1
|
Negi V, Gavlock D, Miedel MT, Lee JK, Shun T, Gough A, Vernetti L, Stern AM, Taylor DL, Yechoor VK. Modeling mechanisms underlying differential inflammatory responses to COVID-19 in type 2 diabetes using a patient-derived microphysiological organ-on-a-chip system. LAB ON A CHIP 2023; 23:4514-4527. [PMID: 37766577 DOI: 10.1039/d3lc00285c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Background: COVID-19 pandemic has caused more than 6 million deaths worldwide. Co-morbid conditions such as Type 2 Diabetes (T2D) have increased mortality in COVID-19. With limited translatability of in vitro and small animal models to human disease, human organ-on-a-chip models are an attractive platform to model in vivo disease conditions and test potential therapeutics. Methods: T2D or non-diabetic patient-derived macrophages and human liver sinusoidal endothelial cells were seeded, along with normal hepatocytes and stellate cells in the liver-on-a-chip (LAMPS - liver acinus micro physiological system), perfused with media mimicking non-diabetic fasting or T2D (high levels of glucose, fatty acids, insulin, glucagon) states. The macrophages and endothelial cells were transduced to overexpress the SARS-CoV2-S (spike) protein with appropriate controls before their incorporation into LAMPS. Cytokine concentrations in the efflux served as a read-out of the effects of S-protein expression in the different experimental conditions (non-diabetic-LAMPS, T2D-LAMPS), including incubation with tocilizumab, an FDA-approved drug for severe COVID-19. Findings: S-protein expression in the non-diabetic LAMPS led to increased cytokines, but in the T2D-LAMPS, this was significantly amplified both in the number and magnitude of key pro-inflammatory cytokines (IL6, CCL3, IL1β, IL2, TNFα, etc.) involved in cytokine storm syndrome (CSS), mimicking severe COVID-19 infection in T2D patients. Compared to vehicle control, tocilizumab (IL6-receptor antagonist) decreased the pro-inflammatory cytokine secretion in T2D-COVID-19-LAMPS but not in non-diabetic-COVID-19-LAMPS. Interpretation: macrophages and endothelial cells play a synergistic role in the pathophysiology of the hyper-inflammatory response seen with COVID-19 and T2D. The effect of Tocilizumab was consistent with large clinical trials that demonstrated Tocilizumab's efficacy only in critically ill patients with severe disease, providing confirmatory evidence that the T2D-COVID-19-LAMPS is a robust platform to model human in vivo pathophysiology of COVID-19 in T2D and for screening potential therapeutics.
Collapse
Affiliation(s)
- Vinny Negi
- Diabetes and Beta Cell Biology Center, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Dillon Gavlock
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark T Miedel
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeong Kyung Lee
- Diabetes and Beta Cell Biology Center, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Tongying Shun
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Gough
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lawrence Vernetti
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew M Stern
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - D Lansing Taylor
- Drug Discovery Institute and Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay K Yechoor
- Diabetes and Beta Cell Biology Center, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
2
|
Jajodia S, Goenka U, Jash D, Tiwary I, Goenka MK. Endovascular management of massive hemoptysis due to covid-19 related pulmonary artery pseudoaneurysm: A rare entity. Radiol Case Rep 2021; 16:3597-3601. [PMID: 34466180 PMCID: PMC8390365 DOI: 10.1016/j.radcr.2021.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pulmonary artery pseudoaneurysms are rare causes of massive hemoptysis, even less common in setting of COVID-19 pneumonia. We describe and discuss an index case of cavitating COVID-19 pneumonia complicated by a pulmonary artery pseudoaneurysm without concomitant pulmonary thromboembolism. The patient presented with severe hemoptysis and was managed by endovascular coil embolization. Good technical and clinical success was achieved with complete resolution of hemoptysis.
Collapse
Affiliation(s)
- Surabhi Jajodia
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
- Corresponding author. S. Jajodia.
| | - Usha Goenka
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
| | - Debraj Jash
- Department of Pulmonary Medicine, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Indrajeet Tiwary
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Mahesh Kumar Goenka
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
| |
Collapse
|
3
|
Mir T, Almas T, Kaur J, Faisaluddin M, Song D, Ullah W, Mamtani S, Rauf H, Yadav S, Latchana S, Michaelson NM, Connerney M, Sattar Y. Coronavirus disease 2019 (COVID-19): Multisystem review of pathophysiology. Ann Med Surg (Lond) 2021; 69:102745. [PMID: 34457265 PMCID: PMC8381637 DOI: 10.1016/j.amsu.2021.102745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 01/10/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) pandemic is associated with high morbidity and mortality. COVID-19, which is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), affects multiple organ systems through a myriad of mechanisms. Afflicted patients present with a vast constellation of symptoms, from asymptomatic disease to life-threatening complications. The most common manifestations pertain to mild pulmonary symptoms, which can progress to respiratory distress syndrome and venous thromboembolism. However, in patients with renal failure, life-threatening cardiac abnormalities can ensue. Various mechanisms such as viral entry through Angiotensin receptor (ACE) affecting multiple organs and thus releasing pro-inflammatory markers have been postulated. Nevertheless, the predictors of various presentations in the affected population remain elusive. An ameliorated understanding of the pathology and pathogenesis of the viral infection has led to the development of variable treatment options, with many more that are presently under trial. This review article discusses the pathogenesis of multiple organ involvement secondary to COVID-19 infection in infected patients. This review sheds light on the pathogenesis of multi-organ involvement secondary to COVID-19 infection. The predictors of various presentations in the affected population are not clear at present. A better understanding of the pathology and pathogenesis of the viral infection will be pivotal in the development of variable treatment options. Various proposed mechanisms such as viral entry through Angiotensin receptor (ACE) affecting multiple organs, releasing pro-inflammatory markers and cytokines inducing hypercoagulable state and cytokine storm syndrome have been postulated.
Collapse
Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University, USA
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jasmeet Kaur
- Internal Medicine, Saint Joseph Mercy, Oakland Hospital, Pontiac, USA
| | | | - David Song
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, PA, USA
| | - Sahil Mamtani
- AtlantiCare Medical Education, 2015 Pacific Avenue, Atlantic City, NJ, USA
| | - Hiba Rauf
- Dow Medical College, Karachi, Pakistan
| | - Sunita Yadav
- NYC Health and Hospitals/Jacobi, The Bronx, NY, USA
| | - Sharaad Latchana
- American University of Integrative Sciences School of Medicine, Cole Bay, Sint Maarten
| | | | | | - Yasar Sattar
- Division of Cardiology, West Virginia University, Morgantown, USA
| |
Collapse
|
4
|
Almas T, Nazar W, Khedro T, Kanawati MA, Adnan A, Almuhaileej M, Alshamlan A, Abdulhadi A, Manamperi KT, Sarfraz S. COVID-19 and mucormycosis superinfection: Exploring the missing pathophysiological links. Ann Med Surg (Lond) 2021; 68:102655. [PMID: 34377450 PMCID: PMC8342861 DOI: 10.1016/j.amsu.2021.102655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 continues to unearth new facets that portend grave clinical implications. In recent times, there has been mounting fervor regarding coronavirus disease 2019 and mucormycosis superinfection. While the correlation between the two is conspicuous, the underlying pathophysiological mechanisms that render a patient with coronavirus disease 2019 susceptible to mucormycosis, or vice versa, are still elusive.
Collapse
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Waqas Nazar
- Cavan General Hospital, County Cavan, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - M Ali Kanawati
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alishba Adnan
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | | | | | | | - Saba Sarfraz
- Islamabad Medical and Dental College, Islamabad, Pakistan
| |
Collapse
|
5
|
Pott-Junior H, Bittencourt NQP, Chacha SFG, Luporini RL, Cominetti MR, Anibal FDF. Elevations in Liver Transaminases in COVID-19: (How) Are They Related? Front Med (Lausanne) 2021; 8:705247. [PMID: 34336904 PMCID: PMC8319468 DOI: 10.3389/fmed.2021.705247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 01/08/2023] Open
Abstract
Liver involvement in COVID-19 is not yet well-understood, but elevations in liver transaminases have been described to occur in 14–53% of the cases and are more frequently seen in severe disease. This cross-sectional study explored the relationship between the elevations in liver transaminases and inflammatory parameters in 209 adults with COVID-19. Demographic and clinical data, serum levels of inflammatory cytokines and liver aminotransferases were analyzed. Three groups were formed according to the liver transaminase abnormalities: (I) Normal transaminases, (II) Borderline transaminases elevation, and (III) Mild to severe transaminases elevation. Altered liver transaminases were directly related to disease severity, showing association with the NEWS2 score at admission and greater need for ICU or death. Moreover, higher levels of IL-2 and CRP were associated with borderline transaminases elevations, whereas higher levels of IL-10 and Neutrophil to Lymphocyte ratio were associated with mild to severe transaminases elevation. These results reinforce the importance of liver transaminases in patients with COVID-19 as a complementary marker for disease severity and also point to them as a parameter reflecting the continuous dynamics between viral infection and the immune response.
Collapse
Affiliation(s)
| | | | - Silvana F G Chacha
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil
| | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.,Biotechnology Graduate Program, Federal University of São Carlos, São Carlos, Brazil
| | | | - Fernanda de Freitas Anibal
- Biotechnology Graduate Program, Federal University of São Carlos, São Carlos, Brazil.,Department of Biological Sciences Parasitology, Federal University of São Carlos, São Carlos, Brazil
| |
Collapse
|