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Zhang N, Wang G, Yang L, Zhang J, Yuan Y, Ma L, Wang Z. Intravenous immunoglobulin alleviates Japanese encephalitis virus-induced peripheral neuropathy by inhibiting the ASM/ceramide pathway. Int Immunopharmacol 2024; 133:112083. [PMID: 38648714 DOI: 10.1016/j.intimp.2024.112083] [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: 10/17/2023] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Japanese encephalitis virus (JEV) infection is considered a global public health emergency. Severe peripheral neuropathy caused by JEV infection has increased disability and mortality rates in recent years. Because there are very few therapeutic options for JEV infection, prompt investigations of the ability of clinically safe, efficacious and globally available drugs to inhibit JEV infection and ameliorate peripheral neuropathy are urgently needed. In this study, we found that high doses of intravenous immunoglobulin, a function inhibitor of acid sphingomyelinase (FIASMA), inhibited acid sphingomyelinase (ASM) and ceramide activity in the serum and sciatic nerve of JEV-infected rats, reduced disease severity, reversed electrophysiological and histological abnormalities, significantly reduced circulating proinflammatory cytokine levels, inhibited Th1 and Th17 cell proliferation, and suppressed the infiltration of inflammatory CD4 + cells into the sciatic nerve. It also maintained the peripheral nerve-blood barrier without causing severe clinical side effects. In terms of the potential mechanisms, ASM was found to participate in immune cell differentiation and to activate immune cells, thereby exerting proinflammatory effects. Therefore, immunoglobulin is a FIASMA that reduces abnormal immune responses and thus targets the ASM/ceramide system to treat peripheral neuropathy caused by JEV infection.
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Affiliation(s)
- Na Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China; Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guowei Wang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Liping Yang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jinyuan Zhang
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - YanPing Yuan
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China; Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Lijun Ma
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhenhai Wang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China; Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia Hui Autonomous Region, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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2
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Wu J, Yang H, Yu D, Yang X. Blood-derived product therapies for SARS-CoV-2 infection and long COVID. MedComm (Beijing) 2023; 4:e426. [PMID: 38020714 PMCID: PMC10651828 DOI: 10.1002/mco2.426] [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: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is capable of large-scale transmission and has caused the coronavirus disease 2019 (COVID-19) pandemic. Patients with COVID-19 may experience persistent long-term health issues, known as long COVID. Both acute SARS-CoV-2 infection and long COVID have resulted in persistent negative impacts on global public health. The effective application and development of blood-derived products are important strategies to combat the serious damage caused by COVID-19. Since the emergence of COVID-19, various blood-derived products that target or do not target SARS-CoV-2 have been investigated for therapeutic applications. SARS-CoV-2-targeting blood-derived products, including COVID-19 convalescent plasma, COVID-19 hyperimmune globulin, and recombinant anti-SARS-CoV-2 neutralizing immunoglobulin G, are virus-targeting and can provide immediate control of viral infection in the short term. Non-SARS-CoV-2-targeting blood-derived products, including intravenous immunoglobulin and human serum albumin exhibit anti-inflammatory, immunomodulatory, antioxidant, and anticoagulatory properties. Rational use of these products can be beneficial to patients with SARS-CoV-2 infection or long COVID. With evidence accumulated since the pandemic began, we here summarize the progress of blood-derived product therapies for COVID-19, discuss the effective methods and scenarios regarding these therapies, and provide guidance and suggestions for clinical treatment.
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Affiliation(s)
- Junzheng Wu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
| | | | - Ding Yu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
- Beijing Tiantan Biological Products Co., Ltd.BeijingChina
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3
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Manganotti P, Garascia G, Furlanis G, Buoite Stella A. Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review. Front Neurosci 2023; 17:1159929. [PMID: 37179564 PMCID: PMC10166837 DOI: 10.3389/fnins.2023.1159929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction Among the clinical manifestations of SARS-CoV-2 infection, neurological features have been commonly reported and the state-of-the-art technique suggests several mechanisms of action providing a pathophysiological rationale for central and peripheral neurological system involvement. However, during the 1st months of the pandemic, clinicians were challenged to find the best therapeutic options to treat COVID-19-related neurological conditions. Methods We explored the indexed medical literature in order to answer the question of whether IVIg could be included as a valid weapon in the therapeutic arsenal against COVID-19-induced neurological disorders. Results Virtually, all reviewed studies were in agreement of detecting an acceptable to great efficacy upon IVIg employment in neurological diseases, with no or mild adverse effects. In the first part of this narrative review, the interaction of SARS-CoV-2 with the nervous system has been discussed and the IVIg mechanisms of action were reviewed. In the second part, we collected scientific literature data over the last 2 years to discuss the use of IVIg therapy in different neuro-COVID conditions, thus providing a summary of the treatment strategies and key findings. Discussion Intravenous immunoglobulin (IVIg) therapy is a versatile tool with multiple molecular targets and mechanisms of action that might respond to some of the suggested effects of infection through inflammatory and autoimmune responses. As such, IVIg therapy has been used in several COVID-19-related neurological diseases, including polyneuropathies, encephalitis, and status epilepticus, and results have often shown improvement of symptoms, thus suggesting IVIg treatment to be safe and effective.
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4
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Delaney SL, Murray LA, Fallon BA. Neuropsychiatric Symptoms and Tick-Borne Diseases. Curr Top Behav Neurosci 2023; 61:279-302. [PMID: 36512289 DOI: 10.1007/7854_2022_406] [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: 06/17/2023]
Abstract
In North America, Lyme disease (LD) is primarily caused by the spirochetal bacterium Borrelia burgdorferi, transmitted to humans by Ixodes species tick bites, at an estimated rate of 476,000 patients diagnosed per year. Acute LD often manifests with flu-like symptoms and an expanding rash known as erythema migrans (EM) and less often with neurologic, neuropsychiatric, arthritic, or cardiac features. Most acute cases of Lyme disease are effectively treated with antibiotics, but 10-20% of individuals may experience recurrent or persistent symptoms. This chapter focuses on the neuropsychiatric aspects of Lyme disease, as these are less widely recognized by physicians and often overlooked. Broader education about the potential complexity, severity, and diverse manifestations of tick-borne diseases is needed.
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Affiliation(s)
- Shannon L Delaney
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA.
| | - Lilly A Murray
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
| | - Brian A Fallon
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
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5
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Noto A, Cassin R, Mattiello V, Bortolotti M, Reda G, Barcellini W. Should treatment of hypogammaglobulinemia with immunoglobulin replacement therapy (IgRT) become standard of care in patients with chronic lymphocytic leukemia? Front Immunol 2023; 14:1062376. [PMID: 37122737 PMCID: PMC10140292 DOI: 10.3389/fimmu.2023.1062376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Hypogammaglobulinemia (HGG) is a frequent finding in patients with hematological malignancies, and is commonly described in chronic lymphocytic leukemia (CLL) before or after treatment. We reviewed published literature available online in the last thirty years through Medline search of indexed articles focusing on the main differences and advantages of the products now available on the market, namely intravenous Ig (IVIg) and subcutaneous Ig (SCIg) preparations. IgRT is effective and safe in the prophylaxis of infections in a selected group of patients with CLL and hypogammaglobulinemia and is therefore a valuable tool for clinicians in the everyday management of infectious risk. We encourage the use of SCIg formulations as they appear to have similar efficacy but better cost-effectiveness and tolerability.
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Affiliation(s)
- Alessandro Noto
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ramona Cassin
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bortolotti
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Gianluigi Reda,
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Guest PC, Neyazi A, Braun-Dullaeus RC, Müller P, Schreiber J, Haghikia A, Vasilevska V, Steiner J. A Molecular Biomarker-Based Triage Approach for Targeted Treatment of Post-COVID-19 Syndrome Patients with Persistent Neurological or Neuropsychiatric Symptoms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1412:97-115. [PMID: 37378763 DOI: 10.1007/978-3-031-28012-2_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Approximately 30% of COVID-19 cases may experience chronic symptoms, known as post-COVID-19 syndrome (PCS). Common PCS symptoms can include fatigue, cognitive impairment, and persistent physical, neurological, and neuropsychiatric complaints. To improve healthcare and management of the current and future pandemics, we highlight the need for establishing interdisciplinary post-viral outpatient clinics comprised of specialists in fields such as psychiatry, psychotherapy, neurology, cardiology, pneumology, and immunology. In this way, PCS patients with a high health burden can receive modern diagnostics and targeted therapeutic recommendations. A key objective is to distinguish the "sick recovered" from the "healthy recovered." Our hypothesis is that there is a PCS subgroup with autoimmune-mediated systemic and brain-vascular dysregulation, which may lead to circulatory disorders, fatigue, cognitive impairment, depression, and anxiety. This can be clarified using a combination of specific antibody diagnostics and precise clinical, psychological, and apparative testing.
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Affiliation(s)
- Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
- Laboratory of Translational Psychiatry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alexandra Neyazi
- Laboratory of Translational Psychiatry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Otto-von-Guericke University, Magdeburg, Germany
| | - Patrick Müller
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Jens Schreiber
- Department of Pneumology, Otto von Guericke University, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Veronika Vasilevska
- Laboratory of Translational Psychiatry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Johann Steiner
- Laboratory of Translational Psychiatry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany.
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.
- Center for Health and Medical Prevention (CHaMP), Magdeburg, Germany.
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Bao WJ, Fu SK, Zhang H, Zhao JL, Jin HM, Yang XH. Clinical characteristics and short-term mortality of 102 hospitalized hemodialysis patients infected with SARS-CoV-2 omicron BA.2.2.1 variant in Shanghai, China. New Microbes New Infect 2022; 49:101058. [PMCID: PMC9691279 DOI: 10.1016/j.nmni.2022.101058] [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: 08/29/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to analyze clinical features and short-term mortality in hemodialysis (HD) patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) omicron BA.2.2.1 variant. Methods In a retrospective single-center case series, 102 consecutive hospitalized HD patients infected with the coronavirus omicron variant were assessed at Pudong Hospital in Shanghai, China, from April 6 to April 18, 2022; the final date of follow-up was May 16, 2022. Clinical, laboratory, chest CT, and treatment data were collected and analyzed. The association between these factors and all-cause mortality was studied using univariate and multivariate analyses. The relationship between lymphocyte count and short-term mortality was based on receiver operating characteristic (ROC) curve analysis. Kaplan–Meier analysis was used to assess overall survival. Results In total, 102 patients were included in this study. The patients were divided into two groups: HD patients with pneumonia (N = 46) and without pneumonia (N = 56). Of the 102 patients, 12 (11.8%) died. Multivariate regression analysis revealed that all-cause mortality was correlated with lymphocyte counts and type B natriuretic peptide (BNP), C-reactive protein (CRP), and D-dimer levels (P < 0.05). The cut-off value of lymphocyte counts was 0.61 × 109/L for all-cause mortality. The overall survival rate was significantly different between HD patients with and without pneumonia (P < 0.05). Conclusions Lymphocyte counts are important for the prediction of short-term mortality in HD patients with SARS-CoV-2 infection. HD patients with lung involvement have poorer survival rates than those without lung involvement.
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Affiliation(s)
- Wen Jing Bao
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Shun Kun Fu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Hua Zhang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
| | - Jun Li Zhao
- Division of Nephrology, Zhoupu Hospital, Shanghai University, Pudong New District, 1500 Zhouyuan Road, Shanghai, China
- Corresponding author.
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
- Corresponding author.
| | - Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong New District, 2800 Gong Wei Road, Shanghai, China
- Corresponding author.
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8
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Höglund P. Resource article: A new category of SJI publications. Scand J Immunol 2022; 96:e13199. [PMID: 35775963 DOI: 10.1111/sji.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Petter Höglund
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden
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9
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The Role of Exposomes in the Pathophysiology of Autoimmune Diseases II: Pathogens. PATHOPHYSIOLOGY 2022; 29:243-280. [PMID: 35736648 PMCID: PMC9231084 DOI: 10.3390/pathophysiology29020020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 11/21/2022] Open
Abstract
In our continuing examination of the role of exposomes in autoimmune disease, we use this review to focus on pathogens. Infections are major contributors to the pathophysiology of autoimmune diseases through various mechanisms, foremost being molecular mimicry, when the structural similarity between the pathogen and a human tissue antigen leads to autoimmune reactivity and even autoimmune disease. The three best examples of this are oral pathogens, SARS-CoV-2, and the herpesviruses. Oral pathogens reach the gut, disturb the microbiota, increase gut permeability, cause local inflammation, and generate autoantigens, leading to systemic inflammation, multiple autoimmune reactivities, and systemic autoimmunity. The COVID-19 pandemic put the spotlight on SARS-CoV-2, which has been called “the autoimmune virus.” We explore in detail the evidence supporting this. We also describe how viruses, in particular herpesviruses, have a role in the induction of many different autoimmune diseases, detailing the various mechanisms involved. Lastly, we discuss the microbiome and the beneficial microbiota that populate it. We look at the role of the gut microbiome in autoimmune disorders, because of its role in regulating the immune system. Dysbiosis of the microbiota in the gut microbiome can lead to multiple autoimmune disorders. We conclude that understanding the precise roles and relationships shared by all these factors that comprise the exposome and identifying early events and root causes of these disorders can help us to develop more targeted therapeutic protocols for the management of this worldwide epidemic of autoimmunity.
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10
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Aggarwal R, Dewan A, Pandey A, Trehan N, Majid MA. Efficacy of high-dose intravenous immunoglobulin in severe and critical COVID-19: A retrospective cohort study. Int Immunopharmacol 2022; 106:108615. [PMID: 35168081 PMCID: PMC8825318 DOI: 10.1016/j.intimp.2022.108615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 01/08/2023]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Ritesh Aggarwal
- Department of Critical Care, Max Smart Super Speciality Hospital, New Delhi 110017, India.
| | - Arun Dewan
- Department of Critical Care, Max Smart Super Speciality Hospital, New Delhi 110017, India
| | - Ankita Pandey
- Department of Internal Medicine, Max Smart Super Speciality Hospital, New Delhi 110017, India
| | - Nikita Trehan
- Department of Critical Care, Max Smart Super Speciality Hospital, New Delhi 110017, India
| | - Muhammad Aamir Majid
- Department of Critical Care, Max Smart Super Speciality Hospital, New Delhi 110017, India
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Scarpa R, Dell'Edera A, Felice C, Buso R, Muscianisi F, Finco Gambier R, Toffolo S, Grossi U, Giobbia M, Barberio G, Landini N, Facchini C, Agostini C, Rattazzi M, Cinetto F. Impact of Hypogammaglobulinemia on the Course of COVID-19 in a Non-Intensive Care Setting: A Single-Center Retrospective Cohort Study. Front Immunol 2022; 13:842643. [PMID: 35359947 PMCID: PMC8960988 DOI: 10.3389/fimmu.2022.842643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Background Severity and mortality of COVID-19 largely depends on the ability of the immune system to clear the virus. Among various comorbidities potentially impacting on this process, the weight and the consequences of an antibody deficiency have not yet been clarified. Methods We used serum protein electrophoresis to screen for hypogammaglobulinemia in a cohort of consecutive adult patients with COVID-19 pneumonia, hospitalized in non-intensive care setting between December 2020 and January 2021. The disease severity, measured by a validated score and by the need for semi intensive (sICU) or intensive care unit (ICU) admission, and the 30-day mortality was compared between patients presenting hypogammaglobulinemia (HYPO) and without hypogammaglobulinemia (no-HYPO). Demographics, comorbidities, COVID-19 specific treatment during the hospital stay, disease duration, complications and laboratory parameters were also evaluated in both groups. Results We enrolled 374 patients, of which 39 represented the HYPO cohort (10.4%). In 10/39 the condition was previously neglected, while in the other 29/39 hematologic malignancies were common (61.5%); 2/39 were on regular immunoglobulin replacement therapy (IgRT). Patients belonging to the HYPO group more frequently developed a severe COVID-19 and more often required sICU/ICU admission than no-HYPO patients. IgRT were administered in 8/39 during hospitalization; none of them died or needed sICU/ICU. Among HYPO cohort, we observed a significantly higher prevalence of neoplastic affections, of active oncologic treatment and bronchiectasis, together with higher prevalence of viral and bacterial superinfections, mechanical ventilation, convalescent plasma and SARS-CoV-2 monoclonal antibodies administration during hospital stay, and longer disease duration. Multivariate logistic regression analysis and Cox proportional hazard regression confirmed the impact of hypogammaglobulinemia on the COVID-19 severity and the probability of sICU/ICU admission. The analysis of the mortality rate in the whole cohort showed no significant difference between HYPO and no-HYPO. Conclusions Hypogammaglobulinemia, regardless of its cause, in COVID-19 patients hospitalized in a non-intensive care setting was associated to a more severe disease course and more frequent admission to s-ICU/ICU, particularly in absence of IgRT. Our findings emphasize the add-value of routine serum protein electrophoresis evaluation in patients admitted with COVID-19 to support clinicians in patient care and to consider IgRT initiation during hospitalization.
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Affiliation(s)
- Riccardo Scarpa
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Alessandro Dell'Edera
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Carla Felice
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Roberta Buso
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Francesco Muscianisi
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Renato Finco Gambier
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Sara Toffolo
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Ugo Grossi
- Department of Surgery, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Mario Giobbia
- Infectious Diseases Unit, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Giuseppina Barberio
- Laboratory Medicine, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Nicholas Landini
- Radiology Unit, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Cesarina Facchini
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Carlo Agostini
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Marcello Rattazzi
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Cinetto
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
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12
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Luchetti Gentiloni MM, Paci V, Marconi V, Gigli M, Benfaremo D, Sordillo R, Macchini C, Massaccesi L, Perna GP, Offidani AM, Moroncini G. SARS-COV-2 Infection, Vaccination, and Immune-Mediated Diseases: Results of a Single-Center Retrospective Study. Front Immunol 2022; 13:859550. [PMID: 35386714 PMCID: PMC8977466 DOI: 10.3389/fimmu.2022.859550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives The relationship between infections or vaccine antigens and exacerbations or new onset of immune-mediated diseases (IMDs) has long been known. In this observational study, conducted during the COVID-19 pandemic, we evaluated the onset of clinical and laboratory immune manifestations related to COVID-19 or SARS-CoV-2 vaccination. Methods Four groups of patients were evaluated: A) 584 COVID-19 inpatients hospitalized from March 2020 to June 2020 and from November 2020 to May 2021; B) 135 outpatients with previous SARS-CoV-2 infection, assessed within 6 months of recovery; C) outpatients with IMDs in remission and flared after SARS-COV-2 infection; D) outpatients with symptoms of probable immune-mediated origin after SARS-CoV-2 vaccination. Results In cohort A we observed n. 28 (4.8%) arthralgia/myalgia, n. 2 (0.3%) arthritis, n. 3 (0.5%) pericarditis, n. 1 (0.2%) myocarditis, n. 11 (1.9%) thrombocytopenia or pancytopenia, and in the follow up cohort B we identified 9 (6.7%) cases of newly diagnosed IMDs after the recovery from COVID-19. In all cases, serological alterations were not observed. In cohort C we observed n.5 flares of pre-existing IMD after SARS-COV2 infection, and in the cohort D n. 13 IMD temporally close with SARS-CoV-2 vaccination in 8 healthy subjects (with clinical classifiable IMD-like presentation) and in 5 patients affected by an anamnestic IMD. Also in these latter cases, except in 2 healthy subjects, there were not found serological alterations specific of a classifiable IMD. Conclusions This study suggests that the interplay between SARS-CoV-2 and the host may induce complex immune-mediated reactions, probably induced by the anti-spike antibodies, in healthy people and IMD patients without specific serological autoimmunity. Moreover, our data suggest that the anti-SARS-CoV-2 antibodies generated by the vaccination may cause in healthy subjects’ clinical manifestations similar to well-definite IMDs. These findings support the hypothesis that SARS-Cov2 infection in COVID-19 induce an innate and adaptive immune response that may be both responsible of the symptoms correlated with the occurrence of the IMDs described in our study. And, in this context, the IMDs observed in healthy people in close temporal correlation with the vaccination suggest that the anti-Spike antibodies may play a key role in the induction of an abnormal and deregulated immune response.
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Affiliation(s)
- Michele Maria Luchetti Gentiloni
- Clinica Medica, Ospedali Riuniti Ancona University Hospital, Ancona, Italy.,Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Valentino Paci
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Valentina Marconi
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Marco Gigli
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Devis Benfaremo
- Clinica Medica, Ospedali Riuniti Ancona University Hospital, Ancona, Italy.,Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Raffaella Sordillo
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Cristina Macchini
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Leonardo Massaccesi
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Gian Piero Perna
- Cardiologia Subintensiva, Ospedali Riuniti Ancona University Hospital, Ancona, Italy
| | - Anna Maria Offidani
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy.,Clinica Dermatologica, Ospedali Riuniti Ancona University Hospital, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Ospedali Riuniti Ancona University Hospital, Ancona, Italy.,Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
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13
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Thompson JS, Thornton AC, Ainger T, Garvy BA. Long-term high-dose immunoglobulin successfully treats Long COVID patients with pulmonary, neurologic, and cardiologic symptoms. Front Immunol 2022; 13:1033651. [PMID: 36818469 PMCID: PMC9932260 DOI: 10.3389/fimmu.2022.1033651] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Long COVID is the overarching name for a wide variety of disorders that may follow the diagnosis of acute SARS-COVID-19 infection and persist for weeks to many months. Nearly every organ system may be affected. Methods We report nine patients suffering with Long COVID for 101 to 547 days. All exhibited significant perturbations of their immune systems, but only one was known to be immunodeficient prior to the studies directed at evaluating them for possible treatment. Neurological and cardiac symptoms were most common. Based on this data and other evidence suggesting autoimmune reactivity, we planned to treat them for 3 months with long-term high-dose immunoglobulin therapy. If there was evidence of benefit at 3 months, the regimen was continued. Results The patients' ages ranged from 34 to 79 years-with five male and four female patients, respectively. All nine patients exhibited significant immune perturbations prior to treatment. One patient declined this treatment, and insurance support was not approved for two others. The other six have been treated, and all have had a significant to remarkable clinical benefit. Conclusion Long-term high-dose immunoglobulin therapy is an effective therapeutic option for treating patients with Long COVID.
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Affiliation(s)
- John S Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Alice C Thornton
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Timothy Ainger
- Department of Neurology, University of Kentucky, College of Medicine, Lexington, KY, United States
| | - Beth A Garvy
- Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY, United States
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14
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Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211101016s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Diabetes mellitus patients represent vulnerable group of
people who are prone to getting infected with severe acute respiratory
syndrome corona virus 2 (SARS-CoV-2). The virus has a high binding affinity
to angiotensin-converting enzyme 2 receptor which allows efficient host cell
entering, prolonged virus retention and possibility of insulin resistance
and ketoacidosis development. Case outline. We describe a case of a
20-year-old patient with a past medical history of type-1 diabetes mellitus
who presented with bilateral COVID-19 pneumonia. Initially treatment with
polyvitamin therapy, corticosteroids, tocilizumab and convalescent plasma
did not improve the patient condition, but might have led to the worsening
of underlying disease, high blood glucose level and ketoacidosis. Patient
developed a rapid progression of the disease and severe pneumonia that
required intubation and mechanical ventilation. Intravenous immunoglobulin
(IVIg) has been administrated in order to suppress a hyperactive immune
response through its immunomodulatory effect. Forty-eight hours later
respiratory gas exchange had been improved, almost complete regression of
changes in the lungs have been seen, normalization of metabolic and gas
exchange parameters have been detected. After 14 days in the hospital the
patient was discharged home in good general condition. Conclusion. COVID-19
complicated by diabetes mellitus leads to a poor outcome of the disease, but
antiviral and anti-inflammatory activity of IVIg suggests that they may be
useful therapeutic agent and in the case of COVID-19. In the presented case,
the application of IVIg very fast led to an improvement in the patient?s
condition.
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