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Lukhna K, do Carmo HRP, Castillo AR, Davidson SM, Geffen H, Giesz S, Golforoush P, Bovi TG, Gorag D, Salama A, Imamdin A, Kalkhoran S, Lecour S, Perroud Jr. MW, Ntsekhe M, Sposito AC, Yellon DM. Effect of Remote Ischaemic Conditioning on the Inflammatory Cytokine Cascade of COVID-19 (RIC in COVID-19): a Randomized Controlled Trial. Cardiovasc Drugs Ther 2024; 38:433-445. [PMID: 36445625 PMCID: PMC9707178 DOI: 10.1007/s10557-022-07411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients hospitalized with COVID-19 may develop a hyperinflammatory, dysregulated cytokine "storm" that rapidly progresses to acute respiratory distress syndrome, multiple organ dysfunction, and even death. Remote ischaemic conditioning (RIC) has elicited anti-inflammatory and cytoprotective benefits by reducing cytokines following sepsis in animal studies. Therefore, we investigated whether RIC would mitigate the inflammatory cytokine cascade induced by COVID-19. METHODS We conducted a prospective, multicentre, randomized, sham-controlled, single-blind trial in Brazil and South Africa. Non-critically ill adult patients with COVID-19 pneumonia were randomly allocated (1:1) to receive either RIC (intermittent ischaemia/reperfusion applied through four 5-min cycles of inflation (20 mmHg above systolic blood pressure) and deflation of an automated blood-pressure cuff) or sham for approximately 15 days. Serum was collected following RIC/sham administration and analyzed for inflammatory cytokines using flow cytometry. The endpoint was the change in serum cytokine concentrations. Participants were followed for 30 days. RESULTS Eighty randomized participants (40 RIC and 40 sham) completed the trial. Baseline characteristics according to trial intervention were overall balanced. Despite downward trajectories of all cytokines across hospitalization, we observed no substantial changes in cytokine concentrations after successive days of RIC. Time to clinical improvement was similar in both groups (HR 1.66; 95% CI, 0.938-2.948, p 0.08). Overall RIC did not demonstrate a significant impact on the composite outcome of all-cause death or clinical deterioration (HR 1.19; 95% CI, 0.616-2.295, p = 0.61). CONCLUSION RIC did not reduce the hypercytokinaemia induced by COVID-19 or prevent clinical deterioration to critical care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04699227.
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Affiliation(s)
- Kishal Lukhna
- Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Helison R. P. do Carmo
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | | | - Sean M. Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX UK
| | - Hayli Geffen
- Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sara Giesz
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX UK
| | - Pelin Golforoush
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX UK
| | - Ticiane Gonçalez Bovi
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Diana Gorag
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Alan Salama
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- The Royal Free Hospital, University College London, Pond St, London, NW3 2QG UK
| | - Aqeela Imamdin
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Siavash Kalkhoran
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX UK
| | - Sandrine Lecour
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Mauricio W. Perroud Jr.
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Mpiko Ntsekhe
- Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrei C. Sposito
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Derek M. Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX UK
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Davidson SM, Lukhna K, Gorog DA, Salama AD, Castillo AR, Giesz S, Golforoush P, Kalkhoran SB, Lecour S, Imamdin A, do Carmo HRP, Bovi TG, Perroud MW, Ntsekhe M, Sposito AC, Yellon DM. RIC in COVID-19-a Clinical Trial to Investigate Whether Remote Ischemic Conditioning (RIC) Can Prevent Deterioration to Critical Care in Patients with COVID-19. Cardiovasc Drugs Ther 2022; 36:925-930. [PMID: 34169381 PMCID: PMC8225459 DOI: 10.1007/s10557-021-07221-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Coronavirus disease 19 (COVID-19) has, to date, been diagnosed in over 130 million persons worldwide and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several variants of concern have emerged including those in the United Kingdom, South Africa, and Brazil. SARS-CoV-2 can cause a dysregulated inflammatory response known as a cytokine storm, which can progress rapidly to acute respiratory distress syndrome (ARDS), multi-organ failure, and death. Suppressing these cytokine elevations may be key to improving outcomes. Remote ischemic conditioning (RIC) is a simple, non-invasive procedure whereby a blood pressure cuff is inflated and deflated on the upper arm for several cycles. "RIC in COVID-19" is a pilot, multi-center, randomized clinical trial, designed to ascertain whether RIC suppresses inflammatory cytokine production. METHODS A minimum of 55 adult patients with diagnosed COVID-19, but not of critical status, will be enrolled from centers in the United Kingdom, Brazil, and South Africa. RIC will be administered daily for up to 15 days. The primary outcome is the level of inflammatory cytokines that are involved in the cytokine storm that can occur following SARS-CoV-2 infection. The secondary endpoint is the time between admission and until intensive care admission or death. The in vitro cytotoxicity of patient blood will also be assessed using primary human cardiac endothelial cells. CONCLUSIONS The results of this pilot study will provide initial evidence on the ability of RIC to suppress the production of inflammatory cytokines in the setting of COVID-19. TRIAL REGISTRATION NCT04699227, registered January 7th, 2021.
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Affiliation(s)
- Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Kishal Lukhna
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Diana A Gorog
- Postgraduate Medicine, University of Hertfordshire, UK & East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Alan D Salama
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | - Sara Giesz
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Pelin Golforoush
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | | | - Sandrine Lecour
- The Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa
| | - Aqeela Imamdin
- The Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa
| | - Helison R P do Carmo
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Ticiane Gonçalez Bovi
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Mauricio W Perroud
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Mpiko Ntsekhe
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrei C Sposito
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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Davidson SM, Lukhna K, Gorog DA, Salama AD, Castillo AR, Giesz S, Golforoush P, Kalkhoran SB, Lecour S, Imamdin A, do Carmo HRP, Bovi TG, Perroud MW, Ntsekhe M, Sposito AC, Yellon DM. Correction to: RIC in COVID-19-a Clinical Trial to Investigate Whether Remote Ischemic Conditioning (RIC) Can Prevent Deterioration to Critical Care in Patients with COVID-19. Cardiovasc Drugs Ther 2022; 36:931. [PMID: 34232434 PMCID: PMC8261032 DOI: 10.1007/s10557-021-07223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sean M Davidson
- The Hatter Cardiovascular Institute, University College, London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Kishal Lukhna
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Diana A Gorog
- Postgraduate Medicine, University of Hertfordshire, UK & East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Alan D Salama
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | - Sara Giesz
- The Hatter Cardiovascular Institute, University College, London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Pelin Golforoush
- The Hatter Cardiovascular Institute, University College, London, 67 Chenies Mews, London, WC1E 6HX, UK
| | | | - Sandrine Lecour
- The Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa
| | - Aqeela Imamdin
- The Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa
| | - Helison R P do Carmo
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Ticiane Gonçalez Bovi
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Mauricio W Perroud
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Mpiko Ntsekhe
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrei C Sposito
- Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College, London, 67 Chenies Mews, London, WC1E 6HX, UK.
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Sposito AC, Breder I, Soares AAS, Kimura-Medorima ST, Munhoz DB, Cintra RMR, Bonilha I, Oliveira DC, Breder JC, Cavalcante P, Moreira C, Moura FA, de Lima-Junior JC, do Carmo HRP, Barreto J, Nadruz W, Carvalho LSF, Quinaglia T. Dapagliflozin effect on endothelial dysfunction in diabetic patients with atherosclerotic disease: a randomized active-controlled trial. Cardiovasc Diabetol 2021; 20:74. [PMID: 33771149 PMCID: PMC8004411 DOI: 10.1186/s12933-021-01264-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022] Open
Abstract
Background The glucose-lowering independent effect of sodium glucose cotransporter-2 inhibitors (SGLT2i) on arterial wall function has not yet been clarified. This study aims to assess whether SGLT2i treatment can attenuate endothelial dysfunction related to type 2 diabetes mellitus (T2D) compared with glucose-lowering equivalent therapy. Methods In a prospective, open-label, single-center, randomized clinical trial, 98 patients with T2DM and carotid intima-media thickness above the 75th percentile were randomized 1:1 to 12 weeks of therapy with dapagliflozin or glibenclamide in addition to metformin in glucose-lowering equivalent regimens. The coprimary endpoints were 1-min flow-mediated dilation (FMD) at rest and 1-min FMD after 15 min of ischemia followed by 15 min of reperfusion time (I/R). Results Ninety-seven patients (61% males, 57 ± 7 years) completed the study. The median HbA1c decreased by − 0.8 (0.7)% and -0.7 (0.95)% following dapagliflozin and glibenclamide, respectively. The first coprimary endpoint, i.e., rest FMD changed by + 3.3(8.2)% and − 1.2(7.5)% for the dapagliflozin and glibenclamide arms, respectively (p = 0.0001). Differences between study arms in the second coprimary endpoint were not significant. Plasma nitrite 1 min after rest FMD was higher for dapagliflozin [308(220) nmol/L] than for glibenclamide (258[110] nmol/L; p = 0.028). The resistive indices at 1 min [0.90 (0.11) vs. 0.93 (0.07); p = 0.03] and 5 min [0.93 (0.07) vs. 0.95 (0.05); p = 0.02] were higher for the glibenclamide group than for the dapagliflozin group. Plasma biomarkers for inflammation and oxidative stress did not differ between the treatments. Conclusions Dapagliflozin improved micro- and macrovascular endothelial function compared to glibenclamide, regardless of glycemic control in patients with T2DM and subclinical carotid atherosclerotic disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01264-z.
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Affiliation(s)
- Andrei C Sposito
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil.
| | - Ikaro Breder
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Alexandre A S Soares
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Sheila T Kimura-Medorima
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Daniel B Munhoz
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Riobaldo M R Cintra
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Isabella Bonilha
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Daniela C Oliveira
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Jessica Cunha Breder
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Pamela Cavalcante
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Camila Moreira
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Filipe A Moura
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Jose Carlos de Lima-Junior
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Helison R P do Carmo
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Joaquim Barreto
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Wilson Nadruz
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Luiz Sergio F Carvalho
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Thiago Quinaglia
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
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