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Outteridge M, Nunn CM, Devine K, Patel B, McLean GR. Antivirals for Broader Coverage against Human Coronaviruses. Viruses 2024; 16:156. [PMID: 38275966 PMCID: PMC10820748 DOI: 10.3390/v16010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Coronaviruses (CoVs) are enveloped positive-sense single-stranded RNA viruses with a genome that is 27-31 kbases in length. Critical genes include the spike (S), envelope (E), membrane (M), nucleocapsid (N) and nine accessory open reading frames encoding for non-structural proteins (NSPs) that have multiple roles in the replication cycle and immune evasion (1). There are seven known human CoVs that most likely appeared after zoonotic transfer, the most recent being SARS-CoV-2, responsible for the COVID-19 pandemic. Antivirals that have been approved by the FDA for use against COVID-19 such as Paxlovid can target and successfully inhibit the main protease (MPro) activity of multiple human CoVs; however, alternative proteomes encoded by CoV genomes have a closer genetic similarity to each other, suggesting that antivirals could be developed now that target future CoVs. New zoonotic introductions of CoVs to humans are inevitable and unpredictable. Therefore, new antivirals are required to control not only the next human CoV outbreak but also the four common human CoVs (229E, OC43, NL63, HKU1) that circulate frequently and to contain sporadic outbreaks of the severe human CoVs (SARS-CoV, MERS and SARS-CoV-2). The current study found that emerging antiviral drugs, such as Paxlovid, could target other CoVs, but only SARS-CoV-2 is known to be targeted in vivo. Other drugs which have the potential to target other human CoVs are still within clinical trials and are not yet available for public use. Monoclonal antibody (mAb) treatment and vaccines for SARS-CoV-2 can reduce mortality and hospitalisation rates; however, they target the Spike protein whose sequence mutates frequently and drifts. Spike is also not applicable for targeting other HCoVs as these are not well-conserved sequences among human CoVs. Thus, there is a need for readily available treatments globally that target all seven human CoVs and improve the preparedness for inevitable future outbreaks. Here, we discuss antiviral research, contributing to the control of common and severe CoV replication and transmission, including the current SARS-CoV-2 outbreak. The aim was to identify common features of CoVs for antivirals, biologics and vaccines that could reduce the scientific, political, economic and public health strain caused by CoV outbreaks now and in the future.
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Affiliation(s)
- Mia Outteridge
- School of Human Sciences, London Metropolitan University, London N7 8DB, UK; (M.O.); (C.M.N.); (K.D.); (B.P.)
| | - Christine M. Nunn
- School of Human Sciences, London Metropolitan University, London N7 8DB, UK; (M.O.); (C.M.N.); (K.D.); (B.P.)
| | - Kevin Devine
- School of Human Sciences, London Metropolitan University, London N7 8DB, UK; (M.O.); (C.M.N.); (K.D.); (B.P.)
| | - Bhaven Patel
- School of Human Sciences, London Metropolitan University, London N7 8DB, UK; (M.O.); (C.M.N.); (K.D.); (B.P.)
| | - Gary R. McLean
- School of Human Sciences, London Metropolitan University, London N7 8DB, UK; (M.O.); (C.M.N.); (K.D.); (B.P.)
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
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Georgianos PI, Agarwal R. Advances in the area of cardiorenal medicine: clinical research highlights from selected papers published in NDT. Nephrol Dial Transplant 2022; 37:1595-1597. [PMID: 35851641 PMCID: PMC9395376 DOI: 10.1093/ndt/gfac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
- Panagiotis I Georgianos
- Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rastogi A, Lerma EV. Anemia management for home dialysis including the new US public policy initiative. Kidney Int Suppl (2011) 2021; 11:59-69. [PMID: 33777496 PMCID: PMC7983021 DOI: 10.1016/j.kisu.2020.12.005] [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: 10/02/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) requiring kidney replacement therapy are often treated in conventional dialysis centers at substantial cost and patient inconvenience. The recent United States Executive Order on Advancing American Kidney Health, in addition to focusing on ESKD prevention and reforming the kidney transplantation system, focuses on providing financial incentives to promote a shift toward home dialysis. In accordance with this order, a goal was set to have 80% of incident dialysis patients receiving home dialysis or a kidney transplant by 2025. Compared with conventional in-center therapy, home dialysis modalities, including both home hemodialysis and peritoneal dialysis, appear to offer equivalent or improved mortality, clinical outcomes, hospitalization rates, and quality of life in patients with ESKD in addition to greater convenience, flexibility, and cost-effectiveness. Treatment of anemia, a common complication of chronic kidney disease, may be easier to manage at home with a new class of agents, hypoxia-inducible factor-prolyl hydroxylase inhibitors, which are orally administered in contrast to the current standard of care of i.v. iron and/or erythropoiesis-stimulating agents. This review evaluates the clinical, quality-of-life, economic, and social aspects of dialysis modalities in patients with ESKD, including during the coronavirus disease 2019 pandemic; explores new therapeutics for the management of anemia in chronic kidney disease; and highlights how the proposed changes in Advancing American Kidney Health provide an opportunity to improve kidney health in the United States.
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Affiliation(s)
- Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Edgar V. Lerma
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Section of Nephrology, Oak Lawn, Illinois, USA
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Polanco E, Aquey M, Collado J, Campos E, Guzman J, Cuevas-Budhart MA, Divino-Filho JC, Ramos-Sanchez A. A COVID-19 pandemic-specific, structured care process for peritoneal dialysis patients facilitated by telemedicine: Therapy continuity, prevention, and complications management. Ther Apher Dial 2021; 25:970-978. [PMID: 33634948 PMCID: PMC8014150 DOI: 10.1111/1744-9987.13635] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) has been declared a pandemic. Peritoneal dialysis (PD), being a home therapy, allows for physical distancing measures and movement restrictions. In order to prevent COVID‐19 contagioun among the Dominican Republic National Health System PD program patients, a follow‐up virtual protocol for this group was developed. The aim of this study is to outline the protocol established by the PD program's healthcare team using telemedicine in order to avoid COVID‐19 transmission and to report initial results and outcomes of this initiative. This is an observational prospective longitudinal study with 946 patients being treated in seven centers distributed throughout the country between April 1 and June 30. The protocol was implemented focusing on the patient follow‐up; risk mitigation data were registered and collected from electronic records. During the follow‐up period, 95 catheters were implanted, 64 patients initiated PD, and the remaining were in training. A total of 9532 consultations were given by the different team specialists, with 8720 (91%) virtual and 812 (9%) face‐to‐face consultations. The transfer rate to hemodialysis was 0.29%, whereas the peritonitis rate was 0.11 episode per patient/year. Eighteen adults tested positive for COVID‐19. The implementation of the protocol and telemedicine utilization have ensured follow‐up and monitoring, preserved therapy, controlled complications, and PD lives protected.
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Affiliation(s)
- Elianny Polanco
- Renal Department, Macrotech, Santo Domingo, Dominican Republic
| | - Mercedes Aquey
- Renal Department, Macrotech, Santo Domingo, Dominican Republic
| | - Jhanna Collado
- Renal Department, Macrotech, Santo Domingo, Dominican Republic
| | - Erwin Campos
- Renal Department, Macrotech, Santo Domingo, Dominican Republic
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Bello AK, Brown M, Caskey FJ, Donner JA, Liew A, Muller E, Naicker S, O'Connell PJ, Filho RP, Vachharajani T. Strategic plan for integrated care of patients with kidney failure. Kidney Int 2020; 98:S117-S134. [PMID: 33126957 DOI: 10.1016/j.kint.2020.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; Manipal Academy of Higher Education (MAHE), Manipal, Kamataka, India
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Tushar Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Lee MBH, Chua HR, Wong WK, Chan GC, Leo CCH, Vathsala A, Teo BW. Going to war on COVID-19: Mobilizing an academic nephrology group practice. Nephrology (Carlton) 2020; 25:822-828. [PMID: 32621527 PMCID: PMC7361387 DOI: 10.1111/nep.13753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/25/2020] [Indexed: 01/19/2023]
Abstract
Aim The COVID‐19 pandemic poses unprecedented operational challenges to nephrology divisions in every country as they cope with COVID‐19‐related kidney disease in addition to regular patient care. Although general approaches have been proposed, there is a lack of practical guidance for nephrology division response in a hospital facing a surge of cases. Here, we describe the specific measures that our division has taken in the hope that our experience in Singapore may be helpful to others. Methods Descriptive narrative. Results A compilation of operational responses to the COVID‐19 pandemic taken by a nephrology division at a Singapore university hospital. Conclusion Nephrology operational readiness for COVID‐19 requires a clinical mindset shift from usual standard of care to a crisis exigency model that targets best outcomes for available resources. Rapid multi‐disciplinary efforts that evolve flexibly with the local dynamics of the outbreak are required. A valuable experience and operational response to COVID‐19 pandemic threat by a nephrology division at a Singapore university hospital. This article gives good example of shift of clinical mindset from usual standard of care to a crisis exigency model that targets best outcomes for available resources.
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Affiliation(s)
- Martin B-H Lee
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Horng R Chua
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Weng K Wong
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Gek C Chan
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Christopher C H Leo
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - A Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Boon W Teo
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
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Quintaliani G, Reboldi G, Di Napoli A, Nordio M, Limido A, Aucella F, Messa P, Brunori G. Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology. J Nephrol 2020; 33:725-736. [PMID: 32621109 PMCID: PMC7333370 DOI: 10.1007/s40620-020-00794-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
Background Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. Methods Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14–2.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34–3.76]) than PD (1.38% [95% CI 1.04–1.78] and Tx (0.86% [95% CI 0.75–0.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11–4.68], followed by the north-east (IR 2.06% [1.79–2.36]), the center (0.91% [0.75–1.09]), the main islands (0.67% [0.47–0.93]), and the south (0.59% [0.45–0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality. Electronic supplementary material The online version of this article (10.1007/s40620-020-00794-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuseppe Quintaliani
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Roma, RM, Italy
| | | | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Maurizio Nordio
- Unit of Nephrology, General Hospital, Piazzale Ospedale, 23, 31100, Treviso, Italy
| | - Aurelio Limido
- Nephrology and Dialysis Unit, ASST Fatebenefratelli e Oftalmico, Milan, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS "Casa Sollievo Della Sofferenza" Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Piergiorgio Messa
- Division of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuliano Brunori
- Italian Society of Nephrology, Viale dell'Università, 11, 00185, Roma, RM, Italy. .,Nephrology and Dialysis Unit, Hospital of Trento, Trento, Italy.
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Li PKT, Rosenberg ME. Foreign Perspective on Achieving a Successful Peritoneal Dialysis-First Program. ACTA ACUST UNITED AC 2020; 1:680-684. [DOI: 10.34067/kid.0000712019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_07_30_KID0000712019.mp3.
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