Emerging cardiological issues during the COVID-19 pandemic

The therapeutic potential of regulatory T cells in reducing cardiovascular complications in patients with severe COVID-19

The SARS coronavirus 2 (SARS CoV-2) causes Coronavirus Disease (COVID-19), is an emerging viral infection. SARS CoV-2 infects target cells by attaching to Angiotensin-Converting Enzyme (ACE2). SARS CoV-2 could cause cardiac damage in patients with severe COVID-19, as ACE2 is expressed in cardiac cells, including cardiomyocytes, pericytes, and fibroblasts, and coronavirus could directly infect these cells. Cardiovascular disorders are the most frequent comorbidity found in COVID-19 patients. Immune cells such as monocytes, macrophages, and T cells may produce inflammatory cytokines and chemokines that contribute to COVID-19 pathogenesis if their functions are uncontrolled. This causes a cytokine storm in COVID-19 patients, which has been associated with cardiac damage. Tregs are a subset of immune cells that regulate immune and inflammatory responses. Tregs suppress inflammation and improve cardiovascular function through a variety of mechanisms. This is an exciting research area to explore the cellular, molecular, and immunological mechanisms related to reducing risks of cardiovascular complications in severe COVID-19. This review evaluated whether Tregs can affect COVID-19-related cardiovascular complications, as well as the mechanisms through which Tregs act.

The importance of myocarditis in Covid-19

BACKGROUND

The outbreak of Covid-19 is a real threat to public health. It causes cardiovascular complications such as acute myocardial injury and myocarditis. Symptoms of myocarditis vary from chest pain, tachycardia, or chest tightness. Inotropes and/or vasopressors and mechanical ventilation are the protocols for cardiogenic shock in patients with myocarditis. Some previous studies stated that the mechanism of cardiac injury is not well defined but, it can be due to direct myocardial infection, respiratory failure or hypoxemia, and indirect injury from systemic inflammatory response separately or all three factors together. The pathologic processes included direct myocardial injury by virus binding to ACE2, systemic inflammation, altered myocardial demand-supply ratio, and plaque and coronary thrombosis. There are disagreements on the usage of corticosteroids in active-infection myocarditis. As everyday new complications of Covid-19 appear, there is a need for further research to overcome them.

AIMS

This narrative study aimed to assess the effect of Covid-19 on myocarditis.

The side effects of the COVID-19 pandemic on key public health elements - How the global emergency has changed the acute management of myocardial infarction and stroke, the network of cancer care, and assistance to frail individuals

The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.

Cardiovascular RNA markers and artificial intelligence may improve COVID-19 outcome: a position paper from the EU-CardioRNA COST Action CA17129

The coronavirus disease 2019 (COVID-19) pandemic has been as unprecedented as unexpected, affecting more than 105 million people worldwide as of 8 February 2020 and causing more than 2.3 million deaths according to the World Health Organization (WHO). Not only affecting the lungs but also provoking acute respiratory distress, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is able to infect multiple cell types including cardiac and vascular cells. Hence a significant proportion of infected patients develop cardiac events, such as arrhythmias and heart failure. Patients with cardiovascular comorbidities are at highest risk of cardiac death. To face the pandemic and limit its burden, health authorities have launched several fast-track calls for research projects aiming to develop rapid strategies to combat the disease, as well as longer-term projects to prepare for the future. Biomarkers have the possibility to aid in clinical decision-making and tailoring healthcare in order to improve patient quality of life. The biomarker potential of circulating RNAs has been recognized in several disease conditions, including cardiovascular disease. RNA biomarkers may be useful in the current COVID-19 situation. The discovery, validation, and marketing of novel biomarkers, including RNA biomarkers, require multi-centre studies by large and interdisciplinary collaborative networks, involving both the academia and the industry. Here, members of the EU-CardioRNA COST Action CA17129 summarize the current knowledge about the strain that COVID-19 places on the cardiovascular system and discuss how RNA biomarkers can aid to limit this burden. They present the benefits and challenges of the discovery of novel RNA biomarkers, the need for networking efforts, and the added value of artificial intelligence to achieve reliable advances.

The challenging pathway towards the identification of SARS-CoV-2/COVID-19 therapeutics

The development of therapeutic agents against SARS-CoV-2/COVID-19  faces numerous barriers and a multidisciplinary approach to evaluating drug efficacy and toxicity is essential. Experimental and preclinical data should be integrated into a comprehensive analysis, where drug potency, the timing of therapy initiation, drug combinations, variability in systemic and local drug exposure and short- and long-term toxicities represent fundamental factors for the rational identification of candidates and prioritization of clinical investigations. Although the identification of SARS-CoV-2 therapeutics is a priority, rigorous and transparent methodologies are crucial to ensure that accelerated research programmes result in high-quality and reproducible findings.