Dosage and utilization of dexamethasone in the management of COVID-19: A critical review

Carbon monoxide potentiates the effect of corticosteroids in suppressing inflammatory responses in cell culture

Inflammation is a pathology implicated in a wide range of human diseases. Recent years have seen tremendous progress in developing new types of anti-inflammatory agents for the treatment of inflammation of various origins. However, each has its own strengths and weaknesses. The very fact that there needs to have multiple types of anti-inflammatory agents underlines the complexity of inflammatory diseases and conditions, their molecular origins, and their treatment. Such complexity dictates the need to search for new approaches with improved potency and efficacy as well as reduced side effects. For these reasons, we are interested in exploring the possibility of generating synergy between carbon monoxide (CO), an endogenously produced cytoprotective agent, and known anti-inflammatory agents. Herein, we report the potentiating actions of CO on the anti-inflammatory effects of cortisone and dexamethasone as demonstrated in their ability to suppress the expression of TNF-α and IL-6 induced by either LPS or the S protein of SARS-CoV-2. Such effects are reflected in the substantially increased potency as well efficacy, when the efficacy of the corticosteroid alone does not allow for complete suppression of the expression of these cytokines. Further, increased attenuation of p65 phosphorylation is at least part of the molecular mechanism for the observed potentiating effects. We hope our work will stimulate a high level of activity along the same direction, leading to anti-inflammatory strategies with improved potency and efficacy and reduced side effects.

Dexamethasone in coronavirus disease 2019 care: Dosage and utilization insights

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2. It was declared a global pandemic on March 11, 2020, by the World Health Organization. An excessive inflammatory response is a severe respiratory manifestation of COVID-19, which becomes predominant in later stages. Due to its immunosuppressive and anti-inflammatory properties, dexamethasone is the first systemic glucocorticoid to treat severe COVID-19 patients. This editorial reviews the efficacy and safety of high-dose vs low-dose dexamethasone in patients with COVID-19. Findings indicate that using low-dose dexamethasone is beneficial and emphasize the need for additional research on the use of high-dose dexamethasone. While the study provides a robust evidence base, it is limited by the lack of long-term data, focus on specific outcomes and heterogeneity of the included studies. Future research should focus on the long-term effects of dexamethasone and its impact across varying disease severities and patient populations to refine treatment strategies and improve patient care.

Revisiting dexamethasone dosage in COVID-19 management

The ongoing coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid advancements in therapeutic strategies, with dexamethasone emerging as a key treatment for severe cases. This editorial discusses the systematic review conducted by Sethi et al, published in the World Journal of Virology. The review critically examines the efficacy and safety of varying dosages of dexamethasone in severe COVID-19 patients, providing a comprehensive meta-analysis that underscores the current clinical recommendations favoring a low-dose regimen. Despite these findings, the review highlights the potential benefits of tailored dosages for specific patient subgroups, suggesting a need for personalized treatment approaches. This editorial expands on the implications of these findings, advocating for the integration of evolving clinical data into treatment protocols and calling for further research into patient-specific responses to therapy. It emphasizes the importance of adaptability and precision in pandemic response, urging the medical community to consider both the robustness of existing evidence and the potential for innovative approaches to enhance patient outcomes in the face of global health challenges.

Neutrophils and COVID-19

Neutrophils are the first line of defense against pathogens, most effectively by forming Neutrophil Extracellular Traps (NETs). Neutrophiles are further classified into several subpopulations during their development, eliminating pathogens through various mechanisms. However, due to the chaotic and uncontrolled immune response, NETs are often severely resulting in tissue damage and lung infections. The uncontrolled and poorly acknowledged host response regarding the cytokine storm is one of the major causes of severe COVID-19 conditions. Specifically, the increased formation of low-density neutrophils (LDNs), together with neutrophil extracellular traps (NETs) is closely linked with the severity and poor prognosis in patients with COVID-19. In this review, we discuss in detail the ontogeny of neutrophils at different stages and their recruitment and activation after infections, focusing on SARS-CoV-2. In addition, this chapter summarized the research progress on potential targeted drugs (NETs and Cytokine inhibitors) for neutrophil medical therapy and hoped to provide reference for the development of related therapeutic drugs for critically ill COVID-19 patients.