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Pineda E, Singh J, Pineda MV, Umanzor JG, Baires F, Benitez LG, Burgos C, Sekhon AK, Crisp N, Lewis AS, Radwanski J, Bermudez M, Barjun KS, Diaz O, Palou E, Escalante RE, Hernandez CI, Stevens ML, Eberhard D, Sierra M, Alvarado T, Videa O, Sierra-Hoffman M, Valerio-Pascua F. Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study. Front Pharmacol 2022; 13:1054644. [PMID: 36532727 PMCID: PMC9748291 DOI: 10.3389/fphar.2022.1054644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 09/06/2023] Open
Abstract
Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.
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Affiliation(s)
- Estela Pineda
- Department of Internal Medicine Hospital CEMESA, San Pedro Sula, Honduras
| | - Jarmanjeet Singh
- Department of Cardiovascular Medicine, University of California, Riverside, Riverside, CA, United States
| | - Miguel Vargas Pineda
- Department of Internal Medicine Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Jose Garay Umanzor
- Department of Obstetrics and Gynecology Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Fernando Baires
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luis G. Benitez
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Cesar Burgos
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Nicole Crisp
- Wound Care Department El Campo Memorial Hospital, El Campo, TX, United States
| | - Anita S. Lewis
- Pharmacy Department El Campo Memorial Hospital, El Campo, TX, United States
| | - Jana Radwanski
- Pharmacy Department Citizens Hospital, Victoria, TX, United States
| | - Marco Bermudez
- Department of Medicine SBH Health System, Bronx, NY, United States
| | - Karen Sanchez Barjun
- Department of Internal Medicine Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Oscar Diaz
- Department of Critical Care Hospital Regional del Norte Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Elsa Palou
- Internal Medicine Department, Facultad de Ciencas Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Rossany E. Escalante
- Department of Medicine, Facultad de Ciencas Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Mark L. Stevens
- Research Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
| | - Deke Eberhard
- Research Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
| | - Manuel Sierra
- Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras
| | - Tito Alvarado
- Infectiology Department, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Omar Videa
- Clínica de Atención Medica Integral CAMI, Tegucigalpa, Honduras
| | - Miguel Sierra-Hoffman
- Research and Infectious Disease Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
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Yudhawati R, Sakina S, Fitriah M. Interleukin-1β and Interleukin-10 Profiles and Ratio in Serum of COVID-19 Patients and Correlation with COVID-19 Severity: A Time Series Study. Int J Gen Med 2022; 15:8043-8054. [PMID: 36389025 PMCID: PMC9645129 DOI: 10.2147/ijgm.s381404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/18/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) can, in severe cases, lead to cytokine-release syndrome owing to an excessive immune response. The release of different cytokines aggravates disease severity. IL-1β is a pro-inflammatory cytokine, while IL-10 is an anti-inflammatory cytokine, and both are involved in the human immune response to infection. This study aimed to determine whether serum levels of IL-1β and IL-10 and the ratio of the two over time in patients with COVID-19 could facilitate early identification of disease severity. METHODS An analytical, observational time-series design was employed. Fifty participants were enrolled between May and October 2020 and were divided into two groups-non-severe (n = 20), and severe (n = 30). IL-1β and IL-10 were analyzed using BD cytometric bead array sets. Association of the IL-1β:IL-10 ratio with COVID-19 severity was analyzed using a Mann-Whitney test and Fisher's exact test. Optimal cut-off values to predict disease severity were determined by Youden's index. RESULTS In non-severe and severe groups, the median serum levels of IL-1β decreased on day 3 (1.72 ng/mL and 2.10 ng/mL, respectively), then increased on day 6 (2.05 ng/mL and 3.31 ng/mL, respectively). However, the median of IL-10 increased on day 3 (1.88 ng/mL and 2.30 ng/mL, respectively) and day 6 (2.02 ng/mL and 2.39 ng/mL, respectively). There was no significant association between the IL-1β:IL-10 ratio and COVID-19 severity at any time-point (p>0.05). The cutoff value of serum IL-10 between the two groups on days 0, 3, and 6 was 1.09 pg/mL (sensitivity: 66.6%; PPV: 71.4%), 2.11 pg/mL (sensitivity: 67.7%; PPV: 50.0%), and 2.08 pg/mL (sensitivity: 78.6%; PPV: 70.9%), respectively. CONCLUSION The IL-1β:IL-10 ratio was not correlated to COVID-19 severity. However, owing to its high sensitivity, IL-10 may be a potential biomarker for disease severity in severe COVID-19.
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Affiliation(s)
- Resti Yudhawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Sakina Sakina
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Munawaroh Fitriah
- Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
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Asrani P, Tiwari K, Eapen MS, McAlinden KD, Haug G, Johansen MD, Hansbro PM, Flanagan KL, Hassan MI, Sohal SS. Clinical features and mechanistic insights into drug repurposing for combating COVID-19. Int J Biochem Cell Biol 2022; 142:106114. [PMID: 34748991 PMCID: PMC8570392 DOI: 10.1016/j.biocel.2021.106114] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from Wuhan in China before it spread to the entire globe. It causes coronavirus disease of 2019 (COVID-19) where mostly individuals present mild symptoms, some remain asymptomatic and some show severe lung inflammation and pneumonia in the host through the induction of a marked inflammatory 'cytokine storm'. New and efficacious vaccines have been developed and put into clinical practice in record time, however, there is a still a need for effective treatments for those who are not vaccinated or remain susceptible to emerging SARS-CoV-2 variant strains. Despite this, effective therapeutic interventions against COVID-19 remain elusive. Here, we have reviewed potential drugs for COVID-19 classified on the basis of their mode of action. The mechanisms of action of each are discussed in detail to highlight the therapeutic targets that may help in reducing the global pandemic. The review was done up to July 2021 and the data was assessed through the official websites of WHO and CDC for collecting the information on the clinical trials. Moreover, the recent research papers were also assessed for the relevant data. The search was mainly based on keywords like Coronavirus, SARS-CoV-2, drugs (specific name of the drugs), COVID-19, clinical efficiency, safety profile, side-effects etc.This review outlines potential areas for future research into COVID-19 treatment strategies.
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Affiliation(s)
- Purva Asrani
- Department of Microbiology, University of Delhi, South Campus, New Delhi, India
| | - Keshav Tiwari
- ICAR - National Institute for Plant Biotechnology, New Delhi, India
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Kielan Darcy McAlinden
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Greg Haug
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia; Department of Respiratory Medicine, Launceston General Hospital, Launceston 7250, Australia
| | - Matt D Johansen
- Centre for Inflammation, Centenary Institute, Sydney, NSW 2050, Australia; University of Technology Sydney, Faculty of Science, School of Life Sciences, Ultimo, NSW 2007, Australia
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute, Sydney, NSW 2050, Australia; University of Technology Sydney, Faculty of Science, School of Life Sciences, Ultimo, NSW 2007, Australia
| | - Katie L Flanagan
- Clinical School, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7250, Australia; School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia; Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia; Tasmania Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania 7250, Australia
| | - Md Imtaiyaz Hassan
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, India
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia.
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Negi N, Maurya SP, Singh R, Das BK. An update on host immunity correlates and prospects of re-infection in COVID-19. Int Rev Immunol 2021; 41:367-392. [PMID: 34961403 PMCID: PMC8787841 DOI: 10.1080/08830185.2021.2019727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023]
Abstract
Reinfection with SARS-CoV-2 is not frequent yet the incidence rate of it is increasing globally owing to the slow emergence of drift variants that pose a perpetual threat to vaccination strategies and have a greater propensity for disease reoccurrence. Long-term protection against SARS-CoV-2 reinfection relies on the induction of the innate as well as the adaptive immune response endowed with immune memory. However, a multitude of factors including the selection pressure, the waning immunity against SARS-CoV-2 over the first year after infection possibly favors evolution of more infectious immune escape variants, amplifying the risk of reinfection. Additionally, the correlates of immune protection, the novel SARS-CoV-2 variants of concern (VOC), the durability of the adaptive and mucosal immunity remain major challenges for the development of therapeutic and prophylactic interventions. Interestingly, a recent body of evidence indicated that the gastrointestinal (GI) tract is another important target organ for SARS-CoV-2 besides the respiratory system, potentially increasing the likelihood of reinfection by impacting the microbiome and the immune response via the gut-lung axis. In this review, we summarized the latest development in SARS-CoV-2 reinfection, and explored the untapped potential of trained immunity. We also highlighted the immune memory kinetics of the humoral and cell-mediated immune response, genetic drift of the emerging viral variants, and discussed the current challenges in vaccine development. Understanding the dynamics and the quality of immune response by unlocking the power of the innate, humoral and cell-mediated immunity during SARS-CoV-2 reinfection would open newer avenues for drug discovery and vaccine designs.
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Affiliation(s)
- Neema Negi
- Department of Chemical Sciences, University of Limerick, Limerick, Ireland
- Bernal Institute, University of Limerick,Limerick, Ireland
| | - Shesh Prakash Maurya
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravinder Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Cloer C, Roudsari L, Rochelle L, Petrie T, Welch M, Charest J, Tan K, Fugang L, Petersen T, Ilagan R, Hogan S. Mesenchymal stromal cell-derived extracellular vesicles reduce lung inflammation and damage in nonclinical acute lung injury: Implications for COVID-19. PLoS One 2021; 16:e0259732. [PMID: 34780505 PMCID: PMC8592477 DOI: 10.1371/journal.pone.0259732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022] Open
Abstract
Mesenchymal stem cell derived extracellular vesicles (MSC-EVs) are bioactive particles that evoke beneficial responses in recipient cells. We identified a role for MSC-EV in immune modulation and cellular salvage in a model of SARS-CoV-2 induced acute lung injury (ALI) using pulmonary epithelial cells and exposure to cytokines or the SARS-CoV-2 receptor binding domain (RBD). Whereas RBD or cytokine exposure caused a pro-inflammatory cellular environment and injurious signaling, impairing alveolar-capillary barrier function, and inducing cell death, MSC-EVs reduced inflammation and reestablished target cell health. Importantly, MSC-EV treatment increased active ACE2 surface protein compared to RBD injury, identifying a previously unknown role for MSC-EV treatment in COVID-19 signaling and pathogenesis. The beneficial effect of MSC-EV treatment was confirmed in an LPS-induced rat model of ALI wherein MSC-EVs reduced pro-inflammatory cytokine secretion and respiratory dysfunction associated with disease. MSC-EV administration was dose-responsive, demonstrating a large effective dose range for clinical translation. These data provide direct evidence of an MSC-EV-mediated improvement in ALI and contribute new insights into the therapeutic potential of MSC-EVs in COVID-19 or similar pathologies of respiratory distress.
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Affiliation(s)
- Caryn Cloer
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
| | - Laila Roudsari
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
| | - Lauren Rochelle
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
| | - Timothy Petrie
- Draper, Cambridge, Massachusetts, United States of America
| | - Michaela Welch
- Draper, Cambridge, Massachusetts, United States of America
| | - Joseph Charest
- Draper, Cambridge, Massachusetts, United States of America
| | - Kelly Tan
- Draper, Cambridge, Massachusetts, United States of America
| | | | - Thomas Petersen
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
| | - Roger Ilagan
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
| | - Sarah Hogan
- Department of Regenerative Medicine, United Therapeutics Corporation, Durham, North Carolina, United States of America
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6
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Das A, Rana S. The role of human C5a as a non-genomic target in corticosteroid therapy for management of severe COVID19. Comput Biol Chem 2021; 92:107482. [PMID: 33845430 PMCID: PMC8020607 DOI: 10.1016/j.compbiolchem.2021.107482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 01/08/2023]
Abstract
Complement system plays a dual role; physiological as well as pathophysiological. While physiological role protects the host, pathophysiological role can substantially harm the host, by triggering several hyper-inflammatory pathways, referred as "hypercytokinaemia". Emerging clinical evidence suggests that exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), tricks the complement to aberrantly activate the "hypercytokinaemia" loop, which significantly contributes to the severity of the COVID19. The pathophysiological response of the complement is usually amplified by the over production of potent chemoattractants and inflammatory modulators, like C3a and C5a. Therefore, it is logical that neutralizing the harmful effects of the inflammatory modulators of the complement system can be beneficial for the management of COVID19. While the hunt for safe and efficacious vaccines were underway, polypharmacology based combination therapies were fairly successful in reducing both the morbidity and mortality of COVID19 across the globe. Repurposing of small molecule drugs as "neutraligands" of C5a appears to be an alternative for modulating the hyper-inflammatory signals, triggered by the C5a-C5aR signaling axes. Thus, in the current study, few specific and non-specific immunomodulators (azithromycin, colchicine, famotidine, fluvoxamine, dexamethasone and prednisone) generally prescribed for prophylactic usage for management of COVID19 were subjected to computational and biophysical studies to probe whether any of the above drugs can act as "neutraligands", by selectively binding to C5a over C3a. The data presented in this study indicates that corticosteroids, like prednisone can have potentially better selectively (Kd ∼ 0.38 μM) toward C5a than C3a, suggesting the positive modulatory role of C5a in the general success of the corticosteroid therapy in moderate to severe COVID19.
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Affiliation(s)
- Aurosikha Das
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, 752050, India
| | - Soumendra Rana
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, 752050, India.
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Sivalokanathan S, Foley M, Cole G, Youngstein T. Gastroenteritis and cardiogenic shock in a healthcare worker: a case report of COVID-19 myocarditis confirmed with serology. Eur Heart J Case Rep 2021; 5:ytab013. [PMID: 34104859 PMCID: PMC8108617 DOI: 10.1093/ehjcr/ytab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/28/2020] [Accepted: 12/28/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) myocarditis is emerging as a component of the hyperactive inflammatory response secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Isolated gastrointestinal symptoms are uncommon presenting features in adults with COVID-19 myocarditis. The availability of antibody testing is a valuable addition to the confirmation of COVID-19, when repeated reverse transcriptase-polymerase chain reaction of nasopharyngeal swabs are negative. CASE SUMMARY A young healthcare worker presented with dizziness and pre-syncope, 4 weeks after his original symptoms that included fever, lethargy, and diarrhoea. Despite 2 weeks of isolation, followed by a quiescent spell, his symptoms had returned. Shortly after, he presented in cardiogenic shock (left ventricular ejection fraction 25%), that required vasopressor support, at the height of the COVID-19 pandemic. Cardiac magnetic resonance imaging suggested florid myocarditis. Three nasopharyngeal swabs (Days 1, 3, and 5) were negative for SARS-CoV-2, but subsequent serology (Day 13) confirmed the presence of SARS-CoV-2 IgG. Treatment with intravenous immunoglobulin and glucocorticoids led to full recovery. DISCUSSION Our case study highlights the significance of the use of the available serological assays for diagnosis of patients presenting late with SARS-CoV-2. Importantly, it supports further research in the use of immunomodulatory drugs for the hyperinflammatory microenvironment induced by COVID-19.
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Affiliation(s)
- Sanjay Sivalokanathan
- Cardiovascular Clinical Academic Group, St George's, University of London and
St George’s University Hospitals NHS Foundation Trust, Cranmer
Terrace, Tooting, London SW17 0RE, UK
| | - Michael Foley
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS
Trust, London, W12 0HS, UK
| | - Graham Cole
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS
Trust, London, W12 0HS, UK
| | - Taryn Youngstein
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS
Trust, London, W12 0HS, UK
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8
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Asrani P, Hassan MI. SARS-CoV-2 mediated lung inflammatory responses in host: targeting the cytokine storm for therapeutic interventions. Mol Cell Biochem 2021; 476:675-687. [PMID: 33064288 PMCID: PMC7563911 DOI: 10.1007/s11010-020-03935-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
The recent exposure of novel coronavirus strain, severe acute respiratory syndrome (SARS-CoV-2) has spread to different countries at an alarming rate. Faster transmission rate and genetic modifications have provoked scientists to search for an immediate solution. With an increasing death rate, it becomes important to throw some light on the life cycle of the virus and its associated pathogenesis in the form of lung inflammation through cytokine storm (CS) production. This paper highlights the different stages of viral-mediated inflammatory responses in the host respiratory system. Previously, known anti-inflammatory drugs and therapeutic strategies that might show potential in controlling the CS of Coronavirus disease-2019 (COVID-19) is also mentioned in this study. Our critical analysis provides insights into the inflammation cycle induced in the lungs by early virus replication, downregulation and shedding of angiotensin-converting enzyme 2 (ACE2), and in the CS production. Identification of suitable targets within the inflammatory pathways for devising the therapeutic strategies useful in controlling the prognosis of COVID-19 finds a special mention in this article. However, antibody-dependent enhancement is the key aspect to consider before testing any drug/compound for therapeutic purposes. Our in-depth analysis would provide similarities and differences between the inflammatory responses induced by SARS-CoV and SARS-CoV-2, providing an excellent avenue to further look at how earlier outbreaks of coronaviruses were controlled and where new steps are required?
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Affiliation(s)
- Purva Asrani
- Division of Biochemistry, Indian Agricultural Research Institute, New Delhi, 110012, India
| | - Md Imtaiyaz Hassan
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India.
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9
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Lee C, Choi WJ. Overview of COVID-19 inflammatory pathogenesis from the therapeutic perspective. Arch Pharm Res 2021; 44:99-116. [PMID: 33398692 PMCID: PMC7781412 DOI: 10.1007/s12272-020-01301-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
The novel beta coronavirus (SARS-CoV-2, designated as COVID-19) that is responsible for severe acute respiratory syndrome has devastated the global economy and health care system. Since COVID-19 changed the definition of “normal” in ordinary life around the world, the development of effective therapeutics and preventive measures is desperately needed to fight SARS-CoV-2 infection and restore normalcy. A clear understanding of COVID-19 pathogenesis is crucial in providing the scientific rationale necessary to develop anti-COVID19 drugs and vaccines. According to the most recently published literature, COVID-19 pathogenesis was postulated to occur in three sequential phases: pulmonary, proinflammatory, and prothrombic. Herein, virus-host interactions, potential pathogenic mechanisms, and clinical manifestations are described for each phase. Additionally, based on this pathogenesis model, various therapeutic strategies involving current clinical trials are presented with an explanation of their modes of action and example drugs. This review is a thorough, updated summary of COVID-19 pathogenesis and the therapeutic options available for this disease.
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Affiliation(s)
- Choongho Lee
- College of Pharmacy, Dongguk University, Goyang, 10326, Republic of Korea.
| | - Won Jun Choi
- College of Pharmacy, Dongguk University, Goyang, 10326, Republic of Korea
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10
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Marik PE, Iglesias J, Varon J, Kory P. A scoping review of the pathophysiology of COVID-19. Int J Immunopathol Pharmacol 2021; 35:20587384211048026. [PMID: 34569339 PMCID: PMC8477699 DOI: 10.1177/20587384211048026] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a highly heterogeneous and complex medical disorder; indeed, severe COVID-19 is probably amongst the most complex of medical conditions known to medical science. While enormous strides have been made in understanding the molecular pathways involved in patients infected with coronaviruses an overarching and comprehensive understanding of the pathogenesis of COVID-19 is lacking. Such an understanding is essential in the formulation of effective prophylactic and treatment strategies. Based on clinical, proteomic, and genomic studies as well as autopsy data severe COVID-19 disease can be considered to be the connection of three basic pathologic processes, namely a pulmonary macrophage activation syndrome with uncontrolled inflammation, a complement-mediated endothelialitis together with a procoagulant state with a thrombotic microangiopathy. In addition, platelet activation with the release of serotonin and the activation and degranulation of mast cells contributes to the hyper-inflammatory state. Auto-antibodies have been demonstrated in a large number of hospitalized patients which adds to the end-organ damage and pro-thrombotic state. This paper provides a clinical overview of the major pathogenetic mechanism leading to severe COVID-19 disease.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Front Line Covid-19 Critical Care Alliance
| | - Jose Iglesias
- Department of Nephrology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
- Front Line Covid-19 Critical Care Alliance
| | - Joseph Varon
- Department of Critical Care Medicine, United Memorial Medical Center, Houston, TX, USA
- Front Line Covid-19 Critical Care Alliance
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Tandon S, Aggarwal A, Jain S, Shukla S, Chaudhary S. Perspective on the Role of Antibodies and Potential Therapeutic Drugs to Combat COVID-19. Protein J 2020; 39:631-643. [PMID: 33034824 PMCID: PMC7544555 DOI: 10.1007/s10930-020-09921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
The sudden emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease of 2019 (COVID-19) has brought the world to a standstill. Thousands of people across the globe are biting the dust with every passing day and yet more are being tested positive for the SARS-CoV-2 infection. In order to dispense this current crisis, numerous treatment options have been tried and tested and many more are still under scrutiny. The development of vaccines may help in the prevention of the global pandemic, however, there is still a need for the development of alternate approaches to combat the disease. In this review we highlight the new discoveries and furtherance in the antibody based therapeutic options and the potent drugs, with special emphasis on the development of the monoclonal and polyclonal antibodies and the repurposed drugs, which may prove to be of significant importance for the treatment of COVID-19, in the days to come. It is an attempt to evaluate the currently presented challenges so as to provide a scope for the ongoing research and assistance in the development of the effective therapeutic options against SARS-CoV-2.
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Affiliation(s)
- Siddhi Tandon
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Plot Nos. 8-11, Tech Zone 2, Greater Noida, Uttar Pradesh, 201310, India
| | - Anchal Aggarwal
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Plot Nos. 8-11, Tech Zone 2, Greater Noida, Uttar Pradesh, 201310, India
| | - Shubhra Jain
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Plot Nos. 8-11, Tech Zone 2, Greater Noida, Uttar Pradesh, 201310, India
| | - Sanjay Shukla
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Plot Nos. 8-11, Tech Zone 2, Greater Noida, Uttar Pradesh, 201310, India
| | - Sarika Chaudhary
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Plot Nos. 8-11, Tech Zone 2, Greater Noida, Uttar Pradesh, 201310, India.
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Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis 2020; 100:327-332. [PMID: 32920235 PMCID: PMC7529115 DOI: 10.1016/j.ijid.2020.09.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES One-fifth of Covid-19 patients suffer a severe course of Covid-19 infection; however, the specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2. Although only recently recognized, MC activation syndrome (MCAS), usually due to acquired MC clonality, is a chronic multisystem disorder with inflammatory and allergic themes, and an estimated prevalence of 17%. This paper describes a novel conjecture explaining how MCAS might cause a propensity for severe acute Covid-19 infection and chronic post-Covid-19 illnesses. METHODS Observations of Covid-19 illness in patients with/without MCAS were compared with extensive clinical experience with MCAS. RESULTS The prevalence of MCAS is similar to that of severe cases within the Covid-19-infected population. Much of Covid-19's hyperinflammation is concordant with manners of inflammation which MC activation can drive. Drugs with activity against MCs or their mediators have preliminarily been observed to be helpful in Covid-19 patients. None of the authors' treated MCAS patients with Covid-19 suffered severe infection, let alone mortality. CONCLUSIONS Hyperinflammatory cytokine storms in many severely symptomatic Covid-19 patients may be rooted in an atypical response to SARS-CoV-2 by the dysfunctional MCs of MCAS rather than a normal response by normal MCs. If proven, this theory has significant therapeutic and prognostic implications.
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Affiliation(s)
- Lawrence B Afrin
- Department of Mast Cell Studies, AIM Center for Personalized Medicine, Purchase, New York, USA.
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Xiong H, Dong Z, Lou G, Gan Q, Wang J, Huang Q. Analysis of the mechanism of Shufeng Jiedu capsule prevention and treatment for COVID-19 by network pharmacology tools. Eur J Integr Med 2020; 40:101241. [PMID: 33520015 PMCID: PMC7836709 DOI: 10.1016/j.eujim.2020.101241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
Abstract
Introduction The novel coronavirus pneumonia that broke out in 2019 has become a global epidemic. According to the diagnosis and treatment plan issued in China and the existing clinical data, Shufeng Jiedu (SFJD) Capsule can be effectively used in the treatment of COVID-19 patients. This study aimed to explore its mechanism of action by network pharmacology and molecular docking technology. Methods The Chinese Medicine System Pharmacology Analysis Platform (TCMSP), a Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine (BATMAN-TCM), the Encyclopedia of Traditional Chinese Medicine (ETCM) and related literature records were used to search the composition and main active compounds of SFJD, and to screen out the targets of drug components. Disease-associated genes were obtained by the Human Gene Database (GeneCards), the Human Online Mendelian Inheritance Platform (OMIM) and the DisGeNET database, and the co-targeted genes/proteins as targets of both SFJD and COVID-19 were selected by the Comparative Toxicogenomics Database (CTD). Co-targeted genes/proteins were analyzed by STRING, the Database for Annotation, Visualization and Integrated Discovery (DAVID) and Reactome for proteins to protein interaction (PPI), pathway and GO (gene ontology) enrichment, and predicted by AutoDock for their high-precision docking simulation. In addition, the therapeutic effect for SFJD treatment on COVID-19 was validated by the Chinese medicine anti-novel coronavirus pneumonia drug effect prediction and analysis platform (TCMCOVID). Results Screening resulted in 163 compounds and 463 targeted genes. The PPI core network contains 76 co-targeted proteins. The Reactome pathways were enriched in signaling by interleukins, immune system, etc. Finally, 6 key proteins of TNF, IL-10, IL-2, IL-6, STAT1 and CCL2 were selected and successfully docked with 4 active ingredients of quercetin, luteolin, wogonin and kaempferol. Conclusion SFJD may play a role in the prevention and treatment of COVID-19 through multiple active compounds acting on multiple targets and then multiple pathways.
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Affiliation(s)
- Haijun Xiong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhaowei Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guanhua Lou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingxia Gan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinwan Huang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Abu-Raya B, Migliori GB, O'Ryan M, Edwards K, Torres A, Alffenaar JW, Märtson AG, Centis R, D'Ambrosio L, Flanagan K, Hung I, Lauretani F, Leung CC, Leuridan E, Maertens K, Maggio MG, Nadel S, Hens N, Niesters H, Osterhaus A, Pontali E, Principi N, Rossato Silva D, Omer S, Spanevello A, Sverzellati N, Tan T, Torres-Torreti JP, Visca D, Esposito S. Coronavirus Disease-19: An Interim Evidence Synthesis of the World Association for Infectious Diseases and Immunological Disorders (Waidid). Front Med (Lausanne) 2020; 7:572485. [PMID: 33195319 PMCID: PMC7662576 DOI: 10.3389/fmed.2020.572485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly evolving, highly transmissible, and potentially lethal pandemic caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of June 11 2020, more than 7,000,000 COVID-19 cases have been reported worldwide, and more than 400,000 patients have died, affecting at least 188 countries. While literature on the disease is rapidly accumulating, an integrated, multinational perspective on clinical manifestations, immunological effects, diagnosis, prevention, and treatment of COVID-19 can be of global benefit. We aimed to synthesize the most relevant literature and experiences in different parts of the world through our global consortium of experts to provide a consensus-based document at this early stage of the pandemic.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Giovanni Battista Migliori
- Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico, Tradate, Italy
| | - Miguel O'Ryan
- Faculty of Medicine, Institute of Biomedical Sciences and Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Kathryn Edwards
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antoni Torres
- Respiratory and Intensive Care Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jan-Willem Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Sydney, NSW, Australia
- Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rosella Centis
- Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico, Tradate, Italy
| | | | - Katie Flanagan
- University of Tasmania, Monash University, RMIT University, Hobart, Australia
| | - Ivan Hung
- Queen Mary Hospital, Hong Kong, China
| | - Fulvio Lauretani
- Geriatric Clinic Unit, Department of Medicine and Surgery, University-Hospital of Parma, University of Parma, Parma, Italy
| | - Chi Chi Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong, China
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Marcello Giuseppe Maggio
- Geriatric Clinic Unit, Department of Medicine and Surgery, University-Hospital of Parma, University of Parma, Parma, Italy
| | | | - Niel Hens
- Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Hubert Niesters
- Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | | | | | - Saad Omer
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico, Tradate, Italy
| | - Nicola Sverzellati
- Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tina Tan
- Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Evanston, IL, United States
| | - Juan Pablo Torres-Torreti
- Department of Pediatrics and Pediatric Surgery, Faculty of Medicine, Dr. Luis Calvo Mackenna Hospital, University of Chile, Santiago, Chile
| | - Dina Visca
- Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico, Tradate, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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