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Meinhardt J, Streit S, Dittmayer C, Manitius RV, Radbruch H, Heppner FL. The neurobiology of SARS-CoV-2 infection. Nat Rev Neurosci 2024; 25:30-42. [PMID: 38049610 DOI: 10.1038/s41583-023-00769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
Worldwide, over 694 million people have been infected with SARS-CoV-2, with an estimated 55-60% of those infected developing COVID-19. Since the beginning of the pandemic in December 2019, different variants of concern have appeared and continue to occur. With the emergence of different variants, an increasing rate of vaccination and previous infections, the acute neurological symptomatology of COVID-19 changed. Moreover, 10-45% of individuals with a history of SARS-CoV-2 infection experience symptoms even 3 months after disease onset, a condition that has been defined as 'post-COVID-19' by the World Health Organization and that occurs independently of the virus variant. The pathomechanisms of COVID-19-related neurological complaints have become clearer during the past 3 years. To date, there is no overt - that is, truly convincing - evidence for SARS-CoV-2 particles in the brain. In this Review, we put special emphasis on discussing the methodological difficulties of viral detection in CNS tissue and discuss immune-based (systemic and central) effects contributing to COVID-19-related CNS affection. We sequentially review the reported changes to CNS cells in COVID-19, starting with the blood-brain barrier and blood-cerebrospinal fluid barrier - as systemic factors from the periphery appear to primarily influence barriers and conduits - before we describe changes in brain parenchymal cells, including microglia, astrocytes, neurons and oligodendrocytes as well as cerebral lymphocytes. These findings are critical to understanding CNS affection in acute COVID-19 and post-COVID-19 in order to translate these findings into treatment options, which are still very limited.
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Affiliation(s)
- Jenny Meinhardt
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Simon Streit
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Carsten Dittmayer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Regina V Manitius
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Cluster of Excellence, NeuroCure, Berlin, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
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2
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Brinjikji W, Kallmes DF, Virmani R, de Meyer SF, Yoo AJ, Humphries W, Zaidat OO, Teleb MS, Jones JG, Siddiqui AH, Andersson T, Nogueira RG, Gil SM, Douglas A, Rossi R, Rentzos A, Ceder E, Carlqvist J, Dunker D, Jood K, Tatlisumak T, Doyle KM. Endotheliitis and cytokine storm as a mechanism of clot formation in COVID-19 ischemic stroke patients: A histopathologic study of retrieved clots. Interv Neuroradiol 2023:15910199231185804. [PMID: 37769315 DOI: 10.1177/15910199231185804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies during the COVID-19 pandemic have demonstrated an association between COVID-19 virus infection and the development of acute ischemic stroke, particularly large vessel occlusion (LVO). Studying the characteristics and immunohistochemistry of retrieved stroke emboli during mechanical thrombectomy for LVO may offer insights into the pathogenesis of LVO in COVID-19 patients. We examined retrieved COVID-19 emboli from the STRIP, EXCELLENT, and RESTORE registries and compared their characteristics to a control group. METHODS We identified COVID-positive LVO patients from the STRIP, RESTORE, and EXCELLENT studies who underwent mechanical thrombectomy. These patients were matched to a control group controlling for stroke etiology based on Trial of Org 10172 in Acute Stroke Treatment criteria. All clots were stained with Martius Scarlet Blue (MSB) along with immunohistochemistry for interleukin-6 (IL-6), C-reactive protein (CRP), von Willebrand factor (vWF), CD66b, fibrinogen, and citrullinated Histone H3. Clot composition was compared between groups. RESULTS Nineteen COVID-19-positive patients and 38 controls were included. COVID-19-positive patients had a significantly higher percentage of CRP and vWF. There was no difference in IL-6, fibrin, CD66b, or citrullinated Histone H3 between groups. Based on MSB staining, there was no statistically significant difference regarding the percentage of red blood cells, white blood cells, fibrin, and platelets. CONCLUSIONS Our study found higher concentrations of CRP and vWF in retrieved clots of COVID-19-positive stroke patients compared to COVID-19-negative controls. These findings support the potential role of systemic inflammation as indicated by elevated CRP and endothelial injury as indicated by elevated vWF as precipitating factors in thrombus development in these patients.
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Affiliation(s)
| | | | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Simon F de Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Plano, TX, USA
| | | | - Osama O Zaidat
- Department of Neuroscience, Mercy Health St Vincent Medical Center, Toledo, OH, USA
| | - Mohamed S Teleb
- Neurointerventional Surgery, Stroke, and Neurocritical Care, Banner Health, Mesa, AZ, USA
| | - Jesse G Jones
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, State University of New York at Buffalo, New York, NY, USA
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center, UPMC Stroke Institute, Pittsburgh, PA, USA
| | - Sara Molina Gil
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Andrew Douglas
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Rosanna Rossi
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Alexander Rentzos
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Erik Ceder
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Jeanette Carlqvist
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Dennis Dunker
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karen M Doyle
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
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3
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Zeng Y, Cao S, Yang H. Global research trends on COVID-19 and stroke: A bibliometric analysis. Front Neurol 2023; 14:1147867. [PMID: 37077570 PMCID: PMC10106632 DOI: 10.3389/fneur.2023.1147867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThe pandemic of COVID-19 has had a profound influence on worldwide healthcare systems. Our study aimed to conduct a bibliometric analysis to explore the impact of COVID-19 on stroke and to highlight the major research trends in this field.MethodsWe searched the original articles and review articles regarding COVID-19 and stroke from the Web of Science collection (WOSCC) database between January 1, 2020 and December 30, 2022. Subsequently, we performed bibliometric analyses and visualization using VOSviewer, Citespace, and Scimago Graphica.ResultsA total of 608 original articles or review articles were included. JOURNAL OF STROKE and CEREBROVASCULAR DISEASES published the most studies on this subject (n = 76), while STROKE was the source of the most-cited references (n = 2,393). The United States is the most influential country in this field, with the highest number of publications (n = 223) and citations (n = 5,042). Shadi Yaghi from New York University is the most prolific author in the field, while Harvard Medical School is the most prolific institution. In addition, through keyword analysis and reference co-citation analysis, three major research topics were identified: (i) the impact of COVID-19 on stroke outcomes (including risk factors, clinical characteristics, mortality, stress, depression, comorbidities, etc.); (ii) the management and care of stroke patients during the COVID-19 pandemic (including thrombolysis, thrombectomy, telemedicine, anticoagulation, vaccination, etc.); and (iii) the potential relationship and pathological mechanism between COVID-19 and stroke (including renin-angiotensin system activation, SARS-CoV-2 virus-induced inflammation leading to endothelial impairment, coagulopathy, etc.).ConclusionOur bibliometric analysis provides a comprehensive overview of the current state of research on COVID-19 and stroke and highlights key areas of focus in the field. Optimizing the treatment of COVID-19-infected stroke patients and elucidating the underlying pathogenic mechanisms of COVID-19 and stroke co-morbidity are key areas of future research that will be beneficial in improving the prognosis of stroke patients during the ongoing COVID-19 epidemic.
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Affiliation(s)
- Youjie Zeng
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Cao
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Heng Yang
- Department of Neurology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Heng Yang
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Takács TT, Berki ÁJ, Böjti PP, Stang R, Fritz-Reunes PA, Schnekenberg L, Siepmann T, Pintér A, Szatmári S, Bereczki D, Gunda B. The impact of SARS-CoV-2 infection on the outcome of acute ischemic stroke-A retrospective cohort study. PLoS One 2023; 18:e0282045. [PMID: 36862706 PMCID: PMC9980769 DOI: 10.1371/journal.pone.0282045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection (COVID-19), but the prognosis of these patients is poorly understood. PURPOSE To explore the impact of COVID-19 on neurological outcomes in AIS patients. METHODS A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1st of March 2020 and 1st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS). RESULTS COVID-19 AIS patients showed tendency to worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10); p = 0.06), higher rate of large vessel occlusion (LVO; 13/32 vs. 14/51; p = 0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days; p = 0.003), had lower chance of functional independence (mRS≤2) (12/32 vs. 32/51; p = 0.02) and showed higher in-hospital mortality (10/32 vs. 6/51; p = 0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%; p = 0.139). CONCLUSION COVID-19-related AIS carries a worse prognosis. COVID-19 with pneumonia seems to be associated with a higher rate of LVO.
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Affiliation(s)
- Tímea Tünde Takács
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
- * E-mail:
| | - Ádám József Berki
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
| | - Péter Pál Böjti
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Rita Stang
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
| | | | - Luiz Schnekenberg
- University Hospital Carl Gustav Carus, Department of Neurology, Dresden, Germany
| | - Timo Siepmann
- University Hospital Carl Gustav Carus, Department of Neurology, Dresden, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Alexandra Pintér
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Semmelweis University, Department of Family Medicine, Budapest, Hungary
| | - Szabolcs Szatmári
- Semmelweis University, Department of Neurology, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group ELKH, Budapest, Hungary
| | - Dániel Bereczki
- Semmelweis University, Department of Neurology, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group ELKH, Budapest, Hungary
- European Academy of Neurology, EANcore COVID-19 Task Force, Vienna, Austria
| | - Bence Gunda
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
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Koh S, Kim YS, Kim MH, Choi YH, Choi JY, Kim TJ. Encephalitis with status epilepticus and stroke as complications of non-severe COVID-19 in a young female patient: a case report. BMC Neurol 2022; 22:253. [PMID: 35820865 PMCID: PMC9274957 DOI: 10.1186/s12883-022-02782-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/24/2022] [Indexed: 12/16/2022] Open
Abstract
Background Neurological manifestations of COVID-19 are thought to be associated with the disease severity of COVID-19 and poor clinical outcomes. Dysregulated immune responses are considered to be mediating such complications. Our case illustrates multiple critical neurological complications simultaneously developed in a patient with non-severe COVID-19 and successful recovery with a multifaceted therapeutic approach. The cerebrospinal fluid (CSF) interleukin-6 (IL-6) level was temporally correlated with the clinical severity of the status epilepticus in our patient, suggesting a causal relationship. Case presentation A previously healthy 20-year-old female patient presented with a first-onset seizure. Concomitant non-severe COVID-19 pneumonia was diagnosed. CSF study showed lymphocytic pleocytosis with elevated IL-6 levels in CSF. During hospitalization under the diagnosis of autoimmune encephalitis, status epilepticus developed, and the seizure frequency was temporally correlated with the CSF IL-6 level. Furthermore, a new embolic stroke developed without a significant cardioembolic source. Contrary to the exacerbated COVID-19-associated neurological complications, COVID-19 pneumonia was cleared entirely. After treatment with antiseizure medications, antithrombotics, antiviral agents, and immunotherapy, the patient was discharged with near-complete recovery. Conclusion Active serological, and radiological evaluation can be helpful even in non-severe COVID-19, and multidimensional treatment strategies, including immunotherapy, can successfully reverse the neurological complication.
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Affiliation(s)
- Seungyon Koh
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yoon Seob Kim
- Department of Neurology, Ajou University Hospital, Suwon, Republic of Korea
| | - Min Hye Kim
- Department of Neurology, Ajou University Hospital, Suwon, Republic of Korea
| | - Young Hwa Choi
- Department of Infectious Disease, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Young Choi
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea. .,Department of Neurology, Ajou University Hospital, Suwon, Republic of Korea.
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Schoene D, Schnekenberg LG, Pallesen LP, Barlinn J, Puetz V, Barlinn K, Siepmann T. Pathophysiology of Cardiac Injury in COVID-19 Patients with Acute Ischaemic Stroke: What Do We Know So Far?-A Review of the Current Literature. LIFE (BASEL, SWITZERLAND) 2022; 12:life12010075. [PMID: 35054468 PMCID: PMC8778241 DOI: 10.3390/life12010075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
With the onset of the COVID-19 pandemic, it became apparent that, in addition to pulmonary infection, extrapulmonary manifestations such as cardiac injury and acute cerebrovascular events are frequent in patients infected with SARS-CoV-2, worsening clinical outcome. We reviewed the current literature on the pathophysiology of cardiac injury and its association with acute ischaemic stroke. Several hypotheses on heart and brain axis pathology in the context of stroke related to COVID-19 were identified. Taken together, a combination of disease-related coagulopathy and systemic inflammation might cause endothelial damage and microvascular thrombosis, which in turn leads to structural myocardial damage. Cardiac complications of this damage such as tachyarrhythmia, myocardial infarction or cardiomyopathy, together with changes in hemodynamics and the coagulation system, may play a causal role in the increased stroke risk observed in COVID-19 patients. These hypotheses are supported by a growing body of evidence, but further research is necessary to fully understand the underlying pathophysiology and allow for the design of cardioprotective and neuroprotective strategies in this at risk population.
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Li G, Wang C, Wang S, Hao Y, Xiong Y, Zhao X. Clinical Significance and Dynamic Change of Coagulation Parameters in Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Clin Appl Thromb Hemost 2022; 28:10760296221121287. [PMID: 36040718 PMCID: PMC9434657 DOI: 10.1177/10760296221121287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective Investigations on coagulation parameters including fibrinogen (Fbg),
fibrinogen degradation products (FDP), and D-dimer in ischemic stroke
patients treated with intravenous thrombolysis are insufficient. We aimed to
investigate the association between in-hospital clinical outcomes and the
coagulation parameters at different time points in ischemic stroke patients
treated with intravenous tissues plasminogen activator (IV tPA). Methods We retrospectively enrolled patients who received IV tPA therapy within 4.5 h
from symptoms onset. Demographics, clinical characteristics, imaging
measures, and the discharge mRS score were collected. Multivariable logistic
regression analyses were performed to test whether coagulation parameters
were independent predictors for the in-hospital clinical outcomes. We also
employed machine learning models to investigate whether coagulation
parameters were able to improve the prediction of favorable functional
outcomes. Results One hundred and fifty-two patients treated with IV tPA were included. Among
the coagulation parameters, low D-dimers at 48 h proved to be an independent
predictor of favorable functional outcome (adjusted odd ratio 0.24, 95%
confidential intervals 0.06-0.92, P = 0.04). The AUC of D-dimer at 48 h to
predict favorable functional outcome was 0.73 (0.60-0.87) and the optimal
cut-off value was 0.92 (sensitivity 0.69, specificity 0.78). Machine
learning models with D-dimer at 48 h had superior performance in predicting
favorable functional outcomes and among the input variables in the machine
learning models, D-dimer at 48 h showed the highest weight in predicting mRS
0-1 at discharge (38.44%). Conclusion Increased levels of D-dimer at 48 h was associated with lower proportion of
favorable functional outcomes in acute ischemic stroke patients with
intravenous thrombolysis.
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Affiliation(s)
- Guangshuo Li
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanying Wang
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shang Wang
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yahui Hao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yunyun Xiong
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Institute for Brain Research, China
| | - Xingquan Zhao
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Widyantara IW, Sarongku T, Laksmidewi AAP. Manifestation of neurological symptoms in patients with severe Covid-19 in the intensive room: a retrospective, observational study. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nazerian Y, Vakili K, Ebrahimi A, Niknejad H. Developing Cytokine Storm-Sensitive Therapeutic Strategy in COVID-19 Using 8P9R Chimeric Peptide and Soluble ACE2. Front Cell Dev Biol 2021; 9:717587. [PMID: 34540833 PMCID: PMC8446510 DOI: 10.3389/fcell.2021.717587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/06/2021] [Indexed: 12/27/2022] Open
Abstract
Currently, the COVID-19 pandemic is an international challenge, largely due to lack of effective therapies. Pharmacotherapy has not yet been able to find a definitive treatment for COVID-19. Since SARS-CoV-2 affects several organs, treatment strategies that target the virus in a wider range are expected to be ultimately more successful. To this end, a two-step treatment strategy has been presented. In the first phase of the disease, when the patient is newly infected with the virus and the cytokine storm has not yet been developed, a chimeric peptide is used to inhibit virus entry into the host cell cytosol (by inhibiting endosomal pH acidification) and viral replication. After the virus entry and decrease of angiotensin converting enzyme 2 (ACE2) level, some people are unable to properly compensate for the ACE2 pathway and progress toward the cytokine storm. In the beginning of the cytokine storm, sACE2 protein is very effective in regulating the immune system toward the anti-inflammatory pathway, including M2 macrophages. Hence, the genes of 8P9R chimeric peptide and sACE2 would be inserted in an episomal vector with a separate promoter for each gene: the chimeric peptide gene promoter is a CMV promoter, while the sACE2 gene promoter is a NF-κB-sensitive promoter. The NF-κB-sensitive promoter induces the expression of sACE2 gene soon after elevation of NF-κB which is the main transcription factor of inflammatory genes. Thus, as the expression of inflammatory cytokines increases, the expression of sACE2 increases simultaneously. In this condition, sACE2 can prevent the cytokine storm by inhibiting the pro-inflammatory pathways. To deliver the designed vector to the target cells, mesenchymal stem cell-derived (MSC-derived) exosome-liposome hybrids are used. Herein, the strategy can be considered as a personalized clinical therapy for COVID-19, that can prevent morbidity and mortality in the future.
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Affiliation(s)
- Yasaman Nazerian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ebrahimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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