Immunological Approaches to the Treatment of New Coronavirus Infection (Review)

The pandemic of the new coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus has spread all over the world. The large amount of information that appears every day requires comprehension and systematization. The immunological aspects of the virus-host interaction are the core issues in the effective treatment and prevention of COVID-19' development. The review analyzes the known pathways of the viral invasion and evasion, the mechanisms of the cytokine storm, endothelial damage, and hypercoagulability associated with SARS-CoV-2 infection. Clinical data from previous SARS and MERS epidemics is discussed here. We also address the therapeutic approaches based on the basic knowledge of immune response and the blood cells' immune functions, as well as the ways to reduce their hyperactivation. The use of interferon therapy, anti-inflammatory therapy, anti-cytokine therapy, neutralizing antibodies, convalescent plasma, and mesenchymal stem cells, as well as prophylactic vaccines, is discussed.

Quality of Life Changes in Women with Osteoporotic Vertebral Fractures and Possibility of its Improvement Using New Complex of Physical Therapy Including Mechanotheraputic Technologies

Objective. To assess quality of life (QOL) in people with osteoporotic (OP) vertebral fractures (VFs) and evaluate effect of new complex of physical rehabilitation including mechanotherapeutic technologies on QOL of those patients. Material and methods. At the 1st stage the study group was comprised of 60 women 40–80 years old with OP VFs. The comparison group (n=60) was formed from patients with OP without any fracture enrolled by the twin-pair method. 2nd stage was carried out inthe form of a prospective controlled open study. 120 patients with OP VFs were randomized to the intervention group (group 1, n=60)which received a new complex of physical therapy including mechanotherapeutic technologies, and control (group 2, n=60) which received only complex of physical exercises. Results. In patients with VFs a significant decrease in main QOL domains such as severity of pain, daily living activity, mobility, mental state, general health and general QUALEFFO-41 scale was revealed (p<0.05 vs comparison group). Administration of a new physical rehabilitation complex resulted in pain reduction and improvement of such QOL aspects as house jobs, mobility and mental state(p<0.05 at 21st day vs baseline). Therapy effect on pain syndrome, daily living activity, mobility and overall QOL remains for at least 4 weeks after the rehabilitation course (p<0.05 at 70th day vs baseline). Conclusion. New physical therapy complex including mechanotherapeutic technologies can be recommended for rehabilitation of patients with osteoporotic VFs to increase QOL and to reduce back pain.

The effectiveness of mechanotherapeutic methods for spine deep stabilization system training in patients with osteoporotic vertebral fractures

The aim of the study was to estimate the effect of new physical rehabilitation complex using of mechanotherapeutic methods on spine muscle strength in patients with osteoporosis (OP) and vertebral fractures (VF). Material and methods: Study comprised of 90 osteoporotic patients aged 50-80 years old (65.4±9.1 years) with OP VFs who were randomized as 2:1 into intervention group (group1, n=60) and control group (group2, n=30). Patients in group 1 received an intensive rehabilitation course including back muscle training with mechanical loads #10; sensorimotor training on double unstable platform #10; kinesohydrotherapy in a pool #15; physical exercises in a gym #10. Group 2 was prescribed only physical exercises in a gym #15. All patients undergo tenzodynamometry on BackCheck diagnostic unit (Dr. Wolff, Germany) at baseline, in 3 weeks at the end of rehabilitation course and in a month of follow-up. Results: In group 1 after the rehabilitation course muscle strength improved in trunk extensors (TE) from 15.8±10.1 to 21.7±13.1 kg (p<0.001), trunk flexors (TF) from 14.5±9.1 to 18.9±10.2 kg (p<0.001), left lateral flexors (LLF) from 12.8±7.2 to 17.5±9.6kg (p<0.001) and right lateral flexors (RLF) from 13.2 ± 7.1 to 17.8 ± 9.2 kg (p<0.01). Strength deficiency significantly decreased in all muscles (p<0.001 for TE and TF, p<0.05 for LLF, p<0.01 for RLF). The achieved effect lasted for a month of follow-up. In group 2 positive dynamics of strength was observed after 3 weeks only in TE and TF (p<0.05), however, after a month of observation, the strength of all the studied muscles did not differ from the baseline (p>0.05). Conclusion: The new 3-week complex of physical rehabilitation using of mechanotherapeutic methods lead to increase of spine muscle strength and improvement of muscle strength deficiency in patients with osteoporotic VFs. Rehabilitation effect lasts for at least a month after the treatment completion.

Loop diuretics decrease the renal elimination rate and increase the plasma levels of trimethylamine-N-oxide

AIMS

Trimethylamine-N-oxide (TMAO) is a novel cardiovascular risk marker. We explored the association of commonly used cardiovascular medications with TMAO levels in patients and validated the identified associations in mice.

METHODS

Detailed history of drug treatment was recorded in 300 patients with cardiovascular disease without diabetes in an observational, cross-sectional study. Animal study was performed in CD1 mice.

RESULTS

Median plasma TMAO (interquartile range) level was 2.144 (1.570-3.104) μmol l^-1 . Among nine cardiovascular drug groups, the use of loop diuretics (0.510 ± 0.296 in users vs. 0.336 ± 0.272 in nonusers, P = 0.008) and mineralocorticoid receptor antagonists (0.482 ± 0.293 in users vs. 0.334 ± 0.272 in nonusers, P = 0.007) was associated with increased log-TMAO. Acute concomitant administration of furosemide or torasemide with TMAO in mice significantly influenced TMAO pharmacokinetic profile and almost doubled the plasma TMAO area under the curve. Furosemide decreased the TMAO excretion rate by 1.9-fold during the first 30 min after administration and increased TMAO concentrations in kidney, heart and liver, suggesting the interaction of furosemide and TMAO with efflux transporters. The concentrations of TMAO in blood plasma after the administration of the organic anion transporter inhibitor probenecid were not different from those of the control group, suggesting an effect not mediated by organic anion transporters.

CONCLUSIONS

Loop diuretics increased plasma TMAO concentration by decreasing its urinary excretion rate. Loop diuretic use should be considered a potential confounder in TMAO studies.

Inhibition of L-carnitine biosynthesis and transport by methyl-γ-butyrobetaine decreases fatty acid oxidation and protects against myocardial infarction

BACKGROUND AND PURPOSE

The important pathological consequences of ischaemic heart disease arise from the detrimental effects of the accumulation of long-chain acylcarnitines in the case of acute ischaemia-reperfusion. The aim of this study is to test whether decreasing the L-carnitine content represents an effective strategy to decrease accumulation of long-chain acylcarnitines and to reduce fatty acid oxidation in order to protect the heart against acute ischaemia-reperfusion injury.

KEY RESULTS

In this study, we used a novel compound, 4-[ethyl(dimethyl)ammonio]butanoate (Methyl-GBB), which inhibits γ-butyrobetaine dioxygenase (IC₅₀ 3 μM) and organic cation transporter 2 (OCTN2, IC₅₀ 3 μM), and, in turn, decreases levels of L-carnitine and acylcarnitines in heart tissue. Methyl-GBB reduced both mitochondrial and peroxisomal palmitate oxidation rates by 44 and 53% respectively. In isolated hearts treated with Methyl-GBB, uptake and oxidation rates of labelled palmitate were decreased by 40%, while glucose oxidation was increased twofold. Methyl-GBB (5 or 20 mg·kg(-1)) decreased the infarct size by 45-48%. In vivo pretreatment with Methyl-GBB (20 mg·kg(-1)) attenuated the infarct size by 45% and improved 24 h survival of rats by 20-30%.

CONCLUSIONS AND IMPLICATIONS

Reduction of L-carnitine and long-chain acylcarnitine content by the inhibition of OCTN2 represents an effective strategy to protect the heart against ischaemia-reperfusion-induced damage. Methyl-GBB treatment exerted cardioprotective effects and increased survival by limiting long-chain fatty acid oxidation and facilitating glucose metabolism.

Detection of IgG binding to Schistosoma mansoni recombinant protein RP26 is a sensitive and specific method for acute schistosomiasis diagnosis

We recently described the first recombinant Schistosoma mansoni protein RP26, which was capable of acute infection diagnosis. The aim of the present work was to further characterize the RP26 diagnostic properties in immunoblot and enzyme-linked immunosorbent (ELISA) assays. Testing sera from uninfected donors and sera from patients with acute or chronic Schistosoma infection by Western blot immunoassay revealed 100% specificity and 100% sensitivity for acute infection identification. Sera from uninfected, acute, and chronic schistosomiasis were also probed for IgG, IgG4, IgA, and IgM reactivity to RP26 plus soluble egg antigens (SEA) in ELISA. The mean IgG reactivity to RP26 by sera from acute schistosomiasis patients was significantly higher than the chronic ones. The IgG4, IgA, and IgM reactivities to RP26 were low and similar in both infected groups. The mean IgA and IgM reactivities to SEA were significantly higher in the group of acute compared to chronic group, whereas mean IgG4 reactivity was higher in chronic group. To estimate the specificity of Schistosoma infection diagnosis sera from patients infected with other different parasites were tested to detect IgG reactivity to RP26 and IgA and IgM reactivity to SEA. For IgA against SEA detection, 72% of sera were positive and 48% of sera were positive for IgM detection. Based on these results we can suggest that detection of sera IgG binding to RP26 is a sensitive and specific method for acute schistosomiasis diagnosis. Therefore, RP26 is a candidate for immunodiagnostic kit development.

Serological differentiation of acute and chronic schistosomiasis using Schistosoma mansoni recombinant protein RP26

We obtained a recombinant protein encoded by Schistosoma mansoni gene which was able to differentiate acute from chronic schistosomiasis when applied as antigen in enzyme-linked immunosorbent assay (ELISA). A cDNA clone encoding a 26 kDa recombinant protein (RP26) was selected by screening of an adult worm S. mansoni lambdaZAP expression library with rabbit sera produced against PIII, an adult worm protein fraction already known to possess protective and immunomodulating effects. The clone cDNA presented 99% identity with S. mansoni Sm22.3 gene. We assayed IgG reactivity of sera from 18 patients with acute, 25 patients with chronic S. mansoni infection and 20 uninfected donors with RP26 in ELISA. Our results showed that 89% of sera were positive in acute schistosomiasis group, and only 26% in chronic group, without false-positive reactions in uninfected group. In mice the immune response to RP26 increased up to week 9 after infection and then diminished. We proposed that production of antibodies binding to RP26 stopped at the chronic stage of disease. The testing of sera from eight other parasitic infections with RP26 revealed no positive reactions in majority of sera. However, we observed low positive reaction in sera from 20% of leishmaniasis patients. Our results indicate that a recombinant protein RP26 can be used as immunodiagnostic reagent for detection of acute phase of schistosomiasis mansoni.

Thrombopoietin serum concentration in patients with reactive and myeloproliferative thrombocytosis

We wished to test whether thrombopoietin (TPO) is entirely regulated by receptor binding or if other factors may play a role in the mechanism of TPO regulation. Therefore, we analyzed the TPO serum levels in 43 patients with reactive (secondary) thrombocytosis and in 37 with myeloproliferative thrombocytosis. Thrombocytosis was defined as a platelet level greater than 440 x 10(9)/l. Forty-two patients (98%) with reactive thrombocytosis had high concentrations of IL-6 correlating with elevated C-reactive protein levels. Twenty-three patients (53%) in this group had TPO serum concentrations of more than 300 pg/ml (normal: below 300 pg/ml). Only nine patients (24%) with myeloproliferative thrombocytosis had TPO serum levels above normal range, whereas 28 patients (76%) had normal levels of TPO. No correlation between the TPO serum levels and the concentrations of IL-6 or EPO was established. The other investigated thrombopoietic cytokines (IL-3, IL-11, GM-CSF) were unmeasurable; therefore, a correlation could not be assessed. We conclude that TPO concentrations are not strictly inversely related to platelet count. TPO serum levels are elevated especially in a considerable percentage of patients with reactive thrombocytosis, arguing for the existence of additional mechanisms of TPO regulation.