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Amado-Rodríguez L, Salgado del Riego E, Gomez de Ona J, López Alonso I, Gil-Pena H, López-Martínez C, Martín-Vicente P, Lopez-Vazquez A, Gonzalez Lopez A, Cuesta-Llavona E, Rodriguez-Garcia R, Boga JA, Elena alvarez-Arguelles M, Mayordomo-Colunga J, Vidal-Castineira JR, Crespo I, Fernandez M, Criado L, Salvadores V, Jimeno-Demuth FJ, Blanch L, Prieto B, Fernandez-Fernandez A, Lopez-Larrea C, Coto E, Albaiceta GM. Effects of IFIH1 rs1990760 variants on systemic inflammation and outcome in critically ill COVID-19 patients in an observational translational study. eLife 2022; 11:73012. [PMID: 35060899 PMCID: PMC8782569 DOI: 10.7554/elife.73012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background:Variants in IFIH1, a gene coding the cytoplasmatic RNA sensor MDA5, regulate the response to viral infections. We hypothesized that IFIH1 rs199076 variants would modulate host response and outcome after severe COVID-19.Methods:Patients admitted to an intensive care unit (ICU) with confirmed COVID-19 were prospectively studied and rs1990760 variants determined. Peripheral blood gene expression, cell populations, and immune mediators were measured. Peripheral blood mononuclear cells from healthy volunteers were exposed to an MDA5 agonist and dexamethasone ex-vivo, and changes in gene expression assessed. ICU discharge and hospital death were modeled using rs1990760 variants and dexamethasone as factors in this cohort and in-silico clinical trials.Results:About 227 patients were studied. Patients with the IFIH1 rs1990760 TT variant showed a lower expression of inflammation-related pathways, an anti-inflammatory cell profile, and lower concentrations of pro-inflammatory mediators. Cells with TT variant exposed to an MDA5 agonist showed an increase in IL6 expression after dexamethasone treatment. All patients with the TT variant not treated with steroids survived their ICU stay (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.29–4.79). Patients with a TT variant treated with dexamethasone showed an increased hospital mortality (HR: 2.19, 95% CI: 1.01–4.87) and serum IL-6. In-silico clinical trials supported these findings.Conclusions:COVID-19 patients with the IFIH1 rs1990760 TT variant show an attenuated inflammatory response and better outcomes. Dexamethasone may reverse this anti-inflammatory phenotype.Funding:Centro de Investigación Biomédica en Red (CB17/06/00021), Instituto de Salud Carlos III (PI19/00184 and PI20/01360), and Fundació La Marató de TV3 (413/C/2021).
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Lorca R, Aparicio A, Cuesta-Llavona E, Pascual I, Junco A, Hevia S, Villazón F, Hernandez-Vaquero D, Reguero JJR, Moris C, Coto E, Gómez J, Avanzas P. Familial Hypercholesterolemia in Premature Acute Coronary Syndrome. Insights from CholeSTEMI Registry. J Clin Med 2020; 9:E3489. [PMID: 33137929 PMCID: PMC7692119 DOI: 10.3390/jcm9113489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an underdiagnosed genetic inherited condition that may lead to premature coronary artery disease (CAD). FH has an estimated prevalence in the general population of about 1:313. However, its prevalence in patients with premature STEMI (ST-elevation myocardial infarction) has not been widely studied. This study aimed to evaluate the prevalence of FH in patients with premature STEMI. Cardiovascular risk factors, LDLc (low-density lipoprotein cholesterol) evolution, and differences between genders were also evaluated. Consecutive patients were referred for cardiac catheterization to our center due to STEMI suspicion in 2018. From the 80 patients with confirmed premature CAD (men < 55 and women < 60 years old with confirmed CAD), 56 (48 men and eight women) accepted to be NGS sequenced for the main FH genes. Clinical information and DLCN (Dutch Lipid Clinic Network) score were analyzed. Only one male patient had probable FH (6-7 points) and no one reached a clinically definite diagnosis. Genetic testing confirmed that the only patient with a DLCN score ≥6 has HF (1.8%). Smoking and high BMI the most frequent cardiovascular risk factors (>80%). Despite high doses of statins being expected to reduce LDLc levels at STEMI to current dyslipidemia guidelines LDL targets (<55 mg/dL), LDLc control levels were out of range. Although still 5.4 times higher than in general population, the prevalence of FH in premature CAD is still low (1.8%). To improve the genetic yield, genetic screening may be considered among patients with probable or definite FH according to clinical criteria. The classical cardiovascular risk factors prevalence far exceeds FH prevalence in patients with premature STEMI. LDLc control levels after STEMI were out range, despite intensive hypolipemiant treatment. These findings reinforce the need for more aggressive preventive strategies in the young and for intensive lipid-lowering therapy in secondary prevention.
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Affiliation(s)
- Rebeca Lorca
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Andrea Aparicio
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Elias Cuesta-Llavona
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Alejandro Junco
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Sergio Hevia
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
| | - Francisco Villazón
- Endocrinology Department, Hospital Universitario Central Asturias, 33014 Oviedo, Spain;
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Jose Julian Rodríguez Reguero
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Cesar Moris
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Eliecer Coto
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Juan Gómez
- Reference Unit of Familiar Cardiomyopathies-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (E.C.-L.); (J.J.R.R.); (C.M.); (E.C.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33014 Oviedo, Spain; (A.A.); (A.J.); (S.H.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
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