Effectivity of repurposed drugs against SARS-CoV-2 infections, A hope for COVID 19: inhibitor modelling studies by docking and molecular dynamics

Diverse roles of SARS-CoV-2 Spike and Nucleocapsid proteins in EndMT stimulation through the TGF-β-MRTF axis inhibited by aspirin

BACKGROUND

The SARS-CoV-2 virus causes severe COVID-19 in one-fifth of patients. In addition to high mortality, infection may induce respiratory failure and cardiovascular complications associated with inflammation. Acute or prolonged inflammation results in organ fibrosis, the cause of which might be endothelial disorders arising during the endothelial-mesenchymal transition (EndMT).

METHODS

HUVECs and HMEC-1 cells were stimulated with SARS-CoV-2 S (Spike) and N (Nucleocapsid) proteins, and EndMT induction was evaluated by studying specific protein markers via Western blotting. Wound healing and tube formation assays were employed to assess the potential of SARS-CoV-2 to stimulate changes in cell behaviour. MRTF nuclear translocation, ROS generation, TLR4 inhibitors, TGF-β-neutralizing antibodies, and inhibitors of the TGF-β-dependent pathway were used to investigate the role of the TGF-β-MRTF signalling axis in SARS-CoV-2-dependent EndMT stimulation.

RESULTS

Both viral proteins stimulate myofibroblast trans-differentiation. However, the N protein is more effective at EndMT induction. The TGF-β-MRTF pathway plays a critical role in this process. The N protein preferentially favours action through TGF-β2, whose secretion is induced through TLR4-ROS action. TGF-β2 stimulates MRTF-A and MRTF-B nuclear translocation and strongly regulates EndMT. In contrast, the Spike protein stimulates TGF-β1 secretion as a result of ACE2 downregulation. TGF-β1 induces only MRTF-B, which, in turn, weakly regulates EndMT. Furthermore, aspirin, a common nonsteroidal anti-inflammatory drug, might prevent and reverse SARS-CoV-2-dependent EndMT induction through TGF-β-MRTF pathway deregulation.

CONCLUSION

The reported study revealed that SARS-CoV-2 infection induces EndMT. Moreover, it was demonstrated for the first time at the molecular level that the intensity of the EndMT triggered by SARS-CoV-2 infection may vary and depend on the viral protein involved. The N protein acts through TLR4-ROS-TGF-β2-MRTF-A/B, whereas the S protein acts through ACE2-TGF-β1-MRTF-B. Furthermore, we identified aspirin as a potential anti-fibrotic drug for treating patients with SARS-CoV-2 infection.

Effectiveness of early pharmaceutical interventions in symptomatic COVID-19 patients: A randomized clinical trial

OBJECTIVE

We assessed the effectiveness of oral Hydroxychloroquine (HC), Azithromycin (AZ) and Oseltamivir (OS), alone or combined, among patients hospitalized with mildly symptomatic coronavirus infectious disease (COVID-19).

METHODS

Following the approval of the National Bioethics Committee and prospective registration (clinicaltrials.gov NCT04338698), a multicenter randomized clinical trial of adaptive design was conducted at 10 multispecialty hospitals in Pakistan. Patients were randomized into seven treatment groups. Starting April 15, 2020, consenting, eligible, otherwise healthy adult patients or those with co-morbidities under control, were recruited if they presented with mildly symptomatic COVID-19 (scored 3 on a 7-point ordinal scale anchored between 1 = not hospitalized, able to undertake normal activities, to 7 = death) confirmed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Two primary outcomes were assessed by day seven: Turning qRT-PCR negative; and clinical improvement of two points from the baseline. Outcome rates were compared using a chi-square test. Multiple imputations were applied to handle missing data. An interim data analysis was carried out on July 19, 2020, following which the study continued without treatment group changes. Data Safety and Monitoring Board advised to stop recruitment due to its futility on January 18, 2021.

RESULTS

Of 471 patients randomized, a total of 426 (90.4%) completed the follow-up for primary outcomes. Based on imputed data analyses at day seven: Total qRT-PCR negative cases were 137/471 (29%, 95% CI 25.0 - 33.4). By day seven, a total of 111/471 (23.5%, 95% CI 19.8 - 27.6) showed clinical improvement. No serious or non-serious adverse event was reported.

CONCLUSIONS

Among patients with mild COVID-19, there was no statistically significant difference in the effectiveness of oral antimalarial, antiviral, or antibiotic treatments.Clinicaltrials.gov ID: NCT04338698.

Knowledge about methods of disinfection of dental impression among dentists from Ecuador post SARS-COV-2 pandemic

Purpose

The aim of this study is to evaluate the understanding of the management of methods and practices of disinfection of dental impressions applied by general dentists and specialists in oral rehabilitation, post SARS-COV-2 pandemic.

Introduction

The oral cavity has a favorable environment for the growth and multiplication of bacteria and viruses, serving as the gateway to viruses such as SARS CoV-2 virus. Given that patients may be hosts of this infectious disease, stricter biosecurity measures in dental offices and a better understanding of the disinfection processes of dental impressions should be considered in addition to avoiding cross-infections, which are very common in our work environment.

Materials and methods

Descriptive, analytical, survey with the topic "Methods and practices of disinfection of dental impressions" that was composed of 14 questions based in OHPD (Oral Health Preventive Dentistry), n = 452 respondents who met the following inclusion criteria: general practice dentists from Ecuador who actively take dental impressions, specialists in oral rehabilitation with 5 years of experience, surveys with information of complete items, n = 270 professionals; n = 192 general dentists, dental hygienist and n = 78 oral rehabilitation specialists.

Results

n = 270 professionals evaluated, with a mean of p = 0.0. At 426 responses with a p value of <0.05, 30.4 % of responses indicated ignorance in the management of dental impressions, with a standard deviation of 2.744, with significant differences between professions (p = 0.035) and higher average knowledge of sample management within specialist dentists, (Chi p = 0.410 p > 0.05).

Conclusion

The understanding of the management of dental impressions among general dentists and specialists in oral rehabilitation is limited.