Target-agnostic drug prediction integrated with medical record analysis uncovers differential associations of statins with increased survival in COVID-19 patients

Drug repurposing requires distinguishing established drug class targets from novel molecule-specific mechanisms and rapidly derisking their therapeutic potential in a time-critical manner, particularly in a pandemic scenario. In response to the challenge to rapidly identify treatment options for COVID-19, several studies reported that statins, as a drug class, reduce mortality in these patients. However, it is unknown if different statins exhibit consistent function or may have varying therapeutic benefit. A Bayesian network tool was used to predict drugs that shift the host transcriptomic response to SARS-CoV-2 infection towards a healthy state. Drugs were predicted using 14 RNA-sequencing datasets from 72 autopsy tissues and 465 COVID-19 patient samples or from cultured human cells and organoids infected with SARS-CoV-2. Top drug predictions included statins, which were then assessed using electronic medical records containing over 4,000 COVID-19 patients on statins to determine mortality risk in patients prescribed specific statins versus untreated matched controls. The same drugs were tested in Vero E6 cells infected with SARS-CoV-2 and human endothelial cells infected with a related OC43 coronavirus. Simvastatin was among the most highly predicted compounds (14/14 datasets) and five other statins, including atorvastatin, were predicted to be active in > 50% of analyses. Analysis of the clinical database revealed that reduced mortality risk was only observed in COVID-19 patients prescribed a subset of statins, including simvastatin and atorvastatin. In vitro testing of SARS-CoV-2 infected cells revealed simvastatin to be a potent direct inhibitor whereas most other statins were less effective. Simvastatin also inhibited OC43 infection and reduced cytokine production in endothelial cells. Statins may differ in their ability to sustain the lives of COVID-19 patients despite having a shared drug target and lipid-modifying mechanism of action. These findings highlight the value of target-agnostic drug prediction coupled with patient databases to identify and clinically evaluate non-obvious mechanisms and derisk and accelerate drug repurposing opportunities.

Target-agnostic drug prediction integrated with medical record analysis uncovers differential associations of statins with increased survival in COVID-19 patients

Importance

Drug repurposing requires distinguishing established drug class targets from novel molecule-specific mechanisms and rapidly derisking their therapeutic potential in a time-critical manner, particularly in a pandemic scenario. In response to the challenge to rapidly identify treatment options for COVID-19, several studies reported that statins, as a drug class, reduce mortality in these patients. However, it is unknown if different statins exhibit consistent function or may have varying therapeutic benefit.

Objectives

To test if different statins differ in their ability to exert protective effects based on molecular computational predictions and electronic medical record analysis.

Main Outcomes and Measures

A Bayesian network tool was used to predict drugs that shift the host transcriptomic response to SARS-CoV-2 infection towards a healthy state. Drugs were predicted using 14 RNA-sequencing datasets from 72 autopsy tissues and 465 COVID-19 patient samples or from cultured human cells and organoids infected with SARS-CoV-2, with a total of 2,436 drugs investigated. Top drug predictions included statins, which were then assessed using electronic medical records containing over 4,000 COVID-19 patients on statins to determine mortality risk in patients prescribed specific statins versus untreated matched controls. The same drugs were tested in Vero E6 cells infected with SARS-CoV-2 and human endothelial cells infected with a related OC43 coronavirus.

Results

Simvastatin was among the most highly predicted compounds (14/14 datasets) and five other statins, including atorvastatin, were predicted to be active in > 50% of analyses. Analysis of the clinical database revealed that reduced mortality risk was only observed in COVID-19 patients prescribed a subset of statins, including simvastatin and atorvastatin. In vitro testing of SARS-CoV-2 infected cells revealed simvastatin to be a potent direct inhibitor whereas most other statins were less effective. Simvastatin also inhibited OC43 infection and reduced cytokine production in endothelial cells.

Conclusions and Relevance

Different statins may differ in their ability to sustain the lives of COVID-19 patients despite having a shared drug target and lipid-modifying mechanism of action. These findings highlight the value of target-agnostic drug prediction coupled with patient databases to identify and clinically evaluate non-obvious mechanisms and derisk and accelerate drug repurposing opportunities.

Prevalence of non-diabetic renal disease among African-American patients with type II diabetes mellitus

OBJECTIVE

This study aimed to characterize the prevalence of non-diabetic renal disease among African-Americans (AA) with type II diabetes mellitus based on a biopsy series. No previous study has investigated the nature of renal lesions in AA with type II DM.

MATERIAL AND METHODS

Thirty AA patients with type II DM who were being managed at an inner-city hospital had kidney biopsies to evaluate suspected non-diabetic renal disease (NDRD) between 1994 and 1998. The demographic, clinical and histopathological data on these patients were analysed retrospectively. Kidney biopsies were reviewed by light microscopy, immunofluorescence and electron microscopy.

RESULTS AND CONCLUSIONS

Three patterns of glomerular disease were observed. Diabetic nephropathy alone was seen in 13 patients (41.9%), diabetic nephropathy coexisted with glomerulonephritis in 12 patients (38.7%), while NDRD was seen in six patients (19.4%).

Coinfection with Giardia lamblia and Enterocytozoon bieneusi in a patient with acquired immunodeficiency syndrome and chronic diarrhea

Diarrhea is an important clinical problem in immunosuppressed patients with acquired immunodeficiency syndrome (AIDS). There are numerous classical as well as emerging enteric pathogens that can produce diarrhea; however, these agents can be missed when only one method, such as microbiological examination of stool, is used for diagnosis. The endoscopic biopsy is a sensitive method for diagnosis of many viral, fungal, and parasitic infections of the gastrointestinal tract. Although only one agent is often identified in mucosal biopsies from these immunosuppressed patients, coinfection with multiple microbial agents is being increasingly recognized. Giardia infection is not as prevalent as other pathogens in patients with AIDS, but it remains an important diarrheal agent that is potentially curable. However, there have been only rare reports of coinfections with giardiasis and other infectious agents. This report describes a patient with AIDS and chronic diarrhea who had repeated negative stool examinations for ova and parasites. Light and electron microscopic examination of subsequent endoscopically obtained small intestinal biopsies revealed coinfection with two parasites, Enterocytozoon bieneusi and Giardia lamblia. Following treatment with metronidazole for giardiasis, the diarrhea persisted, but was less severe. This report also describes the diagnostic features of Giardia and Enterocytozoon infections in biopsy tissues and emphasizes the importance of identifying enteric coinfections in patients with AIDS to ensure timely and specific modes of therapy.

Integrating mental health into community health nursing

Future nursing graduates will face a challenge as they seek employment in a changing healthcare system. A managed-care system using community-based sites is the trend of the future, with economy of care as the norm. The authors describe one model for educating students to meet community mental health challenges. The chronically mentally ill have traditionally been underserved in the community, resulting in frequent and costly readmissions to psychiatric hospitals. Appropriately prepared graduates can successfully manage the care of these clients economically in the community. The integration of community mental health into the community health course group meets that challenge.

CERT: a perceived exertion scale for young children

This paper describes the rationale for the Children's Effort Rating Table (CERT) designed for assessing perceived exertion by children aged 6 to 9 years. This device is similar to Borg's Rating of Perceived Exertion (RPE) which is internationally recognized and currently used in conjunction with standard metabolic measures in a wide range of settings where exercise is prescribed and the intensity of various forms of physical activity is regulated by adults. We devised CERT for use in our research on the development of perception of effort by younger children. Some validation research on CERT has been completed.

The renaissance nurse: permeating clinical competence with the humanities

In order to reclaim the "art" of nursing, educators need to prepare their graduates with human caring skills that draw from phenomenology, existentialism, and all segments of the humanities. Nurses of the future will be healers of the body and spirit. The authors discuss, from theoretical perspectives, how the humanities empower the student and offer suggestions for the integration of the humanities into lecture and clinical settings.

Leiomyosarcoma of the upper extremity

A case of rapidly fatal, high-grade leiomyosarcoma of the upper extremity is described. The pleomorphic appearance of this sarcoma on light microscopy required the use of immunohistochemistry and electron microscopy to establish the morphologic diagnosis and to exclude a diagnosis of other high-grade sarcoma, such as malignant fibrous histiocytoma or pleomorphic rhabdomyosarcoma. The observed clinical behavior of this leiomyosarcoma of the upper extremity seemed unusually aggressive compared with the biologic behavior predicted by the independent prognostic indicators of location, tumor size, and depth of invasion. The observed clinical behavior did not seem unusual compared with the clinical behavior predicted by the use of a staging scheme for soft tissue sarcomas.

Perineurial cell differentiation in benign tumors and tumorlike proliferation of peripheral nerves

An unusual, benign, spindle cell peripheral nerve sheath tumor (PNST) is reported that on ultrastructural examination was composed only of perineurial cells. The neoplastic cells showed positive immunoreactivity for S-100 protein and negative immunoreactivity for epithelial membrane antigen; this is not the expected immunophenotype of a perineurioma. Continued examination of benign PNSTs using electron microscopy and immunohistochemistry has the potential to reveal additional variations in the cellular composition and immunophenotype of these soft tissue tumors. PNSTs such as the one described will renew the debate about the cytogenesis of the perineurial cell and its role in PNSTs.

Cytomegalovirus in a macerated second trimester fetus: persistent viral inclusions on light and electron microscopy

The macerated stillborn fetus represents at least one third of all perinatal deaths. Microscopic examination of these specimens is often unrewarding. We have reported a clinically unsuspected cytomegalovirus infection in a second trimester macerated fetus. Cells suggestive of CMV inclusions were identified by light microscopy, but electron microscopy confirmed the presence of viral infection and proved valuable in making the diagnosis even though necrosis was severe.

Endothelium-derived relaxing factor inhibits in vitro platelet aggregation

We studied the effects of endothelium-derived relaxing factor (EDRF), bovine retractor penis muscle inhibitory factor and sodium nitroprusside, three stimulants of guanylate cyclase, on the in vitro aggregation of washed human platelets. Platelet aggregation induced either by collagen or by the thromboxane A2 analogue U46619 was inhibited by all three agents. The anti-aggregatory effect of each agent was inhibited by haemoglobin. The anti-aggregatory effect of EDRF was potentiated by superoxide dismutase. These findings are discussed in relation to a potential role for EDRF in haemostasis.

Ovarian granulosa cell tumors--immunohistochemical localization of estradiol and ultrastructure, with functional correlations

The authors studied immunohistochemical localization of estradiol and ultrastructure in 11 ovarian granulosa cell tumors in an effort to establish the cellular source of increased estrogen in patients with granulosa cell tumors. Estradiol was identified by the immunoperoxidase method in 10 tumors, and staining was confined to scattered groups of granulosa cells or isolated granulosa cells. The majority of tumor cells in all 5 cases examined by electron microscopy were undifferentiated cells, but in 2 cases, a small percentage of tumor cells contained mitochondria with tubular cristae and well-developed smooth endoplasmic reticulum. Interpreted in conjunction with in vitro studies of granulosa cells, the results suggest that neoplastic granulosa cells may resemble ovarian follicular granulosa cells of all stages of maturation and are capable of estrogen production.