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The Possible Role of Glucose-6-Phosphate Dehydrogenase in the SARS-CoV-2 Infection. Cells 2022; 11:cells11131982. [PMID: 35805067 PMCID: PMC9265820 DOI: 10.3390/cells11131982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/18/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) is the second rate-limiting enzyme of the pentose phosphate pathway. This enzyme is present in the cytoplasm of all mammalian cells, and its activity is essential for an adequate functioning of the antioxidant system and for the response of innate immunity. It is responsible for the production of nicotinamide adenine dinucleotide phosphate (NADPH), the first redox equivalent, in the pentose phosphate pathway. Viral infections such as SARS-CoV-2 may induce the Warburg effect with an increase in anaerobic glycolysis and production of lactate. This condition ensures the success of viral replication and production of the virion. Therefore, the activity of G6PD may be increased in COVID-19 patients raising the level of the NADPH, which is needed for the enzymatic and non-enzymatic antioxidant systems that counteract the oxidative stress caused by the cytokine storm. G6PD deficiency affects approximately 350–400 million people worldwide; therefore, it is one of the most prevalent diseases related to enzymatic deficiency worldwide. In G6PD-deficient patients exposed to SARS-CoV-2, the amount of NADPH is reduced, increasing the susceptibility for viral infection. There is loss of the redox homeostasis in them, resulting in severe pneumonia and fatal outcomes.
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La Rocca U, Giovannetti G, Maldarelli F, Farinelli M, Piazzolla M, Angeloni A, Pugliese F, Coluzzi S. Blood transfusion needs in COVID-19 patients: An observational prospective unicentric study. Transfus Med 2022; 32:343-345. [PMID: 35698763 PMCID: PMC9350398 DOI: 10.1111/tme.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/05/2022] [Accepted: 04/24/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Ursula La Rocca
- Immunohematology and Transfusion Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Department of Molecular Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluca Giovannetti
- Immunohematology and Transfusion Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Maldarelli
- Department of General Surgery, Surgical Specialities and Organ Transplantation "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mirella Farinelli
- Immunohematology and Transfusion Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mario Piazzolla
- Department of General Surgery, Surgical Specialities and Organ Transplantation "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Angeloni
- Immunohematology and Transfusion Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of General Surgery, Surgical Specialities and Organ Transplantation "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Serelina Coluzzi
- Immunohematology and Transfusion Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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3
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Hua Y, Dai X, Xu Y, Xing G, Liu H, Lu T, Chen Y, Zhang Y. Drug repositioning: Progress and challenges in drug discovery for various diseases. Eur J Med Chem 2022; 234:114239. [PMID: 35290843 PMCID: PMC8883737 DOI: 10.1016/j.ejmech.2022.114239] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 12/17/2022]
Abstract
Compared with traditional de novo drug discovery, drug repurposing has become an attractive drug discovery strategy due to its low-cost and high efficiency. Through a comprehensive analysis of the candidates that have been identified with drug repositioning potentials, it is found that although some drugs do not show obvious advantages in the original indications, they may exert more obvious effects in other diseases. In addition, some drugs have a synergistic effect to exert better clinical efficacy if used in combination. Particularly, it has been confirmed that drug repositioning has benefits and values on the current public health emergency such as the COVID-19 pandemic, which proved the great potential of drug repositioning. In this review, we systematically reviewed a series of representative drugs that have been repositioned for different diseases and illustrated successful cases in each disease. Especially, the mechanism of action for the representative drugs in new indications were explicitly explored for each disease, we hope this review can provide important insights for follow-up research.
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Affiliation(s)
- Yi Hua
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Xiaowen Dai
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Yuan Xu
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Guomeng Xing
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Haichun Liu
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Tao Lu
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Yadong Chen
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China.
| | - Yanmin Zhang
- Laboratory of Molecular Design and Drug Discovery, School of Science, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China.
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Inducible Nitric Oxide Synthase (iNOS): Why a Different Production in COVID-19 Patients of the Two Waves? Viruses 2022; 14:v14030534. [PMID: 35336941 PMCID: PMC8948744 DOI: 10.3390/v14030534] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 12/18/2022] Open
Abstract
Profound clinical differences between the first and second waves of COVID-19 were observed in Europe. Nitric oxide (NO) may positively impact patients with Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection. It is mainly generated by inducible nitric oxide synthase (iNOS). We studied serum iNOS levels together with serum interleukin (IL)-6 and IL-10 in patients with SARS-CoV-2 infection in the first wave (n = 35) and second wave (n = 153). In the first wave, serum iNOS, IL-6, IL-10 levels increased significantly, in line with the World Health Organization (WHO) score severity, while in the second wave, iNOS did not change with the severity. The patients of the second wave showed lower levels of iNOS, IL-6, and IL-10, as compared to the corresponding subgroup of the first wave, suggesting a less severe outcome of COVID-19 in these patients. However, in the severe patients of the second wave, iNOS levels were significantly lower in patients treated with steroids or azithromycin before the hospitalization, as compared to the untreated patients. This suggests an impairment of the defense mechanism against the virus and NO-based therapies as a potential therapy in patients with low iNOS levels.
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5
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Scalia G, Raia M, Gelzo M, Cacciapuoti S, De Rosa A, Pinchera B, Scotto R, Giaccone A, Mormile M, Fabbrocini G, Gentile I, Parrella R, Castaldo G. Cytometric analysis of patients with COVID-19: what is changed in the second wave? J Transl Med 2021; 19:403. [PMID: 34556132 PMCID: PMC8460184 DOI: 10.1186/s12967-021-03072-1] [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: 07/19/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic had a 1st wave in Europe from March to May 2020 and a 2nd wave since September 2020. We previously studied 35 hospitalized COVID-19 patients of the 1st wave demonstrating a cytokine storm and the exhaustion of most lymphocyte subpopulations. Herein, we describe the results obtained from COVID-19 patients of the 2nd wave. Methods We analyzed interleukin (IL)-6 by human-specific enzyme-linked immunosorbent assay and a large set of lymphocyte subpopulations by flow cytometry in 274 COVID-19 patients hospitalized from September 2020 to May 2021. Results Patients of 2nd wave compared with those of 1st wave showed lower serum IL-6 levels and a higher number of B and most T lymphocyte subpopulations in advanced stages, in relation with the age and the gender. On the other hand, we observed in 2nd wave patients: (i) a reduction of most lymphocyte subpopulations at mild and moderate stages; (ii) a reduction of natural killer cells and T regulatory cells together with a higher number of activated T helper (TH) 17 lymphocytes in all stages, which were mainly related to steroid and azithromycin therapies before hospitalization. Conclusions COVID-19 had a less severe impact in patients of the 2nd wave in advanced stages, while the impact appeared more severe in patients of mild and moderate stages, as compared with 1st wave patients. This finding suggests that in COVID-19 patients with milder expression at diagnosis, steroid and azithromycin therapies appear to worsen the immune response against the virus. Furthermore, the cytometric profile may help to drive targeted therapies by monoclonal antibodies to modulate specific IL/lymphocyte inhibition or activation in COVID-19 patients.
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Affiliation(s)
- Giulia Scalia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Maddalena Raia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di malattie infettive respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Riccardo Scotto
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Agnese Giaccone
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di malattie infettive respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy. .,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy.
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Mormile M, Fabbrocini G, Parrella R, Gentile I, Castaldo G. Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy? Front Public Health 2021; 9:664108. [PMID: 34211953 PMCID: PMC8239130 DOI: 10.3389/fpubh.2021.664108] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 may appear with a widely heterogeneous clinical expression. Thus, predictive markers of the outcome/progression are of paramount relevance. The neutrophil/lymphocyte ratio (NLR) has been suggested as a good predictive marker of disease severity and mortality. Accordingly, we found that NLR significantly increased in parallel with the WHO severity stage in COVID-19 patients during the Ist wave (March-May 2020; n = 49), due to the significant reduction of lymphocyte and the significant increase of neutrophil in severe COVID-19 patients. While, we did not observe significant differences of NLR between the WHO severity stage among COVID-19 patients of the IInd wave (September 2020-April 2021; n = 242). In these patients, the number of lymphocytes and neutrophils did not change significantly between patients of different severity subgroups. This difference likely depends on the steroids therapy that the patients of the IInd wave performed before hospitalization while most patients of the Ist wave were hospitalized soon after diagnosis. This is also confirmed by serum interleukin (IL)-6 and myeloperoxidase (MPO) that gradually increased with the disease stage in patients of the Ist wave, while such biomarkers (whose production is inhibited by steroids) did not show differences among patients of the IInd wave in different stages. Thus, the NLR could be tested at diagnosis in naïve patients before starting therapies.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
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7
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Scialo F, Vitale M, Daniele A, Nigro E, Perrotta F, Gelzo M, Iadevaia C, Cerqua FS, Costigliola A, Allocca V, Amato F, Pastore L, Castaldo G, Bianco A. SARS-CoV-2: One Year in the Pandemic. What Have We Learned, the New Vaccine Era and the Threat of SARS-CoV-2 Variants. Biomedicines 2021; 9:611. [PMID: 34072088 PMCID: PMC8226851 DOI: 10.3390/biomedicines9060611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023] Open
Abstract
Since the beginning of 2020, the new pandemic caused by SARS-CoV-2 and named coronavirus disease 19 (COVID 19) has changed our socio-economic life. In just a few months, SARS-CoV-2 was able to spread worldwide at an unprecedented speed, causing hundreds of thousands of deaths, especially among the weakest part of the population. Indeed, especially at the beginning of this pandemic, many reports highlighted how people, suffering from other pathologies, such as hypertension, cardiovascular diseases, and diabetes, are more at risk of severe outcomes if infected. Although this pandemic has put the entire academic world to the test, it has also been a year of intense research and many important contributions have advanced our understanding of SARS-CoV-2 origin, its molecular structure and its mechanism of infection. Unfortunately, despite this great effort, we are still a long way from fully understanding how SARS-CoV-2 dysregulates organismal physiology and whether the current vaccines will be able to protect us from possible future pandemics. Here, we discuss the knowledge we have gained during this year and which questions future research should address.
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Affiliation(s)
- Filippo Scialo
- Dipartimento di Scienze Mediche Traslazionali, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
| | - Maria Vitale
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Aurora Daniele
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Ersilia Nigro
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Fabio Perrotta
- U.O.C Pneumologia Azienda Ospedaliera Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Monica Gelzo
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Carlo Iadevaia
- Pneumology Vanvitelly-COVID Unit A.O. dei Colli Hospital Monaldi, 80131 Naples, Italy; (C.I.); (F.S.C.); (A.C.); (V.A.)
| | - Francesco Saverio Cerqua
- Pneumology Vanvitelly-COVID Unit A.O. dei Colli Hospital Monaldi, 80131 Naples, Italy; (C.I.); (F.S.C.); (A.C.); (V.A.)
| | - Adriano Costigliola
- Pneumology Vanvitelly-COVID Unit A.O. dei Colli Hospital Monaldi, 80131 Naples, Italy; (C.I.); (F.S.C.); (A.C.); (V.A.)
| | - Valentino Allocca
- Pneumology Vanvitelly-COVID Unit A.O. dei Colli Hospital Monaldi, 80131 Naples, Italy; (C.I.); (F.S.C.); (A.C.); (V.A.)
| | - Felice Amato
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Lucio Pastore
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Giuseppe Castaldo
- CEINGE, Biotecnologie Avanzate, 80131 Naples, Italy; (M.V.); (A.D.); (E.N.); (M.G.); (F.A.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Andrea Bianco
- Dipartimento di Scienze Mediche Traslazionali, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
- Pneumology Vanvitelly-COVID Unit A.O. dei Colli Hospital Monaldi, 80131 Naples, Italy; (C.I.); (F.S.C.); (A.C.); (V.A.)
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Offerhaus JA, Wilde AAM, Remme CA. Prophylactic (hydroxy)chloroquine in COVID-19: Potential relevance for cardiac arrhythmia risk. Heart Rhythm 2020; 17:1480-1486. [PMID: 32622993 PMCID: PMC7332460 DOI: 10.1016/j.hrthm.2020.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
(Hydroxy)chloroquine ((H)CQ) is being investigated as a treatment for COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to the hospital and hence likely already (severely) affected. Another suggested approach uses prophylactic (H)CQ treatment aimed at preventing either severe acute respiratory syndrome coronavirus 2 infection or the development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ. However, (H)CQ may lead to QT prolongation and potentially induce life-threatening arrhythmias. This may be of particular relevance to patients with preexisting cardiovascular disease and those taking other QT-prolonging drugs. In addition, it is known that a certain percentage of the population carries genetic variant(s) that reduces their repolarization reserve, predisposing them to (H)CQ-induced QT prolongation, and this may be more relevant to female patients who already have a longer QT interval to start with. This review provides an overview of the current evidence on (H)CQ therapy in patients with COVID-19 and discusses different strategies for prophylactic (H)CQ therapy (ie, preinfection, postexposure, and postinfection). In particular, the potential cardiac effects, including QT prolongation and arrhythmias, will be addressed. Based on these insights, recommendations will be presented as to which preventive measures should be taken when giving (H)CQ prophylactically, including electrocardiographic monitoring.
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Affiliation(s)
- Joost A Offerhaus
- Amsterdam UMC, location AMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Amsterdam UMC, location AMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; https://guardheart.ern-net.eu); European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA)
| | - Carol Ann Remme
- Amsterdam UMC, location AMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA).
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9
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Infante M, Ricordi C, Alejandro R, Caprio M, Fabbri A. Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection. Expert Rev Anti Infect Ther 2020; 19:5-16. [PMID: 32693652 PMCID: PMC7441799 DOI: 10.1080/14787210.2020.1799785] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Over the last few months, coronavirus disease 2019 (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has posed a serious threat to public health on a global scale. Given the current lack of an effective vaccine, several drugs have been repurposed for treatment and prophylaxis of COVID-19 in an attempt to find an effective cure. Areas covered The antimalarial drug hydroxychloroquine (HCQ) initially garnered widespread attention following the publication of preliminary results showing that this drug exerts an anti-SARS-CoV-2 activity in vitro. Expert opinion To date, clinical evidence suggests lack of benefit from HCQ use for the treatment of hospitalized patients with COVID-19. In such patients, HCQ also appears to be associated with an increased risk of QT interval prolongation and potentially lethal ventricular arrhythmias. Therefore, FDA has recently revoked the Emergency Use Authorization (EUA) for emergency use of HCQ and chloroquine to treat COVID-19. Conversely, whether HCQ use may represent an effective prophylactic strategy against COVID-19 is a separate question that still remains to be answered. In addition, relevant aspects regarding the potential risks and benefits of HCQ need to be clarified, in pursuit of a rational use of this drug in the COVID-19 pandemic era.
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Affiliation(s)
- Marco Infante
- Division of Endocrinology, CTO Andrea Alesini Hospital, ASL Roma 2, Department of Systems Medicine, University of Rome "Tor Vergata" , Rome, Italy.,UniCamillus, Saint Camillus International University of Health Sciences , Rome, Italy.,Diabetes Research Institute Federation (DRIF), Department of Systems Medicine, University of Rome "Tor Vergata" , Rome, Italy.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN) , Rome, Italy.,Diabetes Research Institute (DRI), University of Miami Miller School of Medicine , Miami, FL, USA
| | - Camillo Ricordi
- Diabetes Research Institute (DRI), University of Miami Miller School of Medicine , Miami, FL, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute (DRI), University of Miami Miller School of Medicine , Miami, FL, USA
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana , Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University , Rome, Italy
| | - Andrea Fabbri
- Division of Endocrinology, CTO Andrea Alesini Hospital, ASL Roma 2, Department of Systems Medicine, University of Rome "Tor Vergata" , Rome, Italy.,Diabetes Research Institute Federation (DRIF), Department of Systems Medicine, University of Rome "Tor Vergata" , Rome, Italy
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