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Yeudall S, Upchurch CM, Leitinger N. The clinical relevance of heme detoxification by the macrophage heme oxygenase system. Front Immunol 2024; 15:1379967. [PMID: 38585264 PMCID: PMC10995405 DOI: 10.3389/fimmu.2024.1379967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Heme degradation by the heme oxygenase (HMOX) family of enzymes is critical for maintaining homeostasis and limiting heme-induced tissue damage. Macrophages express HMOX1 and 2 and are critical sites of heme degradation in healthy and diseased states. Here we review the functions of the macrophage heme oxygenase system and its clinical relevance in discrete groups of pathologies where heme has been demonstrated to play a driving role. HMOX1 function in macrophages is essential for limiting oxidative tissue damage in both acute and chronic hemolytic disorders. By degrading pro-inflammatory heme and releasing anti-inflammatory molecules such as carbon monoxide, HMOX1 fine-tunes the acute inflammatory response with consequences for disorders of hyperinflammation such as sepsis. We then discuss divergent beneficial and pathological roles for HMOX1 in disorders such as atherosclerosis and metabolic syndrome, where activation of the HMOX system sits at the crossroads of chronic low-grade inflammation and oxidative stress. Finally, we highlight the emerging role for HMOX1 in regulating macrophage cell death via the iron- and oxidation-dependent form of cell death, ferroptosis. In summary, the importance of heme clearance by macrophages is an active area of investigation with relevance for therapeutic intervention in a diverse array of human diseases.
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Affiliation(s)
- Scott Yeudall
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, United States
- Medical Scientist Training Program, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Clint M. Upchurch
- Department of Neuroscience, Center for Brain Immunology and Glia (BIG), University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Norbert Leitinger
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, United States
- Robert M Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, United States
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Fares K, El-Deeb MK, Elsammak O, Ouf A, Saeed HMS, Baess A, Elsammak M, El-Attar E. SNP (A > G - rs13057211) but not GT(n) polymorphism in HMOX-1 promotor gene is associated with COVID-19 mortality. BMC Pulm Med 2023; 23:514. [PMID: 38129860 PMCID: PMC10734135 DOI: 10.1186/s12890-023-02785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION COVID-19 causes severe inflammatory respiratory distress syndrome. The global pandemic caused millions of cases of morbidity and mortality worldwide. Patients may present with variable symptoms including dyspnea, fever, and GIT manifestations. The HMOX-1 gene is located on the long (q) arm of chromosome 22 at position 12.3. HMOX-1 is expressed in all mammalian tissues at basal levels and is considered as a stress response enzyme. HMOX-1 has a specific polymorphic site with variable GT(n) repeats at the promotor region. Several authors evaluated the HMOX-1 GT(n) promoter polymorphism in different inflammatory conditions. We evaluated HMOX-1 promoter polymorphism in relation to serum Hemoxygenase level and inflammatory makers (CRP, Ferritin, PCT, IL-6 and D-dimer) in patients affected by SARS-COV-2 disease. SUBJECTS AND METHODS Ninety patients confirmed to be infected with COVID-19 were followed up till the study end point (recovery and discharge or death). HMOX-1 promotor GT(n) polymorphism was evaluated using Sanger sequencing. HMOX-1 enzyme serum level was measured by ELISA and the level of different inflammatory markers was assessed by available commercial kits. RESULTS A novel Single nucleotide polymorphism (SNP) (A > G) - rs13057211 in the GT(n) region of HMOX-1 promoter gene was found in 40 (61.5%) COVID-19 patients out of the studied 65 patients. This (A > G) SNP was associated with higher mortality rate in COVID-19 as it was detected in 27 patients (75% of the patients who succumbed to the disease) (p = 0.021, Odds ratio = 3.7; 95% CI:1.29-10.56). Serum IL-6 (Interleuken-6) was positively correlated the length of Hospital Stay (LOHS) and procalcitonin (PCT); (p = 0.014, r: 0.651 and p < 0.001, r:0.997) respectively while negatively correlated with levels of HMOX-1 enzyme serum level (p = 0.013, r: -0.61). CRP correlated positively with LOHS (p = 0.021, r = 0.4), PCT (p = 0.044, r = 0.425) and age (p < 0.001, r = 0.685). Higher levels of D-Dimer and PCT were observed in patients with the long repeat. There was no significant difference between patients who recovered and those who died from COVID-19 as regards HMOX-1 level and GT(n) polymorphism. CONCLUSION We report a novel SNP (A > G, rs13057211) in the GT(n) region of HMOX-1 promoter gene that was associated with mortality in COVID-19 patients, however no significant difference was found in HMOX-1 serum level or HMOX-1 (GT)n repeats within the studied groups.
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Affiliation(s)
- Kerolos Fares
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mona K El-Deeb
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Al Jouf University, Sakakah, Saudi Arabia
| | - Omar Elsammak
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amged Ouf
- Department of Biology and Biotechnology Graduate Program, School of Sciences and Engineering (SSE), The American University in Cairo (AUC), New Cairo, Egypt
| | - Hesham Mahmoud Sayd Saeed
- Department of Biotechnology, Institute of Graduate Studies and Research Alexandria University, Alexandria, Egypt
| | - Ayman Baess
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Elsammak
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt.
| | - Eman El-Attar
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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3
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Roy-Vallejo E, Fernández De Córdoba-Oñate S, Delgado-Wicke P, Triguero-Martínez A, Montes N, Carracedo-Rodríguez R, Zurita-Cruz N, Marcos-Jiménez A, Lamana A, Galván-Román JM, Villapalos García G, Zubiaur P, Ciudad M, Rabes L, Sanz M, Rodríguez C, Villa A, Rodríguez JÁ, Marcos C, Hernando J, Díaz-Fernández P, Abad F, de los Santos I, Rodríguez Serrano DA, García-Vicuña R, Suárez Fernández C, P. Gomariz R, Muñoz-Calleja C, Fernández-Ruiz E, González-Álvaro I, Cardeñoso L. Occurrence of SARS-CoV-2 viremia is associated with genetic variants of genes related to COVID-19 pathogenesis. Front Med (Lausanne) 2023; 10:1215246. [PMID: 37809329 PMCID: PMC10557488 DOI: 10.3389/fmed.2023.1215246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction SARS-CoV-2 viral load has been related to COVID-19 severity. The main aim of this study was to evaluate the relationship between SARS-CoV-2 viremia and SNPs in genes previously studied by our group as predictors of COVID-19 severity. Materials and methods Retrospective observational study including 340 patients hospitalized for COVID-19 in the University Hospital La Princesa between March 2020 and December 2021, with at least one viremia determination. Positive viremia was considered when viral load was above the quantifiable threshold (20 copies/ml). A total of 38 SNPs were genotyped. To study their association with viremia a multivariate logistic regression was performed. Results The mean age of the studied population was 64.5 years (SD 16.6), 60.9% patients were male and 79.4% white non-Hispanic. Only 126 patients (37.1%) had at least one positive viremia. After adjustment by confounders, the presence of the minor alleles of rs2071746 (HMOX1; T/T genotype OR 9.9 p < 0.0001), rs78958998 (probably associated with SERPING1 expression; A/T genotype OR 2.3, p = 0.04 and T/T genotype OR 12.9, p < 0.0001), and rs713400 (eQTL for TMPRSS2; C/T + T/T genotype OR 1.86, p = 0.10) were associated with higher risk of viremia, whereas the minor alleles of rs11052877 (CD69; A/G genotype OR 0.5, p = 0.04 and G/G genotype OR 0.3, p = 0.01), rs2660 (OAS1; A/G genotype OR 0.6, p = 0.08), rs896 (VIPR1; T/T genotype OR 0.4, p = 0.02) and rs33980500 (TRAF3IP2; C/T + T/T genotype OR 0.3, p = 0.01) were associated with lower risk of viremia. Conclusion Genetic variants in HMOX1 (rs2071746), SERPING1 (rs78958998), TMPRSS2 (rs713400), CD69 (rs11052877), TRAF3IP2 (rs33980500), OAS1 (rs2660) and VIPR1 (rs896) could explain heterogeneity in SARS-CoV-2 viremia in our population.
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Affiliation(s)
- Emilia Roy-Vallejo
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | | | | | - Ana Triguero-Martínez
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Rheumathology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Nuria Montes
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Rheumathology Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Nelly Zurita-Cruz
- Microbiology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Ana Marcos-Jiménez
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Immunology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Amalia Lamana
- Cell Biology Department, Facultad de Biología, Universidad Complutense, Madrid, Spain
| | - José María Galván-Román
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Villapalos García
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Clinical Pharmacology Department, Hospital Universitario La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Pablo Zubiaur
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Clinical Pharmacology Department, Hospital Universitario La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Marianela Ciudad
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Laura Rabes
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Marta Sanz
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Carlos Rodríguez
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Almudena Villa
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Celeste Marcos
- Pneumology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Julia Hernando
- Anesthesiology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Paula Díaz-Fernández
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Immunology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Francisco Abad
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Clinical Pharmacology Department, Hospital Universitario La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio de los Santos
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Rosario García-Vicuña
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Rheumathology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Carmen Suárez Fernández
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Rosa P. Gomariz
- Cell Biology Department, Facultad de Biología, Universidad Complutense, Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Immunology Department, Hospital Universitario La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Elena Fernández-Ruiz
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Molecular Biology Unit, Hospital Universitario La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Isidoro González-Álvaro
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Rheumathology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Laura Cardeñoso
- Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Microbiology Department, Hospital Universitario La Princesa, Madrid, Spain
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Grigorov I, Pejić S, Todorović A, Drakulić D, Veljković F, Vukajlović JM, Bobić K, Soldatović I, Đurašević S, Jasnić N, Stanković S, Glumac S, Mihailović-Vučinić V, Milenković B. Serum High-Mobility Group Box 1 and Heme Oxygenase-1 as Biomarkers in COVID-19 Patients at Hospital Admission. Int J Mol Sci 2023; 24:13164. [PMID: 37685970 PMCID: PMC10488018 DOI: 10.3390/ijms241713164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The careful monitoring of patients with mild/moderate COVID-19 is of particular importance because of the rapid progression of complications associated with COVID-19. For prognostic reasons and for the economic management of health care resources, additional biomarkers need to be identified, and their monitoring can conceivably be performed in the early stages of the disease. In this retrospective cross-sectional study, we found that serum concentrations of high-mobility group box 1 (HMGB1) and heme oxygenase-1 (HO-1), at the time of hospital admission, could be useful biomarkers for COVID-19 management. The study included 160 randomly selected recovered patients with mild to moderate COVID-19 on admission. Compared with healthy controls, serum HMGB1 and HO-1 levels increased by 487.6 pg/mL versus 43.1 pg/mL and 1497.7 pg/mL versus 756.1 pg/mL, respectively. Serum HO-1 correlated significantly with serum HMGB1, oxidative stress parameters (malondialdehyde (MDA), the phosphatidylcholine/lysophosphatidylcholine ratio (PC/LPC), the ratio of reduced and oxidative glutathione (GSH/GSSG)), and anti-inflammatory acute phase proteins (ferritin, haptoglobin). Increased heme catabolism/hemolysis were not detected. We hypothesize that the increase in HO-1 in the early phase of COVID-19 disease is likely to have a survival benefit by providing protection against oxidative stress and inflammation, whereas the level of HMGB1 increase reflects the activity of the innate immune system and represents levels within which the disease can be kept under control.
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Affiliation(s)
- Ilijana Grigorov
- Institute for Biological Research “Siniša Stanković”—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia
| | - Snežana Pejić
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Ana Todorović
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Dunja Drakulić
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Filip Veljković
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Jadranka Miletić Vukajlović
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Katarina Bobić
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (A.T.); (D.D.); (F.V.); (J.M.V.); (K.B.)
| | - Ivan Soldatović
- Institute of Medical Statistics and Informatic, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Siniša Đurašević
- Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (S.Đ.); (N.J.)
| | - Nebojša Jasnić
- Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (S.Đ.); (N.J.)
| | - Sanja Stanković
- Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Sofija Glumac
- Institute of Pathology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.G.); (V.M.-V.); (B.M.)
| | - Violeta Mihailović-Vučinić
- Institute of Pathology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.G.); (V.M.-V.); (B.M.)
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branislava Milenković
- Institute of Pathology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.G.); (V.M.-V.); (B.M.)
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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5
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Lotsios NS, Keskinidou C, Jahaj E, Mastora Z, Dimopoulou I, Orfanos SE, Vassilaki N, Vassiliou AG, Kotanidou A. Prognostic Value of HIF-1α-Induced Genes in Sepsis/Septic Shock. Med Sci (Basel) 2023; 11:41. [PMID: 37367740 DOI: 10.3390/medsci11020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Hypoxia is characterized as one of the main consequences of sepsis, which is recognized as the leading cause of death in intensive care unit (ICU) patients. In this study, we aimed to examine whether the expression levels of genes regulated under hypoxia could be utilized as novel biomarkers for sepsis prognosis in ICU patients. Whole blood expression levels of hypoxia-inducible factor-1α (HIF1A), interferon-stimulated gene 15 (ISG15), hexokinase 2 (HK2), lactate dehydrogenase (LDHA), heme oxygenase-1 (HMOX1), erythropoietin (EPO), and the vascular endothelial growth factor A (VEGFA) were measured on ICU admission in 46 critically ill, initially non-septic patients. The patients were subsequently divided into two groups, based on the development of sepsis and septic shock (n = 25) or lack thereof (n = 21). HMOX1 mRNA expression was increased in patients who developed sepsis/septic shock compared to the non-septic group (p < 0.0001). The ROC curve, multivariate logistic regression, and Kaplan-Meier analysis demonstrated that HMOX1 expression could be utilized for sepsis and septic shock development probability. Overall, our results indicate that HMOX1 mRNA levels have the potential to be a valuable predictive factor for the prognosis of sepsis and septic shock in ICU patients.
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Affiliation(s)
- Nikolaos S Lotsios
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Chrysi Keskinidou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Edison Jahaj
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Zafeiria Mastora
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Ioanna Dimopoulou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Stylianos E Orfanos
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Niki Vassilaki
- Laboratory of Molecular Virology, Hellenic Pasteur Institute, 11521 Athens, Greece
| | - Alice G Vassiliou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
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