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Yoon HA, Bartash R, Gendlina I, Rivera J, Nakouzi A, Bortz RH, Wirchnianski AS, Paroder M, Fehn K, Serrano-Rahman L, Babb R, Sarwar UN, Haslwanter D, Laudermilch E, Florez C, Dieterle ME, Jangra RK, Fels JM, Tong K, Mariano MC, Vergnolle O, Georgiev GI, Herrera NG, Malonis RJ, Quiroz JA, Morano NC, Krause GJ, Sweeney JM, Cowman K, Allen S, Annam J, Applebaum A, Barboto D, Khokhar A, Lally BJ, Lee A, Lee M, Malaviya A, Sample R, Yang XA, Li Y, Ruiz R, Thota R, Barnhill J, Goldstein DY, Uehlinger J, Garforth SJ, Almo SC, Lai JR, Gil MR, Fox AS, Chandran K, Wang T, Daily JP, Pirofski LA. Treatment of Severe COVID-19 with Convalescent Plasma in the Bronx, NYC. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.12.02.20242909. [PMID: 33300012 PMCID: PMC7724683 DOI: 10.1101/2020.12.02.20242909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as treatment for Coronavirus Disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200mL of CCP with a Spike protein IgG titer ≥1:2,430 (median 1:47,385) within 72 hours of admission to propensity score-matched controls cared for at a medical center in the Bronx, between April 13 to May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroids, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared to matched controls, CCP recipients <65 years had 4-fold lower mortality and 4-fold lower deterioration in oxygenation or mortality at day 28. For CCP recipients, pre-transfusion Spike protein IgG, IgM and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients <65 years, but data from controlled trials is needed to validate this finding and establish the effect of ageing on CCP efficacy.
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Affiliation(s)
- Hyun ah Yoon
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Johanna Rivera
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Antonio Nakouzi
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Robert H. Bortz
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Ariel S. Wirchnianski
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Monika Paroder
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Karen Fehn
- Department of Oncology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Leana Serrano-Rahman
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rachelle Babb
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Uzma N. Sarwar
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Denise Haslwanter
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Ethan Laudermilch
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Catalina Florez
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
- Department of Chemistry and Life Science, United States Military Academy at West Point, NY
| | - M. Eugenia Dieterle
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Rohit K. Jangra
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - J. Maximilian Fels
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Karen Tong
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | | | - Olivia Vergnolle
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - George I. Georgiev
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Natalia G. Herrera
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Ryan J. Malonis
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Jose A. Quiroz
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas C. Morano
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Gregory J. Krause
- Department of Developmental and Molecular Biology. Albert Einstein College of Medicine, Bronx, NY
- Institute of Aging Studies. Albert Einstein College of Medicine, Bronx, NY
| | - Joseph M. Sweeney
- Department Physiology and Biophysics. Albert Einstein College of Medicine, Bronx, NY
| | - Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | | | | | | | | | - Audrey Lee
- Albert Einstein College of Medicine, Bronx, NY
| | - Max Lee
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Yang Li
- Department of Epidemiology and Population Health. Albert Einstein College of Medicine, Bronx, NY
| | - Rafael Ruiz
- Network Performance Group. Montefiore Medical Center, Bronx, NY
- Division of Hospital Medicine, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Raja Thota
- Network Performance Group. Montefiore Medical Center, Bronx, NY
| | - Jason Barnhill
- Department of Chemistry and Life Science, United States Military Academy at West Point, NY
| | - Doctor Y. Goldstein
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Joan Uehlinger
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Scott J. Garforth
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Steven C. Almo
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
- Department Physiology and Biophysics. Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan R. Lai
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Morayma Reyes Gil
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Amy S. Fox
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Kartik Chandran
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Tao Wang
- Department of Epidemiology and Population Health. Albert Einstein College of Medicine, Bronx, NY
| | - Johanna P. Daily
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
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152
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Brown SA, Zaharova S, Mason P, Thompson J, Thapa B, Ishizawar D, Wilkes E, Ahmed G, Rubenstein J, Sanchez J, Joyce D, Kalyanaraman B, Widlansky M. Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology. Front Cardiovasc Med 2020; 7:568720. [PMID: 33344513 PMCID: PMC7746643 DOI: 10.3389/fcvm.2020.568720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Svetlana Zaharova
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jonathan Thompson
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bicky Thapa
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Ishizawar
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Wilkes
- Department of Pharmacy, Froedtert Health and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Gulrayz Ahmed
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason Rubenstein
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joyce Sanchez
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Michael Widlansky
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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153
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Chan Y, Banglawala SM, Chin CJ, Côté DWJ, Dalgorf D, de Almeida JR, Desrosiers M, Gall RM, Gevorgyan A, Hassan Hassan A, Janjua A, Lee JM, Leung RM, Mechor BD, Mertz D, Monteiro E, Nayan S, Rotenberg B, Scott J, Smith KA, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan A, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:81. [PMID: 33272328 PMCID: PMC7714255 DOI: 10.1186/s40463-020-00476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/25/2020] [Indexed: 01/19/2023] Open
Abstract
Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.
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Affiliation(s)
- Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - Sarfaraz M Banglawala
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Saint John, NB, Canada
| | - David W J Côté
- University of Montreal Hospital Center (CHUM) and Research Center (CRCHUM), Montreal, QC, Canada
| | - Dustin Dalgorf
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Richard M Gall
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Artur Gevorgyan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - A Hassan Hassan
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John M Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Randy M Leung
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John Scott
- Department of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kristine A Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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154
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Xu Z, Wang Z, Wang S, Ye Y, Luo D, Wan L, Yu A, Sun L, Tesfaye S, Meng Q, Gao L. The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID-19. J Diabetes 2020; 12:909-918. [PMID: 32638507 PMCID: PMC7361557 DOI: 10.1111/1753-0407.13084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although type 2 diabetes mellitus (T2DM) patients with coronavirus disease 2019 (COVID-19) develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with antihyperglycemic drugs and glucocorticoids is unclear. METHODS From 1584 COVID-19 patients, 364 severe/critical COVID-19 patients with clinical outcome were enrolled for the final analysis, and patients without preexisting T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes. RESULTS Of 364 enrolled severe COVID-19 inpatients, 114 (31.3%) had a history of T2DM. Twenty-seven (23.7%) T2DM patients died, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury compared with non-DM patients. In severe COVID-19 patients with T2DM, we demonstrated a higher risk of all-cause fatality with glucocorticoid treatment (adjusted hazard ratio [HR], 3.61; 95% CI, 1.14-11.46; P = .029) and severe hyperglycemia (fasting plasma glucose ≥11.1 mmol/L; adjusted HR, 11.86; 95% CI, 1.21-116.44; P = .034). CONCLUSIONS T2DM status aggravated the clinical condition of COVID-19 patients and increased their critical illness risk. Poor fasting blood glucose (≥ 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID-19.
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Affiliation(s)
- Zihui Xu
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhongjing Wang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shuo Wang
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Yingchun Ye
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Deng Luo
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Li Wan
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Ailin Yu
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
| | - Lifang Sun
- Intensive Care UnitRenmin Hospital of Wuhan UniversityWuhanChina
| | - Solomon Tesfaye
- Diabetes Research UnitSheffield Teaching Hospitals, Royal Hallamshire HospitalSheffieldUK
| | - Qingtao Meng
- Anesthesiology DepartmentRenmin Hospital of Wuhan UniversityWuhanChina
| | - Ling Gao
- Department of Endocrinology & MetabolismRenmin Hospital of Wuhan UniversityWuhanChina
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155
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Sahebnasagh A, Avan R, Saghafi F, Mojtahedzadeh M, Sadremomtaz A, Arasteh O, Tanzifi A, Faramarzi F, Negarandeh R, Safdari M, Khataminia M, Rezai Ghaleno H, Habtemariam S, Khoshi A. Pharmacological treatments of COVID-19. Pharmacol Rep 2020; 72:1446-1478. [PMID: 32816200 PMCID: PMC7439639 DOI: 10.1007/s43440-020-00152-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
The viral infection due to the new coronavirus or coronavirus disease 2019 (COVID-19), which was reported for the first time in December 2019, was named by the World Health Organization (WHO) as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV2), because of the very similar genome and also its related symptoms to SARS-CoV1. The ongoing COVID-19 pandemic with significant mortality, morbidity, and socioeconomic impact is considered by the WHO as a global public health emergency. Since there is no specific treatment available for SARS-CoV2 infection, and or COVID-19, several clinical and sub-clinical studies are currently undertaken to find a gold-standard therapeutic regimen with high efficacy and low side effect. Based on the published scientific evidence published to date, we summarized herein the effects of different potential therapies and up-to-date clinical trials. The review is intended to help readers aware of potentially effective COVID-19 treatment and provide useful references for future studies.
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Affiliation(s)
- Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Razieh Avan
- Department of Clinical Pharmacy, Medical Toxicology and Drug Abuse Research Center (MTDRC), Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojataba Mojtahedzadeh
- Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadremomtaz
- XB20 Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, 9700 AD Groningen, The Netherlands
| | - Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asal Tanzifi
- Sepanta Faragene Azma Research Laboratory. Co. LTD., Gorgan, Iran
- Department of Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Faramarzi
- Clinical Pharmacy Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Student Research Committee, Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammadreza Safdari
- Department of Orthopedic Surgery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Masoud Khataminia
- Student Research Committee, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Rezai Ghaleno
- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services, University of Greenwich, Central Avenue, Chatham-Maritime, Kent, ME4 4TB UK
| | - Amirhosein Khoshi
- Department of Clinical Biochemistry, School of Medicine, North Khorasan University of Medical Sciences, Arkan roadway, Bojnurd, Iran
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156
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O’Connell P, Aldhamen YA. Systemic innate and adaptive immune responses to SARS-CoV-2 as it relates to other coronaviruses. Hum Vaccin Immunother 2020; 16:2980-2991. [PMID: 32878546 PMCID: PMC8641610 DOI: 10.1080/21645515.2020.1802974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
The deadly pandemic caused by the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represents one of the greatest threats humanity has faced in the last century. Infection with this easily transmissible virus can run the gamut from asymptomatic to fatal, and the disease caused by SARS-CoV-2 has been termed Coronavirus Disease 2019 (COVID-19). What little research that has already been conducted implicates pathological responses by the immune system as the leading culprit responsible for much of the morbidity and mortality caused by COVID-19. In this review we will summarize what is currently known about the systemic immune response to SARS-CoV-2 and potential immunotherapeutic approaches.
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Affiliation(s)
- Patrick O’Connell
- Department of Microbiology and Molecular Genetics, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Yasser A. Aldhamen
- Department of Microbiology and Molecular Genetics, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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157
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Seaton RA, Gibbons CL, Cooper L, Malcolm W, McKinney R, Dundas S, Griffith D, Jeffreys D, Hamilton K, Choo-Kang B, Brittain S, Guthrie D, Sneddon J. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. J Infect 2020; 81:952-960. [PMID: 32987097 PMCID: PMC7518971 DOI: 10.1016/j.jinf.2020.09.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Concern regarding bacterial co-infection complicating SARS-CoV-2 has created a challenge for antimicrobial stewardship. Following introduction of national antibiotic recommendations for suspected bacterial respiratory tract infection complicating COVID-19, a point prevalence survey of prescribing was conducted across acute hospitals in Scotland. METHODS Patients in designated COVID-19 units were included and demographic, clinical and antimicrobial data were collected from 15 hospitals on a single day between 20th and 30th April 2020. Comparisons were made between SARS-CoV-2 positive and negative patients and patients on non-critical care and critical care units. Factors associated with antibiotic prescribing in SARS-CoV-2 positive patients were examined using Univariable and multivariable regression analyses. FINDINGS There were 820 patients were included, 64.8% were SARS-CoV-2 positive and 14.9% were managed in critical care, and 22.1% of SARS-CoV-2 infections were considered probable or definite nosocomial infections. On the survey day, antibiotic prevalence was 45.0% and 73.9% were prescribed for suspected respiratory tract infection. Amoxicillin, doxycycline and co-amoxiclav accounted for over half of all antibiotics in non-critical care wards and meropenem, piperacillin-tazobactam and co-amoxiclav accounted for approximately half prescribed in critical care. Of all SARS-CoV-2 patients, 38.3% were prescribed antibiotics. In a multivariable logistic regression analysis, COPD/chronic lung disease and CRP ≥ 100 mg/l were associated with higher odds and probable or confirmed nosocomial COVID-19, diabetes and management on an elderly care ward had lower odds of an antibiotic prescription. Systemic antifungals were prescribed in 9.8% of critical care patients and commenced a median of 18 days after critical care admission. INTERPRETATION A relatively low prevalence of antibiotic prescribing in SARS-CoV-2 hospitalised patients and low proportion of broad spectrum antibiotics in non-critical care settings was observed potentially reflecting national antimicrobial stewardship initiatives. Broad spectrum antibiotic and antifungal prescribing in critical care units was observed indicating the importance of infection prevention and control and stewardship initiatives in this setting. FUNDING The Scottish Antibiotic Prescribing Group is funded by Scottish Government.
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Affiliation(s)
- Ronald A Seaton
- Infection unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK; Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 48 West Nile Street, Glasgow G1 2NP, UK.
| | - Cheryl L Gibbons
- National ARHAI Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - Lesley Cooper
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 48 West Nile Street, Glasgow G1 2NP, UK
| | - William Malcolm
- National ARHAI Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - Rachel McKinney
- Regional Infectious diseases unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Stephanie Dundas
- Infection unit, University Hospital Monklands, Monkscourt Avenue, Airdrie ML6 OJS, UK
| | - David Griffith
- Department of Microbiology, Victoria Infirmary, Hayfield Road, Kirkcaldy KY2 5AH, UK
| | - Danielle Jeffreys
- Department of Medical Education, Centre For Health Science, Old Perth Road, Inverness IV2 3UJ
| | - Kayleigh Hamilton
- Antimicrobial Management Team, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, Kilmarnock KA2 0BE, UK
| | - Brian Choo-Kang
- Respiratory Medicine unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - Suzanne Brittain
- Antimicrobial Management Team, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill road, Aberdeen AB25 2ZN, UK
| | - Debbie Guthrie
- Pharmacy Department, Ninewells Hospital, James Arrott Drive, Dundee DD2 1SG, UK
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 48 West Nile Street, Glasgow G1 2NP, UK
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158
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Shannon VR, Anderson R, Blidner A, Choi J, Cooksley T, Dougan M, Glezerman I, Ginex P, Girotra M, Gupta D, Johnson DB, Suarez-Almazor ME, Rapoport BL. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity. Support Care Cancer 2020; 28:6145-6157. [PMID: 32880733 PMCID: PMC7471521 DOI: 10.1007/s00520-020-05708-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
Abstract
The immune checkpoints associated with the CTLA-4 and PD-1 pathways are critical modulators of immune activation. These pathways dampen the immune response by providing brakes on activated T cells, thereby ensuring more uniform and controlled immune reactions and avoiding immune hyper-responsiveness and autoimmunity. Cancer cells often exploit these regulatory controls through a variety of immune subversion mechanisms, which facilitate immune escape and tumor survival. Immune checkpoint inhibitors (ICI) effectively block negative regulatory signals, thereby augmenting immune attack and tumor killing. This process is a double-edged sword in which release of regulatory controls is felt to be responsible for both the therapeutic efficacy of ICI therapy and the driver of immune-related adverse events (IrAEs). These adverse immune reactions are common, typically low-grade and may affect virtually every organ system. In the early clinical trials, lung IrAEs were rarely described. However, with ever-expanding clinical applications and more complex ICI-containing regimens, lung events, in particular, pneumonitis, have become increasingly recognized. ICI-related lung injury is clinically distinct from other types of lung toxicity and may lead to death in advanced stage disease. Thus, knowledge regarding the key characteristics and optimal treatment of lung-IrAEs is critical to good outcomes. This review provides an overview of lung-IrAEs, including risk factors and epidemiology, as well as clinical, radiologic, and histopathologic features of ICI-related lung injury. Management principles for ICI-related lung injury, including current consensus on steroid refractory pneumonitis and the use of other immune modulating agents in this setting are also highlighted.
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Affiliation(s)
- Vickie R. Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002 South Africa
| | - Ada Blidner
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine-CONICET, Buenos Aires, Argentina
| | - Jennifer Choi
- Division of Oncodermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Tim Cooksley
- Manchester University Foundation Trust, Manchester, UK
- The Christie, University of Manchester, Manchester, UK
| | - Michael Dougan
- Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ilya Glezerman
- Renal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY USA
| | | | - Monica Girotra
- Endocrine Division, Department of Medicine, Weill Cornell Medical College (MG, AF), New York, NY USA
- Department of Medicine (DJB), Memorial Sloan-Kettering Cancer Center (MC), New York, NY USA
| | - Dipti Gupta
- Department of Medicine (DJB), Memorial Sloan-Kettering Cancer Center (MC), New York, NY USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN USA
| | - Maria E. Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bernardo L. Rapoport
- Department of Immunology, Faculty of Health Sciences, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002 South Africa
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196 South Africa
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159
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Theise ND, Arment AR, Chakravarty D, Gregg JMH, Jacobson IM, Jung KH, Nair SS, Tewari AK, Thurston AW, Van Drie J, Westover JB. Clinical stage molecule PT150 is a modulator of glucocorticoid and androgen receptors with antiviral activity against SARS-CoV-2. Cell Cycle 2020; 19:3632-3638. [PMID: 33305659 PMCID: PMC7738205 DOI: 10.1080/15384101.2020.1859752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/20/2023] Open
Abstract
PT150 is a clinical-stage molecule, taken orally, with a strong safety profile having completed Phase 1 and Phase 2 clinical trials for its original use as an antidepressant. It has an active IND for COVID-19. Antiviral activities have been found for PT150 and other members of its class in a variety of virus families; thus, it was now tested against SARS-CoV-2 in human bronchial epithelial lining cells and showed effective 90% inhibitory antiviral concentration (EC90) of 5.55 µM. PT150 is a member of an extended platform of novel glucocorticoid receptor (GR) and androgen receptor (AR) modulating molecules. In vivo, their predominant net effect is one of systemic glucocorticoid antagonism, but they also show direct downregulation of AR and minor GR agonism at the cellular level. We hypothesize that anti-SARS-CoV-2 activity depends in part on this AR downregulation through diminished TMPRSS2 expression and modulation of ACE2 activity. Given that hypercortisolemia is now suggested to be a significant co-factor for COVID-19 progression, we also postulate an additive role for its potent immunomodulatory effects through systemic antagonism of cortisol.
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Affiliation(s)
- Neil D. Theise
- Department of Pathology, New York University-Grossman School of Medicine, New York, NY, USA
- Palisades Therapeutics/Pop Test Oncology LLC, Cliffside Park, NJ, USA
| | - Anthony R. Arment
- Department of Biology, Central State University, Wilberforce, OH, USA
| | - Dimple Chakravarty
- Department of Urology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M. H. Gregg
- Palisades Therapeutics/Pop Test Oncology LLC, Cliffside Park, NJ, USA
| | - Ira M. Jacobson
- Department of Medicine, New York University-Grossman School of Medicine, New York, NY, USA
| | - Kie Hoon Jung
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, UT, USA
| | - Sujit S. Nair
- Department of Urology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh K. Tewari
- Department of Urology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Jonna B. Westover
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, UT, USA
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160
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Affiliation(s)
- Amita Sudhir
- University of Virginia Department of Emergency Medicine, Charlottesville, Virginia, USA
| | - Nachiket Mor
- The Banyan Academy of Leadership in Mental Health, Bangalore, Karnataka, India
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161
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Chérrez-Ojeda I, Vanegas E, Felix M. The unusual experience of managing a severe COVID-19 case at home: what can we do and where do we go? BMC Infect Dis 2020; 20:862. [PMID: 33213364 PMCID: PMC7675380 DOI: 10.1186/s12879-020-05608-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The speed and reach of the COVID-19 pandemic has created special scenarios to be considered, such as those in where patients who meet criteria for hospitalization due to moderate/severe disease cannot be hospitalized due to economic constraints and saturation of national health systems. The aim of this report is to present an unusual case of a severe COVID-19 patient managed at home in a developing country, and to discuss some of the available guidelines and potential therapeutic options for this type of cases. CASE PRESENTATION A 60-year-old female seeking medical attention through teleconsultation presents with profound dyspnea, oppressive chest pain, fatigue, episodic hallucinations, and difficulty sleeping, for what she originally sought medical attention at an ER but could not be admitted due to saturation of the health system. A positive PCR test for COVID-19, and a CT scan of the chest showing bilateral consolidations with ground-glass opacities confirmed the diagnosis. The patient was managed at home, with corticosteroids, nitazoxanide and a single dose of 40 mg of subcutaneous enoxaparin. Colchicine was added at the third day of treatment. Standard oxygen therapy through nasal cannula was also recommended. Daily follow-ups were established to monitor for signs of clinical improvement. Two weeks later from the initial consultation the patient presents marked improvement in her symptoms, as well as in her CT scan, which prompted in discontinuation of the medications and the oxygen therapy. CONCLUSIONS There are several limitations in this report regarding the clinical data and the management, but such limitations do also reflect the state of emergency and the chaos that resides in the health care systems of developing nations. For the ambulatory care of COVID-19 patients, several aspects of disease management may differ from current guidelines and basic requirements may represent a huge challenge to cover. Further research is needed to assist physicians in the daily clinical decision making, to optimize patient outcomes, and to reduce the probability of adverse scenarios of patients with COVID-19 managed in the ambulatory setting.
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Affiliation(s)
- Ivan Chérrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, 0901-952 Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, 0901-952 Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, 0901-952 Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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162
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Borcherding N, Jethava Y, Vikas P. Repurposing Anti-Cancer Drugs for COVID-19 Treatment. Drug Des Devel Ther 2020; 14:5045-5058. [PMID: 33239864 PMCID: PMC7680713 DOI: 10.2147/dddt.s282252] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has caused catastrophic damage to human life across the globe along with social and financial hardships. According to the Johns Hopkins University Coronavirus Resource Center, more than 41.3 million people worldwide have been infected, and more than 1,133,000 people have died as of October 22, 2020. At present, there is no available vaccine and a scarcity of efficacious therapies. However, there is tremendous ongoing effort towards identifying effective drugs and developing novel vaccines. Early data from Adaptive COVID-19 Treatment Trials (ACTT) sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) and compassionate use study have shown promise for remdesivir, leading to emergency authorization by the Food and Drug Administration (FDA) for treatment of hospitalized COVID-19 patients. However, several randomized studies have now shown no benefit or increased adverse events associated with remdesivir treatment. Drug development is a time-intensive process and requires extensive safety and efficacy evaluations. In contrast, drug repurposing is a time-saving and cost-effective drug discovery strategy geared towards using existing drugs instead of de novo drug discovery. Treatments for cancer and COVID-19 often have similar goals of controlling inflammation, inhibiting cell division, and modulating the host microenvironment to control the disease. In this review, we focus on anti-cancer drugs that can potentially be repurposed for COVID-19 and are currently being tested in clinical trials.
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Affiliation(s)
- Nicholas Borcherding
- Holden Comprehensive Cancer Center, University of Iowa, College of Medicine, Iowa City, IA, USA
- Department of Pathology, University of Iowa, College of Medicine, Iowa City, IA, USA
- Cancer Biology Graduate Program, University of Iowa, College of Medicine, Iowa City, IA, USA
- Medical Scientist Training Program, University of Iowa, College of Medicine, Iowa City, IA, USA
| | - Yogesh Jethava
- Holden Comprehensive Cancer Center, University of Iowa, College of Medicine, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City, IA, USA
| | - Praveen Vikas
- Holden Comprehensive Cancer Center, University of Iowa, College of Medicine, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City, IA, USA
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163
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Zhou L, Huntington K, Zhang S, Carlsen L, So EY, Parker C, Sahin I, Safran H, Kamle S, Lee CM, Geun Lee C, A. Elias J, S. Campbell K, T. Naik M, J. Atwood W, Youssef E, A. Pachter J, Navaraj A, A. Seyhan A, Liang O, El-Deiry WS. MEK inhibitors reduce cellular expression of ACE2, pERK, pRb while stimulating NK-mediated cytotoxicity and attenuating inflammatory cytokines relevant to SARS-CoV-2 infection. Oncotarget 2020; 11:4201-4223. [PMID: 33245731 PMCID: PMC7679035 DOI: 10.18632/oncotarget.27799] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 affects vulnerable populations including elderly individuals and patients with cancer. Natural Killer (NK) cells and innate-immune TRAIL suppress transformed and virally-infected cells. ACE2, and TMPRSS2 protease promote SARS-CoV-2 infectivity, while inflammatory cytokines IL-6, or G-CSF worsen COVID-19 severity. We show MEK inhibitors (MEKi) VS-6766, trametinib and selumetinib reduce ACE2 expression in human cells. In some human cells, remdesivir increases ACE2-promoter luciferase-reporter expression, ACE2 mRNA and protein, and ACE2 expression is attenuated by MEKi. In serum-deprived and stimulated cells treated with remdesivir and MEKi we observed correlations between pRB, pERK, and ACE2 expression further supporting role of proliferative state and MAPK pathway in ACE2 regulation. We show elevated cytokines in COVID-19-(+) patient plasma (N = 9) versus control (N = 11). TMPRSS2, inflammatory cytokines G-CSF, M-CSF, IL-1α, IL-6 and MCP-1 are suppressed by MEKi alone or with remdesivir. We observed MEKi stimulation of NK-cell killing of target-cells, without suppressing TRAIL-mediated cytotoxicity. Pseudotyped SARS-CoV-2 virus with a lentiviral core and SARS-CoV-2 D614 or G614 SPIKE (S) protein on its envelope infected human bronchial epithelial cells, small airway epithelial cells, or lung cancer cells and MEKi suppressed infectivity of the pseudovirus. We show a drug class-effect with MEKi to stimulate NK cells, inhibit inflammatory cytokines and block host-factors for SARS-CoV-2 infection leading also to suppression of SARS-CoV-2-S pseudovirus infection of human cells. MEKi may attenuate SARS-CoV-2 infection to allow immune responses and antiviral agents to control disease progression.
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Affiliation(s)
- Lanlan Zhou
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- These authors contributed equally to this work
| | - Kelsey Huntington
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Pathobiology Graduate Program, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- These authors contributed equally to this work
| | - Shengliang Zhang
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Lindsey Carlsen
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Pathobiology Graduate Program, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Eui-Young So
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Hematology-Oncology Division, Department of Medicine, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Cassandra Parker
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Surgery, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Ilyas Sahin
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Hematology-Oncology Division, Department of Medicine, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Howard Safran
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Hematology-Oncology Division, Department of Medicine, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Suchitra Kamle
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Chang-Min Lee
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Chun Geun Lee
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Jack A. Elias
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Kerry S. Campbell
- Blood Cell and Development Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Mandar T. Naik
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Pharmacology, Physiology and Biotechnology, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Walter J. Atwood
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Molecular Biology, Cell Biology, and Biochemistry, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | | | | | - Arunasalam Navaraj
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Attila A. Seyhan
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Olin Liang
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Hematology-Oncology Division, Department of Medicine, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Wafik S. El-Deiry
- Brown Experimentalists Against COVID-19 (BEACON) Group, Brown University, Providence, RI 02912, USA
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- The Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, RI 02912, USA
- Cancer Center at Brown University, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Pathobiology Graduate Program, Brown University, Providence, RI 02912, USA
- Hematology-Oncology Division, Department of Medicine, Lifespan Health System and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
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164
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Reese JT, Unni D, Callahan TJ, Cappelletti L, Ravanmehr V, Carbon S, Shefchek KA, Good BM, Balhoff JP, Fontana T, Blau H, Matentzoglu N, Harris NL, Munoz-Torres MC, Haendel MA, Robinson PN, Joachimiak MP, Mungall CJ. KG-COVID-19: A Framework to Produce Customized Knowledge Graphs for COVID-19 Response. PATTERNS (NEW YORK, N.Y.) 2020; 2:100155. [PMID: 33196056 PMCID: PMC7649624 DOI: 10.2196/13803.100155 10.1016/j.patter.2020.100155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Integrated, up-to-date data about SARS-CoV-2 and COVID-19 is crucial for the ongoing response to the COVID-19 pandemic by the biomedical research community. While rich biological knowledge exists for SARS-CoV-2 and related viruses (SARS-CoV, MERS-CoV), integrating this knowledge is difficult and time-consuming, since much of it is in siloed databases or in textual format. Furthermore, the data required by the research community vary drastically for different tasks; the optimal data for a machine learning task, for example, is much different from the data used to populate a browsable user interface for clinicians. To address these challenges, we created KG-COVID-19, a flexible framework that ingests and integrates heterogeneous biomedical data to produce knowledge graphs (KGs), and applied it to create a KG for COVID-19 response. This KG framework also can be applied to other problems in which siloed biomedical data must be quickly integrated for different research applications, including future pandemics.
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Affiliation(s)
- Justin T. Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA,Corresponding author
| | - Deepak Unni
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Tiffany J. Callahan
- Computational Bioscience Program, Department of Pharmacology, University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA
| | - Luca Cappelletti
- Department of Computer Science, University of Milano, 20122 Milan, Italy
| | - Vida Ravanmehr
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Seth Carbon
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Kent A. Shefchek
- Linus Pauling Institute, Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97331, USA
| | - Benjamin M. Good
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - James P. Balhoff
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA
| | - Tommaso Fontana
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | | | - Nomi L. Harris
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Monica C. Munoz-Torres
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA,Linus Pauling Institute, Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97331, USA
| | - Melissa A. Haendel
- Linus Pauling Institute, Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97331, USA
| | - Peter N. Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Marcin P. Joachimiak
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Christopher J. Mungall
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
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165
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Sultana J, Crisafulli S, Gabbay F, Lynn E, Shakir S, Trifirò G. Challenges for Drug Repurposing in the COVID-19 Pandemic Era. Front Pharmacol 2020; 11:588654. [PMID: 33240091 PMCID: PMC7677570 DOI: 10.3389/fphar.2020.588654] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has affected an estimated 16 million persons and caused 0.6 million deaths worldwide by September 2020. The pandemic has led to a rush to repurpose existing drugs, although the underlying evidence base is of variable quality. The improving knowledge of the virology and clinical presentation of COVID-19 is leading to a broadening pool of potential pharmacological targets. The aim of this review is to describe regulatory and pharmacological aspects of drug repurposing and to identify drugs proposed for repurposing in COVID-19 based on registered clinical trials, discussing the evidence to support their use in the treatment of this disease. The challenges of the correct interpretation of existing pre-clinical/clinical evidence as well as the generation of new evidence concerning drug repurposing in COVID-19 will also be discussed. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT04321174, NCT04342663, NCT04280705, NCT04244591, NCT04359329, NCT04348695, NCT04304313, NCT043505931.
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Affiliation(s)
- Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | | - Elizabeth Lynn
- Drug Safety Research Unit, Southampton, United Kingdom
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Saad Shakir
- Drug Safety Research Unit, Southampton, United Kingdom
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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166
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Nagarkatti P, Miranda K, Nagarkatti M. Use of Cannabinoids to Treat Acute Respiratory Distress Syndrome and Cytokine Storm Associated with Coronavirus Disease-2019. Front Pharmacol 2020; 11:589438. [PMID: 33240092 PMCID: PMC7677512 DOI: 10.3389/fphar.2020.589438] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2. A significant proportion of COVID-19 patients develop Acute Respiratory Distress Syndrome (ARDS) resulting from hyperactivation of the immune system and cytokine storm, which leads to respiratory and multi-organ failure, and death. Currently, there are no effective treatments against hyperimmune syndrome and ARDS. We propose that because immune cells express cannabinoid receptors and their agonists are known to exhibit potent anti-inflammatory activity, targeting cannabinoid receptors, and endocannabinoids deserve intense investigation as a novel approach to treat systemic inflammation, cytokine storm, and ARDS in patients with COVID-19.
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Affiliation(s)
- Prakash Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States.,University of South Carolina, Columbia, SC, United States
| | - Kathryn Miranda
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States
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167
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Kaye AG, Siegel R. The efficacy of IL-6 inhibitor Tocilizumab in reducing severe COVID-19 mortality: a systematic review. PeerJ 2020; 8:e10322. [PMID: 33194450 PMCID: PMC7643559 DOI: 10.7717/peerj.10322] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the absence of highly effective antiviral therapies against SARS-CoV-2, it is crucial to counter the known pathophysiological causes of severe COVID-19. Evaluating the efficacy existing drugs may expedite the development of such therapeutics. Severe COVID-19 is largely the result of a dysregulated immune response characterized by lymphocytopenia, neutrophilia and critical hypercytokinemia, or "cytokine storm," which is largely mediated by the cytokine interleukin-6 (IL-6). The IL-6 inhibitor tocilizumab (TCZ) could potentially suppress the effects of the pro-inflammatory cytokine and thereby lower mortality from the disease. This systematic analysis aimed to investigate and synthesize existing evidence for the efficacy of TCZ in reducing COVID-19 mortality. METHODOLOGY PubMed and SearchWorks searches were performed to locate clinical studies with primary data on TCZ treatment for severe COVID-19. Sixteen case-control studies comparing mortality between TCZ and standard of care (SOC) were identified for quantitative synthesis. The systematic analysis was pre-approved through PROSPERO (CRD42020193479). RESULTS Combined mortality for the TCZ-treated and SOC groups were 26.0% and 43.4% respectively. In all but one of the studies, the odds ratio of mortality from COVID-19 pointed towards lower fatality with TCZ vs the SOC. A combined random effects odds ratio calculation yielded an odds ratio of 0.453 (95% CI [0.376-0.547], p < 0.001). Additionally, 18 uncontrolled trials were identified for qualitative analysis producing a raw combined mortality rate of 16.0%. CONCLUSIONS Important caveats to this research include the lack of prospective randomized control trials and the absence of data from the large COVATA study from the published literature. However, results from this systematic analysis of published research provide positive evidence for the potential efficacy of TCZ to treat severe COVID-19, validating the ethical basis and merit of ongoing randomized controlled clinical trials.
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Affiliation(s)
| | - Robert Siegel
- Human Biology, Stanford University, Stanford, CA, USA
- Microbiology & Immunology, Stanford University, Stanford, CA, USA
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168
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Jackson DJ, Busse WW, Togias A, Gern JE, Altman MC. Reply. J Allergy Clin Immunol 2020; 146:1214-1215. [PMID: 32828589 PMCID: PMC7427546 DOI: 10.1016/j.jaci.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Alkis Togias
- The National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Mathew C Altman
- Department of Medicine, University of Washington, Seattle, Wash; Benaroya Research Institute, Systems Immunology Division, Seattle, Wash
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169
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Dye C, Cheng RCH, Dagpunar JS, Williams BG. The scale and dynamics of COVID-19 epidemics across Europe. ROYAL SOCIETY OPEN SCIENCE 2020; 7:201726. [PMID: 33391818 PMCID: PMC7735356 DOI: 10.1098/rsos.201726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/18/2020] [Indexed: 05/20/2023]
Abstract
The number of COVID-19 deaths reported from European countries has varied more than 100-fold. In terms of coronavirus transmission, the relatively low death rates in some countries could be due to low intrinsic (e.g. low population density) or imposed contact rates (e.g. non-pharmaceutical interventions) among individuals, or because fewer people were exposed or susceptible to infection (e.g. smaller populations). Here, we develop a flexible empirical model (skew-logistic) to distinguish among these possibilities. We find that countries reporting fewer deaths did not generally have intrinsically lower rates of transmission and epidemic growth, and flatter epidemic curves. Rather, countries with fewer deaths locked down earlier, had shorter epidemics that peaked sooner and smaller populations. Consequently, as lockdowns were eased, we expected, and duly observed, a resurgence of COVID-19 across Europe.
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Affiliation(s)
- Christopher Dye
- Department of Zoology, University of Oxford, Oxford, UK
- Author for correspondence: Christopher Dye e-mail:
| | - Russell C. H. Cheng
- Department of Mathematical Sciences, University of Southampton, Southampton, UK
| | - John S. Dagpunar
- Department of Mathematical Sciences, University of Southampton, Southampton, UK
| | - Brian G. Williams
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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170
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Poulsen NN, von Brunn A, Hornum M, Blomberg Jensen M. Cyclosporine and COVID-19: Risk or favorable? Am J Transplant 2020; 20:2975-2982. [PMID: 32777170 PMCID: PMC7436557 DOI: 10.1111/ajt.16250] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is declared a global health emergency. COVID-19 is triggered by a novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Baseline characteristics of admitted patients with COVID-19 show that adiposity, diabetes, and hypertension are risk factors for developing severe disease, but so far immunosuppressed patients who are listed as high-risk patients have not been more susceptible to severe COVID-19 than the rest of the population. Multiple clinical trials are currently being conducted, which may identify more drugs that can lower mortality, morbidity, and burden on the society. Several independent studies have convincingly shown that cyclosporine inhibit replication of several different coronaviruses in vitro. The cyclosporine-analog alisporivir has recently been shown to inhibit SARS-CoV-2 in vitro. These findings are intriguing, although there is no clinical evidence for a protective effect to reduce the likelihood of severe COVID-19 or to treat the immune storm or acute respiratory distress syndrome (ARDS) that often causes severe morbidity. Here, we review the putative link between COVID-19 and cyclosporine, while we await more robust clinical data.
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Affiliation(s)
- Nadia Nicholine Poulsen
- Department of Growth and Reproduction, Group of Skeletal, Mineral, and Gonadal Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Albrecht von Brunn
- Max von Pettenkofer-Institute, Ludwig-Maximilians-University Munich/German Center for Infection Research (DZIF), Munich, Germany
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Martin Blomberg Jensen
- Department of Growth and Reproduction, Group of Skeletal, Mineral, and Gonadal Endocrinology, Rigshospitalet, Copenhagen, Denmark,Division of Bone and Mineral Research, HSDM/HMS Harvard University, Boston, MA, USA,Correspondence Martin Blomberg Jensen
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171
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Modern Principles of Adjuvant Therapy of COVID-19. Fam Med 2020. [DOI: 10.30841/2307-5112.4.2020.217289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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172
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Baer B, McCaig L, Yamashita C, Veldhuizen R. Exogenous Surfactant as a Pulmonary Delivery Vehicle for Budesonide In Vivo. Lung 2020; 198:909-916. [PMID: 33106891 PMCID: PMC7587541 DOI: 10.1007/s00408-020-00399-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022]
Abstract
Background Lung inflammation is associated with many respiratory conditions. Consequently, anti-inflammatory medications, like glucocorticoids, have become mainstay intrapulmonary therapeutics. However, their effectiveness for treating inflammation occurring in the alveolar regions of the lung is limited by suboptimal delivery. To improve the pulmonary distribution of glucocorticoids, such as budesonide to distal regions of the lung, exogenous surfactant has been proposed as an ideal delivery vehicle for such therapies. It was therefore hypothesized that fortifying an exogenous surfactant (BLES) with budesonide would enhance efficacy for treating pulmonary inflammation in vivo. Methods An intratracheal instillation of heat-killed bacteria was used to elicit an inflammatory response in the lungs of male and female rats. Thirty minutes after this initial instillation, either budesonide or BLES combined with budesonide was administered intratracheally. To evaluate the efficacy of surfactant delivery, various markers of inflammation were measured in the bronchoalveolar lavage and lung tissue. Results Although budesonide exhibited anti-inflammatory effects when administered alone, delivery with BLES enhanced those effects by lowering the lavage neutrophil counts and myeloperoxidase activity in lung tissue. Combining budesonide with BLES was also shown to reduce several other pro-inflammatory mediators. These results were shown across both sexes, with no observed sex differences. Conclusion Based on these findings, it was concluded that exogenous surfactant can enhance the delivery and efficacy of budesonide in vivo.
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Affiliation(s)
- Brandon Baer
- Department of Physiology and Pharmacology, Western University, London, ON, Canada.
| | - Lynda McCaig
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Cory Yamashita
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
| | - Ruud Veldhuizen
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
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173
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Dickinson PJ. Coronavirus Infection of the Central Nervous System: Animal Models in the Time of COVID-19. Front Vet Sci 2020; 7:584673. [PMID: 33195610 PMCID: PMC7644464 DOI: 10.3389/fvets.2020.584673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
Naturally occurring coronaviral infections have been studied for several decades in the context of companion and production animals, and central nervous system involvement is a common finding, particularly in cats with feline infectious peritonitis (FIP). These companion and production animal coronaviruses have many similarities to recent human pandemic-associated coronaviruses such as SARS-CoV, MERS-CoV, and SARS-CoV2 (COVID-19). Neurological involvement is being increasingly recognized as an important clinical presentation in human COVID-19 patients, often associated with para-infectious processes, and potentially with direct infection within the CNS. Recent breakthroughs in the treatment of coronaviral infections in cats, including neurological FIP, have utilized antiviral drugs similar to those currently in human COVID-19 clinical trials. Differences in specific coronavirus and host factors are reflected in major variations in incidence and mechanisms of CNS coronaviral infection and pathology between species; however, broad lessons relating to treatment of coronavirus infection present within the CNS may be informative across species.
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Affiliation(s)
- Peter J. Dickinson
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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174
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Ghosh R, Chakraborty A, Biswas A, Chowdhuri S. Potential therapeutic use of corticosteroids as SARS CoV-2 main protease inhibitors: a computational study. J Biomol Struct Dyn 2020; 40:2053-2066. [PMID: 33094701 PMCID: PMC7596904 DOI: 10.1080/07391102.2020.1835728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The outbreak of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), represents a pandemic threat to global public health. To date, ∼530,000 people died of this disease worldwide. Presently, researchers/clinicians are adopting the drug repurposing strategy to combat this disease. It has also been observed that some repurposed anti-viral drugs may serve as potent inhibitors of SARS CoV-2 Mpro, a key component of viral replication. Apart from these anti-viral drugs, recently dexamethasone (an important corticosteroid) is effectively used to treat COVID-19 patients. However, the mechanism behind the mode of its action is not so clear. Additionally, the effect of other well-known corticosteroids to control this disease by inhibiting the proteolytic activity of Mpro is ambiguous. In this study, we have adopted computational approaches to understand these aspects. Six well-known corticosteroids (cortisone, hydrocortisone, prednisolone, methylprednisolone, betamethasone and dexamethasone) and two repurposed drugs (darunavir and lopinavir) against COVID-19 were subjected for molecular docking studies. Two of them (betamethasone and dexamethasone) were selected by comparing their binding affinities with selected repurposed drugs toward Mpro. Betamethasone and dexamethasone interacted with both the catalytic residues of Mpro (His41 and Cys145). Molecular dynamics studies further revealed that these two Mpro-corticosteroid complexes are more stable, experience less conformational fluctuations and more compact than Mpro-darunavir/lopinavir complexes. These findings were additionally validated by MM-GBSA analysis. This study provides corroboration for execution of anti-COVID-19 activity of dexamethasone. Our study also emphasizes on the use of another important corticosteroid (betamethasone) as potential therapeutic agent for COVID-19 treatment.
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Affiliation(s)
- Rajesh Ghosh
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Ayon Chakraborty
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Ashis Biswas
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Snehasis Chowdhuri
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
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175
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Dubey A, Dahiya S, Rouse BT, Sehrawat S. Perspective: Reducing SARS-CoV2 Infectivity and Its Associated Immunopathology. Front Immunol 2020; 11:581076. [PMID: 33193385 PMCID: PMC7642257 DOI: 10.3389/fimmu.2020.581076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has become difficult to contain in our interconnected world. In this article, we discuss some approaches that could reduce the consequences of COVID-19. We elaborate upon the utility of camelid single-domain antibodies (sdAbs), also referred to as nanobodies, which are naturally poised to neutralize viruses without enhancing its infectivity. Smaller sized sdAbs can be easily selected using microbes or the subcellular organelle display methods and can neutralize SARS-CoV2 infectivity. We also discuss issues related to their production using scalable platforms. The favorable outcome of the infection is evident in patients when the inflammatory response is adequately curtailed. Therefore, we discuss approaches to mitigate hyperinflammatory reactions initiated by SARS-CoV2 but orchestrated by immune mediators.
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Affiliation(s)
- Abhishek Dubey
- Department of Biological Sciences, Indian Institute of Science Education and Research Mohali, Mohali, India
| | - Surbhi Dahiya
- Department of Biological Sciences, Indian Institute of Science Education and Research Mohali, Mohali, India
| | - Barry T. Rouse
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, United States
| | - Sharvan Sehrawat
- Department of Biological Sciences, Indian Institute of Science Education and Research Mohali, Mohali, India
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176
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Talwar S, Sood S, Kumar J, Chauhan R, Sharma M, Tuli HS. Ayurveda and Allopathic Therapeutic Strategies in Coronavirus Pandemic Treatment 2020. CURRENT PHARMACOLOGY REPORTS 2020; 6:354-363. [PMID: 33106765 PMCID: PMC7577842 DOI: 10.1007/s40495-020-00245-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 12/20/2022]
Abstract
Purpose of Review In the last month of 2019, i.e., December, COVID-19 hit Wuhan city in China. Since then, it has infected more than 210 countries and nearly about 33.4 million people with one million deaths globally. It is a viral disease with flu-like symptoms; hence, prevention and management is the best option to be adopted for its cure. Recent Findings Many healthcare systems, scientists, and researchers are fighting for the cure of this pandemic. Ayurvedic and allopathic treatments have been studied extensively and approached for the cure of COVID-19. In addition to ayurvedic treatments, the Ministry of Ayush, India, has also recommended many remedies to boost up immunity. Allopathic studies involved several antiviral drugs which were used in different combinations for the treatment of COVID-19. Summary Comparative analysis of Ayurveda and allopathic treatment strategies were carried out in the present study. Depending upon the patient's conditions and symptoms, Ayurveda is useful for the treatment of COVID-19. Allopathic treatments inhibit viral infection by targeting majorly endocytosis, and angiotensin-converting enzyme (Ace) receptor signaling. In this article, we summarize different ayurvedic and allopathic medicines and treatment strategies which have been used for the treatment of COVID-19, a global pandemic.
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Affiliation(s)
- Shivangi Talwar
- Amity Institute of Biotechnology, Amity University, Noida, Noida, India
| | - Shivani Sood
- Department of Biotechnology, Mukand Lal National College, Yamuna Nagar, India
| | - Jayant Kumar
- Department of Biotechnology, Mukand Lal National College, Yamuna Nagar, India
| | - Ritu Chauhan
- Amity Institute of Biotechnology, Amity University, Noida, Noida, India
| | - Mamta Sharma
- School of Law, Justice and Governance, Gautam Buddha University, Greater Noida, India
| | - Hardeep Singh Tuli
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, 133207 India
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177
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Effect of Tocilizumab in Hospitalized Patients with Severe COVID-19 Pneumonia: A Case-Control Cohort Study. Pharmaceuticals (Basel) 2020; 13:ph13100317. [PMID: 33080877 PMCID: PMC7603074 DOI: 10.3390/ph13100317] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Tocilizumab, an anti-interleukin-6 receptor, administrated during the right timeframe may be beneficial against coronavirus-disease-2019 (COVID-19) pneumonia. All patients admitted for severe COVID-19 pneumonia (SpO2 ≤ 96% despite O2-support ≥ 6 L/min) without invasive mechanical ventilation were included in a retrospective cohort study in a primary care hospital. The treatment effect of a single-dose, 400 mg, of tocilizumab was assessed by comparing those who received tocilizumab to those who did not. Selection bias was mitigated using three statistical methods. Primary outcome measure was a composite of mortality and ventilation at day 28. A total of 246 patients were included (106 were treated with tocilizumab). Overall, 105 (42.7%) patients presented the primary outcome, with 71 (28.9%) deaths during the 28-day follow-up. Propensity-score-matched 84 pairs of comparable patients. In the matched cohort (n = 168), tocilizumab was associated with fewer primary outcomes than the control group (hazard ratio (HR) = 0.49 (95% confidence interval (95%CI) = 0.3-0.81), p-value = 0.005). These results were similar in the overall cohort (n = 246), with Cox multivariable analysis yielding a protective association between tocilizumab and primary outcome (adjusted HR = 0.26 (95%CI = 0.135-0.51, p = 0.0001), confirmed by inverse probability score weighting (IPSW) analysis (p < 0.0001). Analyses on mortality only, with 28 days of follow-up, yielded similar results. In this study, tocilizumab 400 mg in a single-dose was associated with improved survival without mechanical ventilation in patients with severe COVID-19.
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178
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Butler DL, Gildersleeve JC. Abnormal antibodies to self-carbohydrates in SARS-CoV-2 infected patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.10.15.341479. [PMID: 33083799 PMCID: PMC7574254 DOI: 10.1101/2020.10.15.341479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
SARS-CoV-2 is a deadly virus that is causing the global pandemic coronavirus disease 2019 (COVID-19). Our immune system plays a critical role in preventing, clearing, and treating the virus, but aberrant immune responses can contribute to deleterious symptoms and mortality. Many aspects of immune responses to SARS-CoV-2 are being investigated, but little is known about immune responses to carbohydrates. Since the surface of the virus is heavily glycosylated, pre-existing antibodies to glycans could potentially recognize the virus and influence disease progression. Furthermore, antibody responses to carbohydrates could be induced, affecting disease severity and clinical outcome. In this study, we used a carbohydrate antigen microarray with over 800 individual components to profile serum anti-glycan antibodies in COVID-19 patients and healthy control subjects. In COVID-19 patients, we observed abnormally high IgG and IgM antibodies to numerous self-glycans, including gangliosides, N -linked glycans, LacNAc-containing glycans, blood group H, and sialyl Lewis X. Some of these anti-glycan antibodies are known to play roles in autoimmune diseases and neurological disorders, which may help explain some of the unusual and prolonged symptoms observed in COVID-19 patients. The detection of antibodies to self-glycans has important implications for using convalescent serum to treat patients, developing safe and effective SARS-CoV-2 vaccines, and understanding the risks of infection. In addition, this study provides new insight into the immune responses to SARS-CoV-2 and illustrates the importance of including host and viral carbohydrate antigens when studying immune responses to viruses.
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Affiliation(s)
- Dorothy L. Butler
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702
| | - Jeffrey C. Gildersleeve
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702
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179
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Khadke S, Ahmed N, Ahmed N, Ratts R, Raju S, Gallogly M, de Lima M, Sohail MR. Harnessing the immune system to overcome cytokine storm and reduce viral load in COVID-19: a review of the phases of illness and therapeutic agents. Virol J 2020; 17:154. [PMID: 33059711 PMCID: PMC7558250 DOI: 10.1186/s12985-020-01415-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, previously named 2019-nCov), a novel coronavirus that emerged in China in December 2019 and was declared a global pandemic by World Health Organization by March 11th, 2020. Severe manifestations of COVID-19 are caused by a combination of direct tissue injury by viral replication and associated cytokine storm resulting in progressive organ damage. DISCUSSION We reviewed published literature between January 1st, 2000 and June 30th, 2020, excluding articles focusing on pediatric or obstetric population, with a focus on virus-host interactions and immunological mechanisms responsible for virus associated cytokine release syndrome (CRS). COVID-19 illness encompasses three main phases. In phase 1, SARS-CoV-2 binds with angiotensin converting enzyme (ACE)2 receptor on alveolar macrophages and epithelial cells, triggering toll like receptor (TLR) mediated nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ƙB) signaling. It effectively blunts an early (IFN) response allowing unchecked viral replication. Phase 2 is characterized by hypoxia and innate immunity mediated pneumocyte damage as well as capillary leak. Some patients further progress to phase 3 characterized by cytokine storm with worsening respiratory symptoms, persistent fever, and hemodynamic instability. Important cytokines involved in this phase are interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α. This is typically followed by a recovery phase with production of antibodies against the virus. We summarize published data regarding virus-host interactions, key immunological mechanisms responsible for virus-associated CRS, and potential opportunities for therapeutic interventions. CONCLUSION Evidence regarding SARS-CoV-2 epidemiology and pathogenesis is rapidly evolving. A better understanding of the pathophysiology and immune system dysregulation associated with CRS and acute respiratory distress syndrome in severe COVID-19 is imperative to identify novel drug targets and other therapeutic interventions.
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Affiliation(s)
- Sumanth Khadke
- Our Lady of Fatima University, 120 MacArthur Highway, 1440, Valenzuela, Metro Manila, Philippines
| | - Nayla Ahmed
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center - Geisel School of Medicine, One Medical Center Drive, Lebanon, NH, 03766, USA
| | - Nausheen Ahmed
- Section of Hematology Oncology, Bone Marrow Transplant and Cellular Therapy, University Of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Ryan Ratts
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center - Geisel School of Medicine, One Medical Center Drive, Lebanon, NH, 03766, USA
- Section of Pediatric Hospital Medicine, Dartmouth-Hitchcock Medical Center - Geisel School of Medicine, One Medical Center Drive, Lebanon, NH, 03766, USA
| | - Shine Raju
- Section of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center - Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Molly Gallogly
- Section of Hematology Oncology, Stem Cell Transplant and Cellular Therapeutics, University Hospitals Seidman Cancer Center - Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Marcos de Lima
- Section of Hematology Oncology, Stem Cell Transplant and Cellular Therapeutics, University Hospitals Seidman Cancer Center - Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Muhammad Rizwan Sohail
- Section of Infectious Diseases and Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, 200 1st St SW, Rochester, MN, 55905, USA.
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180
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Sharma L, Chang D, Dela Cruz CS. Does inflammation help during COVID-19? ERJ Open Res 2020; 6:00557-2020. [PMID: 33083436 PMCID: PMC7553107 DOI: 10.1183/23120541.00557-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has emerged as the most devastating pandemic in the last 100 years and has already killed almost 1 million people [1] despite the most aggressive efforts to contain the infection in recorded history. Currently, it remains unclear what drives disease severity in COVID-19, limiting therapeutic options. Various immune modulators such as glucocorticoids and anti-inflammatory therapies are being used to treat COVID-19 without clear evidence of inflammation playing a detrimental role. Here we review evidence to suggest that the host's ability to clear the viral infection is the major determinant in the host survival where a robust early inflammatory response in the lung provides a survival advantage to the host by aiding effective viral clearance. However, failure to clear the viral infection leads to an exacerbated inflammatory response at a later time point, which becomes detrimental to the host's survival. This concept can explain the high susceptibility associated with advanced age or male sex and at the same time explains why children are largely spared of this lethal disease but have inflammatory manifestations such as multi-system inflammatory syndrome in children (MIS-C) or Kawasaki-like disease. Persistent viral presence, rather than the early exaggerated inflammation, may be a key determinant of disease severity in #COVID19. If so, the focus of new therapies should be to promote viral clearance to decrease disease severity and mortality.https://bit.ly/3ahgzkP
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Affiliation(s)
- Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, Yale University School of Medicine, New Haven, USA.,All authors contributed equally
| | - De Chang
- Third Medical Center of Chinese PLA General Hospital, Beijing, China.,All authors contributed equally
| | - Charles S Dela Cruz
- Section of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, Yale University School of Medicine, New Haven, USA.,All authors contributed equally
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181
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Chaccour C, Abizanda G, Irigoyen-Barrio Á, Casellas A, Aldaz A, Martínez-Galán F, Hammann F, Gil AG. Nebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in rats. Sci Rep 2020; 10:17073. [PMID: 33051517 PMCID: PMC7555481 DOI: 10.1038/s41598-020-74084-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
Ivermectin is a widely used antiparasitic drug with known efficacy against several single-strain RNA viruses. Recent data shows significant reduction of SARS-CoV-2 replication in vitro by ivermectin concentrations not achievable with safe doses orally. Inhaled therapy has been used with success for other antiparasitics. An ethanol-based ivermectin formulation was administered once to 14 rats using a nebulizer capable of delivering particles with alveolar deposition. Rats were randomly assigned into three target dosing groups, lower dose (80-90 mg/kg), higher dose (110-140 mg/kg) or ethanol vehicle only. A toxicology profile including behavioral and weight monitoring, full blood count, biochemistry, necropsy and histological examination of the lungs was conducted. The pharmacokinetic profile of ivermectin in plasma and lungs was determined in all animals. There were no relevant changes in behavior or body weight. There was a delayed elevation in muscle enzymes compatible with rhabdomyolysis, that was also seen in the control group and has been attributed to the ethanol dose which was up to 11 g/kg in some animals. There were no histological anomalies in the lungs of any rat. Male animals received a higher ivermectin dose adjusted by adipose weight and reached higher plasma concentrations than females in the same dosing group (mean Cmax 86.2 ng/ml vs. 26.2 ng/ml in the lower dose group and 152 ng/ml vs. 51.8 ng/ml in the higher dose group). All subjects had detectable ivermectin concentrations in the lungs at seven days post intervention, up to 524.3 ng/g for high-dose male and 27.3 ng/g for low-dose females. nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats, additional experiments are required to assess the safety of this formulation in larger animals.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036, Barcelona, Spain.
- Ifakara Health Institute, 67501, Ifakara, United Republic of Tanzania.
- Facultad de Medicina, Universidad de Navarra, 31008, Pamplona, Spain.
| | - Gloria Abizanda
- Centro de Investigación Médica Aplicada, 31008, Pamplona, Spain
- Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Ángel Irigoyen-Barrio
- Facultad de Farmacia y Nutrición, Universidad de Navarra, 31008, Pamplona, Spain
- Drug Development Unit Universidad de Navarra, 31008, Pamplona, Spain
| | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036, Barcelona, Spain
- Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Azucena Aldaz
- Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Facultad de Farmacia y Nutrición, Universidad de Navarra, 31008, Pamplona, Spain
| | | | - Felix Hammann
- Department of General Internal Medicine, Clinical Pharmacology and Toxicology, Inselspital, Bern, University Hospital, 3010, Bern, Switzerland
| | - Ana Gloria Gil
- Facultad de Farmacia y Nutrición, Universidad de Navarra, 31008, Pamplona, Spain
- Drug Development Unit Universidad de Navarra, 31008, Pamplona, Spain
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182
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Frydman GH, Streiff MB, Connors JM, Piazza G. The Potential Role of Coagulation Factor Xa in the Pathophysiology of COVID-19: A Role for Anticoagulants as Multimodal Therapeutic Agents. ACTA ACUST UNITED AC 2020; 4:e288-e299. [PMID: 33043235 PMCID: PMC7541169 DOI: 10.1055/s-0040-1718415] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 infection (COVID-19) results in local and systemic activation of inflammation and coagulation. In this review article, we will discuss the potential role of coagulation factor Xa (FXa) in the pathophysiology of COVID-19. FXa, a serine protease, has been shown to play a role in the cleavage of SARS-CoV-1 spike protein (SP), with the inhibition of FXa resulting in the inhibition of viral infectivity. FX is known to be primarily produced in the liver, but it is also expressed by multiple cells types, including alveolar epithelium, cardiac myocytes, and macrophages. Considering that patients with preexisting conditions, including cardiopulmonary disease, are at an increased risk of severe COVID-19, we discuss the potential role of increased levels of FX in these patients, resulting in a potential increased propensity to have a higher infectious rate and viral load, increased activation of coagulation and inflammation, and development of fibrosis. With these observations in mind, we postulate as to the potential therapeutic role of FXa inhibitors as a prophylactic and therapeutic treatment for high-risk patients with COVID-19.
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Affiliation(s)
- Galit H Frydman
- Coagulo Medical Technologies, Inc., Auburndale, Massachusetts, United States.,Center for Biomedical Engineering, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States.,Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jean M Connors
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Gregory Piazza
- Division of Cardiovascular Medicine Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
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183
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Burn E, You SC, Sena AG, Kostka K, Abedtash H, Abrahão MTF, Alberga A, Alghoul H, Alser O, Alshammari TM, Aragon M, Areia C, Banda JM, Cho J, Culhane AC, Davydov A, DeFalco FJ, Duarte-Salles T, DuVall S, Falconer T, Fernandez-Bertolin S, Gao W, Golozar A, Hardin J, Hripcsak G, Huser V, Jeon H, Jing Y, Jung CY, Kaas-Hansen BS, Kaduk D, Kent S, Kim Y, Kolovos S, Lane JCE, Lee H, Lynch KE, Makadia R, Matheny ME, Mehta PP, Morales DR, Natarajan K, Nyberg F, Ostropolets A, Park RW, Park J, Posada JD, Prats-Uribe A, Rao G, Reich C, Rho Y, Rijnbeek P, Schilling LM, Schuemie M, Shah NH, Shoaibi A, Song S, Spotnitz M, Suchard MA, Swerdel JN, Vizcaya D, Volpe S, Wen H, Williams AE, Yimer BB, Zhang L, Zhuk O, Prieto-Alhambra D, Ryan P. Deep phenotyping of 34,128 adult patients hospitalised with COVID-19 in an international network study. Nat Commun 2020; 11:5009. [PMID: 33024121 PMCID: PMC7538555 DOI: 10.1038/s41467-020-18849-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.
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Affiliation(s)
- Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Amanda Alberga
- Observational Health Data Sciences and Informatics Network, Alberta, Canada
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Maria Aragon
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, GA, USA
| | - Jaehyeong Cho
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Aedin C Culhane
- Data Science, Dana-Farber Cancer Institute. Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander Davydov
- Odysseus Data Services, Inc., Cambridge, MA, USA
- Department for Microbiology, Virology and Immunology, Belarusian State Medical University, Minsk, Belarus
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Scott DuVall
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Sergio Fernandez-Bertolin
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Weihua Gao
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Asieh Golozar
- Pharmacoepidemiology, Regeneron, NY, USA
- Department of Epidemiology, Johns Hopkins School of Public, Baltimore, MD, USA
| | - Jill Hardin
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Vojtech Huser
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Hokyun Jeon
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Yonghua Jing
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Chi Young Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Benjamin Skov Kaas-Hansen
- Clinical Pharmacology Unit, Zealand University Hospital, Køge, Denmark
- NNF Centre for Protein Research, University of Copenhagen, København, Denmark
| | - Denys Kaduk
- Odysseus Data Services, Inc., Cambridge, MA, USA
- Department of Pediatrics № 2, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Seamus Kent
- Science Policy and Research, National Institute for Health and Care Excellence, London, UK
| | - Yeesuk Kim
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Spyros Kolovos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Hyejin Lee
- Bigdata Department, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Kristine E Lynch
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Michael E Matheny
- GRECC, Tennessee Valley Healthcare System VA, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paras P Mehta
- College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Jose D Posada
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Yeunsook Rho
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa M Schilling
- Data Science to Patient Value Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martijn Schuemie
- Janssen Research and Development, Titusville, NJ, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Nigam H Shah
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Seokyoung Song
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu, School of Medicine, Gyeongsan, Korea
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Marc A Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | - Salvatore Volpe
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Haini Wen
- Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Andrew E Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Belay B Yimer
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Lin Zhang
- School of Public Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Oleg Zhuk
- Odysseus Data Services, Inc., Cambridge, MA, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK.
| | - Patrick Ryan
- Janssen Research and Development, Titusville, NJ, USA
- Columbia University, New York, NY, USA
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184
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Singh K, Mittal S, Gollapudi S, Butzmann A, Kumar J, Ohgami RS. A meta-analysis of SARS-CoV-2 patients identifies the combinatorial significance of D-dimer, C-reactive protein, lymphocyte, and neutrophil values as a predictor of disease severity. Int J Lab Hematol 2020; 43:324-328. [PMID: 33010111 PMCID: PMC7675731 DOI: 10.1111/ijlh.13354] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), known to be the causative agent of COVID‐19, has led to a worldwide pandemic. At presentation, individual clinical laboratory blood values, such as lymphocyte counts or C‐reactive protein (CRP) levels, may be abnormal and associated with disease severity. However, combinatorial interpretation of these laboratory blood values, in the context of COVID‐19, remains a challenge. Methods To assess the significance of multiple laboratory blood values in patients with SARS‐CoV‐2 and develop a COVID‐19 predictive equation, we conducted a literature search using PubMed to seek articles that included defined laboratory data points along with clinical disease progression. We identified 9846 papers, selecting primary studies with at least 20 patients for univariate analysis to identify clinical variables predicting nonsevere and severe COVID‐19 cases. Multiple regression analysis was performed on a training set of patient studies to generate severity predictor equations, and subsequently tested on a validation cohort of 151 patients who had a median duration of observation of 14 days. Results Two COVID‐19 predictive equations were generated: one using four variables (CRP, D‐dimer levels, lymphocyte count, and neutrophil count), and another using three variables (CRP, lymphocyte count, and neutrophil count). In adult and pediatric populations, the predictive equations exhibited high specificity, sensitivity, positive predictive values, and negative predictive values. Conclusion Using the generated equations, the outcomes of COVID‐19 patients can be predicted using commonly obtained clinical laboratory data. These predictive equations may inform future studies evaluating the long‐term follow‐up of COVID‐19 patients.
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Affiliation(s)
- Kunwar Singh
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Sasha Mittal
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Sumanth Gollapudi
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Butzmann
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Jyoti Kumar
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Robert S Ohgami
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
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185
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Patrocínio de Jesus R, Silva R, Aliyeva E, Lopes L, Portugalyan M, Antunes L, Diaz P, Costa C, Araújo AC, Coelho S, Mendes JJ, Gomes S, Serra I, Freitas P. Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2402-2405. [PMID: 33043249 PMCID: PMC7531809 DOI: 10.1007/s42399-020-00548-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
As SARS-CoV-2 and its related clinical syndrome (COVID-19) became a pandemic worldwide, questions regarding its clinical presentation, infectivity, and immune response have been the subject of investigation. We present a case of a patient previously considered recovered from nosocomially transmitted asymptomatic COVID-19 illness, who presented with new respiratory, radiological, and RT-PCR findings consistent with COVID-19, while on high-dose prednisolone due to a suspected secondary demyelinating disease. Importantly, it led to three subsequent cases within patient's household after discharge from the hospital. After reviewing this case in light of current evidence and debates surrounding SARS-CoV-2 RT-PCR results, we hypothesize that patients on corticosteroids may have particular viral shedding dynamics and should prompt a more conservative approach in regard to isolation discontinuation and monitoring.
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Affiliation(s)
- Rita Patrocínio de Jesus
- Department of Infectious Diseases, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Raquel Silva
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Elzara Aliyeva
- Department of Clinical Pathology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Luís Lopes
- Department of Anesthesiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Mihran Portugalyan
- Department of Anesthesiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Liliana Antunes
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Priscila Diaz
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Carolina Costa
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Carolina Araújo
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Sílvia Coelho
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - João João Mendes
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Sara Gomes
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Isabel Serra
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Paulo Freitas
- Department of Intensive Care, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Janiaud P, Axfors C, van't Hooft J, Saccilotto R, Agarwal A, Appenzeller-Herzog C, Contopoulos-Ioannidis DG, Danchev V, Dirnagl U, Ewald H, Gartlehner G, Goodman SN, Haber NA, Ioannidis AD, Ioannidis JPA, Lythgoe MP, Ma W, Macleod M, Malički M, Meerpohl JJ, Min Y, Moher D, Nagavci B, Naudet F, Pauli-Magnus C, O'Sullivan JW, Riedel N, Roth JA, Sauermann M, Schandelmaier S, Schmitt AM, Speich B, Williamson PR, Hemkens LG. The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days. F1000Res 2020; 9:1193. [PMID: 33082937 PMCID: PMC7539080 DOI: 10.12688/f1000research.26707.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120; interquartile range [IQR] 60-300) but randomized (75.8%; n=522) and were often conducted in China (51.1%; n=352) or the USA (11%; n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112); 78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273; IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%; 3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample; 27 between 20-50%; and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.
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Affiliation(s)
- Perrine Janiaud
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Janneke van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Ramon Saccilotto
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Valentin Danchev
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
| | - Ulrich Dirnagl
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park Laboratories, Raleigh, North Carolina, USA
| | - Steven N. Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Noah A. Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Angeliki Diotima Ioannidis
- Molecular Toxicology Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Mark P. Lythgoe
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Wenyan Ma
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mario Malički
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Yan Min
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 [(Centre d’Investigation Clinique de Rennes)],, University of Rennes 1, Rennes, France
| | | | - Jack W. O'Sullivan
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan A. Roth
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Mandy Sauermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andreas M. Schmitt
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Deparment of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Speich
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paula R. Williamson
- MRC/NIHR Trials Methodology Research Partnership, University of Liverpool, Liverpool, UK
| | - Lars G. Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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Janiaud P, Axfors C, van't Hooft J, Saccilotto R, Agarwal A, Appenzeller-Herzog C, Contopoulos-Ioannidis DG, Danchev V, Dirnagl U, Ewald H, Gartlehner G, Goodman SN, Haber NA, Ioannidis AD, Ioannidis JPA, Lythgoe MP, Ma W, Macleod M, Malički M, Meerpohl JJ, Min Y, Moher D, Nagavci B, Naudet F, Pauli-Magnus C, O'Sullivan JW, Riedel N, Roth JA, Sauermann M, Schandelmaier S, Schmitt AM, Speich B, Williamson PR, Hemkens LG. The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days. F1000Res 2020; 9:1193. [PMID: 33082937 PMCID: PMC7539080 DOI: 10.12688/f1000research.26707.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120; interquartile range [IQR] 60-300) but randomized (75.8%; n=522) and were often conducted in China (51.1%; n=352) or the USA (11%; n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112); 78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273; IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%; 3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample; 27 between 20-50%; and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.
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Affiliation(s)
- Perrine Janiaud
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Janneke van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Ramon Saccilotto
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Valentin Danchev
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
| | - Ulrich Dirnagl
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park Laboratories, Raleigh, North Carolina, USA
| | - Steven N. Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Noah A. Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Angeliki Diotima Ioannidis
- Molecular Toxicology Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine,, Stanford University School of Medicine, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Mark P. Lythgoe
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Wenyan Ma
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mario Malički
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Yan Min
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Naudet
- CHU Rennes, Inserm, CIC 1414 [(Centre d’Investigation Clinique de Rennes)],, University of Rennes 1, Rennes, France
| | | | - Jack W. O'Sullivan
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan A. Roth
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Mandy Sauermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andreas M. Schmitt
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Deparment of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Speich
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paula R. Williamson
- MRC/NIHR Trials Methodology Research Partnership, University of Liverpool, Liverpool, UK
| | - Lars G. Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University,, Stanford, California, USA
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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188
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Zahedi Niaki O, Anadkat MJ, Chen ST, Fox LP, Harp J, Micheletti RG, Nambudiri VE, Pasieka HB, Shinohara MM, Rosenbach M, Merola JF. Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists. J Am Acad Dermatol 2020; 83:1150-1159. [PMID: 32569797 PMCID: PMC7303642 DOI: 10.1016/j.jaad.2020.06.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in coronavirus disease 2019 (COVID-19) are scarce. This article reviews and offers guidance based on currently available safety data and the most recent COVID-19 outcome data in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasizes a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic.
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Affiliation(s)
- Omid Zahedi Niaki
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Milan J Anadkat
- Division of Dermatology, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Steven T Chen
- Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helena B Pasieka
- Department of Dermatology, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC
| | - Michi M Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
| | - Misha Rosenbach
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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189
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Riley MJ, Hicks SR, Irvine S, Blanchard TJ, Britton E, Shawki H, Sajid Pervaiz M, Fletcher TE. Hereditary haemochromatosis, haemophagocytic lymphohistiocytosis and COVID-19. CLINICAL INFECTION IN PRACTICE 2020; 7:100052. [PMID: 33163955 PMCID: PMC7604131 DOI: 10.1016/j.clinpr.2020.100052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Syndromes of iron overload have been shown to increase the risk of severe clinical disease in viral infections. Immune dysfunction is similarly described in hereditary haemochromatosis (HH). We present here the case of a 51-year-old man who developed severe coronavirus disease 2019 (COVID-19) complicated by suspected haemophagocytic lymphohistiocytosis (HLH). He was found to have HH post-mortem and we propose a link between his iron overload and the development of severe COVID-19. CASE REPORT The initial clinical presentation consisted of cough, shortness of breath and fever. Pancytopenia, markedly elevated ferritin and d-dimer were present. Computed tomography (CT) showed bilateral ground glass changes consistent with COVID-19, widespread lymphadenopathy and splenomegaly. A subsequent combined nose and throat swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). HLH was suspected based upon the H-score and Anakinra, an IL-1 receptor antagonist, was commenced. Liver function acutely worsened and magnetic resonance cholangiopancreatography (MRCP) revealed hepatic haemosiderosis. Intense splenic and cervical lymph node uptake were seen on a positron emission tomography (PET) scan and high doses of intravenous steroids were administered due to concerns over haematological malignancy. RESULTS Day fourteen of admission heralded the start of progressive clinical deterioration with rapid increase in oxygen demands. Continuous positive airway pressure (CPAP) was trialled without success and the patient unfortunately died seventeen days into admission. Results returned after his death showed homozygous C282Y mutation of the HFE gene consistent with a diagnosis of HH. Post-mortem examination revealed widespread haemosiderin deposition in the liver along with lung pathology in keeping with severe COVID-19 and widespread splenic infarctions. CONCLUSION An association between HH and COVID-19 is not currently described in the literature. What does exist, however, is an evidence base for the detrimental impacts iron overload has on viral infections in general and the negative effects of HH on the immune system. We therefore postulate that the underlying metabolic and immune disturbances seen in HH should be considered a potential risk factor for the development of severe COVID-19. This case also adds to the evidence that hyperinflammation appears to be a unique and interesting characteristic of this novel viral disease.
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Affiliation(s)
- Matthew J Riley
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Scott R Hicks
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Sharon Irvine
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Tom J Blanchard
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Edward Britton
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Howida Shawki
- Liverpool Clinical Laboratories, Duncan Building, Royal Liverpool University Hospital, Daulby Street, Liverpool L69 3GA, United Kingdom
| | - Muhammad Sajid Pervaiz
- Department of Haematology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Tom E Fletcher
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
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190
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Chakraborty R, Parvez S. COVID-19: An overview of the current pharmacological interventions, vaccines, and clinical trials. Biochem Pharmacol 2020; 180:114184. [PMID: 32739342 PMCID: PMC7392210 DOI: 10.1016/j.bcp.2020.114184] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Abstract
COVID-19, the greatest public health emergency of the 21st century, has affected 215 countries and territories around the world resulting in 15,151,738 confirmed cases and 621,121 deaths. The outbreak has continued at breakneck pace despite stringent public health measures, ravaging the global economy and causing profound human casualties. Vaccination is currently the best bet for the prevention of COVID-19. Still, in its absence, there has been considerable interest in repurposing existing therapeutic agents to reduce the severity of the illness and ease the burden on the already strained healthcare systems. This review outlines the current evidence regarding proposed treatments- experimental or repurposed, for COVID-19, and gives an insight into the clinical trial landscape for drugs as well as vaccines.
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Affiliation(s)
- Rohan Chakraborty
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Suhel Parvez
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India.
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191
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Jo Y, Jamieson L, Edoka I, Long L, Silal S, Pulliam JRC, Moultrie H, Sanne I, Meyer-Rath G, Nichols BE. Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32995824 DOI: 10.1101/2020.09.24.20200196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care. Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.
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192
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Tsoupras A, Lordan R, Zabetakis I. Thrombosis and COVID-19: The Potential Role of Nutrition. Front Nutr 2020; 7:583080. [PMID: 33102511 PMCID: PMC7545367 DOI: 10.3389/fnut.2020.583080] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease (COVID-19), is a contagion that has rapidly spread around the globe. COVID-19 has caused significant loss of life and disrupted global society at a level never before encountered. While the disease was predominantly characterized by respiratory symptoms initially, it became clear that other systems including the cardiovascular and neurological systems were also involved. Several thrombotic complications were reported including venous thrombosis, vasculitis, cardiomyopathy, and stroke. Thrombosis and inflammation are implicated in various non-communicable diseases (NCDs). This is of significant concern as people with pre-existing conditions such as cardiovascular disorders, renal disorders, obesity, metabolic syndrome, and diabetes are at greater risk of severe COVID-19 infection. Consequently, the research surrounding the use of anticoagulants, antiplatelet, and antithrombotic strategies for prophylaxis and treatment of COVID-19 is of critical importance. The adoption of a healthy diet, physical exercise, and lifestyle choices can reduce the risk factors associated with NCDs and the thrombo-inflammatory complications. In this review, these thrombotic complications and potential foods, nutraceuticals, and the antithrombotic constituents within that may prevent the onset of severe thrombotic complications as a result of infection are discussed. While nutrition is not a panacea to tackle COVID-19, it is apparent that a patient's nutritional status may affect patient outcomes. Further intensive research is warranted to reduce to incidence of thrombotic complications.
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Affiliation(s)
- Alexandros Tsoupras
- Department of Biological Sciences, University of Limerick, Limerick, Ireland
- Bernal Institute, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ronan Lordan
- Health Research Institute, University of Limerick, Limerick, Ireland
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ioannis Zabetakis
- Department of Biological Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Torres-Macho J, Ryan P, Valencia J, Pérez-Butragueño M, Jiménez E, Fontán-Vela M, Izquierdo-García E, Fernandez-Jimenez I, Álvaro-Alonso E, Lazaro A, Alvarado M, Notario H, Resino S, Velez-Serrano D, Meca A. The PANDEMYC Score. An Easily Applicable and Interpretable Model for Predicting Mortality Associated With COVID-19. J Clin Med 2020; 9:E3066. [PMID: 32977606 PMCID: PMC7598151 DOI: 10.3390/jcm9103066] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to build an easily applicable prognostic model based on routine clinical, radiological, and laboratory data available at admission, to predict mortality in coronavirus 19 disease (COVID-19) hospitalized patients. METHODS We retrospectively collected clinical information from 1968 patients admitted to a hospital. We built a predictive score based on a logistic regression model in which explicative variables were discretized using classification trees that facilitated the identification of the optimal sections in order to predict inpatient mortality in patients admitted with COVID-19. These sections were translated into a score indicating the probability of a patient's death, thus making the results easy to interpret. RESULTS Median age was 67 years, 1104 patients (56.4%) were male, and 325 (16.5%) died during hospitalization. Our final model identified nine key features: age, oxygen saturation, smoking, serum creatinine, lymphocytes, hemoglobin, platelets, C-reactive protein, and sodium at admission. The discrimination of the model was excellent in the training, validation, and test samples (AUC: 0.865, 0.808, and 0.883, respectively). We constructed a prognostic scale to determine the probability of death associated with each score. CONCLUSIONS We designed an easily applicable predictive model for early identification of patients at high risk of death due to COVID-19 during hospitalization.
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Affiliation(s)
- Juan Torres-Macho
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
- Department of Mathematics, Complutense de Madrid University (UCM), 28040 Madrid, Spain;
| | - Pablo Ryan
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
- Department of Mathematics, Complutense de Madrid University (UCM), 28040 Madrid, Spain;
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Jorge Valencia
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Mario Pérez-Butragueño
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Eva Jiménez
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Mario Fontán-Vela
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Elsa Izquierdo-García
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Inés Fernandez-Jimenez
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Elena Álvaro-Alonso
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Andrea Lazaro
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Marta Alvarado
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Helena Notario
- University Hospital Infanta Leonor, 28031 Madrid, Spain; (J.T.-M.); (J.V.); (M.P.-B.); (E.J.); (M.F.-V.); (E.I.-G.); (I.F.-J.); (E.Á.-A.); (A.L.); (M.A.); (H.N.)
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Instituto de Salud Carlos III, 28007 Madrid, Spain;
| | - Daniel Velez-Serrano
- Department of Mathematics, Complutense de Madrid University (UCM), 28040 Madrid, Spain;
| | - Alejandro Meca
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, 28933 Madrid, Spain;
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Halimi V, Daci A, Ridova N, Panovska-Stavridis I, Stevanovic M, Filipce V, Dimovski A, Grozdanova A. The use of remdesivir outside of clinical trials during the COVID-19 pandemic. J Pharm Policy Pract 2020; 13:61. [PMID: 32968487 PMCID: PMC7503054 DOI: 10.1186/s40545-020-00258-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022] Open
Abstract
With a scientific background from filoviruses, paramyxoviruses, SARS-CoV, and MERS-CoV, remdesivir entered into the COVID-19 battle to become one of the favorable therapeutic candidates with potential antiviral activity in the treatment of this disease. Globally, remdesivir was accessed and investigated through clinical research (clinical trials) and clinical practice (compassionate use, expanded access, early access scheme, and emergency use). Currently, remdesivir approval status differs between states. This paper aims to review and analyze regulatory approaches for accessing and investigating remdesivir, by communicating regulatory variability between countries in terms of terminology, modalities, and protocols.
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Affiliation(s)
- Vesa Halimi
- Faculty of Pharmacy, University Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Armond Daci
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Nevenka Ridova
- University Clinic of Hematology, Medical Faculty, University Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Irina Panovska-Stavridis
- University Clinic of Hematology, Medical Faculty, University Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Milena Stevanovic
- University Clinic of Infection Diseases and Febrile Conditions, Medical Faculty, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Venko Filipce
- University Clinic for Neurosurgery, Medical Faculty, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Aleksandar Dimovski
- Faculty of Pharmacy, University Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Aleksandra Grozdanova
- Faculty of Pharmacy, University Ss. Cyril and Methodius University, Skopje, North Macedonia
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195
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Köstenberger M, Hasibeder W, Dankl D, Germann R, Hörmann C, Joannidis M, Markstaller K, Müller-Muttonen SO, Neuwersch-Sommeregger S, Schaden E, Staudinger T, Ullrich R, Valentin A, Likar R. SARS-CoV-2: recommendations for treatment in intensive care medicine. Wien Klin Wochenschr 2020; 132:664-670. [PMID: 32948888 PMCID: PMC7500247 DOI: 10.1007/s00508-020-01734-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) progresses mildly in most of the cases; however, about 5% of the patients develop a severe acute respiratory distress syndrome (ARDS). Of all COVID-19 patients 3% need intensive care treatment, which becomes a great challenge for anesthesiology and intensive care medicine, medically, hygienically and for technical safety requirements. For these reasons, only experienced medical and nursing staff in the smallest grouping possible should be assigned. For these team members, a consistent use of personal protective equipment (PPE) is essential. Due to the immense medical challenges, the following treatment guidelines were developed by the ÖGARI (Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin), FASIM (Federation of Austrian Societies of Intensive Care Medicine) and ÖGIAIN (Österreichische Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin). The recommendations given in this article are to be understood as short snapshots of the moment; all basic guidelines are works in progress and will be regularly updated as evidence levels, new study results and additional experience are gathered.
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Affiliation(s)
- Markus Köstenberger
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria.
| | - Walter Hasibeder
- Department of Anaesthesiology and Critical Care Medicine, Hospital Zams, Zams, Austria
| | - Daniel Dankl
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Reinhard Germann
- Department of Anaesthesiology and Critical Care Medicine, Hospital Feldkirch, Feldkirch, Austria
| | - Christoph Hörmann
- Department of Anaesthesiology an Critical Care Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Michael Joannidis
- University Hospital Innsbruck, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Markstaller
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Neuwersch-Sommeregger
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Eva Schaden
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Internal and Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Internal and Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Valentin
- Department of Internal and Critical Care Medicine, Hospital Schwarzach, Schwarzach, Austria
| | - Rudolf Likar
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
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196
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Tahir Ul Qamar M, Shahid F, Aslam S, Ashfaq UA, Aslam S, Fatima I, Fareed MM, Zohaib A, Chen LL. Reverse vaccinology assisted designing of multiepitope-based subunit vaccine against SARS-CoV-2. Infect Dis Poverty 2020; 9:132. [PMID: 32938504 PMCID: PMC7492789 DOI: 10.1186/s40249-020-00752-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) linked with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause severe illness and life-threatening pneumonia in humans. The current COVID-19 pandemic demands an effective vaccine to acquire protection against the infection. Therefore, the present study was aimed to design a multiepitope-based subunit vaccine (MESV) against COVID-19. METHODS Structural proteins (Surface glycoprotein, Envelope protein, and Membrane glycoprotein) of SARS-CoV-2 are responsible for its prime functions. Sequences of proteins were downloaded from GenBank and several immunoinformatics coupled with computational approaches were employed to forecast B- and T- cell epitopes from the SARS-CoV-2 highly antigenic structural proteins to design an effective MESV. RESULTS Predicted epitopes suggested high antigenicity, conserveness, substantial interactions with the human leukocyte antigen (HLA) binding alleles, and collective global population coverage of 88.40%. Taken together, 276 amino acids long MESV was designed by connecting 3 cytotoxic T lymphocytes (CTL), 6 helper T lymphocyte (HTL) and 4 B-cell epitopes with suitable adjuvant and linkers. The MESV construct was non-allergenic, stable, and highly antigenic. Molecular docking showed a stable and high binding affinity of MESV with human pathogenic toll-like receptors-3 (TLR3). Furthermore, in silico immune simulation revealed significant immunogenic response of MESV. Finally, MEV codons were optimized for its in silico cloning into the Escherichia coli K-12 system, to ensure its increased expression. CONCLUSION The MESV developed in this study is capable of generating immune response against COVID-19. Therefore, if designed MESV further investigated experimentally, it would be an effective vaccine candidate against SARS-CoV-2 to control and prevent COVID-19.
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MESH Headings
- Betacoronavirus/immunology
- COVID-19
- COVID-19 Vaccines
- Coronavirus Infections/genetics
- Coronavirus Infections/immunology
- Coronavirus Infections/prevention & control
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Epitopes, T-Lymphocyte/chemistry
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Humans
- Immunogenicity, Vaccine/immunology
- Molecular Docking Simulation
- Pandemics/prevention & control
- Pneumonia, Viral/immunology
- Pneumonia, Viral/prevention & control
- SARS-CoV-2
- Sequence Analysis, Protein
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
- Toll-Like Receptor 3/chemistry
- Toll-Like Receptor 3/genetics
- Toll-Like Receptor 3/immunology
- Vaccines, Subunit/chemistry
- Vaccines, Subunit/genetics
- Vaccines, Subunit/immunology
- Vaccinology/methods
- Viral Matrix Proteins/chemistry
- Viral Matrix Proteins/genetics
- Viral Matrix Proteins/immunology
- Viral Vaccines/chemistry
- Viral Vaccines/genetics
- Viral Vaccines/immunology
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Affiliation(s)
| | - Farah Shahid
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad (GCUF), Faisalabad, Pakistan
| | | | - Usman Ali Ashfaq
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad (GCUF), Faisalabad, Pakistan.
| | - Sidra Aslam
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad (GCUF), Faisalabad, Pakistan
| | - Israr Fatima
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad (GCUF), Faisalabad, Pakistan
| | - Muhammad Mazhar Fareed
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad (GCUF), Faisalabad, Pakistan
| | - Ali Zohaib
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Ling-Ling Chen
- College of Life Science and Technology, Guangxi University, Nanning, P. R. China.
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197
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Biondi-Zoccai G, Cavarretta E, Frati G, Versaci F. Of Size and Men: A Call for Larger Trials and Meta-Analyses on Vasopressors During General Anesthesia. J Cardiothorac Vasc Anesth 2020; 35:70-72. [PMID: 33023817 PMCID: PMC7490586 DOI: 10.1053/j.jvca.2020.09.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Francesco Versaci
- UOC UTIC, Emodinamica e Cardiologia, Ospedale S. Maria Goretti, Latina, Italy
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198
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Fernandes ACL, Vale AJM, Guzen FP, Pinheiro FI, Cobucci RN, de Azevedo EP. Therapeutic Options Against the New Coronavirus: Updated Clinical and Laboratory Evidences. Front Med (Lausanne) 2020; 7:546. [PMID: 33043030 PMCID: PMC7522372 DOI: 10.3389/fmed.2020.00546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
The pandemic caused by the new coronavirus (SARS-Cov-2) has encouraged numerous in vitro studies and clinical trials around the world, with research groups testing existing drugs, novel drug candidates and vaccines that can prevent or treat infection caused by this virus. The urgency for an effective therapy is justified by the easy and fast viral transmission and the high number of patients with severe respiratory distress syndrome who have increasingly occupied intensive care hospital beds, leading to a collapse in health systems in several countries. However, to date, there is no sufficient evidence of the effectiveness of any researched therapy. The off-label or compassionate use of some drugs by health professionals is a reality in all continents, whose permission by regulatory agencies has been based on the results of some clinical trials. In order to guide decision-making for the treatment of COVID-19, this review aims to present studies and guidelines on the main therapies that have been and are currently being tested against SARS-CoV-2 and to critically analyze the reported evidences.
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Affiliation(s)
| | - Adson José Martins Vale
- Tocogynecology Department, Medical School, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Graduate Program of Biotechnology, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
| | - Fausto Pierdoná Guzen
- Graduate Program of Biotechnology, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
| | - Francisco Irochima Pinheiro
- Graduate Program of Biotechnology, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
- Medical School, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
| | - Ricardo Ney Cobucci
- Graduate Program of Biotechnology, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
- Medical School, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
| | - Eduardo Pereira de Azevedo
- Graduate Program of Biotechnology, Laureate International Universities - Universidade Potiguar (UnP), Natal, Brazil
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199
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Olaleye OA, Kaur M, Onyenaka CC. Ambroxol Hydrochloride Inhibits the Interaction between Severe Acute Respiratory Syndrome Coronavirus 2 Spike Protein's Receptor Binding Domain and Recombinant Human ACE2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020. [PMID: 32995775 DOI: 10.1101/2020.09.13.295691] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), enters the host cells through two main pathways, both involving key interactions between viral envelope-anchored spike glycoprotein of the novel coronavirus and the host receptor, angiotensin-converting enzyme 2 (ACE2). To date, SARS-CoV-2 has infected up to 26 million people worldwide; yet, there is no clinically approved drug or vaccine available. Therefore, a rapid and coordinated effort to re-purpose clinically approved drugs that prevent or disrupt these critical entry pathways of SARS-CoV-2 spike glycoprotein interaction with human ACE2, could potentially accelerate the identification and clinical advancement of prophylactic and/or treatment options against COVID-19, thus providing possible countermeasures against viral entry, pathogenesis and survival. Herein, we discovered that Ambroxol hydrochloride (AMB), and its progenitor, Bromhexine hydrochloride (BHH), both clinically approved drugs are potent effective modulators of the key interaction between the receptor binding domain (RBD) of SARS-CoV-2 spike protein and human ACE2. We also found that both compounds inhibited SARS-CoV-2 infection-induced cytopathic effect at micromolar concentrations. Therefore, in addition to the known TMPRSS2 activity of BHH; we report for the first time that the BHH and AMB pharmacophore has the capacity to target and modulate yet another key protein-protein interaction essential for the two known SARS-CoV-2 entry pathways into host cells. Altogether, the potent efficacy, excellent safety and pharmacologic profile of both drugs along with their affordability and availability, makes them promising candidates for drug repurposing as possible prophylactic and/or treatment options against SARS-CoV-2 infection.
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200
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Inde Z, Yapp C, Joshi GN, Spetz J, Fraser C, Deskin B, Ghelfi E, Sodhi C, Hackam DJ, Kobzik L, Croker BA, Brownfield D, Jia H, Sarosiek KA. Age-dependent regulation of SARS-CoV-2 cell entry genes and cell death programs correlates with COVID-19 disease severity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.09.13.276923. [PMID: 32935109 PMCID: PMC7491524 DOI: 10.1101/2020.09.13.276923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Angiotensin-converting enzyme 2 (ACE2) maintains cardiovascular and renal homeostasis but also serves as the entry receptor for the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), the causal agent of novel coronavirus disease 2019 (COVID-19). COVID-19 disease severity is typically lower in pediatric patients than adults (particularly the elderly), but higher rates of hospitalizations requiring intensive care are observed in infants than in older children - the reasons for these differences are unknown. ACE2 is expressed in several adult tissues and cells, including alveolar type 2 cells of the distal lung epithelium, but expression at other ages is largely unexplored. Here we show that ACE2 transcripts are expressed in the lung and trachea shortly after birth, downregulated during childhood, and again expressed at high levels in late adulthood. Notably, the repertoire of cells expressing ACE2 protein in the mouse lung and airways shifts during key phases of lung maturation. In particular, podoplanin-positive cells, which are likely alveolar type I cells responsible for gas exchange, express ACE2 only in advanced age. Similar patterns of expression were evident in analysis of human lung tissue from over 100 donors, along with extreme inter- and intra-individual heterogeneity in ACE2 protein expression in epithelial cells. Furthermore, we find that apoptosis, which is a natural host defense system against viral infection, is dynamically regulated during lung maturation, resulting in periods of heightened apoptotic priming and dependence on pro-survival BCL-2 family proteins including MCL-1. Infection of human lung cells with SARS-CoV-2 triggers an unfolded protein stress response and upregulation of the endogenous MCL-1 inhibitor Noxa; in young individuals, MCL-1 inhibition is sufficient to trigger apoptosis in lung epithelial cells and may thus limit virion production and inflammatory signaling. Overall, we identify strong and distinct correlates of COVID-19 disease severity across lifespan and advance our understanding of the regulation of ACE2 and cell death programs in the mammalian lung. Furthermore, our work provides the framework for translation of apoptosis modulating drugs as novel treatments for COVID-19.
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Affiliation(s)
- Zintis Inde
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
| | - Clarence Yapp
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
- Image and Data Analysis Core, Harvard Medical School, Boston, MA
| | - Gaurav N. Joshi
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
- Integrated Cellular Imaging Core, Emory University, Atlanta, GA
| | - Johan Spetz
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
| | - Cameron Fraser
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
| | - Brian Deskin
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
| | - Elisa Ghelfi
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
| | - Chhinder Sodhi
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - David J. Hackam
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Lester Kobzik
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
| | - Ben A. Croker
- Division of Allergy, Immunology and Rheumatology, University of California, San Diego, CA
| | - Douglas Brownfield
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
| | - Hongpeng Jia
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Kristopher A. Sarosiek
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA
- Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA
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