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Singh M, Pushpakumar S, Zheng Y, Smolenkova I, Akinterinwa OE, Luulay B, Tyagi SC. Novel mechanism of the COVID-19 associated coagulopathy (CAC) and vascular thromboembolism. NPJ VIRUSES 2023; 1:3. [PMID: 38077924 PMCID: PMC10710223 DOI: 10.1038/s44298-023-00003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/20/2023] [Indexed: 01/31/2024]
Abstract
Previous studies from our laboratory revealed that SARS-CoV-2 spike protein (SP) administration to a genetically engineered model expressing the human angiotensin-converting enzyme 2; ACE2 receptor (i.e., hACE2 humanized mouse) mimicked the coronavirus disease-19 (COVID-19) pathology. In humans the cause of high morbidity, and mortality is due to 'cytokine-storm' led thromboembolism; however, the exact mechanisms of COVID-19 associated coagulopathy (CAC) have yet to be discovered. Current knowledge suggests that CAC is distinct from the standard coagulopathy, in that the intrinsic and extrinsic thrombin-dependent coagulation factors, and the pathway(s) that are common to coagulopathy, are not recruited by SARS-CoV-2. Findings from patients revealed that there is little change in their partial thromboplastin, or the prothrombin time coupled with a significant decline in platelets. Further, there appears to be an endothelial dysfunction during COVID-19 suggesting an interaction of the endothelia with immune cells including neutrophils. There are also reports that inflammatory NGAL is elevated during COVID-19. Furthermore, the levels of NPT are also increased indicating an increase in inflammatory M1 macrophage iNOS which sequesters BH4; an essential enzyme co-factor that acts as a potent antioxidant thus causing damage to endothelia. SARS-CoV-2 entry into the host cells is facilitated by a co-operative action between TMPRSS2 and the main ACE2 receptor. Interestingly, after infection ADAMTS13; a von Willebrand factor; VWF cleaving enzyme is found to be decreased. Based on these facts, we hypothesize that vascular thromboembolism is associated with serine and metalloproteinase, and in that context, we opine that inhibition of iNOS might help mitigate COVID-19 harmful effects. To test this hypothesis, we administered SP to the hACE2 mice that were subsequently treated with amino guanidine (AG; a potent inhibitor of glycoxidation, lipoxidation and oxidative vicious cycles). Our results revealed increase in TMPRSS2, and NGAL by SP but treatment with AG mitigated their levels. Similarly, levels of MMP-2, and -9 were increased; however, AG treatment normalized these levels. Our findings suggest that occurrence of CAC is influenced by TMPRSS2, ADAMTS13, NGAL and MMP- 2, and -9 factors, and an intervention with iNOS blocker helped mitigate the CAC condition in experimental settings.
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Affiliation(s)
- Mahavir Singh
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- These authors contributed equally: Mahavir Singh, Sathnur Pushpakumar
| | - Sathnur Pushpakumar
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- These authors contributed equally: Mahavir Singh, Sathnur Pushpakumar
| | - Yuting Zheng
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Irina Smolenkova
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Oluwaseun E. Akinterinwa
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Bana Luulay
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Suresh C. Tyagi
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Bao Q, Li R, Wang C, Wang S, Cheng M, Pu C, Zou L, Liu C, Zhang Q, Wang Q. Differences in door-to-balloon time and outcomes in SARS-CoV-2-positive ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35612. [PMID: 37832042 PMCID: PMC10578758 DOI: 10.1097/md.0000000000035612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 infection has significantly impacted the world and placed a heavy strain on the medical system and the public, especially those with cardiovascular diseases. Hoverer, the differences in door-to-balloon time and outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not known too much. METHODS Web of Science, EMBASE, PubMed, Cochrane Library, Wanfang, VIP, and China's National Knowledge Infrastructure were utilized to perform a systematic literature search until April 30, 2023. We computed the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) to determine the correlation. A random-effects model was used for the meta-analysis if the study had significant heterogeneity. Meanwhile, sensitivity analysis and Trial sequential analysis were also accomplished using Rveman5.4 and trial sequential analysis 0.9.5.10 Beta software, respectively. RESULTS A total of 5 eligible studies were explored in our meta-analysis, including 307 cases and 1804 controls. By meta-analysis, the pooled data showed that SARS-CoV-2-positive STEMI patients undergoing percutaneous coronary intervention had a longer door-to-balloon time (OR 6.31, 95% CI 0.99, 11.63, P = .02) than the negative subjects. The glycoprotein IIb/IIIa inhibitor use after SARS-CoV-2 infection (OR 2.71, 95% CI 1.53, 4.81, P = .0006) was relatively frequent compared with controls, and the postoperative Thrombolysis in Myocardial Infarction blood flow (OR 0.48, 95% CI 0.34, 0.67, P < .0001) was worse compared that. The in-hospital mortality (OR 5.16, 95% CI 3.53, 7.53, P < .00001) was higher than non-SARS-CoV-2 infection ones. In addition, we also discovered that age, gender (male), hypertension, diabetes mellitus, hyperlipidemia, smoking, previous myocardial infarction, total ischemia time, and thrombus aspiration use did not have a significant association with the development of STEMI patients with SARS-CoV-2. CONCLUSION SARS-CoV-2 positivity is significantly associated with longer door-to-balloon time and higher in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- Qinxue Bao
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Rui Li
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chengfeng Wang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Shan Wang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Minli Cheng
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chunhua Pu
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Lei Zou
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chao Liu
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Qine Zhang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Qun Wang
- Department of Medical Laboratory, Dayi County People’s Hospital, Chengdu, Sichuan, China
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Matsuzaka Y, Yashiro R. Extracellular Vesicle-Based SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:vaccines11030539. [PMID: 36992123 DOI: 10.3390/vaccines11030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Messenger ribonucleic acid (RNA) vaccines are mainly used as SARS-CoV-2 vaccines. Despite several issues concerning storage, stability, effective period, and side effects, viral vector vaccines are widely used for the prevention and treatment of various diseases. Recently, viral vector-encapsulated extracellular vesicles (EVs) have been suggested as useful tools, owing to their safety and ability to escape from neutral antibodies. Herein, we summarize the possible cellular mechanisms underlying EV-based SARS-CoV-2 vaccines.
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Affiliation(s)
- Yasunari Matsuzaka
- Division of Molecular and Medical Genetics, The Institute of Medical Science, Center for Gene and Cell Therapy, University of Tokyo, Minato-ku, Tokyo 108-8639, Japan
- Administrative Section of Radiation Protection, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Ryu Yashiro
- Administrative Section of Radiation Protection, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
- Department of Infectious Diseases, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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Blau K, Lehr S, Aschoff R, Al Gburi S, Brück N, Chapsa M, Schnabel A, Abraham S, Jöhrens K, Beissert S, Günther C. Course and outcome of chilblain-like acral lesions during COVID-19 pandemic. J Eur Acad Dermatol Venereol 2022; 37:e29-e31. [PMID: 36149533 PMCID: PMC9538847 DOI: 10.1111/jdv.18582] [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: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Kristin Blau
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany,Institut of Pathology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Sophia Lehr
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Roland Aschoff
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Suzan Al Gburi
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Normi Brück
- Department of Pediatrics, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Maria Chapsa
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Anja Schnabel
- Department of Pediatrics, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Susanne Abraham
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Korinna Jöhrens
- Institut of Pathology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Stefan Beissert
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Claudia Günther
- Department of Dermatology, University Hospital, Carl Gustav CarusTechnical University DresdenDresdenGermany
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Aghajani Shahrivar A, Khakpourian Z, Majdi F, Sobhani S, Coleman-Fuller N, Gholami M, Motaghinejad M. Hypothesized neuroprotective effect of minocycline against COVID-19-induced stroke and neurological dysfunction: possible role of matrix metalloprotease signaling pathway. Biologia (Bratisl) 2022; 77:3027-3035. [PMID: 35966933 PMCID: PMC9360701 DOI: 10.1007/s11756-022-01162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (COVID-19) is a respiratory disease that causes dysfunction in respiration. Since late 2019, this virus has infected and killed millions of people around the world and imposed many medical and therapeutic problems in the form of a pandemic. According to recent data, COVID-19 disease can increase the risk of stroke, which can be deadly or cause many neurological disorders after the disease. During the last two years, many efforts have been made to introduce new therapies for management of COVID-19-related complications, including stroke. To achieve this goal, several conventional drugs have been investigated for their possible therapeutic roles. Minocycline, a broad-spectrum, long-acting antibiotic with anti-inflammatory and antioxidant properties, is one such conventional drug that should be considered for treating COVID-19-related stroke, as indirect evidence indicates that it exerts neuroprotective effects, can modulate stroke occurrence, and can play an effective and strategic role in management of the molecular signals caused by stroke and its destructive consequences. The matrix metalloprotease (MMP) signaling pathway is one of the main signaling pathways involved in the occurrence and exacerbation of stroke; however, its role in COVID-19-induced stroke and the possible role of minocycline in the management of this signaling pathway in patients with COVID-19 is unclear and requires further investigation. Based on this concept, we hypothesize that minocycline might act via MMP signaling as a neuroprotective agent against COVID-19-induced neurological dysfunction, particularly stroke.
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Affiliation(s)
- Ali Aghajani Shahrivar
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Khakpourian
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Majdi
- Department of Pharmaceutical Biomaterials, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Sobhani
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Natalie Coleman-Fuller
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN 55108 USA
| | - Mina Gholami
- College of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Motaghinejad
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Salabei JK, Asnake ZT, Ismail ZH, Charles K, Stanger GT, Abdullahi AH, Abraham AT, Okonoboh P. COVID-19 and the Cardiovascular System: An Update. Am J Med Sci 2022; 364:139-147. [PMID: 35151635 PMCID: PMC8830924 DOI: 10.1016/j.amjms.2022.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 12/20/2022]
Abstract
As COVID-19 continues to cause an increasing number of deaths worldwide, it is important that providers stay abreast with new research related to the pathophysiology of COVID-19 disease presentation states and clinical management. It is now well recognized that COVID-19 affects extrapulmonary organs, particularly the cardiovascular system. For example, cardiogenic shock has been increasingly observed in patients with COVID-19, owing to the various mechanisms involved and the affinity of the SARS-CoV-2 virus to cells comprising the cardiovascular system. In this review, we have briefly discussed the link between the cardiovascular system and COVID-19 infection, focusing on underlying mechanisms including but not limited to cytokine storm, direct virus-induced myocarditis, and ST-elevation myocardial infarction leading to cardiogenic shock. We have highlighted the cardiovascular risk factors associated with disease prognostication in COVID-19 patients. We have also briefly discussed vasopressors and inotropes used for treating shock and presented their mechanism of action, contraindications, and side effects in the hopes of providing a quick reference to help the provider optimize management of COVID-19 patients presenting with cardiovascular complications such as shock.
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Affiliation(s)
- Joshua K Salabei
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA.
| | - Zekarias T Asnake
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Zeeshan H Ismail
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Kipson Charles
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Gregory-Thomas Stanger
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Abdullahi H Abdullahi
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Andrew T Abraham
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
| | - Peters Okonoboh
- Department of Internal Medicine, University of Central Florida School of Medicine/North Florida Regional Medical Center, Gainesville, USA
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