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Uckun FM, Saeed M, Awili M, Ozercan IH, Qazi S, Lee C, Shibli A, Skolnick AW, Prusmack A, Varon J, Barrera CI, Orhan C, Volk M, Sahin K. Evaluation of the potential of Rejuveinix plus dexamethasone against sepsis. Future Microbiol 2022; 17:1217-1229. [PMID: 36052743 PMCID: PMC9443789 DOI: 10.2217/fmb-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: Our main objectives were to compare the effects of Rejuveinix (RJX), dexamethasone (DEX) and their combination on the severity of sepsis and survival outcome in an animal model of fatal sepsis. Methods: We used the LPS plus D-galactosamine mouse model of sepsis to compare the anti-inflammatory activities of RJX, dexamethasone and a combination of RJX plus DEX. Additionally, we examined the clinical feasibility and tolerability of combining RJX with DEX in COVID-19 patients in a clinical phase I study. Data were analyzed using standard methods. Results & conclusion: RJX exhibited potent anti-inflammatory activity in the murine sepsis model. The combination of RJX plus DEX was more effective than either agent alone, decreased the inflammatory cytokine responses and associated organ damage, and improved the survival outcome in mice. In the phase I clinical study, RJX plus DEX was well tolerated by COVID-19 patients.
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Affiliation(s)
- Fatih M Uckun
- Drug Discovery Program, Reven Pharmaceuticals, Westminster, CO 80234, USA.,Department of Developmental Therapeutics, Immunology & Integrative Medicine, Ares Pharmaceuticals, St Paul, MN 55110, USA
| | - Muhammad Saeed
- PRX Research & Dallas Regional Medical Center, Dallas, TX 75149, USA
| | - Mustafa Awili
- PRX Research & Dallas Regional Medical Center, Dallas, TX 75149, USA
| | - Ibrahim H Ozercan
- Department of Pathology Faculty of Medicine, Firat University, Elazig, 23119, Turkey
| | - Sanjive Qazi
- Department of Developmental Therapeutics, Immunology & Integrative Medicine, Ares Pharmaceuticals, St Paul, MN 55110, USA
| | - Cynthia Lee
- Drug Discovery Program, Reven Pharmaceuticals, Westminster, CO 80234, USA
| | - Adeel Shibli
- PRX Research & Dallas Regional Medical Center, Dallas, TX 75149, USA
| | - Alan W Skolnick
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA; HD Research, Bellaire, TX 77401, USA
| | | | - Joseph Varon
- United Memorial Medical Center, Houston, TX 77091, USA
| | | | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary, Firat University, Elazig, 23119, Turkey
| | - Michael Volk
- Drug Discovery Program, Reven Pharmaceuticals, Westminster, CO 80234, USA
| | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary, Firat University, Elazig, 23119, Turkey
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Izrael M, Molakandov K, Revel A, Slutsky SG, Sonnenfeld T, Weiss JM, Revel M. Astrocytes Downregulate Inflammation in Lipopolysaccharide-Induced Acute Respiratory Distress Syndrome: Applicability to COVID-19. Front Med (Lausanne) 2021; 8:740071. [PMID: 34778302 PMCID: PMC8585990 DOI: 10.3389/fmed.2021.740071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: An acute respiratory distress syndrome (ARDS) is caused by the increased amounts of pro-inflammatory cytokines and neutrophil-mediated tissue injury. To date, there is no effective treatment for the ARDS available, while the need for one is growing due to the most severe complications of the current coronavirus disease-2019 (COVID-19) pandemic. The human astrocytes (AstroRx) have shown immunomodulatory properties in the central nervous system (CNS). This study aimed to evaluate the capacity of astrocytes to decrease lung inflammation and to be applied as a treatment therapy in ARDS. Methods: First, we assessed the ability of clinical-grade AstroRx to suppress T-cell proliferation in a mixed lymphocyte reaction test. Next, we tested the therapeutical potential of AstroRx cells in a lipopolysaccharide (LPS)-based ARDS mouse model by injecting AstroRx intravenously (i.v). We determined the degree of lung injury by using a severity scoring scale of 0–2, based on the American Thoracic Society. The scoring measured the presence of neutrophils, fibrin deposits, and the thickening of alveolar walls. The state of inflammation was further assessed by quantifying the immune-cell infiltration to the bronchoalveolar lavage fluid (BALF) and by the presence of proinflammatory cytokines and chemokines in the BALF and serum. Results: We detected that AstroRx cells were capable to suppress T-cell proliferation in vitro after exposure to the mitogen concanavalin A (ConA). In vivo, AstroRx cells were able to lower the degree of lung injury in LPS-treated animals compared with the sham injected animals (P = 0.039). In this study, 30% of AstroRx treated mice showed no lung lesions (responder mice), these mice presented a steady number of eosinophils, T cells, and neutrophils comparable with the level of naïve control mice. The inflammatory cytokines and chemokines, such as TNFα, IL1b, IL-6, and CXCL1, were also kept in check in responder AstroRx-treated mice and were not upregulated as in the sham-injected mice (P < 0.05). As a result, the LPS-treated ARDS mice had a higher survival rate when they were treated with AstroRx. Conclusions: Our results demonstrate that the immunosuppressive activity of AstroRx cells support the application of AstroRx cells as a cell therapy treatment for ARDS. The immunoregulatory activity may also be a part of the mechanism of action of AstroRx reported in the amyotrophic lateral sclerosis (ALS) neurodegenerative disease.
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Affiliation(s)
- Michal Izrael
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Kfir Molakandov
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Ariel Revel
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Shalom Guy Slutsky
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Tehila Sonnenfeld
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Julia Miriam Weiss
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel
| | - Michel Revel
- Research and Development Department at Kadimastem Ltd, Nes-Ziona, Israel.,Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
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Coiffard B, Lepper PM, Prud’Homme E, Daviet F, Cassir N, Wilkens H, Hraiech S, Langer F, Thomas PA, Reynaud-Gaubert M, Bals R, Schäfers HJ, Papazian L, Seiler F. Management of lung transplantation in the COVID-19 era-An international survey. Am J Transplant 2021; 21:1586-1596. [PMID: 33084144 PMCID: PMC9906357 DOI: 10.1111/ajt.16368] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 01/25/2023]
Abstract
It is unknown if solid organ transplant recipients are at higher risk for severe COVID-19. The management of a lung transplantation (LTx) program and the therapeutic strategies to adapt the immunosuppressive regimen and antiviral measures is a major issue in the COVID-19 era, but little is known about worldwide practice. We sent out to 180 LTx centers worldwide in June 2020 a survey with 63 questions, both regarding the management of a LTx program in the COVID-19 era and the therapeutic strategies to treat COVID-19 LTx recipients. We received a total of 78 responses from 15 countries. Among participants, 81% declared a reduction of the activity and 47% restricted LTx for urgent cases only. Sixteen centers observed deaths on waiting listed patients and eight centers performed LTx for COVID-19 disease. In 62% of the centers, COVID-19 was diagnosed in LTx recipients, most of them not severe cases. The most common immunosuppressive management included a decreased dose or pausing of the cell cycle inhibitors. Remdesivir, hydroxychloroquine, and azithromycin were the most proposed antiviral strategies. Most of the centers have been affected by the COVID-19 pandemic and proposed an active therapeutic strategy to treat LTx recipients with COVID-19.
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Affiliation(s)
- Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Eloi Prud’Homme
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Florence Daviet
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Nadim Cassir
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Heinrike Wilkens
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Sami Hraiech
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Pascal A. Thomas
- Department of Thoracic Surgery, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Robert Bals
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Laurent Papazian
- Aix Marseille Univ, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Frederik Seiler
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
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Uckun FM, Saund S, Windlass H, Trieu V. Repurposing Anti-Malaria Phytomedicine Artemisinin as a COVID-19 Drug. Front Pharmacol 2021; 12:649532. [PMID: 33815126 PMCID: PMC8017220 DOI: 10.3389/fphar.2021.649532] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
Artemisinin is an anti-inflammatory phytomedicine with broad-spectrum antiviral activity. Artemisinin and its antimalarial properties were discovered by the Chinese scientist Tu Youyu, who became one of the laureates of the 2015 Nobel Prize in Physiology or Medicine for this breakthrough in tropical medicine. It is a commonly used anti-malaria drug. Artemisinin has recently been repurposed as a potential COVID-19 drug. Its documented anti-SARS-CoV-2 activity has been attributed to its ability to inhibit spike-protein mediated and TGF-β-dependent early steps in the infection process as well as its ability to disrupt the post-entry intracellular events of the SARS-CoV-2 infection cycle required for viral replication. In addition, Artemisinin has anti-inflammatory activity and reduces the systemic levels of inflammatory cytokines that contribute to cytokine storm and inflammatory organ injury in high-risk COVID-19 patients. We postulate that Artemisinin may prevent the worsening of the health condition of patients with mild-moderate COVID-19 when administered early in the course of their disease.
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Affiliation(s)
| | - Saran Saund
- Oncotelic Inc., Agoura Hills, CA, United States
| | | | - Vuong Trieu
- Oncotelic Inc., Agoura Hills, CA, United States
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Uckun FM, Carlson J, Orhan C, Powell J, Pizzimenti NM, van Wyk H, Ozercan IH, Volk M, Sahin K. Rejuveinix Shows a Favorable Clinical Safety Profile in Human Subjects and Exhibits Potent Preclinical Protective Activity in the Lipopolysaccharide-Galactosamine Mouse Model of Acute Respiratory Distress Syndrome and Multi-Organ Failure. Front Pharmacol 2020; 11:594321. [PMID: 33244300 PMCID: PMC7683794 DOI: 10.3389/fphar.2020.594321] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background: New treatment platforms that can prevent acute respiratory distress syndrome (ARDS) or reduce its mortality rate in high-risk coronavirus disease 2019 (COVID-19) patients, such as those with an underlying cancer, are urgently needed. Rejuveinix (RJX) is an intravenous formulation of anti-oxidants and anti-inflammatory agents. Its active ingredients include ascorbic acid, cyanocobalamin, thiamine hydrochloride, riboflavin 5' phosphate, niacinamide, pyridoxine hydrochloride, and calcium D-pantothenate. RJX is being developed as an anti-inflammatory and anti-oxidant treatment platform for patients with sepsis, including COVID-19 patients with viral sepsis and ARDS. Here, we report its clinical safety profile in a phase 1 clinical study (ClinicalTrials.gov Identifier: NCT03680105) and its potent protective activity in the lipopolysaccharide galactosamine (LPS-GalN) mouse model of ARDS. Methods: A phase 1, double-blind, placebo-controlled, randomized, two-part, ascending dose-escalation study was performed in participating 76 healthy volunteer human subjects in compliance with the ICH (E6) good clinical practice guidelines to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of RJX (Protocol No. RPI003; ClinicalTrials.gov Identifier: NCT03680105). The ability of RJX to prevent fatal shock, ARDS, and multi-organ failure was examined in the well-established LPS-GalN mouse model of sepsis and ARDS. Standard methods were employed for the statistical analysis of data in both studies. Findings: In the phase 1 clinical study, no participant developed serious adverse events (SAEs) or Grade 3-Grade 4 adverse events (AEs) or prematurely discontinued participation in the study. In the non-clinical study, RJX exhibited potent and dose-dependent protective activity, decreased the inflammatory cytokine responses (interleukin-6, tumor necrosis factor alpha, transforming growth factor beta), and improved survival in the LPS-GalN mouse model of sepsis and ARDS. Histopathological examinations showed that RJX attenuated the LPS-GalN induced acute lung injury (ALI) and pulmonary edema as well as liver damage. Conclusion: RJX showed a very favorable safety profile and tolerability in human subjects. It shows potential to favorably affect the clinical course of high-risk COVID-19 by preventing ARDS and its complications.
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Affiliation(s)
- Fatih M. Uckun
- Drug Discovery Program, Reven Pharmaceuticals, Golden, CO, United States
- Department of Developmental Therapeutics, Immunology, and Integrative Medicine, Ares Pharmaceuticals, St. Paul, MN, United States
| | - James Carlson
- Drug Discovery Program, Reven Pharmaceuticals, Golden, CO, United States
| | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary, Firat University, Elazig, Turkey
| | - Joy Powell
- Drug Discovery Program, Reven Pharmaceuticals, Golden, CO, United States
| | | | - Hendrik van Wyk
- Drug Discovery Program, Reven Pharmaceuticals, Golden, CO, United States
| | - Ibrahim H. Ozercan
- Department of Pathology Faculty of Medicine, Firat University, Elazig, Turkey
| | - Michael Volk
- Drug Discovery Program, Reven Pharmaceuticals, Golden, CO, United States
| | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary, Firat University, Elazig, Turkey
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Kumar R, Lee MH, Mickael C, Kassa B, Pasha Q, Tuder R, Graham B. Pathophysiology and potential future therapeutic targets using preclinical models of COVID-19. ERJ Open Res 2020; 6:00405-2020. [PMID: 33313306 PMCID: PMC7720688 DOI: 10.1183/23120541.00405-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) gains entry into the lung epithelial cells by binding to the surface protein angiotensin-converting enzyme 2. Severe SARS-CoV-2 infection, also known as coronavirus disease 2019 (COVID-19), can lead to death due to acute respiratory distress syndrome mediated by inflammatory immune cells and cytokines. In this review, we discuss the molecular and biochemical bases of the interaction between SARS-CoV-2 and human cells, and in doing so we highlight knowledge gaps currently precluding development of new effective therapies. In particular, discovery of novel treatment targets in COVID-19 will start from understanding pathologic changes based on a large number of autopsy lung tissue samples. Pathogenetic roles of potential molecular targets identified in human lung tissues must be validated in established animal models. Overall, this stepwise approach will enable appropriate selection of candidate therapeutic modalities targeting SARS-CoV2 and the host inflammatory response.
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Affiliation(s)
- Rahul Kumar
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael H. Lee
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Claudia Mickael
- Dept of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Biruk Kassa
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Qadar Pasha
- Functional Genomics Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Rubin Tuder
- Dept of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian Graham
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
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7
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Guven DC, Aktas BY, Aksun MS, Ucgul E, Sahin TK, Yildirim HC, Guner G, Kertmen N, Dizdar O, Kilickap S, Aksoy S, Yalcin S, Turker A, Uckun FM, Arik Z. COVID-19 pandemic: changes in cancer admissions. BMJ Support Palliat Care 2020:bmjspcare-2020-002468. [PMID: 32665259 DOI: 10.1136/bmjspcare-2020-002468] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND COVID-19 pandemic could create a collateral damage to cancer care denoting disruptions in care due to a significant burden on healthcare and resource allocations. Herein, we evaluate the early changes in the inpatient and outpatient oncology clinics to take a snapshot of this collateral damage at Hacettepe University Cancer Institute. METHODS Patients applying the outpatient clinic and outpatient palliative care (OPC) clinic for the first time and patients admitted to inpatient wards in the first 30 days after the first case of COVID-19 in Turkey were evaluated. These data were compared with data from the same time frame in the previous 3 years. RESULTS The mean number of daily new patient applications to the outpatient clinic (9.87±3.87 vs 6.43±4.03, p<0.001) and OPC clinic (3.87±1.49 vs 1.13±1.46, p<0.001) was significantly reduced compared with the previous years. While the number of inpatient admissions was similar for a month frame, the median duration of hospitalisation was significantly reduced. The frequency of hospitalisations for chemotherapy was higher than in previous years (p<0.001). By comparison, the rate of hospitalisations for palliative care (p=0.028) or elective interventional procedures (p=0.001) was significantly reduced. CONCLUSION In our experience, almost all domains of care were affected during the pandemic other than patients' systemic treatments. There were significant drops in the numbers of newly diagnosed patients, patients having interventional procedures and palliative care services, and these problems should be the focus points for the risk mitigation efforts for prevention of care disruptions.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Burak Yasin Aktas
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Enes Ucgul
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Gurkan Guner
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Neyran Kertmen
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Preventive Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Alev Turker
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Fatih Mehmet Uckun
- COVID-19 Task Force, Worldwide Clinical Trials, Wayne, Pennsylvania, USA
| | - Zafer Arik
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
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