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Mehboob R, Oehme P, Anwar T, von Kries JP. Substance P - a regulatory peptide with defense and repair functions. Results and perspectives for the fight against COVID-19. Front Neurol 2024; 15:1370454. [PMID: 38872816 PMCID: PMC11169637 DOI: 10.3389/fneur.2024.1370454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS CoV-2) is the cause of Corona virus disease 2019 (COVID-19), which turned into a pandemic in late 2019 and early 2020. SARS CoV-2 causes endothelial cell destruction and swelling, microthrombosis, constriction of capillaries, and malfunction of pericytes, all of which are detrimental to capillary integrity, angiogenesis, and healing processes. Cytokine storming has been connected to COVID-19 disease. Hypoxemia and tissue hypoxia may arise from impaired oxygen diffusion exchange in the lungs due to capillary damage and congestion. This personal view will look at how inflammation and capillary damage affect blood and tissue oxygenation, cognitive function, and the duration and intensity of COVID-19 disease. The general effects of microvascular injury, hypoxia, and capillary damage caused by COVID-19 in key organs are also covered in this point of view. Once initiated, this vicious cycle leads to diminished capillary function, which exacerbates inflammation and tissue damage, and increased inflammation due to hypoxia. Brain damage may result from low oxygen levels and high cytokines in brain tissue. In this paper we give a summary in this direction with focus on the role of the neuropeptide Substance P. On the basis of this, we discuss selected approaches to the question: "How Substance P is involved in the etiology of the COVID-19 and how results of our research could improve the prevention or therapy of corona? Thereby pointing out the role of Substance P in the post-corona syndrome and providing novel concepts for therapy and prevention.
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Affiliation(s)
- Riffat Mehboob
- Lahore Medical Research Center, Lahore, Pakistan
- National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD, United States
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Xu S, He K. Hemophagocytic lymphohistiocytosis after solid organ transplantation: A challenge for clinicians. Transpl Immunol 2024; 83:102007. [PMID: 38307154 DOI: 10.1016/j.trim.2024.102007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare inflammatory disorder with a high mortality rate and a wide range of symptoms. Solid organ transplantation, which provides patients with a unique immunosuppressive state, is a less common predisposing factor for HLH. HLH after solid organ transplantation (HLH-SOT) is very rare and fatal. It is hard to diagnose and treat and extremely understudied. The use of immunosuppressants makes the situation of HLH-SOT more complex. This review summarizes the existing literature on HLH after solid organ transplantation and describes its triggers and symptoms, focusing on its diagnosis and treatment. We performed a literature search of case reports, case series, letters to the editor, and clinical quizzes describing patients with HLH after solid organ transplantation (HLH-SOT). We provide recommendations on the diagnosis protocol and treatment strategy based on the existing evidence.
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Affiliation(s)
- Shanshan Xu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Engineering Research Center of Transplantation and Immunology, Shanghai, China; Shanghai Institute of Transplantation, Shanghai, China
| | - Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Engineering Research Center of Transplantation and Immunology, Shanghai, China; Shanghai Institute of Transplantation, Shanghai, China.
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Kim HY, Jeong KM, Kim SH, Choi YJ, Kang HG, Jung H, Min K, Kim HM, Jeong HJ. Modulating effect of Eunkyo-san on expression of inflammatory cytokines and angiotensin-converting enzyme 2 in human mast cells. In Vitro Cell Dev Biol Anim 2024; 60:195-208. [PMID: 38228999 DOI: 10.1007/s11626-024-00847-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024]
Abstract
Eunkyo-san is widely used in the treatment of severe respiratory infections. Mast cells not only serve as host cells for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but also they also exacerbate Coronavirus disease in 2019 (COVID-19) by causing a cytokine storm. Here we investigated whether Eunkyo-san and its active compound naringenin regulate the expression of inflammatory cytokines and factors connected to viral infection in activated human mast cell line, HMC-1 cells. Eunkyo-san and naringenin significantly reduced levels of inflammatory cytokines including interleukin (IL)-1β, IL-6, IL-8, thymic stromal lymphopoietin, and tumor necrosis factor-α without impacting cytotoxicity. Eunkyo-san and naringenin reduced levels of factors connected to SARS-CoV-2 infection such as angiotensin-converting enzyme 2 (ACE2, SARS-CoV-2 receptor), transmembrane protease/serine subfamily member 2, and tryptase in activated HMC-1 cells. Treatment with Eunkyo-san and naringenin considerably reduced expression levels of ACE2 transcription factor, AP-1 (C-JUN and C-FOS) by blocking phosphatidylinositide-3-kinase and c-Jun NH2-terminal kinases signaling pathways. In addition, Eunkyo-san and naringenin effectively suppressed activation of signal transducer and activator of transcription 3, nuclear translocation of nuclear factor-κB, and activation of caspase-1 in activated HMC-1 cells. Furthermore, Eunkyo-san and naringenin reduced expression of ACE2 mRNA in two activated mast cell lines, RBL-2H3 and IC-2 cells. The overall study findings showed that Eunkyo-san diminished the expression levels of inflammatory cytokines and ACE2, and these findings imply that Eunkyo-san is able to effectively mitigating the cytokine storm brought on by SARS-CoV-2 infection.
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Affiliation(s)
- Hee-Yun Kim
- Biochip Research Center, Hoseo University, Asan, 31499, Republic of Korea
| | - Kyung-Min Jeong
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, 31499, Republic of Korea
| | - Seung-Hwan Kim
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, 31499, Republic of Korea
| | - Yu-Jin Choi
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, 31499, Republic of Korea
| | - Ho-Geun Kang
- Department of Bio-Convergence System, Graduate School, Hoseo University, Asan, 31499, Republic of Korea
| | - Hanchul Jung
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Kyunghwon Min
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Hyung-Min Kim
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Hyun-Ja Jeong
- Biochip Research Center, Hoseo University, Asan, 31499, Republic of Korea.
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, 31499, Republic of Korea.
- Department of Bio-Convergence System, Graduate School, Hoseo University, Asan, 31499, Republic of Korea.
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El-Sayed HS, Saad AS, Tawfik WA, Adel A, Abdelmagid MA, Momenah MA, Azab DM, Omar SE, El-Habbaa AS, Bahshwan SMA, Alghamdi AM, El-Saadony MT, El-Tarabily KA, El-Mayet FS. The role of turmeric and black pepper oil nanoemulsion in attenuating cytokine storm triggered by duck hepatitis A virus type I (DHAV-I)-induced infection in ducklings. Poult Sci 2024; 103:103404. [PMID: 38242053 PMCID: PMC10831264 DOI: 10.1016/j.psj.2023.103404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
The cytokine storm induced by duck hepatitis A virus type 1 (DHAV-1) infection significantly contributes to severe, rapid deaths and economic losses in the duck industry in Egypt. This study aimed to investigate the potential inhibitory effect of a nanoemulsion containing turmeric and black pepper oil on the immune response and pathogenesis of DHAV-1 in ducklings. A total of 105 ducklings from nonvaccinated breeders were divided into 5 experimental groups, each comprising 21 birds. The negative control group (G1) remained noninfected with DHAV-1 and nontreated with nanoemulsion, while the positive control group (G2) was infected with DHAV-1 but not treated with nanoemulsion. The other 2 groups (G3, the supplemented group which was noninfected with DHAV-1), and group 4 (the prophylactic group G4) which was infected with DHAV-1, both received nanoemulsion throughout the experiment. Group 5 (G5, the therapeutic group), on the other hand, which was infected with DHAV-1 received nanoemulsion only from the onset of clinical signs. At 5 days old, the ducklings in the positive control (G2), the prophylactic (G4), and the therapeutic group (G5) were infected with DHAV-1. All the ducklings in the infected groups exhibited depression, anorexia, and opisthotonos, and their livers displayed various degrees of ecchymotic hemorrhage, liver enlargement, and microscopic pathological lesions. Notably, the positive control group (G2) experienced the most severe and pronounced effects compared to the other infected groups treated with the nanoemulsion. Meanwhile, the viral RNA loads were lower in the liver tissues of the infected ducklings treated with the nanoemulsion (G4, and G5) compared to the positive control group G2. Additionally, the nanoemulsion effectively modulated proinflammatory cytokine expression, antioxidant enzymes, liver enzymes, and lipid profile of treated ducklings. In conclusion, the turmeric and black pepper oil nanoemulsion has the potential to be a therapeutic agent for regulating and modulating the immune response, decreasing DHAV-1-induced cytokine storms, and minimizing mortality and economic losses in the duck business. More research is needed to understand how turmeric and black pepper oil nanoemulsion alleviates DHVA-1-induced cytokine storms and lowers duckling mortality.
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Affiliation(s)
- Hemat S El-Sayed
- Department of Poultry Diseases, Animal Health Research Institute, Benha-Branch, Agriculture Research Center (ARC), Benha 12618, Egypt
| | - Aalaa S Saad
- Biotechnology Department, Animal Health Research Institute, Agriculture Research Center (ARC), Giza 12618, Egypt
| | - Wesam A Tawfik
- Holding Company for Biological Products and Vaccines, Dokki, Giza 12311, Egypt; NaQaa Nanotechnology Network (NNN), Giza, Egypt
| | - Amany Adel
- Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center (ARC), Giza 12618, Egypt
| | - Marwa A Abdelmagid
- Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center (ARC), Giza 12618, Egypt
| | - Maha Abdullah Momenah
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Dalia M Azab
- Biochemistry Department (Pharmacology), Animal Health Research Institute, Benha-Branch, Agriculture Research Center (ARC), Benha 12618, Egypt
| | - Sabry E Omar
- Department of Poultry Diseases, Animal Health Research Institute, Benha-Branch, Agriculture Research Center (ARC), Benha 12618, Egypt
| | - Ayman S El-Habbaa
- Department of Virology, Faculty of Veterinary Medicine, Benha University, Moshtohor 13736, Qalyubia, Egypt
| | - Safia M A Bahshwan
- Biological Sciences Department, College of Science and Arts, King Abdulaziz University, Rabigh 21911, Saudi Arabia
| | - Amira M Alghamdi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohamed T El-Saadony
- Department of Agricultural Microbiology, Faculty of Agriculture, Zagazig University, Zagazig 44511, Egypt
| | - Khaled A El-Tarabily
- Department of Biology, College of Science, United Arab Emirates University, Al Ain 15551, United Arab Emirates.
| | - Fouad S El-Mayet
- Department of Virology, Faculty of Veterinary Medicine, Benha University, Moshtohor 13736, Qalyubia, Egypt; Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
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Rosado FG, Gopal P. Laboratory Features and Pathology of Cytokine Storm Syndromes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:43-58. [PMID: 39117807 DOI: 10.1007/978-3-031-59815-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
The laboratory diagnosis of cytokine storm syndromes (CSSs), i.e., hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), is often challenging. The laboratory features using routinely available tests lack specificity, whereas confirmatory testing is available in only few laboratories in the United States. The disease mechanisms are still largely unclear, particularly in adults. In this chapter, the pathogenesis of CSSs, their associated laboratory findings, and recommended diagnostic strategies are reviewed.
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Affiliation(s)
- Flavia G Rosado
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Purva Gopal
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Muto T, Machida S, Imaizumi S, Kamoi K. Possible association between vaccination against SARS-CoV-2 and recurrence of macular edema due to branch retinal vein occlusion: a case report. J Int Med Res 2023; 51:3000605231213777. [PMID: 38000009 PMCID: PMC10676065 DOI: 10.1177/03000605231213777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
We herein describe a patient who developed recurrence of macular edema (ME) due to branch retinal vein occlusion (BRVO) 3 days after administration of the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A man in his early 50s visited our hospital because of vision loss in his right eye. His logarithmic best-corrected visual acuity (BCVA) was -0.79 in both eyes. ME due to superior temporal BRVO was observed in his right eye, and the central foveal thickness (CFT) was 486 µm. The patient was treated with an intravitreal aflibercept injection with logarithmic BCVA of -0.79, leading to resolution of the ME with a CFT of 299 µm. Three months after the initial visit, he received a fourth dose of an mRNA vaccine. Three days later, he developed vision loss in his right eye. Although the logarithmic BCVA was maintained at -0.79, ME recurred with a CFT of 507 µm. The patient was treated with an additional dose of intravitreal aflibercept injection. The ME resolved and the logarithmic BCVA in the right eye was maintained at -0.79. This case indicates a possible association between vaccination against SARS-CoV-2 and recurrence of ME due to BRVO.
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Affiliation(s)
- Tetsuya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
- Imaizumi Eye Hospital, Koriyama, Japan
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | | | - Koju Kamoi
- Imaizumi Eye Hospital, Koriyama, Japan
- Department of Ophthalmology and Visual Science, Tokyo Medical Dental University, Tokyo, Japan
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Karkala A, Tzinas A, Kotoulas S, Zacharias A, Sourla E, Pataka A. Neuropsychiatric Outcomes and Sleep Dysfunction in COVID-19 Patients: Risk Factors and Mechanisms. Neuroimmunomodulation 2023; 30:237-249. [PMID: 37757765 DOI: 10.1159/000533722] [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: 04/12/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.
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Affiliation(s)
- Aliki Karkala
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Tzinas
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Zacharias
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdokia Sourla
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki and Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ghasemi P, Shirvani H, Shamsoddini A. Effect of four-week home-based exercise program on immune response, fat and muscle mass in subjects recovered from COVID-19. Horm Mol Biol Clin Investig 2023; 44:329-336. [PMID: 36869869 DOI: 10.1515/hmbci-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES A rehabilitation program for patients with COVID-19 may be required to improve related side effects. This study aimed to investigate the effect of a four-week home workout on body composition and serum levels of IL-6 and cortisol in men recovering from COVID-19. METHODS The present study is quasi-experimental. To this end, 45 healthy individuals in Tehran were purposefully divided into three groups: those who recovered after COVID-19 (n=30), including two groups of exercise and non-exercise, and individuals who did not have COVID-19 (control) (15=n). The four-week training program included three days of training per week with Traband resistance stretches, weight body training, and cardio exercises. The smirnov-Kolmogorov test was employed for data normality. A one-way analysis of variance test will be used to compare both the mean of variables in groups and the mean of variables before and after the exercise, correlated t-test was employed at a significance level of 0.05. RESULTS The results showed that serum levels of interleukin 6 and cortisol were significantly reduced in the recovered training group (p=0.001) and the non-trained recovery group (p=0.001) and a significant difference was observed between the groups (p=0.001). Furthermore, only in the recovered training group, did the fat percentage (p=0.001) and muscle mass (p=0.001) respectively decreased and increased. CONCLUSIONS Four-week home training improves body composition by reducing body fat percentage and increasing muscle mass. In addition, lowering interleukin-6 and cortisol leads to reduced inflammation, faster recovery, and increased immunity.
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Affiliation(s)
- Peyman Ghasemi
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Shirvani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Shamsoddini
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Mulet A, Tarrasó J, Rodríguez-Borja E, Carbonell-Asins JA, Lope-Martínez A, Martí-Martinez A, Murria R, Safont B, Fernandez-Fabrellas E, Ros JA, Rodriguez-Portal JA, Andreu AL, Soriano JB, Signes-Costa J. Biomarkers of Fibrosis in Patients with COVID-19 One Year After Hospital Discharge: A Prospective Cohort Study. Am J Respir Cell Mol Biol 2023; 69:321-327. [PMID: 36848314 PMCID: PMC10503307 DOI: 10.1165/rcmb.2022-0474oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/24/2023] [Indexed: 03/01/2023] Open
Abstract
Beyond the acute infection of coronavirus disease (COVID-19), concern has arisen about long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of our study was to analyze if there is any biomarker of fibrogenesis in patients with COVID-19 pneumonia capable of predicting post-COVID-19 pulmonary sequelae. We conducted a multicenter, prospective, observational cohort study of patients admitted to a hospital with bilateral COVID-19 pneumonia. We classified patients into two groups according to severity, and blood sampling to measure matrix metalloproteinase 1 (MMP-1), MMP-7, periostin, and VEGF and respiratory function tests and high-resolution computed tomography were performed at 2 and 12 months after hospital discharge. A total of 135 patients were evaluated at 12 months. Their median age was 61 (interquartile range, 19) years, and 58.5% were men. We found between-group differences in age, radiological involvement, length of hospital stay, and inflammatory laboratory parameters. Differences were found between 2 and 12 months in all functional tests, including improvements in predicted forced vital capacity (98.0% vs. 103.9%; P = 0.001) and DlCO <80% (60.9% vs. 39.7%; P = 0.001). At 12 months, 63% of patients had complete high-resolution computed tomography resolution, but fibrotic changes persisted in 29.4%. Biomarker analysis demonstrated differences at 2 months in periostin (0.8893 vs. 1.437 ng/ml; P < 0.001) and MMP-7 (8.7249 vs. 15.2181 ng/ml; P < 0.001). No differences were found at 12 months. In multivariable analysis, only 2-month periostin was associated with 12-month fibrotic changes (odds ratio, 1.0013; 95% confidence interval, 1.0006-1.00231; P = 0.003) and 12-month DlCO impairment (odds ratio, 1.0006; 95% confidence interval, 1.0000-1.0013; P = 0.047). Our data suggest that early periostin postdischarge could predict the presence of fibrotic pulmonary changes.
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Affiliation(s)
- Alba Mulet
- Pulmonary Department, Hospital Clínico, and
| | | | - Enrique Rodríguez-Borja
- Laboratory of Biochemistry and Molecular Pathology, Hospital Clínico de Valencia, Valencia, Spain
| | | | - Amaia Lope-Martínez
- Laboratory of Biochemistry and Molecular Pathology, Hospital Clínico de Valencia, Valencia, Spain
| | - Arancha Martí-Martinez
- Laboratory of Biochemistry and Molecular Pathology, Hospital Clínico de Valencia, Valencia, Spain
| | - Rosa Murria
- Laboratory of Biochemistry and Molecular Pathology, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | - José A. Ros
- Pulmonary Department, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Ada L. Andreu
- Pulmonary Department, Hospital los Arcos del Mar Menor, Murcia, Spain; and
| | - Joan B. Soriano
- Pulmonary Department, Hospital de La Princesa, Universidad Autónoma, Madrid, Spain
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Alhowaish TS, Alhamadh MS, Mathkour A, Alamoudi M, Alqahtani HA, Alrashid A. Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience. Open Access Rheumatol 2023; 15:145-159. [PMID: 37663367 PMCID: PMC10473421 DOI: 10.2147/oarrr.s424316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Patients receiving rituximab (RTX) may be at increased risk for severe Coronavirus infections and worse outcomes compared with the general population. Because of the conflicting results concerning the effect of RTX on the clinical course and outcomes of COVID-19 infection, we aimed to share our experience with 35 patients infected with COVID-19 while treated with RTX for a variety of clinical indications. Methods This was a single-centre retrospective cohort study that included 35 patients. All patients aged ≥14 years who were treated with RTX for various conditions and were found to have COVID-19 infection were included. Patients with poor outcomes or patients with suspected COVID-19 infection were excluded. Results The patients' mean age was 42.8 ± 16.3 years with an average BMI of 29.9 ± 11.4 kg/m2. Over half (51.4%, n = 18) of the patients received RTX at a dose of 375 mg/m2 with a median frequency of 4 doses. More than a third (37.1%, n = 13) of the patients had hypogammaglobulinemia and 25.7% had low CD19. Over a third (42.9%, n= 15) of the patients required hospitalization and almost a third (25.7%, n = 9) required treatment in the intensive care unit. There was a statistically significant association between intensive care unit admission and age, steroid use, and low CD19. The mortality rate was 25.7%, and it was significantly higher in elderly, diabetics, corticosteroid users, patients who were hospitalized, treated in the intensive care unit, and had low immunoglobin or CD19. Conclusion Treatment with RTX seems to be a potential risk factor for unfavorable outcomes in COVID-19 patients. RTX should be used with caution or avoided unless the benefit clearly outweighs the risk.
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Affiliation(s)
- Thamer S Alhowaish
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Moustafa S Alhamadh
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Alaa Mathkour
- Ministry of Health, Riyadh, 12613, Kingdom of Saudi Arabia
| | - Marwan Alamoudi
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hossam Ali Alqahtani
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Abdulrahman Alrashid
- King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
- Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
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Maity S, Santra A, Vardhan Hebbani A, Pulakuntla S, Chatterjee A, Rao Badri K, Damodara Reddy V. Targeting cytokine storm as the potential anti-viral therapy: Implications in regulating SARS-CoV-2 pathogenicity. Gene 2023:147612. [PMID: 37423400 DOI: 10.1016/j.gene.2023.147612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The latest global pandemic corona virus disease - 2019 (COVID-19) caused by the virus SARS-CoV-2 is still a matter of worrying concern both for the scientific communities and health care organizations. COVID-19 disease is proved to be a highly contagious disease transmitted through respiratory droplets and even close contact with affected individuals. COVID-19 disease is also understood to exhibit diverse symptoms of ranging severities i.e., from mild fatigue to death. Affected individuals' susceptibility to induce immunologic dysregulation phenomena termed 'cytokine storm' seems to be playing the damaging role of escalating the disease manifestation from mild to severe. Cytokine storm in patients with severe symptoms is understood to be characterized by enhanced serum levels of many cytokines including interleukin-1β, interleukin-6, IL-10, TNF, interferon-γ, MIP-1α, MIP-1β and VEGF. Since cytokine production in general is the most important antiviral defense response, understanding the COVID-19 associated cytokine storm in particular and differentiating it from the regular cytokine production response becomes crucial in developing an effective therapeutic strategy.This review focuses on the potential targeting of COVID-19 associated cytokine storm and its challenges.
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Affiliation(s)
- Subashish Maity
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Ayantika Santra
- Department of Biochemistry, Indian Academy Degree College, Bengaluru, 560 043, India
| | | | - Swetha Pulakuntla
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Ankita Chatterjee
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Kameswara Rao Badri
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Morehouse School of Medicine, GA, Atlanta-30310, USA; Clinical Analytical Chemistry Laboratory, COVID-19 Testing Laboratory, Morehouse School of Medicine, GA, Atlanta-30310, USA.
| | - Vaddi Damodara Reddy
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India.
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12
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Yousefi P, Soltani S, Siri G, Rezayat SA, Gholami A, Zafarani A, Razizadeh MH, Alborzi E, Mokhtary‐Irani G, Abedi B, Karampoor S, Tabibzadeh A, Farahani A. Coagulopathy and thromboembolic events a pathogenic mechanism of COVID-19 associated with mortality: An updated review. J Clin Lab Anal 2023; 37:e24941. [PMID: 37431777 PMCID: PMC10431412 DOI: 10.1002/jcla.24941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
During 2019, the SARS-CoV-2 emerged from China, and during months, COVID-19 spread in many countries around the world. The expanding data about pathogenesis of this virus could elucidate the exact mechanism by which COVID-19 caused death in humans. One of the pathogenic mechanisms of this disease is coagulation. Coagulation disorders that affect both venous and arterial systems occur in patients with COVID-19. The possible mechanism involved in the coagulation could be excessive inflammation induced by SARS-CoV-2. However, it is not yet clear well how SARS-CoV-2 promotes coagulopathy. However, some factors, such as pulmonary endothelial cell damage and some anticoagulant system disorders, are assumed to have an important role. In this study, we assessed conducted studies about COVID-19-induced coagulopathy to obtain clearer vision of the wide range of manifestations and possible pathogenesis mechanisms.
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Affiliation(s)
- Parastoo Yousefi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Saber Soltani
- Department of Virology, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Sara Akhavan Rezayat
- Department of Health Care Management and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Ali Gholami
- School of MedicineArak University of Medical SciencesArakIran
| | - Alireza Zafarani
- Department of Hematology and Blood Banking, Faculty of Allied MedicineIran University of Medical SciencesTehranIran
| | | | - Ehsan Alborzi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Golnaz Mokhtary‐Irani
- Department of Virology, Faculty of MedicineAhvaz Jondishapur University of Medical SciencesAhvazIran
| | - Behnam Abedi
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
| | - Sajad Karampoor
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
- Gastrointestinal and Liver Diseases Research CenterIran University of Medical SciencesTehranIran
| | - Alireza Tabibzadeh
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Abbas Farahani
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
- Molecular and Medicine Research CenterKhomein University of Medical SciencesKhomeinIran
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13
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Shevchuk O, Palii S, Pak A, Chantada N, Seoane N, Korda M, Campos-Toimil M, Álvarez E. Vessel-on-a-Chip: A Powerful Tool for Investigating Endothelial COVID-19 Fingerprints. Cells 2023; 12:cells12091297. [PMID: 37174696 PMCID: PMC10177552 DOI: 10.3390/cells12091297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Coronavirus disease (COVID-19) causes various vascular and blood-related reactions, including exacerbated responses. The role of endothelial cells in this acute response is remarkable and may remain important beyond the acute phase. As we move into a post-COVID-19 era (where most people have been or will be infected by the SARS-CoV-2 virus), it is crucial to define the vascular consequences of COVID-19, including the long-term effects on the cardiovascular system. Research is needed to determine whether chronic endothelial dysfunction following COVID-19 could lead to an increased risk of cardiovascular and thrombotic events. Endothelial dysfunction could also serve as a diagnostic and therapeutic target for post-COVID-19. This review covers these topics and examines the potential of emerging vessel-on-a-chip technology to address these needs. Vessel-on-a-chip would allow for the study of COVID-19 pathophysiology in endothelial cells, including the analysis of SARS-CoV-2 interactions with endothelial function, leukocyte recruitment, and platelet activation. "Personalization" could be implemented in the models through induced pluripotent stem cells, patient-specific characteristics, or genetic modified cells. Adaptation for massive testing under standardized protocols is now possible, so the chips could be incorporated for the personalized follow-up of the disease or its sequalae (long COVID) and for the research of new drugs against COVID-19.
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Affiliation(s)
- Oksana Shevchuk
- Department of Pharmacology and Clinical Pharmacology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Svitlana Palii
- Department of Pharmacology and Clinical Pharmacology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Anastasiia Pak
- Department of Medical Biochemistry, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Nuria Chantada
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Nuria Seoane
- Physiology and Pharmacology of Chronic Diseases (FIFAEC) Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Mykhaylo Korda
- Department of Medical Biochemistry, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Manuel Campos-Toimil
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Physiology and Pharmacology of Chronic Diseases (FIFAEC) Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Ezequiel Álvarez
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, 28220 Madrid, Spain
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14
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Marquès M, Iftimie S, Camps J, Joven J, Domingo JL. The concentrations of essential/toxic elements in serum of COVID-19 patients are not directly related to the severity of the disease. J Trace Elem Med Biol 2023; 78:127160. [PMID: 36996642 PMCID: PMC10044018 DOI: 10.1016/j.jtemb.2023.127160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND In recent months, the current COVID-19 pandemic has generated thousands of studies directly or indirectly related with this disease and/or the coronavirus SARS-CoV-2 causing the infection. On August 22, 2022, the database PUBMED included 287,639 publications containing the term COVID-19. However, in spite of the importance of trace elements in human health, including the immune system, data on the levels of metals/metalloids in COVID-19 patients is very limited. METHODS The concentrations of As, Cd, Cr, Cu, Hg, Fe, Mg, Mn, Pb, Se, V and Zn were determined by inductively coupled plasma-mass spectrometry (ICP-MS) in 126 serum samples of individuals infected with SARS-CoV-2, as well as in 88 samples of non-infected individuals. Participants were divided into four groups: i) individuals COVID-19 positive (COVID-19 +) with an asymptomatic infection course; ii) individuals suffering mild COVID-19; iii) individuals suffering severe COVID-19, and iv) individuals COVID-19 negative (COVID-19-) (control group). The occurrence of the analyzed metals/metalloids was evaluated along with the biochemical profile, including blood cell counts, lipids, proteins and crucial enzymes. RESULTS Serum levels of Mg, V, Cr, Cu, Cd, and Pb were higher in COVID-19 positive patients than those in the control group. Although no significant differences were observed between the different groups of patients, the concentrations of Cd, Pb, V and Zn showed a tendency to be higher in individuals with severe COVID-19 than in those showing mild symptoms or being asymptomatic. Arsenic and Hg were rarely detected, regardless if the subjects were infected by SARS-CoV-2, or not. The current results did not show significant differences in the levels of the rest of analyzed elements according to the severity of the disease (asymptomatic, mild and severe). CONCLUSIONS In spite of the results here obtained, we highlight the need to reduce the exposure to Cd, Pb and V to minimize the potential adverse health outcomes after COVID-19 infection. On the other hand, although a protective role of essential elements was not found, Mg and Cu concentrations were higher in severe COVID-19 patients than in non-infected individuals.
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Affiliation(s)
- Montse Marquès
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, 43201 Reus, Spain; Center of Environmental, Food and Toxicological Technology - TecnATox, Universitat Rovira i Virgili, Spain
| | - Simona Iftimie
- Universitat Rovira i Virgili, Department of Internal Medicine, Hospital Universitari de Sant Joan, IISPV, 43204 Reus, Spain
| | - Jordi Camps
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, 43201 Reus, Spain
| | - Jorge Joven
- Universitat Rovira i Virgili, Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, 43201 Reus, Spain
| | - José L Domingo
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, 43201 Reus, Spain; Center of Environmental, Food and Toxicological Technology - TecnATox, Universitat Rovira i Virgili, Spain.
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15
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Tepebaşı MY, İlhan İ, Temel EN, Sancer O, Öztürk Ö. Investigation of inflammation, oxidative stress, and DNA damage in COVID-19 patients. Cell Stress Chaperones 2023; 28:191-199. [PMID: 36797451 PMCID: PMC9936118 DOI: 10.1007/s12192-023-01330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/11/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
COVID-19 disease, which spreads worldwide, is a disease characterized by widespread inflammation and affects many organs, especially the lungs. The resulting inflammation can lead to reactive oxygen radicals, leading to oxidative DNA damage. The pneumonia severity of 95 hospitalized patients with positive RT-PCR test was determined and divided into three groups: mild, moderate, and severe/critical. Inflammation markers (neutrophil-lymphocyte ratio, serum reactive protein, procalcitonin, etc.) were determined, and IL-10 and IFN-γ measurements were analyzed using the enzyme-linked immunosorbent assay method. In evaluating oxidative damage, total thiol, native thiol, disulfide, and ischemia-modified albumin (IMA) levels were determined by measuring spectrophotometrically. The comet assay method's percentage of tail DNA obtained was used to determine oxidative DNA damage. As a result, when the mild and severe/critical groups were compared, we found that total thiol, native thiol, and disulfide levels decreased significantly in the severe/critical group due to the increase in inflammation markers and cytokine levels (p < 0.05). We could not detect any significance in IMA levels between the groups (p > 0.05). At the same time, we determined an increase in the tail DNA percent level, that is, DNA damage, due to the increased oxidative effect. As a result, we determined that inflammation and oxidative stress increased in patients with severe pneumonia, and there was DNA damage in these patients.
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Affiliation(s)
| | - İlter İlhan
- Department of Biochemistry, University of Süleyman Demirel, Isparta, Turkey
| | - Esra Nurlu Temel
- Department of Infectious Diseases, University of Süleyman Demirel, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology, University of Süleyman Demirel, Isparta, Turkey
| | - Önder Öztürk
- Department of Chest Diseases, University of Süleyman Demirel, Isparta, Turkey
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16
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Isnardi CA, Soriano ER, Graf C, de la Vega MC, Pons-Estel BA, Roberts K, Quintana R, Gomez G, Yazdany J, Saurit V, Báez RM, Coello VVC, Pisoni CN, Berbotto G, Vivero F, Zelaya MD, Haye Salinas MJ, Reyes Torres ÁA, Ornella S, Nieto RE, Maldonado FN, Gamba MJ, Severina MDLÁ, Tissera Y, Alba P, Cogo AK, Alle G, Gobbi C, Baños A, Velozo E, Pera M, Tanten R, Albiero JA, Maldonado Ficco H, Martire MV, Elkin MSG, Cosatti M, Cusa MA, Pereira D, Savio VG, Pons-Estel GJ. Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry). J Clin Rheumatol 2023; 29:68-77. [PMID: 36454054 PMCID: PMC9940788 DOI: 10.1097/rhu.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND/OBJECTIVE This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs). METHODS Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out. RESULTS A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06). CONCLUSIONS SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs. STUDY REGISTRATION This study has been registered in ClinicalTrials.gov under the number NCT04568421.
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Affiliation(s)
| | | | - Cesar Graf
- Argentine Society of Rheumatology, Argentina
| | | | | | | | | | | | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | | | | | | | - Cecilia Nora Pisoni
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | - Guillermo Berbotto
- Hospital Escuela Eva Perón, Granadero Baigorria
- Sanatorio Británico, Chief of the Rheumatology Service, Rosario, Santa Fe
| | | | | | | | | | | | - Romina Estefanía Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Argentina
- Hospital Escuela Eva Perón, Granadero Baigorria
- Hospital Intendente Carrasco, Rosario, Santa Fe
| | | | | | | | | | - Paula Alba
- Hospital Córdoba, Córdoba
- Hospital Materno-Neonatal
- Hospital Italiano de Córdoba, Córdoba, Córdoba
| | - Adriana Karina Cogo
- Hospital Interzonal Luis Guemes, Haedo
- Hospital San Juan de Dios, Castelar, Buenos Aires
| | - Gelsomina Alle
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | - Carla Gobbi
- Cátedra de Clínica Médica I, Hospital Córdoba, FCM, UNC, Córdoba, Córdoba
| | - Andrea Baños
- Fundación CIDEA, Ciudad Autónoma de Buenos Aires
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Edson Velozo
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Mariana Pera
- Hospital Ángel C Padilla, San Miguel de Tucumán, Tucumán
| | - Romina Tanten
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | | | | | | | | | - Micaela Cosatti
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | | | | | - Verónica G. Savio
- Hospital Córdoba, Córdoba
- Consultora Integral de Salud CMP, Córdoba, Córdoba
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COVID-19: Mechanisms, risk factors, genetics, non-coding RNAs and neurologic impairments. Noncoding RNA Res 2023; 8:240-254. [PMID: 36852336 PMCID: PMC9946734 DOI: 10.1016/j.ncrna.2023.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
The novel coronavirus infection (COVID-19) causes a severe acute illness with the development of respiratory distress syndrome in some cases. COVID-19 is a global problem of mankind to this day. Among its most important aspects that require in-depth study are pathogenesis and molecular changes in severe forms of the disease. A lot of literature data is devoted to the pathogenetic mechanisms of COVID-19. Without dwelling in detail on some paths of pathogenesis discussed, we note that at present there are many factors of development and progression. Among them, this is the direct role of both viral non-coding RNAs (ncRNAs) and host ncRNAs. One such class of ncRNAs that has been extensively studied in COVID-19 is microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). Moreover, Initially, it was believed that this COVID-19 was limited to damage to the respiratory system. It has now become clear that COVID-19 affects not only the liver and kidneys, but also the nervous system. In this review, we summarized the current knowledge of mechanisms, risk factors, genetics and neurologic impairments in COVID-19. In addition, we discuss and evaluate evidence demonstrating the involvement of miRNAs and lnRNAs in COVID-19 and use this information to propose hypotheses for future research directions.
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18
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Autoimmune complications of COVID-19 and potential consequences for long-lasting disease syndromes. Transfus Apher Sci 2023; 62:103625. [PMID: 36585276 PMCID: PMC9757887 DOI: 10.1016/j.transci.2022.103625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The latest WHO report determined the increasing diversity within the CoV-2 omicron and its descendent lineages. Some heavily mutated offshoots of BA.5 and BA.2, such as BA.4.6, BF.7, BQ.1.1, and BA.2.75, are responsible for about 20% of infections and are spreading rapidly in multiple countries. It is a sign that Omicron subvariants are now developing a capacity to be more immune escaping and may contribute to a new wave of COVID-19. Covid-19 infections often induce many alterations in human physiological defense and the natural control systems, with exacerbated activation of the inflammatory and homeostatic response, as for any infectious diseases. Severe activation of the early phase of hemostatic components, often occurs, leading to thrombotic complications and often contributing to a lethal outcome selectively in certain populations. Development of autoimmune complications increases the disease burden and lowers its prognosis. While the true mechanism still remains unclear, it is believed to mainly be related to the host autoimmune responses as demonstrated, only in some patients suffering from the presence of autoantibodies that worsens the disease evolution. In fact in some studies the development of autoantibodies to angiotensin converting enzyme 2 (ACE2) was identified, and in other studies autoantibodies, thought to be targeting interferon or binding to annexin A1, or autoantibodies to phospholipids were seen. Moreover, the occurrence of autoimmune heparin induced thrombocytopenia has also been described in infected patients treated with heparin for controlling thrombogenicity. This commentary focuses on the presence of various autoantibodies reported so far in Covid-19 diseases, exploring their association with the disease course and the durability of some related symptoms. Attempts are also made to further analyze the potential mechanism of actions and link the presence of antibodies with pathological complications.
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19
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El Hennawy HM, Safar O, Elatreisy A, Al Faifi AS, Shalkamy O, Hadi SA, Alqahtani M, Alkahtani SA, Alqahtani FS, El Nazer W, Al Atta E, Ibrahim AT, Abdelaziz AA, Mirza N, Mahedy A, Tom NM, Assiri Y, Al Fageeh A, Elgamal G, Al Shehri AA, Zaitoun MF. The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience. Transplant Proc 2023; 55:521-529. [PMID: 36681582 PMCID: PMC9826984 DOI: 10.1016/j.transproceed.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/27/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. METHODS A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. RESULTS Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. CONCLUSIONS Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia,Address correspondence to Hany M El Hennawy, MD, Department of Surgery, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, 101, KSA
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Osama Shalkamy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sara Abdullah Hadi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mofareh Alqahtani
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Sultan Ahmad Alkahtani
- Pathology and Laboratory Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Faisal Saeed Alqahtani
- Adult Infectious Diseases Section, Internal Medicine Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Asad Taha Ibrahim
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Abdelaziz a Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Nayana Mary Tom
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Yahya Assiri
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Galal Elgamal
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali Amer Al Shehri
- Adult Infectious Diseases Section, Internal Medicine Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
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20
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Escudero-Pérez B, Lawrence P, Castillo-Olivares J. Immune correlates of protection for SARS-CoV-2, Ebola and Nipah virus infection. Front Immunol 2023; 14:1156758. [PMID: 37153606 PMCID: PMC10158532 DOI: 10.3389/fimmu.2023.1156758] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Correlates of protection (CoP) are biological parameters that predict a certain level of protection against an infectious disease. Well-established correlates of protection facilitate the development and licensing of vaccines by assessing protective efficacy without the need to expose clinical trial participants to the infectious agent against which the vaccine aims to protect. Despite the fact that viruses have many features in common, correlates of protection can vary considerably amongst the same virus family and even amongst a same virus depending on the infection phase that is under consideration. Moreover, the complex interplay between the various immune cell populations that interact during infection and the high degree of genetic variation of certain pathogens, renders the identification of immune correlates of protection difficult. Some emerging and re-emerging viruses of high consequence for public health such as SARS-CoV-2, Nipah virus (NiV) and Ebola virus (EBOV) are especially challenging with regards to the identification of CoP since these pathogens have been shown to dysregulate the immune response during infection. Whereas, virus neutralising antibodies and polyfunctional T-cell responses have been shown to correlate with certain levels of protection against SARS-CoV-2, EBOV and NiV, other effector mechanisms of immunity play important roles in shaping the immune response against these pathogens, which in turn might serve as alternative correlates of protection. This review describes the different components of the adaptive and innate immune system that are activated during SARS-CoV-2, EBOV and NiV infections and that may contribute to protection and virus clearance. Overall, we highlight the immune signatures that are associated with protection against these pathogens in humans and could be used as CoP.
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Affiliation(s)
- Beatriz Escudero-Pérez
- WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Reims, Braunschweig, Germany
- *Correspondence: Beatriz Escudero-Pérez, ; Javier Castillo-Olivares,
| | - Philip Lawrence
- CONFLUENCE: Sciences et Humanités (EA 1598), Université Catholique de Lyon (UCLy), Lyon, France
| | - Javier Castillo-Olivares
- Laboratory of Viral Zoonotics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Beatriz Escudero-Pérez, ; Javier Castillo-Olivares,
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21
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Mehboob R, Oehme P, Pfaff G. The role of Substance P in the defense line of the respiratory tract and neurological manifestations post COVID-19 infection. Front Neurol 2023; 14:1052811. [PMID: 36949854 PMCID: PMC10025330 DOI: 10.3389/fneur.2023.1052811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Substance P (SP) has been a great interest for scientists due to its unique properties and involvement in various physiological and pathological phenomenon. It took almost a century for the current understanding of this peptide so far. Its role in brain and gut were initially discussed and later on it was widely studied and observed in cardiovascular system, asthma, traumatic brain injury, immune response, vasodilation, behavior, inflammation, arthritis, cancer, airway hyper responsiveness and respiratory disorders. Involvement of SP in sudden perinatal death and COVID-19 has also been discussed which shed light on its vital role in respiratory rhythm regulation and initiation of cytokine storming in COVID-19. This article will provide a comprehensive overview of the researches done to understand the basic functions and involvement of SP in different processes of cell and its association with various diseases. This article describes the historical and scientific journey of SP from its discovery until today, including its future perspectives.
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Affiliation(s)
- Riffat Mehboob
- Lahore Medical Research Center and LMRC Laboratories, LLP, Lahore, Pakistan
- *Correspondence: Riffat Mehboob
| | | | - Gerhard Pfaff
- Department of Chemistry, Technical University Darmstadt, Darmstadt, Germany
- Gerhard Pfaff
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22
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Rebić N, Park JY, Garg R, Ellis U, Kelly A, Davidson E, De Vera MA. Rapid Review of Medication Taking (Adherence) Among Patients With Rheumatic Diseases During the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2022; 74:1961-1969. [PMID: 34219400 PMCID: PMC8426729 DOI: 10.1002/acr.24744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to identify, appraise, synthesize, and contextualize rapidly emerging reports on medication taking (adherence) among patients with rheumatic diseases during the COVID-19 pandemic. METHODS We searched MEDLINE, EMBASE, and CINAHL for peer-reviewed communications, letters, and articles published during the COVID-19 pandemic evaluating medication taking among individuals with rheumatic diseases. We appraised assessment and reporting of medication adherence according to established definitions of 3 distinct problems of medication taking (i.e., noninitiation, poor implementation, and discontinuation) and pooled findings using random-effects models. RESULTS We included 31 peer-reviewed studies in our synthesis from various jurisdictions, of which 25 described medication taking among rheumatology patients and 6 described medication prescribing among rheumatology providers. The pooled prevalence of overall medication nonadherence was 14.8% (95% confidence interval [95% CI] 12.3-17.2) and that of medication discontinuation (i.e., stopping of prescriptions) and poor implementation (i.e., not taking medication at the dose/frequency prescribed) as 9.5% (95% CI 5.1-14.0) and 9.6% (95% CI 6.2-13.0), respectively. Noninitiation (i.e., not starting/not filling new prescriptions) was not addressed. CONCLUSION Medication taking among individuals with rheumatic diseases during the COVID-19 pandemic varies globally. Unclear reporting and extensive variation in research methods between studies create barriers to research replication, comparison, and generalization to specific patient populations. Future research in this area should use consistent and transparent approaches to defining and measuring medication taking problems to ensure that findings appropriately describe the epidemiology of medication adherence and have the potential to identify modifiable targets for improving patient care.
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Affiliation(s)
- Nevena Rebić
- University of British Columbia and Collaboration for Outcomes Research and Evaluation, Vancouver, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Jamie Y. Park
- University of British Columbia and Collaboration for Outcomes Research and EvaluationVancouverBritish ColumbiaCanada
| | - Ria Garg
- University of British Columbia and Collaboration for Outcomes Research and EvaluationVancouverBritish ColumbiaCanada
| | - Ursula Ellis
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ayano Kelly
- Australian National University and Canberra Rheumatology, Canberra, ACT, and The Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | | | - Mary A. De Vera
- University of British Columbia and Collaboration for Outcomes Research and Evaluation, Vancouver, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
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23
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Molecular Function of cGAS-STING in SARS-CoV-2: A Novel Approach to COVID-19 Treatment. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6189254. [PMID: 36457340 PMCID: PMC9708357 DOI: 10.1155/2022/6189254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Coronavirus illness 2019 is a significant worldwide health danger that began with severe acute respiratory syndrome coronavirus two infections. It is the largest pandemic of our lifetime to date, affecting millions of people and crippling economies globally. There is currently no viable therapy for this devastating condition. The fast spread of SARS-CoV-2 underlines the critical need for favorable treatments to prevent SARS-CoV-2 infection and dissemination. Regulating the upstream cytokine release might be a possible method for COVID-19 therapy. We propose that more consideration be paid to the dysregulated IFN-I release in COVID-19 and that cGAS and STING be considered therapeutic targets for avoiding cytokine storms and as critical components in host antiviral defense mechanisms.
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24
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Signore A, Lauri C, Bianchi MP, Pelliccia S, Lenza A, Tetti S, Martini ML, Franchi G, Trapasso F, De Biase L, Aceti A, Tafuri A. [ 18F]FDG PET/CT in Patients Affected by SARS-CoV-2 and Lymphoproliferative Disorders and Treated with Tocilizumab. J Pers Med 2022; 12:jpm12111839. [PMID: 36579547 PMCID: PMC9692335 DOI: 10.3390/jpm12111839] [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: 09/02/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Interstitial pneumonia is a severe complication induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several treatments have been proposed alone or, more often, in combination, depending, also, on the presence of other organ disfunction. The most frequently related, well-described, and associated phenomenon is pan-lymphopenia with circulating, high levels of cytokines. We report, here, on two patients with COVID-19 and lymphoproliferative disorders treated with Tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor) and followed by an [18F]FDG PET/CT to early evaluate the therapy's efficacy. METHODS One patient with angioimmunoblastic T-lymphoma (A), one with Hodgkin lymphoma (A), and both with positive RT-PCR for SARS-CoV-2 and with similar clinical findings of interstitial pneumonia at the CT scan, were imaged by [18F]FDG PET/CT before and 14 days after a single dose of Tocilizumab. RESULTS In both patients, the basal [18F]FDG PET/CT showed a diffused lung parenchyma uptake, corresponding to the hyperdense areas at the CT scan. After 2 weeks of a Tocilizumab infusion, patient B had an improvement of symptoms, with normalization of the [18F]FDG uptake. By contrast, patient A, who was still symptomatic, showed a persisting and abnormal distribution of [18F]FDG. Interestingly, both patients showed a low bone marrow uptake of [18F]FDG at the diagnosis and after 15 days, while the spleen uptake was low only in lymphopenic patient A; both are indirect signs of an immune deficiency. CONCLUSIONS In conclusion, in these two patients, interstitial pneumonia was efficiently treated with Tocilizumab, as demonstrated by the [18F]FDG PET/CT. Our results confirm that interleukin-6 (IL6) has a role in the COVID-19 disease and that anti-cytokine treatment can also be performed in patients with lymphoproliferative disorders.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Paola Bianchi
- Haematology, “Sant’Andrea” University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Sabrina Pelliccia
- Haematology, “Sant’Andrea” University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Andrea Lenza
- Nuclear Medicine Unit, AOU Sant’Andrea, 00189 Rome, Italy
| | - Simone Tetti
- Nuclear Medicine Unit, AOU Sant’Andrea, 00189 Rome, Italy
| | | | | | - Fabio Trapasso
- Nuclear Medicine Unit, AOU Sant’Andrea, 00189 Rome, Italy
| | - Luciano De Biase
- Heart Failure Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Aceti
- Infection Unit, Department NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Agostino Tafuri
- Haematology, “Sant’Andrea” University Hospital, Sapienza University of Rome, 00189 Rome, Italy
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25
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Lee H, Thein OS, Muneer T. De novo pancytopaenia in an older adult with severe COVID-19 infection. BMJ Case Rep 2022; 15:15/11/e252609. [PMID: 36379633 PMCID: PMC9668033 DOI: 10.1136/bcr-2022-252609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During the COVID-19 pandemic, it was recognised that SARS-CoV-2 can cause multisystem illness. Non-respiratory complications observed early in the pandemic were haematological in nature. A rare but serious haematological complication of COVID-19 infection is pancytopaenia. We describe a case of an older adult without pre-existing haematological disease or risk factors for cell dyscrasia with severe pancytopaenia induced by COVID-19, who developed critical illness requiring respiratory support in intensive care and died. Our case report highlights that de novo pancytopaenia may only present with mild dermatological manifestations and may indicate severe COVID-19 infection. Management is primarily supportive and early involvement of haematology should be sought.
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Affiliation(s)
- Helena Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Geriatric Medicine, Walsall Manor Hospital, Walsall, UK
| | - Onn Shaun Thein
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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26
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Casillas N, Torres AM, Moret M, Gómez A, Rius-Peris JM, Mateo J. Mortality predictors in patients with COVID-19 pneumonia: a machine learning approach using eXtreme Gradient Boosting model. Intern Emerg Med 2022; 17:1929-1939. [PMID: 36098861 PMCID: PMC9469825 DOI: 10.1007/s11739-022-03033-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/12/2022] [Indexed: 12/15/2022]
Abstract
Recently, global health has seen an increase in demand for assistance as a result of the COVID-19 pandemic. This has prompted many researchers to conduct different studies looking for variables that are associated with increased clinical risk, and find effective and safe treatments. Many of these studies have been limited by presenting small samples and a large data set. Using machine learning (ML) techniques we can detect parameters that help us to improve clinical diagnosis, since they are a system for the detection, prediction and treatment of complex data. ML techniques can be valuable for the study of COVID-19, especially because they can uncover complex patterns in large data sets. This retrospective study of 150 hospitalized adult COVID-19 patients, of which we established two groups, those who died were called Case group (n = 53) while the survivors were Control group (n = 98). For analysis, a supervised learning algorithm eXtreme Gradient Boosting (XGBoost) has been used due to its good response compared to other methods because it is highly efficient, flexible and portable. In this study, the response to different treatments has been evaluated and has made it possible to accurately predict which patients have higher mortality using artificial intelligence, obtaining better results compared to other ML methods.
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Affiliation(s)
- N. Casillas
- Departament of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
- Neurobiological Research Group, Institute of Technology, Castilla-La Mancha University, Cuenca, Spain
| | - A. M. Torres
- Neurobiological Research Group, Institute of Technology, Castilla-La Mancha University, Cuenca, Spain
| | - M. Moret
- Departament of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
| | - A. Gómez
- Departament of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
| | - J. M. Rius-Peris
- Neurobiological Research Group, Institute of Technology, Castilla-La Mancha University, Cuenca, Spain
- Departament of Pediatrics, Hospital Virgen de la Luz, Cuenca, Spain
| | - J. Mateo
- Neurobiological Research Group, Institute of Technology, Castilla-La Mancha University, Cuenca, Spain
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27
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Rarani FZ, Rashidi B, Jafari Najaf Abadi MH, Hamblin MR, Reza Hashemian SM, Mirzaei H. Cytokines and microRNAs in SARS-CoV-2: What do we know? MOLECULAR THERAPY. NUCLEIC ACIDS 2022; 29:219-242. [PMID: 35782361 PMCID: PMC9233348 DOI: 10.1016/j.omtn.2022.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic constitutes a global health emergency. Currently, there are no completely effective therapeutic medications for the management of this outbreak. The cytokine storm is a hyperinflammatory medical condition due to excessive and uncontrolled release of pro-inflammatory cytokines in patients suffering from severe COVID-19, leading to the development of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) and even mortality. Understanding the pathophysiology of COVID-19 can be helpful for the treatment of patients. Evidence suggests that the levels of tumor necrosis factor alpha (TNF-α) and interleukin (IL)-1 and IL-6 are dramatically different between mild and severe patients, so they may be important contributors to the cytokine storm. Several serum markers can be predictors for the cytokine storm. This review discusses the cytokines involved in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, focusing on interferons (IFNs) and ILs, and whether they can be used in COVID-19 treatment. Moreover, we highlight several microRNAs that are involved in these cytokines and their role in the cytokine storm caused by COVID-19.
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Affiliation(s)
- Fahimeh Zamani Rarani
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahman Rashidi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mirzaei
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran
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28
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Vakil MK, Mansoori Y, Al‐Awsi GRL, Hosseinipour A, Ahsant S, Ahmadi S, Ekrahi M, Montaseri Z, Pezeshki B, Mohaghegh P, Sohrabpour M, Bahmanyar M, Daraei A, Dadkhah Jouybari T, Tavassoli A, Ghasemian A. Individual genetic variability mainly of Proinflammatory cytokines, cytokine receptors, and toll-like receptors dictates pathophysiology of COVID-19 disease. J Med Virol 2022; 94:4088-4096. [PMID: 35538614 PMCID: PMC9348290 DOI: 10.1002/jmv.27849] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
Innate and acquired immunity responses are crucial for viral infection elimination. However, genetic variations in coding genes may exacerbate the inflammation or initiate devastating cytokine storms which poses severe respiratory conditions in coronavirus disease-19 (COVID-19). Host genetic variations in particular those related to the immune responses determine the patients' susceptibility and COVID-19 severity and pathophysiology. Gene polymorphisms such as single nucleotide polymorphisms (SNPs) of interferons, TNF, IL1, IL4, IL6, IL7, IL10, and IL17 predispose patients to the severe form of COVID-19 or severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). These variations mainly alter the gene expression and cause a severe response by B cells, T cells, monocytes, neutrophils, and natural killer cells participating in a cytokine storm. Moreover, cytokines and chemokines SNPs are associated with the severity of COVID-19 and clinical outcomes depending on the corresponding effect. Additionally, genetic variations in genes encoding toll-like receptors (TLRs) mainly TLR3, TLR7, and TLR9 have been related to the COVID-19 severe respiratory symptoms. The specific relation of these mutations with the novel variants of concern (VOCs) infection remains to be elucidated. Genetic variations mainly within genes encoding proinflammatory cytokines, cytokine receptors, and TLRs predispose patients to COVID-19 disease severity. Understanding host immune gene variations associated with the SARS-COV-2 infection opens insights to control the pathophysiology of emerging viral infections.
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Affiliation(s)
- Mohammad Kazem Vakil
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Yaser Mansoori
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Ghaidaa Raheem Lateef Al‐Awsi
- University of Al‐QadisiyahCollege of ScienceAl DiwaniyahIraq
- Department of Radiological TechniquesAl‐Mustaqbal University CollegeBabylonIraq
| | - Ali Hosseinipour
- Department of Internal MedicineFasa University of Medical SciencesFasaIran
| | - Samaneh Ahsant
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Sedigheh Ahmadi
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Mohammad Ekrahi
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Zahra Montaseri
- Department of Infectious DiseasesFasa University of Medical SciencesFasaIran
| | - Babak Pezeshki
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Poopak Mohaghegh
- Pediatrics Department, School of MedicineFasa University of Medical SciencesFasaIran
| | - Mojtaba Sohrabpour
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
| | - Maryam Bahmanyar
- Pediatrics Department, School of MedicineFasa University of Medical SciencesFasaIran
| | - Abdolreza Daraei
- Department of Medical Genetics, School of MedicineBabol University of Medical SciencesBabolIran
| | | | | | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research CenterFasa University of Medical SciencesFasaIran
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29
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Tappe B, Lauruschkat CD, Strobel L, Pantaleón García J, Kurzai O, Rebhan S, Kraus S, Pfeuffer-Jovic E, Bussemer L, Possler L, Held M, Hünniger K, Kniemeyer O, Schäuble S, Brakhage AA, Panagiotou G, White PL, Einsele H, Löffler J, Wurster S. COVID-19 patients share common, corticosteroid-independent features of impaired host immunity to pathogenic molds. Front Immunol 2022; 13:954985. [PMID: 36052094 PMCID: PMC9427195 DOI: 10.3389/fimmu.2022.954985] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
Patients suffering from coronavirus disease-2019 (COVID-19) are susceptible to deadly secondary fungal infections such as COVID-19-associated pulmonary aspergillosis and COVID-19-associated mucormycosis. Despite this clinical observation, direct experimental evidence for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-driven alterations of antifungal immunity is scarce. Using an ex-vivo whole blood stimulation assay, we challenged blood from twelve COVID-19 patients with Aspergillus fumigatus and Rhizopus arrhizus antigens and studied the expression of activation, maturation, and exhaustion markers, as well as cytokine secretion. Compared to healthy controls, T-helper cells from COVID-19 patients displayed increased expression levels of the exhaustion marker PD-1 and weakened A. fumigatus- and R. arrhizus-induced activation. While baseline secretion of proinflammatory cytokines was massively elevated, whole blood from COVID-19 patients elicited diminished release of T-cellular (e.g., IFN-γ, IL-2) and innate immune cell-derived (e.g., CXCL9, CXCL10) cytokines in response to A. fumigatus and R. arrhizus antigens. Additionally, samples from COVID-19 patients showed deficient granulocyte activation by mold antigens and reduced fungal killing capacity of neutrophils. These features of weakened anti-mold immune responses were largely decoupled from COVID-19 severity, the time elapsed since diagnosis of COVID-19, and recent corticosteroid uptake, suggesting that impaired anti-mold defense is a common denominator of the underlying SARS-CoV-2 infection. Taken together, these results expand our understanding of the immune predisposition to post-viral mold infections and could inform future studies of immunotherapeutic strategies to prevent and treat fungal superinfections in COVID-19 patients.
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Affiliation(s)
- Beeke Tappe
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Chris D. Lauruschkat
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Lea Strobel
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jezreel Pantaleón García
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Silke Rebhan
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Elena Pfeuffer-Jovic
- Department of Pulmonary Medicine, Missionsärztliche Klinik Würzburg, Würzburg, Germany
| | - Lydia Bussemer
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Lotte Possler
- Department of Internal Medicine, Main-Klinik Ochsenfurt, Würzburg, Germany
| | - Matthias Held
- Department of Pulmonary Medicine, Missionsärztliche Klinik Würzburg, Würzburg, Germany
| | - Kerstin Hünniger
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Olaf Kniemeyer
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Sascha Schäuble
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Axel A. Brakhage
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Friedrich Schiller University, Jena, Germany
| | - Gianni Panagiotou
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - P. Lewis White
- Public Health Wales, Microbiology Cardiff, Wales, United Kingdom
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
- *Correspondence: Jürgen Löffler, ; Sebastian Wurster,
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- *Correspondence: Jürgen Löffler, ; Sebastian Wurster,
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30
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Kalın S, Sözeri B. Radiological findings of multisystem inflammatory syndrome in children associated with COVID-19. Br J Radiol 2022; 95:20220101. [PMID: 35762341 PMCID: PMC10162047 DOI: 10.1259/bjr.20220101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the imaging and clinical findings of patients diagnosed with multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. METHODS The clinical, laboratory and radiological data of 110 patients (74 male and 36 female) diagnosed with COVID-19-related MIS-C between June 2020 and November 2021 were evaluated retrospectively. Cases with a diagnosis of MIS-C based on a positive real time polymerase chain reaction (RT-PCR) test or serology results according to the WHO criteria were included in the study. All the radiological data were evaluated by a pediatric radiologist with 14 years of radiology experience. RESULTS Peribronchial thickening and hyperinflation were the most common findings on chest X-ray, while atelectasis and pleural effusion were often present in thoracic CT. Cardiac involvement was detected in 30% of the patients, mainly with valve insufficiency and systolic dysfunction, and 7.2% of these patients had sequalae findings. The most common abdominal findings were hepatosplenomegaly, mesenteric inflammation, lymphadenomegaly, thickening of the intestinal walls and free fluid. 23 of the patients had comorbidities. Neurological radiological findings observed in a total of six patients were reversible splenial lesion syndrome, posterior reversible encephalopathy syndrome, meningitis, and cerebral edema. 37 patients were followed up in the intensive care unit and 2 of them died. CONCLUSION Radiological findings seen in MIS-C vary according to the affected system. There is no specific radiologic finding for this disease, but radiological findings can assist in the evaluation of affected systems and guide treatment. ADVANCES IN KNOWLEDGE Since there are few studies with a limited number of patients in the literature, data on this subject are limited. We aimed to contribute to the literature with our large patient data.
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Affiliation(s)
- Sevinç Kalın
- University of Health Sciences İstanbul Ümraniye Training and Research Hospital, Pediatric Radiology, İstanbul, Turkey
| | - Betül Sözeri
- University of Health Sciences İstanbul Ümraniye Training and Research Hospital, Pediatric Radiology, İstanbul, Turkey
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31
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Aryan H, Farahani RH, Chamanara M, Elyasi S, Jaafari MR, Haddad M, Sani AT, Ardalan MA, Mosaed R. Evaluation of the efficacy of oral nano-silymarin formulation in hospitalized patients with COVID-19: A double-blind placebo-controlled clinical trial. Phytother Res 2022; 36:3924-3931. [PMID: 35859298 PMCID: PMC9349546 DOI: 10.1002/ptr.7537] [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: 12/16/2021] [Revised: 04/20/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
Abstract
Considering the outbreak pandemic of Coronavirus Disease 2019 (COVID-19), the lack of effective therapeutic strategies for the management of this viral disease, and the increasing evidence on the antiviral potential of silymarin, this study aimed to investigate the effectiveness of silymarin nanomicelles on the symptom's resolution time, laboratory parameters, and liver enzymes in patients with COVID-19. The participants were assigned to the nano-silymarin (n = 25) (receiving SinaLive soft gel, containing 70 mg silymarin as nanomicelles) or placebo groups (n = 25) three times daily for two weeks. Patients' symptoms and laboratory findings were assessed at baseline and during the follow-up period (one week and one month after the beginning of the treatment). No significant differences were observed between the two groups in terms of symptoms resolution time, laboratory parameters, and hospitalization duration (p > 0.05). However, the alanine aminotransferase level decreased significantly in the treatment group, compared to the placebo group (p < 0.001). Concomitant use of dexamethasone and remdesivir with silymarin might make the effects of silymarin on the improvement of patients' condition unclear. Further clinical trials are recommended with diverse dosages and larger sample sizes.
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Affiliation(s)
- Hossein Aryan
- Department of Anesthesiology and Intensive Care, Aja University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Mohsen Chamanara
- Toxicology Research Center, Aja University of Medical Sciences, Tehran, Iran.,Department of Pharmacology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Jaafari
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Haddad
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashraf Tavanaee Sani
- Department of Infectious Diseases and Tropical medicine, Faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran
| | | | - Reza Mosaed
- Internal Medicine Department, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Favalli A, Favalli EG, Gobbini A, Zagato E, Bombaci M, Maioli G, Pesce E, Donnici L, Gruarin P, Biggioggero M, Curti S, Manganaro L, Marchisio E, Bevilacqua V, Martinovic M, Fabbris T, Sarnicola ML, Crosti M, Marongiu L, Granucci F, Notarbartolo S, Bandera A, Gori A, De Francesco R, Abrignani S, Caporali R, Grifantini R. Immunosuppressant Treatment in Rheumatic Musculoskeletal Diseases Does Not Inhibit Elicitation of Humoral Response to SARS-CoV-2 Infection and Preserves Effector Immune Cell Populations. Front Immunol 2022; 13:873195. [PMID: 35757699 PMCID: PMC9226581 DOI: 10.3389/fimmu.2022.873195] [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: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 has proven to be particularly serious and life-threatening for patients presenting with pre-existing pathologies. Patients affected by rheumatic musculoskeletal disease (RMD) are likely to have impaired immune responses against SARS-CoV-2 infection due to their compromised immune system and the prolonged use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) DMARDs or biologic and targeted synthetic (b/ts) DMARDs. To provide an integrated analysis of the immune response following SARS-CoV-2 infection in RMD patients treated with different classes of DMARDs we carried out an immunological analysis of the antibody responses toward SARS-CoV-2 nucleocapsid and RBD proteins and an extensive immunophenotypic analysis of the major immune cell populations. We showed that RMD individuals under most DMARD treatments mount a sustained antibody response to the virus, with neutralizing activity. In addition, they displayed a sizable percentage of effector T and B lymphocytes. Among b-DMARDs, we found that anti-TNFα treatments are more favorable drugs to elicit humoral and cellular immune responses as compared to CTLA4-Ig and anti-IL6R inhibitors. This study provides a whole picture of the humoral and cellular immune responses in RMD patients by reassuring the use of DMARD treatments during COVID-19. The study points to TNF-α inhibitors as those DMARDs permitting elicitation of functional antibodies to SARS-CoV-2 and adaptive effector populations available to counteract possible re-infections.
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Affiliation(s)
- Andrea Favalli
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Ph.D. Program in Translational and Molecular Medicine, Dottorato in Medicina Molecolare e Traslazionale (DIMET), University of Milan-Bicocca, Monza, Italy
| | - Ennio Giulio Favalli
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Andrea Gobbini
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Elena Zagato
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Bombaci
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Gabriella Maioli
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Elisa Pesce
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Lorena Donnici
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Paola Gruarin
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Martina Biggioggero
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Serena Curti
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Lara Manganaro
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | | | - Valeria Bevilacqua
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Martina Martinovic
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Tanya Fabbris
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Maria Lucia Sarnicola
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Mariacristina Crosti
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Laura Marongiu
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Francesca Granucci
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Samuele Notarbartolo
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Alessandra Bandera
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Infectious Diseases Unit, Foundation Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale MaggiorePoliclinico, Milan, Italy.,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Infectious Diseases Unit, Foundation Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale MaggiorePoliclinico, Milan, Italy.,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Raffaele De Francesco
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Sergio Abrignani
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Renata Grifantini
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
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Alhowaish TS, Alhamadh MS, Alhabeeb AY, Aldosari SF, Masuadi E, Alrashid A. Outcomes of COVID-19 in Inflammatory Rheumatic Diseases: A Retrospective Cohort Study. Cureus 2022; 14:e26343. [PMID: 35903564 PMCID: PMC9322141 DOI: 10.7759/cureus.26343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Similar to coronavirus disease 2019 (COVID-19), the pathogenesis of inflammatory rheumatic diseases includes cytokines dysregulation and increased expression of pro-inflammatory cytokines. Although current data from international studies suggest that rheumatic diseases are associated with a higher risk of COVID-19 infection and worse outcomes, there is limited literature in Saudi Arabia. This study aims to evaluate the outcomes and length of hospital stay of COVID-19 patients with inflammatory rheumatic diseases in Saudi Arabia. Method This was a single-center retrospective cohort study that included 122 patients with inflammatory rheumatic diseases and documented coronavirus disease 2019 (COVID-19) infection from 2019 to 2021. Patients with suspected COVID-19 infection, non-inflammatory diseases, such as osteoarthritis, or inflammatory diseases but without or with weak systemic involvement, such as gout, were excluded. Results The vast majority (81.1%) of the patients were females. Rheumatoid arthritis was the most common primary rheumatological diagnosis. The admission rate was 34.5% with an overall mortality rate of 11.5%. Number of episodes of COVID-19 infection, mechanical ventilation, cytokine storm syndrome, secondary bacterial infection, number of comorbidities, rituximab, diabetes mellitus, hypertension, chronic kidney disease, and heart failure were significantly associated with a longer hospital stay. Additionally, hypertension, heart failure, rituximab, mechanical ventilation, cytokine storm syndrome, and secondary bacterial infection were significantly associated with higher mortality. Predictors of longer hospitalization were obesity, number of episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease, whereas, hypertension was the only predictor of mortality. Conclusion Obesity, number of episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease were significantly associated with higher odds of longer hospitalization, whereas, hypertension was significantly associated with higher odds of mortality. We recommend that these patients should be prioritized for the COVID-19 vaccine booster doses, and rituximab should be avoided unless its benefit clearly outweighs its risk.
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Lagousi T, Papadatou I, Strempas P, Chatzikalil E, Spoulou V. Paving the Way Towards Precision Vaccinology: The Paradigm of Myocarditis After Coronavirus Disease 2019 (COVID-19) Vaccination. Clin Infect Dis 2022; 75:S18-S23. [PMID: 35607748 PMCID: PMC9213845 DOI: 10.1093/cid/ciac396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Systems vaccinology approaches have introduced novel tools for the evaluation of the safety profile of novel vaccine antigens by developing biomarkers of vaccine reactogenicity associated with potential adverse events. The use of such approaches may prove extremely advantageous in the context of a global pandemic where accelerated approval of new vaccine formulations for all ages is essential for the containment of the epidemic. The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had devastating effects on global health, but the emergency authorization of mRNA vaccines significantly reduced SARS-CoV-2-associated morbidity and mortality. Despite their favorable safety profile in adult populations, recent reports have raised concerns about an association of the mRNA-based vaccines with acute myocarditis, predominantly among male adolescents and young adults following the second vaccine dose. Here, we review data on myocarditis epidemiology following SARS-CoV-2 mRNA vaccination and describe potential mechanisms involved that may explain the sex- and age-related differences, focusing on mRNA immune reactivity. The case of vaccine-associated myocarditis highlights the need to incorporate precision vaccinology approaches for the development of safe and effective vaccines for everyone.
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Affiliation(s)
- Theano Lagousi
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece,First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece,Corresponding Author Dr Theano Lagousi Immunobiology and Vaccinology Research Laboratory and Infectious Diseases Department First Department of Paediatrics “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece
| | - Ioanna Papadatou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece,First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece
| | - Petros Strempas
- Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Elena Chatzikalil
- Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Spoulou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece,First Department of Paediatrics, “Aghia Sophia” Children's Hospital, Athens Medical School, 11527 Athens, Greece
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Signore A, Lauri C, Colandrea M, Di Girolamo M, Chiodo E, Grana CM, Campagna G, Aceti A. Lymphopenia in patients affected by SARS-CoV-2 infection is caused by margination of lymphocytes in large bowel: an [ 18F]FDG PET/CT study. Eur J Nucl Med Mol Imaging 2022; 49:3419-3429. [PMID: 35486145 PMCID: PMC9050483 DOI: 10.1007/s00259-022-05801-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the cause of lymphopenia in patients with newly diagnosed COVID-19, we measured [18F]FDG uptake in several tissues, including the ileum, right colon, and caecum at diagnosis and after recovery and correlated these measurements with haematological parameters. METHODS We studied, by [18F]FDG PET/CT, 18 newly diagnosed patients with COVID-19. Regions of interest were drawn over major organs and in the terminal ileum, caecum, and right colon, where the bowel wall was evaluable. Five patients were re-examined after recovery, and three of them also performed a white blood cell scan with 99mTc-HMPAO-WBC on both occasions. Complete blood count was performed on both occasions, and peripheral blood lymphocyte subsets were measured at diagnosis. Data were analysed by a statistician. RESULTS Patients had moderate severity COVID-19 syndrome. Basal [18F]FDG PET/CT showed focal lung uptake corresponding to hyperdense areas at CT. We also found high spleen, ileal, caecal, and colonic activity as compared to 18 control subjects. At recovery, hypermetabolic tissues tended to normalize, but activity in the caecum remained higher than in controls. Regression analyses showed an inverse correlation between CD4 + lymphocytes and [18F]FDG uptake in the caecum and colon and a direct correlation between CD8 + lymphocytes and [18F]FDG uptake in lungs and bone marrow. WBC scans showed the presence of leukocytes in the caecum and colon that disappeared at recovery. CONCLUSIONS These findings indicate that lymphopenia in COVID-19 patients is associated with large bowel inflammation supporting the hypothesis that CD4 + lymphocytes migrate to peripheral lymphoid tissues in the bowel.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marzia Colandrea
- Nuclear Medicine Division, European Institute of Oncology - IRCCS, Milan, Italy
| | - Marco Di Girolamo
- Radiology Unit, AOU Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Erika Chiodo
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Maria Grana
- Nuclear Medicine Division, European Institute of Oncology - IRCCS, Milan, Italy
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonio Aceti
- Infection Unit, Department NESMOS, Sapienza University of Rome, Rome, Italy
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Tsvetkova AV, Koneva ES, Kostenko AA, Bisheva DR, Sidyakina IV, Konev SM, Zhumanova EN, Illarionov VE, Shestakov AV. [The role of systemic ozone therapy in the rehabilitation of patients after COVID-19]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:22-29. [PMID: 36083814 DOI: 10.17116/kurort20229904222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of ozone therapy in rehabilitation of patients with previous COVID-19. MATERIAL AND METHODS A randomized controlled clinical trial included 51 patients aged 29 - 78 years with SARS-CoV-2 pneumonia (J12.8). Patients were divided into 3 comparable groups depending on the complex of rehabilitation. In the first (control) group (n=17), a 10-day course included daily breathing exercises and physiotherapy for the lungs (drug electrophoresis and low-frequency magnetotherapy). In the second (main) group (n=18), rehabilitation was combined with daily intravenous infusions of ozonized saline with ozone concentration of 2.0 mg/l within 5 days with subsequent standard rehabilitation. In the third group (n=16), patients received 5 ozone therapy procedures every other day. To determine the effectiveness and safety of systemic ozone therapy in rehabilitation of patients with previous COVID-19, we analyzed oxygen saturation, laboratory data (D-dimer and C-reactive protein), need for oxygen support before and after rehabilitation course. Complaints and quality of life throughout the rehabilitation program were assessed using the EQ-5D questionnaire. RESULTS All patients had positive changes of all parameters. There were no adverse reactions throughout the rehabilitation program and 2 months later. We observed higher effectiveness of rehabilitation with systemic ozone therapy. Moreover, daily ozone therapy had a better effect on laboratory parameters compared to ozone therapy every other day. CONCLUSION Ozone therapy is safe and effective in complex rehabilitation of patients with previous COVID-19. Further studies of large samples are needed to determine indications and appropriate criteria for this rehabilitation program.
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Affiliation(s)
- A V Tsvetkova
- Sechenov First Moscow State Medical University, Moscow, Russia
- Group of companies «MEDSI», Otradnoe, Russia
| | - E S Koneva
- Sechenov First Moscow State Medical University, Moscow, Russia
- Group of companies «MEDSI», Otradnoe, Russia
| | - A A Kostenko
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D R Bisheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - S M Konev
- Sechenov First Moscow State Medical University, Moscow, Russia
- Group of companies «MEDSI», Otradnoe, Russia
| | | | - V E Illarionov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - A V Shestakov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Tanaka H, Nagasato D, Nakakura S, Tanabe H, Nagasawa T, Wakuda H, Imada Y, Mitamura Y, Tabuchi H. Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports. Medicine (Baltimore) 2021; 100:e28236. [PMID: 34918688 PMCID: PMC8677974 DOI: 10.1097/md.0000000000028236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. PATIENT CONCERNS Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment. DIAGNOSES Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25. INTERVENTIONS Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice. OUTCOMES Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25. LESSONS Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.
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Affiliation(s)
- Hayato Tanaka
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
| | - Daisuke Nagasato
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
| | - Hirotaka Tanabe
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
| | | | - Hiroyuki Wakuda
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
| | | | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Hyogo, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
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May BC, Gallivan KH. Levocetirizine and montelukast in the COVID-19 treatment paradigm. Int Immunopharmacol 2021; 103:108412. [PMID: 34942461 PMCID: PMC8673734 DOI: 10.1016/j.intimp.2021.108412] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022]
Abstract
Levocetirizine, a third-generation antihistamine, and montelukast, a leukotriene receptor antagonist, exhibit remarkable synergistic anti-inflammatory activity across a spectrum of signaling proteins, cell adhesion molecules, and leukocytes. By targeting cellular protein activity, they are uniquely positioned to treat the symptoms of COVID-19. Clinical data to date with an associated six-month follow-up, suggests the combination therapy may prevent the progression of the disease from mild to moderate to severe, as well as prevent/treat many of the aspects of ‘Long COVID,’ thereby cost effectively reducing both morbidity and mortality. To investigate patient outcomes, 53 consecutive COVID-19 test (+) cases (ages 3–90) from a well-established, single-center practice in Boston, Massachusetts, between March – November 2020, were treated with levocetirizine and montelukast in addition to then existing protocols [2]. The data set was retrospectively reviewed. Thirty-four cases were considered mild (64%), 17 moderate (32%), and 2 (4%) severe. Several patients presented with significant comorbidities (obesity: n = 22, 41%; diabetes: n = 10, 19%; hypertension: n = 24, 45%). Among the cohort there were no exclusions, no intubations, and no deaths. The pilot study in Massachusetts encompassed the first COVID-19 wave which peaked on April 23, 2020 as well as the ascending portion of the second wave in the fall. During this period the average weekly COVID-19 case mortality rate (confirmed deaths/confirmed cases) varied considerably between 1 and 7.5% [37]. FDA has approved a multicenter, randomized, placebo-controlled, Phase 2 clinical trial design, replete with electronic diaries and laboratory metrics to explore scientific questions not addressed herein.
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Affiliation(s)
- Bruce Chandler May
- Inflammatory Response Research, Inc., 515 E. Micheltorena, Suite G, Santa Barbara, CA 93103, United States; Otolaryngology, Head & Neck Surgery, Cottage Health, 400 West Pueblo Street, Santa Barbara, CA 93105, United States.
| | - Kathleen Holly Gallivan
- Otolaryngology, Head & Neck Surgery, 100 Unicorn Park, Suite 102, Woburn, MA 01801, United States.
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Adil MS, Khulood D, Narayanan SP, Somanath PR. Bioinformatics analyses reveal cell-barrier junction modulations in lung epithelial cells on SARS-CoV-2 infection. Tissue Barriers 2021; 10:2000300. [PMID: 34740309 DOI: 10.1080/21688370.2021.2000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cell junctions maintain the blood-tissue barriers to preserve vascular and tissue integrity. Viral infections reportedly modulate cell-cell junctions to facilitate their invasion. However, information on the effect of COVID-19 infection on the gene expression of cell junction and cytoskeletal proteins is limited. Using the Gene Expression Omnibus and Reactome databases, we analyzed the data on human lung A549, NHBE, and Calu-3 cells for the expression changes in cell junction and cytoskeletal proteins by SARS-CoV-2 (CoV-2) infection. The analysis revealed changes in 3,660 genes in A549, 100 genes in NHBE, and 592 genes in Calu-3 cells with CoV-2 infection. Interestingly, EGOT (9.8-, 3- and 8.3-fold; p < .05) and CSF3 (4.3-, 33- and 56.3-fold; p < .05) were the only two genes significantly elevated in all three cell lines (A549, NHBE and Calu-3, respectively). On the other hand, 39 genes related to cell junctions and cytoskeleton were modulated in lung cells, with DLL1 demonstrating alterations in all cells. Alterations were also seen in several miRNAs associated with the cell junction and cytoskeleton genes modulated in the analysis. Further, matrix metalloproteinases involved in disease pathologies, including MMP-3, -9, and -12 demonstrated elevated expression on CoV-2 infection (p < .05). The study findings emphasize the integral role of cell junction and cytoskeletal genes in COVID-19, suggesting their therapeutic potential. Our analysis also identified a distinct EGOT gene that has not been previously implicated in COVID-19. Further studies on these newly identified genes and miRNAs could lead to advances in the pathogenesis and therapeutics of COVID-19.
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Affiliation(s)
- Mir S Adil
- Clinical and Experimental Therapeutics, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Daulat Khulood
- Clinical and Experimental Therapeutics, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - S Priya Narayanan
- Clinical and Experimental Therapeutics, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Payaningal R Somanath
- Clinical and Experimental Therapeutics, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA
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40
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Blagojević A, Šušteršič T, Lorencin I, Šegota SB, Anđelić N, Milovanović D, Baskić D, Baskić D, Petrović NZ, Sazdanović P, Car Z, Filipović N. Artificial intelligence approach towards assessment of condition of COVID-19 patients - Identification of predictive biomarkers associated with severity of clinical condition and disease progression. Comput Biol Med 2021; 138:104869. [PMID: 34547582 PMCID: PMC8438805 DOI: 10.1016/j.compbiomed.2021.104869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Although ML has been studied for different epidemiological and clinical issues as well as for survival prediction of COVID-19, there is a noticeable shortage of literature dealing with ML usage in prediction of disease severity changes through the course of the disease. In that way, predicting disease progression from mild towards moderate, severe and critical condition, would help not only to respond in a timely manner to prevent lethal results, but also to minimize the number of patients in hospitals where this is not necessary. METHODS We present a methodology for the classification of patients into 4 distinct categories of the clinical condition of COVID-19 disease. Classification of patients is based on the values of blood biomarkers that were assessed by Gradient boosting regressor and which were selected as biomarkers that have the greatest influence in the classification of patients with COVID-19. RESULTS The results show that among several tested algorithms, XGBoost classifier achieved best results with an average accuracy of 94% and an average F1-score of 94.3%. We have also extracted 10 best features from blood analysis that are strongly associated with patient condition and based on those features we can predict the severity of the clinical condition. CONCLUSIONS The main advantage of our system is that it is a decision tree-based algorithm which is easier to interpret, instead of the use of black box models, which are not appealing in medical practice.
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Affiliation(s)
- Anđela Blagojević
- University of Kragujevac, Faculty of Engineering, Sestre Janjić 6, 34000, Kragujevac, Serbia,Bioengineering Research and Development Center (BioIRC), Prvoslava Stojanovića 6, 34000, Kragujevac, Serbia
| | - Tijana Šušteršič
- University of Kragujevac, Faculty of Engineering, Sestre Janjić 6, 34000, Kragujevac, Serbia,Bioengineering Research and Development Center (BioIRC), Prvoslava Stojanovića 6, 34000, Kragujevac, Serbia
| | - Ivan Lorencin
- University of Rijeka, Faculty of Engineering, Vukovarska 58, 51000, Rijeka, Croatia
| | - Sandi Baressi Šegota
- University of Rijeka, Faculty of Engineering, Vukovarska 58, 51000, Rijeka, Croatia
| | - Nikola Anđelić
- University of Rijeka, Faculty of Engineering, Vukovarska 58, 51000, Rijeka, Croatia
| | - Dragan Milovanović
- Clinical Centre Kragujevac, Zmaj Jovina 30, 34000, Kragujevac, Serbia,University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovića 69, 34000, Kragujevac, Serbia
| | - Danijela Baskić
- Clinical Centre Kragujevac, Zmaj Jovina 30, 34000, Kragujevac, Serbia
| | - Dejan Baskić
- University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovića 69, 34000, Kragujevac, Serbia,Institute of Public Health Kragujevac, Nikole Pašića 1, 34000, Kragujevac, Serbia
| | - Nataša Zdravković Petrović
- Clinical Centre Kragujevac, Zmaj Jovina 30, 34000, Kragujevac, Serbia,University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovića 69, 34000, Kragujevac, Serbia
| | - Predrag Sazdanović
- Clinical Centre Kragujevac, Zmaj Jovina 30, 34000, Kragujevac, Serbia,University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovića 69, 34000, Kragujevac, Serbia
| | - Zlatan Car
- University of Rijeka, Faculty of Engineering, Vukovarska 58, 51000, Rijeka, Croatia
| | - Nenad Filipović
- University of Kragujevac, Faculty of Engineering, Sestre Janjić 6, 34000, Kragujevac, Serbia,Bioengineering Research and Development Center (BioIRC), Prvoslava Stojanovića 6, 34000, Kragujevac, Serbia,Corresponding author. Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia
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Arena R, Bond S, Calvo IR, Lebowicz L, Ozemek C, Severin R, Laddu D, Faghy MA, Lavie CJ, Carbone S. Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era. Prog Cardiovasc Dis 2021; 73:56-60. [PMID: 34153291 PMCID: PMC8214803 DOI: 10.1016/j.pcad.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19) continues to have a devastating effect on a global scale. COVID-19 variants continue to arise and counteract vaccination efficacy. As such, preventative health measures, such as social distancing and stay at home mandates, will continue for the foreseeable future. Evidence on those at greatest risk for poor outcomes if infected with COVID-19 has rapidly come to light. It has become clear that those with unhealthy lifestyle characteristics, chronic disease risk factors and/or a confirmed diagnosis of one or more chronic conditions are at greatest risk for hospitalization, intensive care unit admission, mechanical ventilation, and death if infected with COVID-19. The cytokine storm is a phenomenon that has been posited as a pathophysiologic response to COVID-19 infection that leads to poor outcomes. The current graphical review illustrates the association between unhealthy lifestyle characteristics and increased vulnerability to the cytokine storm as well as the physiologic mechanisms healthy living behaviors elicit and decrease risk for the cytokine storm. Through this graphical review, we will demonstrate unhealthy lifestyle characteristics, chronic disease risk factors and diagnoses, and COVID-19 outcomes are intricately linked, creating a new global syndemic. It is also clear that a primary way to uncouple this syndemic is through increasing healthy living behaviors, as illustrated in this graphical review. Moving forward, healthy living medicine should be practiced with renewed vigor to improve human resiliency to health threats posed by both chronic disease and viral infections.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States.
| | - Samantha Bond
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Department of Biomedical Health Information Sciences, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Isabel Romero Calvo
- Department of Biomedical Health Information Sciences, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Leah Lebowicz
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Department of Biomedical Health Information Sciences, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Richard Severin
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Mark A Faghy
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Human Sciences Research Centre, University of Derby, Derby, United Kingdom
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, United States
| | - Salvatore Carbone
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Mazumder P, Kalamdhad A, Chaminda GT, Kumar M. Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world. CASE STUDIES IN CHEMICAL AND ENVIRONMENTAL ENGINEERING 2021; 3:100093. [PMID: 38620798 PMCID: PMC7897456 DOI: 10.1016/j.cscee.2021.100093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 05/07/2023]
Abstract
In viral respiratory infections, bacterial co-pathogens are widely known to co-infect, and they significantly increase the morbidity and mortality rate. During the influenza season, the advent of 2019-nCoV (novel coronavirus) has led to the widespread use of oral and intravenous antibiotics and inhibitors of neuraminidase enzyme. Owing to causes such as extended intubation, the ubiquitous use of intrusive catheters, and compromised host immunity, coronavirus disease (COVID-19) patients are at heightened risk of secondary bacterial and fungal infections, leading to the difficulty in their treatment. Apart from the pandemic, the primary risk is a likely surge in multidrug resistance. In this work, we evaluated the coalescence of present co-infection alongside the COVID-19 and post-pandemic antimicrobial resistance due to high ongoing drug use for the treatment of COVID-19. We found that while there is currently limited evidence of bacterial infections in COVID-19, available proof supports the restricted use of antibiotics from an antibiotic stewardship viewpoint, primarily upon entry. Paramount attempts should be made to collect sputum and blood culture samples as well as pneumococcal urinary antigen monitoring in order to endorse stringent antibiotic usage. For antimicrobial stewardship, inflammatory markers like procalcitonin have been added, but such biomarkers are typically upraised in COVID-19. Antimicrobials cannot be completely removed in wastewater treatment plants (WWTPs) and once they enter the water environment, possesses a great risk of inducing resistance to drugs in microbes. Hence, their prescription and administrations should be regulated and alternate solutions such as vaccines, preventive measures and personal hygiene should be given top priority. It is imperative to establish an antimicrobial strategy discrete to COVID-19, as this pandemic has caused an outbreak of numerous other associated diseases and has the potential to drive microbial resistance. Coordinated plans are essential for this at the citizen, health-care and policy levels.
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Affiliation(s)
- Payal Mazumder
- Centre for the Environment, Indian Institute of Technology Guwahati, Assam, 781039, India
| | - Ajay Kalamdhad
- Department of Civil Engineering, Indian Institute of Technology Guwahati, Assam, 781039, India
| | - Gg Tushara Chaminda
- Departmnet of Civil and Environmental Engineering, University of Ruhuna, Galle, Sri Lanka
| | - Manish Kumar
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat, 3823009, India
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Rubio-Sánchez R, Lepe-Balsalobre E, Viloria-Peñas MDM. Prognostic factors for the severity of SARS-CoV-2 infection. ADVANCES IN LABORATORY MEDICINE 2021; 2:253-265. [PMID: 37363332 PMCID: PMC10197509 DOI: 10.1515/almed-2021-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/14/2020] [Indexed: 06/28/2023]
Abstract
Objectives Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is a novel coronavirus that causes COVID-19. This disease is associated with leukocytosis with lymphopenia, neutrophilia, and elevated levels of d-dimer, and C-reactive protein, ferritin, procalcitonin, and lactate dehydrogenase. The aim of this study was to describe the clinical and analytical characteristics of hospitalized patients with SARS-CoV-2 infection and to identify prognostic factors of disease progression. Methods Patients were categorized into two groups based on COVID-19 severity. Study variables included demographic data, medical history, length of hospital stay, course of pneumonia, drug therapy, and analytical parameters. A descriptive and multivariate analysis was performed to identify prognostic factors for disease severity. Results The study population included 197 patients, of whom 127 had mild disease and 70 had severe COVID-19. Statistically significant differences were observed in most analytical parameters. The parameters included in the multivariate analysis were advanced age and elevated levels of leukocytes, CRP, GGT, and PCT at admission as prognostic factors for disease severity. Conclusions The prognostic factors for the severity of SARS-CoV-2 infection identified in this study (age, leukocytes, CRP, GGT, and PCT) will help predict the course of the disease at an early stage.
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Affiliation(s)
- Ricardo Rubio-Sánchez
- Clinical Laboratory, Virgen de Valme University Hospital, South Health District of Seville, Seville, Spain
| | - Esperanza Lepe-Balsalobre
- Clinical Laboratory, Virgen de Valme University Hospital, South Health District of Seville, Seville, Spain
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Meanwatthana J, Majam T. Interleukin-6 Antagonists: Lessons From Cytokine Release Syndrome to the Therapeutic Application in Severe COVID-19 Infection. J Pharm Pract 2021; 35:752-761. [PMID: 33759631 DOI: 10.1177/08971900211000691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current retrospective data have found up to 20% of COVID-19 infection had developed into severe cases with hyperinflammatory pulmonary symptoms. Interleukin 6 (IL-6) is recognized as a key mediator of hyperinflammation previously mentioned in cytokine release syndrome. This leads to implementing IL-6 pathway inhibition in severe COVID-19. This review aimed to explore the clinical evidences of using IL-6 antagonists in COVID-19 infection based on most recent available data. Relevant studies were searched through PubMed, scopus, and ISI databases focusing on interleukin-6 antagonists in cytokine release syndrome and prospective data on COVID-19 infection. Only papers in English were included in the search. There were several studies conducted to evaluate the potential efficacy and safety of IL-6 antagonists and mostly with tocilizumab. After the search, we found that studies recruited patients with severe COVID-19 and elevated inflammatory mediators such as C-reactive protein (CRP), IL-6, or ferritin to receive tocilizumab, situximab or sarilumab in combination with other medications. Result showed that these agents may provide a clinical advantage as patients were able to refrain from invasive ventilation support after initiating IL-6 antagonists. In summary, IL-6 pathway inhibition in severe COVID-19 may be an emerging candidate to subside pulmonary complication. These agents may carry benefits in COVID-19 infection as well as safety risks such as bone marrow suppression. Current pharmacists' role is to provide most recent update information as well as intensive monitoring plan in patients who receive IL-6 inhibitor. However, robust clinical evidences are warranted to confirm efficacy and safety of IL-6 antagonists.
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Affiliation(s)
- Jennis Meanwatthana
- 68022Faculty of Pharmacy, Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Teerapat Majam
- 68022Faculty of Pharmacy, Department of Pharmacy, Mahidol University, Bangkok, Thailand.,School of Pharmacy, 68022Walailak University, Nakhonsithammarat, Thailand
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Tanwar O, Soni A, Prajapat P, Shivhare T, Pandey P, Samaiya PK, Pandey SP, Kar P. Ethyl Pyruvate as a Potential Defense Intervention against Cytokine Storm in COVID-19? ACS OMEGA 2021; 6:7754-7760. [PMID: 33778286 PMCID: PMC7992141 DOI: 10.1021/acsomega.1c00157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
COVID-19 is a deadly pandemic and has resulted in a huge loss of money and life in the past few months. It is well known that the SARS-CoV-2 gene mutates relatively slowly as compared to other viruses but still may create hurdles in developing vaccines. Therefore, there is a need to develop alternative routes for its management and treatment of COVID-19. Based on the severity of viral infection in COVID-19 patients, critically ill patients (∼5%, with old age, and comorbidities) are at high risk of morbidities. The reason for this severity in such patients is attributed to "misleading cytokine storm", which produces ARDS and results in the deaths of critically ill patients. In this connection, ethyl pyruvate (EP) controls these cytokines/chemokines, is an anti-inflammatory agent, and possesses a protective effect on the lungs, brain, heart, and mitochondria against various injuries. Considering these facts, we propose that the site-selective EP formulations (especially aerosols) could be the ultimate adjuvant therapy for the regulation of misleading cytokine storm in severely affected COVID-19 patients and could reduce the mortalities.
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Affiliation(s)
- Omprakash Tanwar
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Aastha Soni
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Pawan Prajapat
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Tanu Shivhare
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Pooja Pandey
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Puneet Kumar Samaiya
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Sharad Prakash Pandey
- Department
of Pharmacy, Shri G.S. Institute of Technology
and Science, 23, Sir
M. Visvesvaraya Marg (Park Road), Indore 452003, Madhya Pradesh, India
| | - Parimal Kar
- Department
of Biosciences & Biomedical Engineering, Indian Institute of Technology, Khandwa Road, Simrol, Indore 453552, Madhya Pradesh, India
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McKenzie MG, Lee YM, Mathew J, Anderson M, Vo AT, Akinyele S, Narayanan M. Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series. J Pharm Pract 2021; 35:587-592. [PMID: 33736526 DOI: 10.1177/08971900211002353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. DESIGN A retrospective case series. SETTING Five community hospitals within 1 urban health system. PATIENTS Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 - 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. CONCLUSIONS Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.
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Affiliation(s)
- Matt G McKenzie
- Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA
| | - Yeunju Michelle Lee
- Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA
| | - Julin Mathew
- Department of Pharmacy Services, Memorial Hermann Greater Heights Hospital, Houston, TX, USA
| | - Megan Anderson
- Department of Pharmacy Services, Memorial Hermann Southeast Hospital, Houston, TX, USA
| | - Alison T Vo
- Department of Pharmacy Services, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Samuel Akinyele
- Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA
| | - Malarvizhi Narayanan
- Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA
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Yang B, Chang X, Huang J, Pan W, Si Z, Zhang C, Li H. The role of IL-6/lymphocyte ratio in the peripheral blood of severe patients with COVID-19. Int Immunopharmacol 2021; 97:107569. [PMID: 33933851 PMCID: PMC7953449 DOI: 10.1016/j.intimp.2021.107569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND To investigate the prognostic value of a novel immune-inflammatory index, the interleukin-6-to-lymphocyte ratio (IL-6/LY), with the clinical outcomes of severe coronavirus disease 2019 (COVID-19) cases. METHODS A cohort study of COVID-19 patients in Tongji Hospital, from January 2020 to February 2020, was evaluated. Kaplan-Meier method and the log-rank test was performed to analyze survival data. Univariate and multivariate analyses were performed with COX proportional hazard regression model. The primary and secondary outcomes were in-hospital mortality and multiple organ dysfunction syndrome (MODS), respectively. RESULTS Total 320 adult patients were enrolled in our analyses. Patients were divided into low IL-6/LY group and high IL-6/LY group based on the cutoff value with 2.50. The Kaplan-Meier survival curves showed that high-value group (IL-6/LY ≥ 2.50) had a greater risk of poor prognosis (P < 0.001, respectively). Multivariate analysis indicated that IL-6/LY was the independent risk predictor for in-hospital mortality (hazard ratio [HR], 3.404; 95% confidence interval [CI], 1.090-10.633, P = 0.035) and MODS development (HR, 4.143; 95%CI, 1.321-12.986, P = 0.015). Meanwhile, IL-6/LY was positively correlated with the MuLBSTA score (r = 0.137, P = 0.031), suggesting that IL-6/LY was associated with long-term mortality (90-day). Furthermore, kinetic analysis revealed that the dynamic changes of inflammatory immune indexes were related to the severity of the disease. CONCLUSIONS The elevated IL-6/LY was related with the increased risk of poor prognosis. Not only that, IL-6/LY could be used for risk stratification and early clinical identification of high-risk patients.
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Affiliation(s)
- Boyi Yang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaoyan Chang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jiabao Huang
- Department of General Practice, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Wen Pan
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhilong Si
- Department of Gastrointestinal Surgery, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hong Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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48
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Padhi AK, Seal A, Khan JM, Ahamed M, Tripathi T. Unraveling the mechanism of arbidol binding and inhibition of SARS-CoV-2: Insights from atomistic simulations. Eur J Pharmacol 2021; 894:173836. [PMID: 33387467 PMCID: PMC7773528 DOI: 10.1016/j.ejphar.2020.173836] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has spread rapidly and poses an unprecedented threat to the global economy and human health. Broad-spectrum antivirals are currently being administered to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). China's prevention and treatment guidelines suggest the use of an anti-influenza drug, arbidol, for the clinical treatment of COVID-19. Reports indicate that arbidol could neutralize SARS-CoV-2. Monotherapy with arbidol is superior to lopinavir-ritonavir or favipiravir for treating COVID-19. In SARS-CoV-2 infection, arbidol acts by interfering with viral binding to host cells. However, the detailed mechanism by which arbidol induces the inhibition of SARS-CoV-2 is not known. Here, we present atomistic insights into the mechanism underlying membrane fusion inhibition of SARS-CoV-2 by arbidol. Molecular dynamics (MD) simulation-based analyses demonstrate that arbidol binds and stabilizes at the receptor-binding domain (RBD)/ACE2 interface with a high affinity. It forms stronger intermolecular interactions with the RBD than ACE2. Analyses of the detailed decomposition of energy components and binding affinities revealed a substantial increase in the affinity between the RBD and ACE2 in the arbidol-bound RBD/ACE2 complex, suggesting that arbidol generates favorable interactions between them. Based on our MD simulation results, we propose that the binding of arbidol induces structural rigidity in the viral glycoprotein, thus restricting the conformational rearrangements associated with membrane fusion and virus entry. Furthermore, key residues of the RBD and ACE2 that interact with arbidol were identified, opening the door for developing therapeutic strategies and higher-efficacy arbidol derivatives or lead drug candidates.
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Affiliation(s)
- Aditya K. Padhi
- Laboratory for Structural Bioinformatics, Center for Biosystems Dynamics Research, RIKEN, Yokohama, Japan
| | - Aniruddha Seal
- School of Chemical Sciences, National Institute of Science Education and Research Bhubaneswar, Khurda, Odisha, India,Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, Maharashtra, India
| | - Javed Masood Khan
- Department of Food Science and Nutrition, Faculty of Food and Agricultural Sciences, King Saud University, 2460, Riyadh, 11451, Saudi Arabia
| | - Maqusood Ahamed
- King Abdullah Institute for Nanotechnology, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Timir Tripathi
- Molecular and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong, India,Corresponding author. Department of Biochemistry North-Eastern Hill University Shillong- 793022, India
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49
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Lovato ECW, Barboza LN, Wietzikoski S, de Souza ANV, Auth PA, Junior AG, Dos Reis Lívero FA. Repurposing Drugs for the Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19). Curr Pharm Des 2021; 27:115-126. [PMID: 32634080 DOI: 10.2174/1381612826666200707121636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed coronavirus disease 2019 (COVID-19) by the World Health Organization, is a newly emerging zoonotic agent that emerged in China in December 2019. No specific treatment for COVID-19 is currently available. Usual palliative treatment includes maintaining hydration and nutrition and controlling fever and cough. The clinical severity and extent of transmission need to be determined, and therapeutic options need to be developed and optimized. METHODS The present review discusses the recent repurposing of drugs for COVID-19 treatment. RESULTS Several compounds, including remdesivir, lopinavir, ritonavir, interferon-β, ribavirin, chloroquine/ hydroxychloroquine, azithromycin, tocilizumab, and ivermectin, have emerged as promising alternatives. They block the virus from entering host cells, prevent viral replication, and attenuate exacerbation of the host's immune response. CONCLUSION Although some evidence indicates the positive actions of different classes of compounds for the treatment of COVID-19, few clinical assays have been established to definitively demonstrate their therapeutic value in humans. Multicenter clinical studies are urgently needed to validate and standardize therapeutic regimens that involve these agents. Although science has not yet presented us with a specific drug against COVID-19, the repurposing of drugs appears to be promising in our fight against this devastating disease.
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Affiliation(s)
- Evellyn Claudia Wietzikoski Lovato
- Laboratory of Preclinical Research of Natural Products, Post-Graduate Program in Medicinal Plants and Phytotherapeutics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
| | - Lorena Neris Barboza
- Laboratory of Preclinical Research of Natural Products, Post-Graduate Program in Medicinal Plants and Phytotherapeutics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
| | - Samantha Wietzikoski
- Laboratory of Preclinical Research of Natural Products, Post-Graduate Program in Medicinal Plants and Phytotherapeutics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
| | - Amanda Nascimento Vasques de Souza
- Laboratory of Preclinical Research of Natural Products, Post-Graduate Program in Medicinal Plants and Phytotherapeutics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
| | - Pablo Alvarez Auth
- Laboratory of Preclinical Research of Natural Products, Post- Graduate Program in Animal Science with Emphasis on Bioactive Products, Paranaense University, Umuarama, PR, Brazil
| | - Arquimedes Gasparotto Junior
- Laboratory of Electrophysiology and Cardiovascular Pharmacology, Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, MS, Brazil
| | - Francislaine Aparecida Dos Reis Lívero
- Laboratory of Preclinical Research of Natural Products, Post-Graduate Program in Medicinal Plants and Phytotherapeutics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
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50
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Li Z, Chen H, Zhang H, Li Y, Wang C, Bai L, Zhang W, Jiang Z. Similarity and Specificity of Traditional Chinese Medicine Formulas for Management of Coronavirus Disease 2019 and Rheumatoid Arthritis. ACS OMEGA 2020; 5:30519-30530. [PMID: 33283100 PMCID: PMC7711705 DOI: 10.1021/acsomega.0c04377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 06/12/2023]
Abstract
The pathogenesis similarity is leading to the introduction of drugs commonly used in rheumatoid arthritis (RA) into coronavirus disease (COVID-19) treatment. Traditional Chinese medicine (TCM) was widely used for the treatment of infectious diseases and rheumatic diseases. However, there is little knowledge of the relationship between COVID-19 and RA treatment employing TCM formulas. The present work was aimed to compare the similarity and specificity of TCM formulas for the management of COVID-19 and RA, as well as to deduce the potential mechanism of TCM for COVID-19 treatment. Two formulas including lianhuaqingwen (LHQW) and duhuojisheng (DHJS) were selected as the representatives of TCM for COVID-19 and RA treatment, respectively. An integrated network pharmacology was used to investigate their similarity and specificity. Although different herbs are present in the two formulas, they generated fairly similar ingredients, targets, interaction networks and enriched pathways, which were mainly involved in virus infection, inflammation, and immune dysregulation. Undoubtedly, they also exhibited their respective specificity. LHQW showed the cold property and lung channel tropism which dominated heat-clearing and lung-freeing, while DHJS showed the warm property and liver channel tropism. Herbal compatibility of LHQW was more in line with the rules of the TCM formula against coronavirus disease. Although both formulas suggested multifunctionality in virus infection and inflammation, LHQW was inclined to cope with virus infection, while DHJS was inclined to cope with inflammation. Therefore, LHQW was reliable for providing the desired efficacy in COVID-19 management because of its cold property, lung channel tropism, and multifunctionality for coping with virus infection and inflammation.
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Affiliation(s)
- Zheng Li
- College
of Health Sciences, Jiangsu Normal University, Xuzhou 221116, China
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Hongwei Chen
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Huixia Zhang
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Yan Li
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Caiyun Wang
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
| | - Liping Bai
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
- Guangdong-Hong
Kong-Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology, Macau 999078, China
| | - Wei Zhang
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
- Guangdong-Hong
Kong-Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology, Macau 999078, China
| | - Zhihong Jiang
- State
Key Laboratory of Quality Research in Chinese Medicines and Macau
Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau, China
- Guangdong-Hong
Kong-Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology, Macau 999078, China
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