How the Innate Immune System of the Blood Contributes to Systemic Pathology in COVID-19-Induced ARDS and Provides Potential Targets for Treatment

Most SARS-CoV-2 infected patients experience influenza-like symptoms of low or moderate severity. But, already in 2020 early during the pandemic it became obvious that many patients had a high incidence of thrombotic complications, which prompted treatment with high doses of low-molecular-weight heparin (LMWH; typically 150-300IU/kg) to prevent thrombosis. In some patients, the disease aggravated after approximately 10 days and turned into a full-blown acute respiratory distress syndrome (ARDS)-like pulmonary inflammation with endothelialitis, thrombosis and vascular angiogenesis, which often lead to intensive care treatment with ventilator support. This stage of the disease is characterized by dysregulation of cytokines and chemokines, in particular with high IL-6 levels, and also by reduced oxygen saturation, high risk of thrombosis, and signs of severe pulmonary damage with ground glass opacities. The direct link between SARS-CoV-2 and the COVID-19-associated lung injury is not clear. Indirect evidence speaks in favor of a thromboinflammatory reaction, which may be initiated by the virus itself and by infected damaged and/or apoptotic cells. We and others have demonstrated that life-threatening COVID-19 ARDS is associated with a strong activation of the intravascular innate immune system (IIIS). In support of this notion is that activation of the complement and kallikrein/kinin (KK) systems predict survival, the necessity for usage of mechanical ventilation, acute kidney injury and, in the case of MBL, also coagulation system activation with thromboembolism. The general properties of the IIIS can easily be translated into mechanisms of COVID-19 pathophysiology. The prognostic value of complement and KKsystem biomarkers demonstrate that pharmaceuticals, which are licensed or have passed the phase I trial stage are promising candidate drugs for treatment of COVID-19. Examples of such compounds include complement inhibitors AMY-101 and eculizumab (targeting C3 and C5, respectively) as well as kallikrein inhibitors ecallantide and lanadelumab and the bradykinin receptor (BKR) 2 antagonist icatibant. In this conceptual review we discuss the activation, crosstalk and the therapeutic options that are available for regulation of the IIIS.

Single Fault Diagnosis Method of Sensors in Cascade System Based on Data-Driven

The reliability and safety of the cascade system, which is widely applied, have attached attention increasingly. Fault detection and diagnosis can play a significant role in enhancing its reliability and safety. On account of the complexity of the double closed-loop system in operation, the problem of fault diagnosis is relatively complex. For the single fault of the second-order valued system sensors, a real-time fault diagnosis method based on data-driven is proposed in this study. Off-line data is employed to establish static fault detection, location, estimation, and separation models. The static models are calibrated with on-line data to obtain the real-time fault diagnosis models. The real-time calibration, working flow and anti-interference measures of the real-time diagnosis system are given. Experiments results demonstrate the validity and accuracy of the fault diagnosis method, which is suitable for the general cascade system.

The Cascade System of Osmotic Homeostasis Regulation

The human and animal osmoregulation system is aimed at stabilizing serum osmolality in order to maintain cell volume. It has been shown that the introduction of 5 mL water per 100 g of body weight into the stomach of rats decreases serum osmolality and the concentration of Na and Ca, but not K and Mg. The cascade system of osmotic homeostasis increases secretion of glucagon-like peptide-1 (GLP-1) and oxytocin, and decreases secretion of vasopressin, which reduces the osmotic permeability of collecting duct. After water loading and the injection of 0.015 nM exenatide (GLP-1 mimetic), the time of excretion of 50% of water was halved from 112 ± 4 to 57 ± 5 min (p < 0.01), and after the injection of 0.015 nM oxytocin, it decreased to 83 ± 6 min (p < 0.01). The physiological mechanism of renal effect of the aforementioned hormones which accelerate the recovery of osmotic homeostasis has been found.