1
|
Dennis A, Cuthbertson DJ, Wootton D, Crooks M, Gabbay M, Eichert N, Mouchti S, Pansini M, Roca-Fernandez A, Thomaides-Brears H, Kelly M, Robson M, Hishmeh L, Attree E, Heightman M, Banerjee R, Banerjee A. Multi- organ impairment and long COVID: a 1-year prospective, longitudinal cohort study. J R Soc Med 2023; 116:97-112. [PMID: 36787802 PMCID: PMC10041626 DOI: 10.1177/01410768231154703] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation. DESIGN Prospective cohort study. PARTICIPANTS Individuals. METHODS In individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function. SETTING Two non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed. MAIN OUTCOME MEASURES Primary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19. RESULTS A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L < 0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively. CONCLUSIONS Organ impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID.Trial Registration: ClinicalTrials.gov Identifier: NCT04369807.
Collapse
Affiliation(s)
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, L7 8TX, UK
| | - Dan Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Michael Crooks
- Department of Respiratory Medicine, Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, HU3 2JZ, UK
- Institute of Clinical and Applied Health Research, University of Hull, Hull, HU6 7RX, UK
| | - Mark Gabbay
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GF, UK
| | | | | | - Michele Pansini
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 0AG, Oxford, UK
| | | | | | | | | | - Lyth Hishmeh
- Long Covid SOS, Faringdon, Oxfordshire, SN7 7EX, UK
| | | | - Melissa Heightman
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | | | - Amitava Banerjee
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Cardiology, Barts Health NHS Trust, London, EC1A 7BE, UK
| |
Collapse
|
2
|
Wang Y, Diep JK, Yu RZ, Hurh E, Karwatowska-Prokopczuk E, Schneider E, Henry S, Bhanot S, Geary RS. Assessment of the Effect of Organ Impairment on the Pharmacokinetics of 2'-MOE and Phosphorothioate Modified Antisense Oligonucleotides. J Clin Pharmacol 2023; 63:21-28. [PMID: 35801818 DOI: 10.1002/jcph.2121] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022]
Abstract
The pharmacokinetics (PK) of 2'-O-methoxyethyl and phosphorothioate antisense oligonucleotides (ASOs), with or without N-acetyl galactosamine conjugation, have been well characterized following subcutaneous or intravenous drug administration. However, the effect of organ impairment on ASO PK, primarily hepatic or renal impairment, has not yet been reported. ASOs distribute extensively to the liver and kidneys, where they are metabolized slowly by endo- and exonucleases, with minimal renal excretion as parent drug (<1%-3%). This short review evaluated the effect of organ impairment on ASO PK using 3 case studies: (1) a phase 1 renal impairment study evaluating a N-acetyl galactosamine-conjugated ASO in healthy study participants and study participants with moderate renal impairment, (2) a phase 2 study evaluating an unconjugated ASO in patients with end-stage renal disease; and (3) a phase 3 study evaluating an unconjugated ASO, which included patients with mild hepatic or renal impairment. Results showed that patients with end-stage renal disease had a mild increase (≈34%) in total plasma exposure, whereas mild or moderate renal impairment showed no effect on plasma PK. The effect of hepatic impairment on ASO PK could not be fully evaluated due to lack of data in moderate and severe hepatic impairment study participants. Nonetheless, available data suggest that mild hepatic impairment had no effect on ASO exposure.
Collapse
Affiliation(s)
- Yanfeng Wang
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - John K Diep
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Rosie Z Yu
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Eunju Hurh
- Akcea Therapeutics, Inc., Boston, Massachusetts, USA
| | | | | | - Scott Henry
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Sanjay Bhanot
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | |
Collapse
|
3
|
Abstract
BACKGROUND Glucose homeostasis relies on insulin to suppress hepatic glucose production and to stimulate glucose uptake by peripheral tissues (primarily skeletal muscle) during and after a meal or glucose load. Glucose metabolism impairments in the liver and/or muscle attenuate these insulin actions, causing hyperglycemia. Thus, identifying the loci of the impairments can improve the understanding of hyperglycemia and enable organ-targeted interventions. METHODS Studies were performed to identify such loci using modified oral glucose tolerance test (OGTT) techniques in individuals with type 2 diabetes (T2D) and overweight/obese individuals. RESULTS Individuals with severe T2D were found to have significantly impaired glucose metabolism in both the liver and muscle. In contrast, impairments in glucose metabolism in individuals with non-severe T2D were predominantly localized in the liver or muscle, but not both. Similarly, milder impairments in overweight or obese individuals were clearly localized in either the liver or muscle, but not both. All these impairments are quantifiable. CONCLUSION Impairments in glucose metabolism in the liver and muscle can be differentiated and quantified in a clinical setting.
Collapse
Affiliation(s)
- Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | | | | | | |
Collapse
|