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Kosenko E, Tikhonova L, Alilova G, Montoliu C. Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer's Disease. Int J Mol Sci 2023; 24:5739. [PMID: 36982809 PMCID: PMC10051442 DOI: 10.3390/ijms24065739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly spreading acute respiratory infection caused by SARS-CoV-2. The pathogenesis of the disease remains unclear. Recently, several hypotheses have emerged to explain the mechanism of interaction between SARS-CoV-2 and erythrocytes, and its negative effect on the oxygen-transport function that depends on erythrocyte metabolism, which is responsible for hemoglobin-oxygen affinity (Hb-O2 affinity). In clinical settings, the modulators of the Hb-O2 affinity are not currently measured to assess tissue oxygenation, thereby providing inadequate evaluation of erythrocyte dysfunction in the integrated oxygen-transport system. To discover more about hypoxemia/hypoxia in COVID-19 patients, this review highlights the need for further investigation of the relationship between biochemical aberrations in erythrocytes and oxygen-transport efficiency. Furthermore, patients with severe COVID-19 experience symptoms similar to Alzheimer's, suggesting that their brains have been altered in ways that increase the likelihood of Alzheimer's. Mindful of the partly assessed role of structural, metabolic abnormalities that underlie erythrocyte dysfunction in the pathophysiology of Alzheimer's disease (AD), we further summarize the available data showing that COVID-19 neurocognitive impairments most probably share similar patterns with known mechanisms of brain dysfunctions in AD. Identification of parameters responsible for erythrocyte function that vary under SARS-CoV-2 may contribute to the search for additional components of progressive and irreversible failure in the integrated oxygen-transport system leading to tissue hypoperfusion. This is particularly relevant for the older generation who experience age-related disorders of erythrocyte metabolism and are prone to AD, and provide an opportunity for new personalized therapies to control this deadly infection.
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Affiliation(s)
- Elena Kosenko
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Lyudmila Tikhonova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Gubidat Alilova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Carmina Montoliu
- Hospital Clinico Research Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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Ceruti S, Minotti B, Glotta A, Biggiogero M, Bona G, Marzano M, Greco P, Spagnoletti M, Garzoni C, Bendjelid K. Reply to Böning et al. Comment on “Ceruti et al. Temporal Changes in the Oxyhemoglobin Dissociation Curve of Critically Ill COVID-19 Patients. J. Clin. Med. 2022, 11, 788”. J Clin Med 2022; 11:jcm11154547. [PMID: 35956162 PMCID: PMC9369590 DOI: 10.3390/jcm11154547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
We would like to thank Böning et al. for all the important issues raised in the present commentary [...]
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Affiliation(s)
- Samuele Ceruti
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
- Correspondence: or ; Tel.: +41-91-960-81-11
| | - Bruno Minotti
- Emergency Department, St. Gallen Cantonal Hospital, 9000 St. Gallen, Switzerland
| | - Andrea Glotta
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Giovanni Bona
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Martino Marzano
- Department of Internal Medicine, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Pietro Greco
- Emergency Department, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Marco Spagnoletti
- Emergency Department, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Christian Garzoni
- Department of Internal Medicine, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Karim Bendjelid
- Intensive Care Division, Geneva University Hospitals, 1205 Geneva, Switzerland
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Temporal Changes in the Oxyhemoglobin Dissociation Curve of Critically Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11030788. [PMID: 35160240 PMCID: PMC8836951 DOI: 10.3390/jcm11030788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023] Open
Abstract
Critical COVID-19 is a life-threatening disease characterized by severe hypoxemia with complex pathophysiological mechanisms that are not yet completely understood. A pathological shift in the oxyhemoglobin curve (ODC) was previously described through the analysis of p50, intended as the oxygen tension at which hemoglobin is saturated by oxygen at 50%. The aim of this study was to analyze Hb-O2 affinity features over time in a cohort of critically ill COVID-19 patients, through the analysis of ODC p50 behavior. A retrospective analysis was performed; through multiple arterial blood gas (ABG) analyses, each p50 was calculated and normalized according to PaCO2, pH and temperature; patients' p50 evolution over time was reported, comparing the first 3 days (early p50s) with the last 3 days (late p50s) of ICU stay. A total of 3514 ABG analyses of 32 consecutive patients were analyzed. The majority of patients presented a left shift over time (p = 0.03). A difference between early p50s and late p50s was found (20.63 ± 2.1 vs. 18.68 ± 3.3 mmHg, p = 0.03); median p50 of deceased patients showed more right shifts than those of alive patients (24.1 vs. 18.45 mmHg, p = 0.01). One-way ANOVA revealed a p50 variance greater in the early p50s (σ2 = 8.6) than in the late p50s (σ2 = 3.84), associated with a reduction over time (p < 0.001). Comparing the Hb-O2 affinity in critically ill COVID-19 patients between ICU admission and ICU discharge, a temporal shift in the ODC was observed.
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Pascual-Guàrdia S, Ferrer A, Díaz Ó, Caguana AO, Tejedor E, Bellido-Calduch S, Rodríguez-Chiaradia DA, Gea J. Absence of relevant clinical effects of SARS-COV-2 on the affinity of hemoglobin for O 2 in patients with COVID-19. Arch Bronconeumol 2021; 57:757-763. [PMID: 34720331 PMCID: PMC8536567 DOI: 10.1016/j.arbr.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
Pulmonary involvement in COVID-19 is frequently associated with alterations in oxygenation. The arterial partial pressure of oxygen (PaO2) is the most clinically used variable to assess such oxygenation, since it decisively influences the oxygen transported by hemoglobin (expressed by its percentage of saturation, SaO2). However, two recent studies conducted respectively in silico and using omic techniques in red blood cells of COVID-19 patients have suggested that SARS-CoV-2 could decrease the affinity of oxygen for the hemoglobin (which would imply that PaO2 would overestimate SaO2), and also reduce the amount of this carrier molecule. OBJECTIVE To evaluate this hypothesis in blood samples from COVID-19 patients. METHODS Blood gases of all COVID-19 patients performed in our laboratory in two months were included, as well as those from two control groups: synchronous patients with negative PCR for SARS-CoV-2 (SCG) and a historical group (HCG). Both SaO2 and venous saturations (SvO2) measured by cooximetry (COX) were compared separately with those calculated using the Kelman (K), Severinghaus (SV) and Siggaard-Andersen (SA) equations in each group. RESULTS Measured and calculated SaO2 and SvO2 were practically equivalent in all groups. Intraclass correlation coefficients (ICC) for SaO2 in COVID-19 were 0.993 for COX-K and 0.992 for both COX-SV and COX-SA; being 0.995 for SvO2 for either COX-K, COX-SV or COX-SA. Hemoglobin and ferritin were slightly higher in COVID-19 compared to SCG and HCG (hemoglobin, p < 0.001 for both; ferritin, p < 0.05 for SCG and p < 0.001 for HCG). CONCLUSION Under clinical conditions SARS-CoV-2 does not have an appreciable influence on the affinity of oxygen for the hemoglobin, nor on the levels of this carrier molecule. Therefore, PaO2 is a good marker of blood oxygenation also in COVID-19.
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Affiliation(s)
- Sergi Pascual-Guàrdia
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Antoni Ferrer
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Óscar Díaz
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, Spain
| | - Antonio O Caguana
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Elvira Tejedor
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, Spain
| | - Salomé Bellido-Calduch
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradia
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
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Böning D, Kuebler WM, Bloch W. The oxygen dissociation curve of blood in COVID-19. Am J Physiol Lung Cell Mol Physiol 2021; 321:L349-L357. [PMID: 33978488 PMCID: PMC8384474 DOI: 10.1152/ajplung.00079.2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
COVID-19 hinders oxygen transport to the consuming tissues by at least two mechanisms: In the injured lung, saturation of hemoglobin is compromised, and in the tissues, an associated anemia reduces the volume of delivered oxygen. For the first problem, increased hemoglobin oxygen affinity [left shift of the oxygen dissociation curve (ODC)] is of advantage, for the second, however, the contrary is the case. Indeed a right shift of the ODC has been found in former studies for anemia caused by reduced cell production or hemolysis. This resulted from increased 2,3-bisphosphoglycerate (2,3-BPG) concentration. In three investigations in COVID-19, however, no change of hemoglobin affinity was detected in spite of probably high [2,3-BPG]. The most plausible cause for this finding is formation of methemoglobin (MetHb), which increases the oxygen affinity and thus apparently compensates for the 2,3-BPG effect. However, this "useful effect" is cancelled by the concomitant reduction of functional hemoglobin. In the largest study on COVID-19, even a clear left shift of the ODC was detected when calculated from measurements in fresh blood rather than after equilibration with gases outside the body. This additional "in vivo" left shift possibly results from various factors, e.g., concentration changes of Cl-, 2,3-BPG, ATP, lactate, nitrocompounds, glutathione, glutamate, because of time delay between blood sampling and end of equilibration, or enlarged distribution space including interstitial fluid and is useful for O2 uptake in the lungs. Under discussion for therapy are the affinity-increasing 5-hydroxymethyl-2-furfural (5-HMF), erythropoiesis-stimulating substances like erythropoietin, and methylene blue against MetHb formation.
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Affiliation(s)
- Dieter Böning
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
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Pascual-Guàrdia S, Ferrer A, Díaz Ó, Caguana AO, Tejedor E, Bellido-Calduch S, Rodríguez-Chiaradia DA, Gea J. Absence of Relevant Clinical Effects of SARS-COV-2 on the Affinity of Hemoglobin for O 2 in Patients with COVID-19. Arch Bronconeumol 2021; 57:S0300-2896(21)00113-7. [PMID: 33875283 PMCID: PMC7997137 DOI: 10.1016/j.arbres.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
Pulmonary involvement in COVID-19 is frequently associated with alterations in oxygenation. The arterial partial pressure of oxygen (PaO2) is the most clinically used variable to assess such oxygenation, since it decisively influences the oxygen transported by hemoglobin (expressed by its percentage of saturation, SaO2). However, two recent studies conducted respectively in silico and using omic techniques in red blood cells of COVID-19 patients have suggested that SARS-CoV-2 could decrease the affinity of oxygen for the hemoglobin (which would imply that PaO2 would overestimate SaO2), and also reduce the amount of this carrier molecule. OBJECTIVE To evaluate this hypothesis in blood samples from COVID-19 patients. METHODS Blood gases of all COVID-19 patients performed in our laboratory in two months were included, as well as those from two control groups: synchronous patients with negative PCR for SARS-CoV-2 (SCG) and a historical group (HCG). Both SaO2 and venous saturations (SvO2) measured by cooximetry (COX) were compared separately with those calculated using the Kelman (K), Severinghaus (SV) and Siggaard-Andersen (SA) equations in each group. RESULTS Measured and calculated SaO2 and SvO2 were practically equivalent in all groups. Intraclass correlation coefficients (ICC) for SaO2 in COVID-19 were 0.993 for COX-K and 0.992 for both COX-SV and COX-SA; being 0.995 for SvO2 for either COX-K, COX-SV or COX-SA. Hemoglobin and ferritin were slightly higher in COVID-19 compared to SCG and HCG (hemoglobin, p < 0.001 for both; ferritin, p < 0.05 for SCG and p < 0.001 for HCG). CONCLUSION Under clinical conditions SARS-CoV-2 does not have an appreciable influence on the affinity of oxygen for the hemoglobin, nor on the levels of this carrier molecule. Therefore, PaO2 is a good marker of blood oxygenation also in COVID-19.
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Affiliation(s)
- Sergi Pascual-Guàrdia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Antoni Ferrer
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Óscar Díaz
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Antonio O Caguana
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Elvira Tejedor
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Salomé Bellido-Calduch
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Diego A Rodríguez-Chiaradia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España.
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