INDUCERS OF THE REGULATORY FACTOR TO HYPOXIA ADAPTATION

Role of Hypoxia-Inducible Factor 1α in Adaptation to Hypoxia in the Pathogenesis of Novel Coronavirus Disease 2019

INTRODUCTION: A novel coronavirus (severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2)) emerged in December 2019 and rapidly spread over the world having provoked a pandemic of respiratory disease. This highly pathogenic virus can attack the lung tissue and derange gas exchange leading to acute respiratory distress syndrome and systemic hypoxia. Hypoxic conditions trigger activation of adaptation mechanisms including hypoxia-inducible factor-1á (HIF-1á) which is involved in the regulation of the key processes, e. g, proliferation and metabolism of cells and angiogenesis. Besides, the level of HIF-1á expression is associated with the intensity of the immune response of an organism including that of the innate immunity mediating inflammatory reaction. Therefore, understanding the peculiarities of the mechanisms underlying the pathogenesis of this disease is of great importance for effective therapy of coronavirus disease 2019 (COVID-19). AIM: Analysis of the current data on HIF-1á and its effect on the pathogenesis and progression of COVID-19. The analysis of the relevant domestic and international literature sources was performed in the following sections: HIF-1á as a key factor of adaptation to hypoxia, targets for HIF-1á in the aspect of the pathogenesis of COVID-19, disorders in HIF-1á-mediated adaptation to hypoxia as an element of the pathogenesis of hyperactivation of the immune cells. CONCLUSION: HIF-1á prevents penetration of SARS-CoV-2 virus into a cell and primarily acts as the main regulator of the proinflammatory activity at the inflammation site surrounded by hypoxia. In the conditions of the deranged metabolic flexibility, a high level of HIF-1á evokes an excessive inflammatory response of the immune cells. A high HIF-1á level in cells of the inflammation focus is associated with enhanced production of the factors of angiogenesis mediating vascular permeability and capillary leakage process. This is accompanied by tissue damage and organ failure. At the same time, HIF-1á can mediate the anti-inflammatory effect through activation of adenosine receptor-dependent pathway, which is considered as a probable protection of cells and organs against damage by hyperactive immune cells.

[The experience of using the drug Reamberin and NPWT-therapy in preparing wounds for autodermoplasty]

OBJECTIVE

To evaluate the effectiveness of preparing a wound for plastic closure of autoskin using a negative pressure apparatus and Reamberin.

MATERIAL AND METHODS

. The results of preoperative preparation of 24 patients with chronic wounds of various etiologies were analyzed. Depending on the treatment regimen, the patients were divided into groups: the main one (n=18), the patients of which were divided into subgroups: in IA (n=9) they used NPWT therapy for 5 days, in IB (n=9) it was combined with Reamberin infusions (1.5% intravenously at a rate of 40-60 drops/min, 500 ml, once a day for 5 days). Patients of the comparison group (II, n=6) received standard preparation. In the dynamics of therapy, a morpho-histological study of wound biopsies was carried out with the determination of the area of fibroblasts, the area of the nucleus of fibroblasts, the number of vessels and the determination of their diameter. After autodermoplasty, the survival of the skin flap was determined.

RESULTS

It was found that the combined use of NPWT therapy and Reamberin significantly increases the effectiveness of therapy: the greatest effect on fibroblastogenesis was exerted by the inclusion of NPWT therapy in the regimen - an increase of 1.5 times compared with the results of the traditional regimen. The vascularization of the wound surface (increase in the area and diameter of blood vessels) was best influenced by the combined preparation (NPWT-therapy and Reamberin) preparations - an increase of 3.4 times in comparison with the comparison group, which affected the dynamics of the survival of the skin flap: it was 1.3 times higher than in the comparison group (p<0.01).

CONCLUSIONS

The results obtained, along with good tolerability of the drug, allows us to recommend the inclusion of Reamberin in the scheme of preoperative preparation of patients with this pathology.