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Ora J, Calzetta L, Frugoni C, Puxeddu E, Rogliani P. Expert guidance on the management and challenges of long-COVID syndrome: a systematic review. Expert Opin Pharmacother 2023; 24:315-330. [PMID: 36542805 DOI: 10.1080/14656566.2022.2161365] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-COVID is a condition characterized by the permanence of symptoms beyond 4 weeks after an initial infection. It affects 1 out of 5 people and is loosely related to the severity of acute infection and pathological mechanisms, which are yet to be understood. AREAS COVERED This article looks at currently available and under-studied therapies for long-COVID syndrome. It particularly gives focus to ongoing trials and reviews the underlying mechanisms. A comprehensive literature search was performed on PubMed and clincaltrial.gov of clinical trials concerning the management of long-COVID syndrome. EXPERT OPINION 'Long-COVID' syndrome is a new emergency characterized by several symptoms such as fatigue, dyspnea, cognitive and attention disorders, sleep disorders, post-traumatic stress disorder, muscle pain, and concentration problems. Despite the many guidelines available to date, there are no established treatments of long-COVID. Pharmacological research is studying known drugs that act on the reduction or modulation of systemic inflammation, or innovative drugs used in similar pathologies. Rehabilitation now seems to be the safest treatment to offer, whereas we will have to wait for the pharmacological research trials in progress as well as plan new trials based on a better understanding of the pathogenic mechanisms.
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Affiliation(s)
- Josuel Ora
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126, Parma, Italy
| | - Chiara Frugoni
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ermanno Puxeddu
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
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Holman R, Gui L, Lorton O, Guillemin P, Desgranges S, Contino-Pépin C, Salomir R. PFOB sonosensitive microdroplets: determining their interaction radii with focused ultrasound using MR thermometry and a Gaussian convolution kernel computation. Int J Hyperthermia 2022; 39:108-119. [PMID: 35000497 DOI: 10.1080/02656736.2021.2021304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Purpose: Micron-sized perfluorocarbon droplet adjuvants to focused ultrasound therapies allow lower applied power, circumvent unwanted prefocal heating, and enhance thermal dose in highly perfused tissues. The heat enhancement has been shown to saturate at increasing concentrations. Experiments were performed to empirically model the saturating heating effects during focused ultrasound.Materials and methods: The measurements were made at varying concentrations using magnetic resonance thermometry and focused ultrasound by circulating droplets of mean diameter 1.9 to 2.3 µm through a perfused phantom. A simulation was performed to estimate the interaction radius size, empirically.Results: The interaction radius, representing the radius of a sphere encompassing 90% of the probability for the transformation of acoustic energy into heat deposition around a single droplet, was determined experimentally from ultrasonic absorption coefficient measurements The simulations suggest the interaction radius was approximately 12.5-fold larger than the geometrical radius of droplets, corresponding to an interaction volume on the order of 2000 larger than the geometrical volume.Conclusions: The results provide information regarding the dose-response relationship from the droplets, a measure with 15% precision of their interaction radii with focused ultrasound, and subsequent insights into the underlying physical heating mechanism.
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Affiliation(s)
- Ryan Holman
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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Charbe NB, Castillo F, Tambuwala MM, Prasher P, Chellappan DK, Carreño A, Satija S, Singh SK, Gulati M, Dua K, González-Aramundiz JV, Zacconi FC. A new era in oxygen therapeutics? From perfluorocarbon systems to haemoglobin-based oxygen carriers. Blood Rev 2022; 54:100927. [PMID: 35094845 DOI: 10.1016/j.blre.2022.100927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 02/09/2023]
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El-Betany AMM, Behiry EM, Gumbleton M, Harding KG. Humidified Warmed CO 2 Treatment Therapy Strategies Can Save Lives With Mitigation and Suppression of SARS-CoV-2 Infection: An Evidence Review. Front Med (Lausanne) 2020; 7:594295. [PMID: 33425942 PMCID: PMC7793941 DOI: 10.3389/fmed.2020.594295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 01/17/2023] Open
Abstract
The coronavirus disease (COVID-19) outbreak has presented enormous challenges for healthcare, societal, and economic systems worldwide. There is an urgent global need for a universal vaccine to cover all SARS-CoV-2 mutant strains to stop the current COVID-19 pandemic and the threat of an inevitable second wave of coronavirus. Carbon dioxide is safe and superior antimicrobial, which suggests it should be effective against coronaviruses and mutants thereof. Depending on the therapeutic regime, CO2 could also ameliorate other COVID-19 symptoms as it has also been reported to have antioxidant, anti-inflammation, anti-cytokine effects, and to stimulate the human immune system. Moreover, CO2 has beneficial effects on respiratory physiology, cardiovascular health, and human nervous systems. This article reviews the rationale of early treatment by inhaling safe doses of warmed humidified CO2 gas, either alone or as a carrier gas to deliver other inhaled drugs may help save lives by suppressing SARS-CoV-2 infections and excessive inflammatory responses. We suggest testing this somewhat counter-intuitive, but low tech and safe intervention for its suitability as a preventive measure and treatment against COVID-19. Overall, development and evaluation of this therapy now may provide a safe and economical tool for use not only during the current pandemic but also for any future outbreaks of respiratory diseases and related conditions.
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Affiliation(s)
- Alaa M. M. El-Betany
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Enas M. Behiry
- School of Medicine, Institute of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Mark Gumbleton
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Keith G. Harding
- Wound Healing Research Unit, Welsh Wound Innovation Centre, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Lorton O, Hyacinthe JN, Desgranges S, Gui L, Klauser A, Celicanin Z, Crowe LA, Lazeyras F, Allémann E, Taulier N, Contino-Pépin C, Salomir R. Molecular oxygen loading in candidate theranostic droplets stabilized with biocompatible fluorinated surfactants: Particle size effect and application to in situ 19F MRI mapping of oxygen partial pressure. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 295:27-37. [PMID: 30096550 DOI: 10.1016/j.jmr.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Perfluorocarbon nano- and micron-sized emulsions are a new field of investigation in cancer treatment due to their ability to be used as imaging contrast agents, or as delivery vectors for pharmaceuticals. They also demonstrated capability to enhance the efficiency of high intensity focused ultrasound thermo-therapy. In the context of new biomedical applications we investigated perfluorooctyl bromide (PFOB) theranostic droplets using 19F NMR. Each droplet contains biocompatible fluorinated surfactants composed of a polar Tris(hydroxymethyl)aminomethane head unit and hydrophobic perfluorinated tail (abbreviated as F-TAC). The influence of the droplet size on the oxygen loading capacity was determined from longitudinal relaxation (T1) data of 19F NMR signal. MATERIAL AND METHODS Liquid PFOB and five samples of PFOB droplets of average diameter 0.177, 0.259, 1.43, 3.12 and 4.53 µm were tested with different oxygen levels. A dedicated gas exchange system was validated to maintain steady state oxygen concentrations, including a spatial gradient of oxygen concentration. A prototyped transmit-receive switchable 19F/1H quadrature coil was integrated on a 3 T clinical scanner. The coil is compatible with focused ultrasound sonication for future application. A spectroscopy FID inversion-recovery (IR) sequence was used to measure the T1 value per sample and per value of equilibrium oxygen pressure. Pixel wise, spatial T1 mapping was performed with magnetization prepared 2D gradient echo sequences in tissue mimicking gels doped with theranostic droplets. RESULTS Experimental data indicated that the longitudinal relaxation rate of 19F signal of the investigated theranostic droplets depended approximately linearly on the oxygen level and its slope decreased with the particle size according to a second order polynomial over the investigated range. This semi-empirical model was derived from general thermodynamics and weak electrostatic forces theory and fitted the experimental data within 0.75% precision. The capacity of oxygen transportation for the described theranostic droplets tended to that of pure PFOB, while micron-sized droplets lost up to 50% of this capacity. In a specific setup producing a steady state gradient of oxygen concentration, we demonstrated spatial mapping of oxygen pressure gradient of 6 kPa/mm with 1 mm in-plane resolution. CONCLUSION The size-tunable PFOB theranostic droplets stabilized with F-TAC surfactants could be characterized by 19F MRI in a clinical setup readily compatible with interventional in vivo studies under MR guidance. Current precision and spatial resolution of T1 mapping are promising. A potential challenge for further in vivo studies is the reduction of the imaging time.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Switzerland.
| | - Jean-Noël Hyacinthe
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Switzerland; School of Health Sciences, HES-SO // University of Applied Sciences and Arts of Western, Switzerland
| | - Stéphane Desgranges
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Switzerland; University of Avignon, CBSA-IBMM (UMR5247), Avignon, France
| | - Laura Gui
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Switzerland
| | - Antoine Klauser
- Department of Radiology and Medical Informatics, University of Geneva, Switzerland
| | - Zarko Celicanin
- Department of Radiological Physics, University Hospital of Basel, Switzerland
| | - Lindsey A Crowe
- Department of Radiology and Medical Informatics, University of Geneva, Switzerland
| | - François Lazeyras
- Department of Radiology and Medical Informatics, University of Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Nicolas Taulier
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), F-75006 Paris, France
| | | | - Rares Salomir
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Switzerland; University Hospitals of Geneva, Radiology Department, Geneva, Switzerland
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Swystun V, Green FHY, Dennis JH, Rampakakis E, Lalli G, Fadayomi M, Chiu A, Shrestha G, El Shahat SG, Nelson DE, El Mays TY, Pieron CA, Leigh R. A phase IIa proof-of-concept, placebo-controlled, randomized, double-blind, crossover, single-dose clinical trial of a new class of bronchodilator for acute asthma. Trials 2018; 19:321. [PMID: 29914544 PMCID: PMC6006836 DOI: 10.1186/s13063-018-2720-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluates a novel bronchodilator, S1226, for its efficacy in reversing allergen-induced bronchoconstriction in subjects with mild, allergic asthma. S1226 is a new class of bronchodilator that is an aerosol/vapor/gas mixture combining pharmacological and biophysical principles for a novel mode of action. It contains a potent bronchodilator gas (carbon dioxide or CO2) and nebulized perflubron (a synthetic surfactant possessing mucolytic properties). It has demonstrated rapid reversal of allergen-induced bronchoconstriction in an ovine study model. METHODS This was a phase IIa proof-of-concept, placebo-controlled, randomized, double-blind, crossover single-dose clinical trial to evaluate the safety, tolerability, and efficacy of S1226 (8% CO2) administered by nebulization following an allergen-induced early asthmatic response in 12 subjects with mild, allergic asthma. Primary safety endpoints were adverse events, vital signs, pulse oximetry, and spirometry. Efficacy endpoints included bronchodilator response (measured as the forced expiratory volume in 1 s or FEV1) over time, the area under the curve of FEV1 for the early asthmatic response over time, and achievement of responder status, defined as a 12% improvement after the allergen challenge. RESULTS No significant safety issues were observed. All adverse events were non-serious, mild, and transient. There was a statistically significant decrease in peripheral blood oxygenation levels over time in the placebo group following allergen inhalation, whereas blood oxygenation was maintained at normal levels in the S1226-treated subjects (P = 0.028). This effect was greatest 5 min after start of treatment (P < 0.001). The recovery rate was faster but not significantly so (P = 0.272) for S1226 compared to the placebo at earlier time points (5, 10, and 15 min), as assessed by ≥12% reversal of FEV1. The recovery of FEV1 over time was significantly greater (P = 0.04) with S1226 compared to the placebo. CONCLUSIONS S1226 was safe, tolerated well, and provided bronchodilation and improved blood oxygenation in subjects with mild atopic asthma following allergen-induced bronchoconstriction. Additional studies to optimize the therapeutic response are indicated. TRIAL REGISTRATION ClinicalTrials.gov, NCT02334553 . Registered on 12 November 2014.
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Affiliation(s)
- Veronica Swystun
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francis H Y Green
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada. .,SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada.
| | - John H Dennis
- SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | | | - Gurkeet Lalli
- SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | - Morenike Fadayomi
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | - Andrea Chiu
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | - Grishma Shrestha
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - David Evan Nelson
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Tamer Y El Mays
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | - Cora A Pieron
- SolAeroMed Inc, 120-4838 Richard Rd SW, Calgary, AB, T3E 6L1, Canada
| | - Richard Leigh
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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