptom management, inpatient length of stay, and overall morbidity and mortality.
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Affiliation(s)
| | - Preeti Jadhav
- Division of Cardiology, BronxCare Hospital Center, Bronx, NY, USA
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34
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Ganesh B, Rajakumar T, Malathi M, Manikandan N, Nagaraj J, Santhakumar A, Elangovan A, Malik YS. Epidemiology and pathobiology of SARS-CoV-2 (COVID-19) in comparison with SARS, MERS: An updated overview of current knowledge and future perspectives. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 10:100694. [PMID: 33462564 PMCID: PMC7806455 DOI: 10.1016/j.cegh.2020.100694] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022] Open
Abstract
Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the causative etiology of ‘Corona Virus Disease-2019’ (COVID-19); formerly referred as ‘novel-Coronavirus-2019’. It was originated in Wuhan city, Hubei province, China in early December 2019. The World Health Organization (WHO) declared it as ‘Public Health Emergency of International Concern’ due to their rapid transmission and causing public and health-care-related casualties worldwide. This review provides an updated overview of COVID-19 (SARS-CoV-2), in comparison with the etiologies of the same group viz. SARS and MERS and also its future perspectives for planning appropriate strategies for prevention, control and treatment modalities to avert similar catastrophe in near future.
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Affiliation(s)
- Balasubramanian Ganesh
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Thangarasu Rajakumar
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Mathiyazhakan Malathi
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Natesan Manikandan
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Jaganathasamy Nagaraj
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Aridoss Santhakumar
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Arumugam Elangovan
- ICMR-National Institute of Epidemiology (ICMR-NIE), R-127, Second Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
| | - Yashpal Singh Malik
- Indian Veterinary Research Institute (IVRI), Izatnagar, 243 122, Bareilly, Uttar Pradesh, India
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35
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Reizine F, Lesouhaitier M, Gregoire M, Pinceaux K, Gacouin A, Maamar A, Painvin B, Camus C, Le Tulzo Y, Tattevin P, Revest M, Le Bot A, Ballerie A, Cador-Rousseau B, Lederlin M, Lebouvier T, Launey Y, Latour M, Verdy C, Rossille D, Le Gallou S, Dulong J, Moreau C, Bendavid C, Roussel M, Cogne M, Tarte K, Tadié JM. SARS-CoV-2-Induced ARDS Associates with MDSC Expansion, Lymphocyte Dysfunction, and Arginine Shortage. J Clin Immunol 2021; 41:515-525. [PMID: 33387156 PMCID: PMC7775842 DOI: 10.1007/s10875-020-00920-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
Purpose The SARS-CoV-2 infection can lead to a severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation and high mortality rate. Interestingly, COVID-19-associated ARDS share biological and clinical features with sepsis-associated immunosuppression since lymphopenia and acquired infections associated with late mortality are frequently encountered. Mechanisms responsible for COVID-19-associated lymphopenia need to be explored since they could be responsible for delayed virus clearance and increased mortality rate among intensive care unit (ICU) patients. Methods A series of 26 clinically annotated COVID-19 patients were analyzed by thorough phenotypic and functional investigations at days 0, 4, and 7 after ICU admission. Results We revealed that, in the absence of any difference in demographic parameters nor medical history between the two groups, ARDS patients presented with an increased number of myeloid-derived suppressor cells (MDSC) and a decreased number of CD8pos effector memory cell compared to patients hospitalized for COVID-19 moderate pneumonia. Interestingly, COVID-19-related MDSC expansion was directly correlated to lymphopenia and enhanced arginase activity. Lastly, T cell proliferative capacity in vitro was significantly reduced among COVID-19 patients and could be restored through arginine supplementation. Conclusions The present study reports a critical role for MDSC in COVID-19-associated ARDS. Our findings open the possibility of arginine supplementation as an adjuvant therapy for these ICU patients, aiming to reduce immunosuppression and help virus clearance, thereby decreasing the duration of mechanical ventilation, nosocomial infection acquisition, and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00920-5.
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Affiliation(s)
- Florian Reizine
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Murielle Gregoire
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Kieran Pinceaux
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Arnaud Gacouin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Adel Maamar
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Benoit Painvin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Christophe Camus
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Yves Le Tulzo
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Berengère Cador-Rousseau
- Department of Internal Medicine and Clinical Immunology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Mathieu Lederlin
- Department of Radiology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Thomas Lebouvier
- Department of Anesthesia and Critical Care, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Yoann Launey
- Department of Anesthesia and Critical Care, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Maelle Latour
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Clotilde Verdy
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Delphine Rossille
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Simon Le Gallou
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Joelle Dulong
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Caroline Moreau
- Department of Biochemistry, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Claude Bendavid
- Department of Biochemistry, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Mikael Roussel
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Michel Cogne
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Karin Tarte
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. .,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. .,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France. .,Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
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36
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Liu BM, Hill HR. Role of Host Immune and Inflammatory Responses in COVID-19 Cases with Underlying Primary Immunodeficiency: A Review. J Interferon Cytokine Res 2020; 40:549-554. [PMID: 33337932 PMCID: PMC7757688 DOI: 10.1089/jir.2020.0210] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/14/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread rapidly and become a pandemic. Caused by a novel human coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), severe COVID-19 is characterized by cytokine storm syndromes due to innate immune activation. Primary immunodeficiency (PID) cases represent a special patient population whose impaired immune system might make them susceptible to severe infections, posing a higher risk to COVID-19, but this could also lead to suppressed inflammatory responses and cytokine storm. It remains an open question as to whether the impaired immune system constitutes a predisposing or protective factor for PID patients when facing SARS-CoV-2 infection. After literature review, it was found that, similar to other patient populations with different comorbidities, PID patients may be susceptible to SARS-CoV-2 infection. Their varied immune status, however, may lead to different disease severity and outcomes after SARS-CoV-2 infection. PID patients with deficiency in antiviral innate immune signaling [eg, Toll-like receptor (TLR)3, TLR7, or interferon regulatory factor 7 (IRF7)] or interferon signaling (IFNAR2) may be linked to severe COVID-19. Because of its anti-infection, anti-inflammatory, and immunomodulatory effects, routine intravenous immunoglobulin therapy may provide some protective effects to the PID patients.
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Affiliation(s)
- Benjamin M. Liu
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Harry R. Hill
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- ARUP Laboratories, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Henry BM, Benoit SW, Vikse J, Berger BA, Pulvino C, Hoehn J, Rose J, Santos de Oliveira MH, Lippi G, Benoit JL. The anti-inflammatory cytokine response characterized by elevated interleukin-10 is a stronger predictor of severe disease and poor outcomes than the pro-inflammatory cytokine response in coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 2020; 59:599-607. [PMID: 33554561 DOI: 10.1515/cclm-2020-1284] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Severe coronavirus disease 2019 (COVID-19) is associated with a dysregulated immune state. While research has focused on the hyperinflammation, little research has been performed on the compensatory anti-inflammatory response. The aim of this study was to evaluate the anti-inflammatory cytokine response to COVID-19, by assessing interleukin-10 (IL-10) and IL-10/lymphocyte count ratio and their association with outcomes. METHODS Adult patients presenting to the emergency department (ED) with laboratory-confirmed COVID-19 were recruited. The primary endpoint was maximum COVID-19 severity within 30 days of index ED visit. RESULTS A total of 52 COVID-19 patients were enrolled. IL-10 and IL-10/lymphocyte count were significantly higher in patients with severe disease (p<0.05), as well as in those who developed severe acute kidney injury (AKI) and new positive bacterial cultures (all p≤0.01). In multivariable analysis, a one-unit increase in IL-10 and IL-10/lymphocyte count were associated with 42% (p=0.031) and 32% (p=0.013) increased odds, respectively, of severe COVID-19. When standardized to a one-unit standard deviations scale, an increase in the IL-10 was a stronger predictor of maximum 30-day severity and severe AKI than increases in IL-6 or IL-8. CONCLUSIONS The hyperinflammatory response to COVID-19 is accompanied by a simultaneous anti-inflammatory response, which is associated with poor outcomes and may increase the risk of new positive bacterial cultures. IL-10 and IL-10/lymphocyte count at ED presentation were independent predictors of COVID-19 severity. Moreover, elevated IL-10 was more strongly associated with outcomes than pro-inflammatory IL-6 or IL-8. The anti-inflammatory response in COVID-19 requires further investigation to enable more precise immunomodulatory therapy against SARS-CoV-2.
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Affiliation(s)
- Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jens Vikse
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway
| | - Brandon A Berger
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Christina Pulvino
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Hoehn
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - James Rose
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Giuseppe Lippi
- Department of Neuroscience, Biomedicine and Movement, Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
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