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Ahmed R, Saba AA, Paul A, Nur J, Alam MS, Chakraborty S, Howlader MZH, Islam LN, Nabi AHMN. Intronic Variants of the Angiotensin-Converting Enzyme 2 Gene Modulate Plasma ACE2 Levels and Possibly Confer Protection against Severe COVID-19. Biomed Res Int 2023; 2023:5705076. [PMID: 37929242 PMCID: PMC10622595 DOI: 10.1155/2023/5705076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/24/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
Membrane-bound angiotensin-converting enzyme 2 (ACE2) receptor acts as the entry point for the novel coronavirus, SARS-CoV-2. Polymorphisms in the ACE2 gene may alter viral binding, regulate the expression of ACE2, and thus, affect disease severity. In this study, 68 COVID-19 patients with varying degrees of severity and 40 healthy controls were enrolled. The genetic landscape of the ACE2 gene was explored by whole exome sequencing of 29 individuals, and specific regions of ACE2 were analyzed for the rest of the participants via PCR, followed by barcode-tagged sequencing. The mean soluble ACE2 level in the plasma of healthy controls and patients did not vary significantly but was higher in the patient group (3.77 ± 1.55 ng/mL vs. 3.94 ± 1.42 ng/mL). Analysis of exon 1, exon 2, and exon 8 of the ACE2 gene revealed that these regions are highly conserved in our population. Investigation of exon 11 and its flanking intronic region revealed that deletions in a stretch of 18T nucleotides in the noncoding region significantly decrease ACE2 levels in plasma, as individuals harboring wild-type variants had higher plasma ACE2 levels compared to those harboring T1del, T2del, and T3del variants. However, the intronic variants were not found to be significantly associated with disease severity.
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Affiliation(s)
- Rubaiat Ahmed
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Abdullah Al Saba
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Anik Paul
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Jasmin Nur
- Department of Immunology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Md Sohrab Alam
- Department of Immunology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Dhaka, Bangladesh
| | - Sajib Chakraborty
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Md. Zakir Hossain Howlader
- Laboratory of Nutrition and Health Research, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Laila N. Islam
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - A. H. M. Nurun Nabi
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
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2
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Kim J, Jozic A, Mukherjee A, Nelson D, Chiem K, Khan MSR, Torrelles JB, Martinez‐Sobrido L, Sahay G. Rapid Generation of Circulating and Mucosal Decoy Human ACE2 using mRNA Nanotherapeutics for the Potential Treatment of SARS-CoV-2. Adv Sci (Weinh) 2022; 9:e2202556. [PMID: 36216580 PMCID: PMC9762296 DOI: 10.1002/advs.202202556] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/19/2022] [Indexed: 05/24/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause lethal pulmonary damage in humans. It contains spike proteins on its envelope that bind to human angiotensin-converting enzyme 2 (hACE2) expressed on airway cells, enabling entry of the virus, and causing infection. The soluble form of hACE2 binds SARS-CoV-2 spike protein, prevents viral entry into target cells, and ameliorates lung injury; however, its short half-life limits therapeutic utilities. Here, synthetic mRNA is engineered to encode a soluble form of hACE2 (hsACE2) to prevent viral infection. A novel lipid nanoparticle (LNP) is used for packaging and delivering mRNA to cells to produce hsACE2 proteins. Intravenously administered LNP delivers mRNA to hepatocytes, leading to the production of circulatory hsACE2 initiated within 2 h and sustained over several days. Inhaled LNP results in lung transfection and secretion of mucosal hsACE2 to lung epithelia, the primary site of entry and pathogenesis for SARS-CoV-2. Furthermore, mRNA-generated hsACE2 binds to the receptor-binding domain of the viral spike protein. Finally, hsACE2 effectively inhibits SARS-CoV-2 and its pseudoviruses from infecting host cells. The proof of principle study shows that mRNA-based nanotherapeutics can be potentially deployed to neutralize SARS-CoV-2 and open new treatment opportunities for coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Jeonghwan Kim
- Department of Pharmaceutical SciencesCollege of PharmacyRobertson Life Sciences BuildingOregon State UniversityPortlandOR97201USA
| | - Antony Jozic
- Department of Pharmaceutical SciencesCollege of PharmacyRobertson Life Sciences BuildingOregon State UniversityPortlandOR97201USA
| | - Anindit Mukherjee
- Department of Pharmaceutical SciencesCollege of PharmacyRobertson Life Sciences BuildingOregon State UniversityPortlandOR97201USA
| | - Dylan Nelson
- Department of Pharmaceutical SciencesCollege of PharmacyRobertson Life Sciences BuildingOregon State UniversityPortlandOR97201USA
- High‐Throughput Screening Services LaboratoryCollege of PharmacyOregon State UniversityCorvallisOR97331USA
| | - Kevin Chiem
- Disease Prevention and Interventionand Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTX78227USA
| | - Md Siddiqur Rahman Khan
- Disease Prevention and Interventionand Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTX78227USA
| | - Jordi B. Torrelles
- Disease Prevention and Interventionand Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTX78227USA
| | - Luis Martinez‐Sobrido
- Disease Prevention and Interventionand Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTX78227USA
| | - Gaurav Sahay
- Department of Pharmaceutical SciencesCollege of PharmacyRobertson Life Sciences BuildingOregon State UniversityPortlandOR97201USA
- Department of Biomedical EngineeringRobertson Life Sciences BuildingOregon Health & Science UniversityPortlandOR97201USA
- Department of OphthalmologyCasey Eye InstituteOregon Health & Science UniversityPortlandOR97239USA
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3
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Akin S, Schriek P, van Nieuwkoop C, Neuman RI, Meynaar I, van Helden EJ, Bouazzaoui HE, Baak R, Veuger M, Mairuhu RA, van den Berg L, van Driel V, Visser LE, de Jonge E, Garrelds IM, Duynstee JF, van Rooden JK, Ludikhuize J, Verdonk K, Caliskan K, Jansen T, van Schaik RH, Danser AJ. A low aldosterone/renin ratio and high soluble ACE2 associate with COVID-19 severity. J Hypertens 2022; 40:606-614. [PMID: 34862332 PMCID: PMC8815849 DOI: 10.1097/hjh.0000000000003054] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The severity of COVID-19 after SARS-CoV-2 infection is unpredictable. Angiotensin-converting enzyme-2 (ACE2) is the receptor responsible for coronavirus binding, while subsequent cell entry relies on priming by the serine protease TMPRSS2 (transmembrane protease, serine 2). Although renin-angiotensin-aldosterone-system (RAAS) blockers have been suggested to upregulate ACE2, their use in COVID-19 patients is now considered well tolerated. The aim of our study was to investigate parameters that determine COVID-19 severity, focusing on RAAS-components and variation in the genes encoding for ACE2 and TMPRSS2. METHODS Adult patients hospitalized due to SARS-CoV-2 infection between May 2020 and October 2020 in the Haga Teaching Hospital were included, and soluble ACE2 (sACE2), renin, aldosterone (in heparin plasma) and polymorphisms in the ACE2 and TMPRSS2 genes (in DNA obtained from EDTA blood) were determined. MEASUREMENTS AND MAIN RESULTS Out of the 188 patients who were included, 60 were defined as severe COVID-19 (ICU and/or death). These patients more often used antidiabetic drugs, were older, had higher renin and sACE2 levels, lower aldosterone levels and a lower aldosterone/renin ratio. In addition, they displayed the TMPRSS2-rs2070788 AA genotype less frequently. No ACE2 polymorphism-related differences were observed. Multivariate regression analysis revealed independent significance for age, sACE2, the aldosterone/renin ratio, and the TMPRSS2 rs2070788 non-AA genotype as predictors of COVID-19 severity, together yielding a C-index of 0.79. Findings were independent of the use of RAAS blockers. CONCLUSION High sACE2, a low aldosterone/renin ratio and having the TMPRSS2 rs2070788 non-AA genotype are novel independent determinants that may help to predict COVID-19 disease severity. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Sakir Akin
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Cardiology, Unit Heart Failure and Transplant Unit, Erasmus MC University Medical Center, Rotterdam
| | | | | | - Rugina I. Neuman
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology Erasmus MC University Medical Center, Rotterdam
| | - Iwan Meynaar
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | - Remon Baak
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | - Lettie van den Berg
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Loes E. Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague
| | - Evert de Jonge
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam
| | - Ingrid M. Garrelds
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology Erasmus MC University Medical Center, Rotterdam
| | | | | | - Jeroen Ludikhuize
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | - Koen Verdonk
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology Erasmus MC University Medical Center, Rotterdam
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure and Transplant Unit, Erasmus MC University Medical Center, Rotterdam
| | - Tim Jansen
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | - Ron H.N. van Schaik
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam
| | - A.H. Jan Danser
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology Erasmus MC University Medical Center, Rotterdam
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4
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Lee JH, Lee CE, Yoo Y, Shin E, An J, Park SY, Song WJ, Kwon HS, Cho YS, Moon HB, Kim TB. Soluble ACE2 and TMPRSS2 Levels in the Serum of Asthmatic Patients. J Korean Med Sci 2022; 37:e65. [PMID: 35226423 PMCID: PMC8885452 DOI: 10.3346/jkms.2022.37.e65] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2) are key proteins mediating viral entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although gene expressions of ACE2 and TMPRSS2 have been analyzed in various organs and diseases, their soluble forms have been less studied, particularly in asthma. Therefore, we aimed to measure circulating ACE2 and TMPRSS2 in the serum of asthmatics and examine their relationship with clinical characteristics. METHODS Clinical data and serum samples of 400 participants were obtained from an asthma cohort. The soluble ACE2 (sACE2) and soluble TMPRSS2 (sTMPRSS2) level was measured by enzyme-linked immunosorbent assay, and the values underwent a natural log transformation. Associations between sACE2 and TMPRSS2 levels and various clinical variables were analyzed. RESULTS The patients younger than 70 years old, those with eosinophilic asthma (eosinophils ≥ 200 cells/µL), and inhaled corticosteroids (ICS) non-users were associated with higher levels of sACE2. Blood eosinophils and fractionated exhaled nitric oxide levels were positively correlated with serum ACE2. In contrast, lower levels of sTMPRSS2 were noted in patients below 70 years and those with eosinophilic asthma, while no association was noted between ICS use and sTMPRSS2. The level of sTMPRSS2 also differed according to sex, smoking history, coexisting hypertension, and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio. The proportion of sputum neutrophils was positively correlated with sTMPRSS2, while the FEV1/FVC ratio reported a negative correlation with sTMPRSS2. CONCLUSION The levels of ACE2 and TMPRSS2 were differently expressed according to age, ICS use, and several inflammatory markers. These findings suggest variable susceptibility and prognosis of SARS-CoV-2 infection among asthmatic patients.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae Eun Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngsang Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Eunyong Shin
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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5
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Schneider MM, Emmenegger M, Xu CK, Condado Morales I, Meisl G, Turelli P, Zografou C, Zimmermann MR, Frey BM, Fiedler S, Denninger V, Jacquat RP, Madrigal L, Ilsley A, Kosmoliaptsis V, Fiegler H, Trono D, Knowles TP, Aguzzi A. Microfluidic characterisation reveals broad range of SARS-CoV-2 antibody affinity in human plasma. Life Sci Alliance 2022; 5:e202101270. [PMID: 34848436 PMCID: PMC8645332 DOI: 10.26508/lsa.202101270] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/31/2022] Open
Abstract
The clinical outcome of SARS-CoV-2 infections, which can range from asymptomatic to lethal, is crucially shaped by the concentration of antiviral antibodies and by their affinity to their targets. However, the affinity of polyclonal antibody responses in plasma is difficult to measure. Here we used microfluidic antibody affinity profiling (MAAP) to determine the aggregate affinities and concentrations of anti-SARS-CoV-2 antibodies in plasma samples of 42 seropositive individuals, 19 of which were healthy donors, 20 displayed mild symptoms, and 3 were critically ill. We found that dissociation constants, K d, of anti-receptor-binding domain antibodies spanned 2.5 orders of magnitude from sub-nanomolar to 43 nM. Using MAAP we found that antibodies of seropositive individuals induced the dissociation of pre-formed spike-ACE2 receptor complexes, which indicates that MAAP can be adapted as a complementary receptor competition assay. By comparison with cytopathic effect-based neutralisation assays, we show that MAAP can reliably predict the cellular neutralisation ability of sera, which may be an important consideration when selecting the most effective samples for therapeutic plasmapheresis and tracking the success of vaccinations.
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Affiliation(s)
- Matthias M Schneider
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
| | - Marc Emmenegger
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Catherine K Xu
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
| | | | - Georg Meisl
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
| | - Priscilla Turelli
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Chryssa Zografou
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Manuela R Zimmermann
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
| | - Beat M Frey
- Regional Blood Transfusion Service Zurich, Swiss Red Cross, Schlieren, Switzerland
| | | | - Viola Denninger
- Fluidic Analytics, Unit A, Paddocks Business Centre, Cambridge, UK
| | - Raphaël Pb Jacquat
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
| | - Lidia Madrigal
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Alison Ilsley
- Fluidic Analytics, Unit A, Paddocks Business Centre, Cambridge, UK
| | - Vasilis Kosmoliaptsis
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK
| | - Heike Fiegler
- Fluidic Analytics, Unit A, Paddocks Business Centre, Cambridge, UK
| | - Didier Trono
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tuomas Pj Knowles
- Centre for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK
- Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge, UK
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
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6
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Genchi A, Semerano A, Schwarz G, Dell'Acqua B, Gullotta GS, Sampaolo M, Boeri E, Quattrini A, Sanvito F, Diamanti S, Bergamaschi A, Grassi S, Podini P, Panni P, Michelozzi C, Simionato F, Scomazzoni F, Remida P, Valvassori L, Falini A, Ferrarese C, Michel P, Saliou G, Hajdu S, Beretta S, Roveri L, Filippi M, Strambo D, Martino G, Bacigaluppi M. Neutrophils predominate the immune signature of cerebral thrombi in COVID-19 stroke patients. Acta Neuropathol Commun 2022; 10:14. [PMID: 35105380 PMCID: PMC8805426 DOI: 10.1186/s40478-022-01313-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic events. Ischemic stroke in COVID-19 patients entails high severity and mortality rates. Here we aimed to analyze cerebral thrombi of COVID-19 patients with large vessel occlusion (LVO) acute ischemic stroke to expose molecular evidence for SARS-CoV-2 in the thrombus and to unravel any peculiar immune-thrombotic features. We conducted a systematic pathological analysis of cerebral thrombi retrieved by endovascular thrombectomy in patients with LVO stroke infected with COVID-19 (n = 7 patients) and non-covid LVO controls (n = 23). In thrombi of COVID-19 patients, the SARS-CoV-2 docking receptor ACE2 was mainly expressed in monocytes/macrophages and showed higher expression levels compared to controls. Using polymerase chain reaction and sequencing, we detected SARS-CoV-2 Clade20A, in the thrombus of one COVID-19 patient. Comparing thrombus composition of COVID-19 and control patients, we noted no overt differences in terms of red blood cells, fibrin, neutrophil extracellular traps (NETs), von Willebrand Factor (vWF), platelets and complement complex C5b-9. However, thrombi of COVID-19 patients showed increased neutrophil density (MPO+ cells) and a three-fold higher Neutrophil-to-Lymphocyte Ratio (tNLR). In the ROC analysis both neutrophils and tNLR had a good discriminative ability to differentiate thrombi of COVID-19 patients from controls. In summary, cerebral thrombi of COVID-19 patients can harbor SARS-CoV2 and are characterized by an increased neutrophil number and tNLR and higher ACE2 expression. These findings suggest neutrophils as the possible culprit in COVID-19-related thrombosis.
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Affiliation(s)
- Angela Genchi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Aurora Semerano
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Ghil Schwarz
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Beatrice Dell'Acqua
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgia Serena Gullotta
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Michela Sampaolo
- Department of Microbiology and Virology, San Raffaele Hospital, Milan, Italy
| | - Enzo Boeri
- Department of Microbiology and Virology, San Raffaele Hospital, Milan, Italy
| | | | | | - Susanna Diamanti
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Andrea Bergamaschi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Grassi
- Department of Pathology, San Raffaele Hospital, Milan, Italy
| | - Paola Podini
- Neuropathology Unit, San Raffaele Hospital, Milan, Italy
| | - Pietro Panni
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | | | - Franco Simionato
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | | | - Paolo Remida
- Department of Neuroradiology, San Gerardo Hospital, Monza, Italy
| | - Luca Valvassori
- Department of Neuroradiology, San Gerardo Hospital, Monza, Italy
| | - Andrea Falini
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | - Carlo Ferrarese
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Guillaume Saliou
- Service of Diagnostic and Interventional Radiology, Interventional Neuroradiological Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Steven Hajdu
- Service of Diagnostic and Interventional Radiology, Interventional Neuroradiological Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Simone Beretta
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Luisa Roveri
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Bacigaluppi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Department of Neurology, San Raffaele Hospital, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
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7
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Tonon F, Tornese G, Giudici F, Nicolardi F, Toffoli B, Barbi E, Fabris B, Bernardi S. Children With Short Stature Display Reduced ACE2 Expression in Peripheral Blood Mononuclear Cells. Front Endocrinol (Lausanne) 2022; 13:912064. [PMID: 35909539 PMCID: PMC9335146 DOI: 10.3389/fendo.2022.912064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cause of short stature remains often unknown. The renin-angiotensin system contributes to growth regulation. Several groups reported that angiotensin-converting enzyme 2 (ACE2)-knockout mice weighed less than controls. Our case-control study aimed to investigate if children with short stature had reduced ACE2 expression as compared to controls, and its significance. MATERIALS AND METHODS children aged between 2 and 14 years were consecutively recruited in a University Hospital pediatric tertiary care center. Cases were children with short stature defined as height SD ≤ -2 diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), before any treatment. Exclusion criteria were: acute diseases, kidney disease, endocrine or autoimmune disorders, precocious puberty, genetic syndromes, SGA history. ACE and ACE2 expression were measured in peripheral blood mononuclear cells, angiotensins were measured by ELISA. RESULTS Children with short stature displayed significantly lower ACE2 expression, being 0.40 fold induction (0.01-2.27) as compared to controls, and higher ACE/ACE2, with no differences between GHD and ISS. ACE2 expression was significantly and inversely associated with the risk of short stature, OR 0.26 (0.07-0.82), and it had a moderate accuracy to predict it, with an AUC of 0.73 (0.61-0.84). The cutoff of 0.45 fold induction of ACE2 expression was the value best predicting short stature, identifying correctly 70% of the children. CONCLUSIONS Our study confirms the association between the reduction of ACE2 expression and growth retardation. Further studies are needed to determine its diagnostic implications.
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Affiliation(s)
- Federica Tonon
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS ‘Burlo Garofolo’, Trieste, Italy
- *Correspondence: Gianluca Tornese,
| | - Fabiola Giudici
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesca Nicolardi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Barbara Toffoli
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Egidio Barbi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS ‘Burlo Garofolo’, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Stella Bernardi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
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8
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Pagano MT, Peruzzu D, Busani L, Pierdominici M, Ruggieri A, Antinori A, D'Offizi G, Petrosillo N, Palmieri F, Piselli P, Cicalini S, Notari S, Nicastri E, Agrati C, Ippolito G, Vaia F, Gagliardi MC, Capobianchi MR, Ortona E. Predicting respiratory failure in patients infected by SARS-CoV-2 by admission sex-specific biomarkers. Biol Sex Differ 2021; 12:63. [PMID: 34809704 PMCID: PMC8607227 DOI: 10.1186/s13293-021-00407-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several biomarkers have been identified to predict the outcome of COVID-19 severity, but few data are available regarding sex differences in their predictive role. Aim of this study was to identify sex-specific biomarkers of severity and progression of acute respiratory distress syndrome (ARDS) in COVID-19. METHODS Plasma levels of sex hormones (testosterone and 17β-estradiol), sex-hormone dependent circulating molecules (ACE2 and Angiotensin1-7) and other known biomarkers for COVID-19 severity were measured in male and female COVID-19 patients at admission to hospital. The association of plasma biomarker levels with ARDS severity at admission and with the occurrence of respiratory deterioration during hospitalization was analysed in aggregated and sex disaggregated form. RESULTS Our data show that some biomarkers could be predictive both for males and female patients and others only for one sex. Angiotensin1-7 plasma levels and neutrophil count predicted the outcome of ARDS only in females, whereas testosterone plasma levels and lymphocytes counts only in males. CONCLUSIONS Sex is a biological variable affecting the choice of the correct biomarker that might predict worsening of COVID-19 to severe respiratory failure. The definition of sex specific biomarkers can be useful to alert patients to be safely discharged versus those who need respiratory monitoring.
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Affiliation(s)
- Maria Teresa Pagano
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Daniela Peruzzu
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Luca Busani
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Marina Pierdominici
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Anna Ruggieri
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Gianpiero D'Offizi
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Nicola Petrosillo
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Fabrizio Palmieri
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Pierluca Piselli
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Stefania Cicalini
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Stefania Notari
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Emanuele Nicastri
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Chiara Agrati
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Giuseppe Ippolito
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Francesco Vaia
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Maria Cristina Gagliardi
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Maria Rosaria Capobianchi
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Via Portuense 292, Rome, Italy
| | - Elena Ortona
- Centro di Riferimento per la Medicina di Genere, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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9
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Xie L, Zhang Z, Wang Q, Chen Y, Lu D, Wu W. COVID-19 and Diabetes: A Comprehensive Review of Angiotensin Converting Enzyme 2, Mutual Effects and Pharmacotherapy. Front Endocrinol (Lausanne) 2021; 12:772865. [PMID: 34867819 PMCID: PMC8639866 DOI: 10.3389/fendo.2021.772865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
The potential relationship between diabetes and COVID-19 has been evaluated. However, new knowledge is rapidly emerging. In this study, we systematically reviewed the relationship between viral cell surface receptors (ACE2, AXL, CD147, DC-SIGN, L-SIGN and DPP4) and SARS-CoV-2 infection risk, and emphasized the implications of ACE2 on SARS-CoV-2 infection and COVID-19 pathogenesis. Besides, we updated on the two-way interactions between diabetes and COVID-19, as well as the treatment options for COVID-19 comorbid patients from the perspective of ACE2. The efficacies of various clinical chemotherapeutic options, including anti-diabetic drugs, renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs, anticoagulants, and glucocorticoids for COVID-19 positive diabetic patients were discussed. Moreover, we reviewed the significance of two different forms of ACE2 (mACE2 and sACE2) and gender on COVID-19 susceptibility and severity. This review summarizes COVID-19 pathophysiology and the best strategies for clinical management of diabetes patients with COVID-19.
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Affiliation(s)
| | | | | | | | | | - Weihua Wu
- Department of Endocrinology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China
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10
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Butler AE, Moin ASM, Sathyapalan T, Atkin SL. Vitamin D association with the renin angiotensin system in polycystic ovary syndrome. J Steroid Biochem Mol Biol 2021; 214:105965. [PMID: 34619249 DOI: 10.1016/j.jsbmb.2021.105965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022]
Abstract
Vitamin D deficiency is a negative endocrine renin-angiotensin system (RAS) modulator and PCOS women are often vitamin D deficient, leading to RAS overactivation in PCOS. A cross-sectional study was performed in 99 PCOS and 68 control women who presented sequentially. Circulating plasma levels of RAS proteins (Angiotensin-converting enzyme 2 (ACE2), renin and angiotensinogen) were measured by Slow Off-rate Modified Aptamer (SOMA)-scan and 25-hydroxyvitamin D [25(OH)D] was measured by tandem mass spectroscopy. The RAS system was found to be overactivated in the PCOS women compared to non-PCOS control women with increased renin and decreased angiotensinogen (p < 0.05); 25-hydroxyvitamin D was also significantly lower in the PCOS group (p < 0.0001). In PCOS women, plasma renin was increased in vitamin D deficient and insufficient groups compared with the vitamin D sufficient group (p < 0.005), but did not differ across non-PCOS control subgroups. In non-PCOS controls, plasma ACE2 decreased from vitamin D insufficiency to deficiency (p < 0.05). Angiotensinogen was not different across the vitamin D sufficiency, insufficiency and deficiency strata for either PCOS or non-PCOS controls. These data show that RAS activation through increased plasma renin levels was seen in vitamin D insufficient and deficient PCOS subjects compared to non-PCOS control women. In addition, decreased plasma ACE2 levels were seen in vitamin D deficiency in non-PCOS controls, which may predispose these vitamin D deficient subjects to increased cardiovascular risk and susceptibility to infectious agents such as COVID-19 where this is a risk factor.
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Affiliation(s)
| | | | - Thozhukat Sathyapalan
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK.
| | - Stephen L Atkin
- Royal College of Surgeons in Ireland Bahrain, Adliya, Bahrain.
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11
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Lundström A, Ziegler L, Havervall S, Rudberg A, von Meijenfeldt F, Lisman T, Mackman N, Sandén P, Thålin C. Soluble angiotensin-converting enzyme 2 is transiently elevated in COVID-19 and correlates with specific inflammatory and endothelial markers. J Med Virol 2021; 93:5908-5916. [PMID: 34138483 PMCID: PMC8426677 DOI: 10.1002/jmv.27144] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022]
Abstract
The main entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 interactions with ACE2 may increase ectodomain shedding but consequences for the renin-angiotensin system and pathology in Coronavirus disease 2019 (COVID-19) remain unclear. We measured soluble ACE2 (sACE2) and sACE levels by enzyme-linked immunosorbent assay in 114 hospital-treated COVID-19 patients compared with 10 healthy controls; follow-up samples after four months were analyzed for 58 patients. Associations between sACE2 respectively sACE and risk factors for severe COVID-19, outcome, and inflammatory markers were investigated. Levels of sACE2 were higher in COVID-19 patients than in healthy controls, median 5.0 (interquartile range 2.8-11.8) ng/ml versus 1.4 (1.1-1.6) ng/ml, p < .0001. sACE2 was higher in men than women but was not affected by other risk factors for severe COVID-19. sACE2 decreased to 2.3 (1.6-3.9) ng/ml at follow-up, p < .0001, but remained higher than in healthy controls, p = .012. sACE was marginally lower during COVID-19 compared with at follow-up, 57 (45-70) ng/ml versus 72 (52-87) ng/ml, p = .008. Levels of sACE2 and sACE did not differ depending on survival or disease severity. sACE2 during COVID-19 correlated with von Willebrand factor, factor VIII and D-dimer, while sACE correlated with interleukin 6, tumor necrosis factor α, and plasminogen activator inhibitor 1. Conclusions: sACE2 was transiently elevated in COVID-19, likely due to increased shedding from infected cells. sACE2 and sACE during COVID-19 differed in correlations with markers of inflammation and endothelial dysfunction, suggesting release from different cell types and/or vascular beds.
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Affiliation(s)
- Annika Lundström
- Division of Neurology, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Louise Ziegler
- Division of Internal Medicine, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Sebastian Havervall
- Division of Internal Medicine, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Ann‐Sofie Rudberg
- Division of Neurology, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Fien von Meijenfeldt
- Surgical Research Laboratory, Department of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Ton Lisman
- Surgical Research Laboratory, Department of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Nigel Mackman
- Division of Hematology, Department of Medicine, UNC Blood Research CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Per Sandén
- Division of Neurology, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
| | - Charlotte Thålin
- Division of Internal Medicine, Department of Clinical SciencesKarolinska Institutet Danderyd HospitalStockholmSweden
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12
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Lallai V, Manca L, Fowler CD. E-cigarette vape and lung ACE2 expression: Implications for coronavirus vulnerability. Environ Toxicol Pharmacol 2021; 86:103656. [PMID: 33838329 PMCID: PMC8025581 DOI: 10.1016/j.etap.2021.103656] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 05/15/2023]
Abstract
Evidence in humans suggests a correlation between nicotine smoking and severe respiratory symptoms with COVID-19 infection. In lung tissue, angiotensin-converting enzyme 2 (ACE2) appears to mechanistically underlie viral entry. Here, we investigated whether e-cigarette vapor inhalation alters ACE2 and nicotinic acetylcholine receptor (nAChR) expression in male and female mice. In male lung, nicotine vapor inhalation induced a significant increase in ACE2 mRNA and protein, but surprisingly, these differences were not found in females. Further, both vehicle and nicotine vapor inhalation downregulated α5 nAChR subunits in both sexes, while differences were not found in α7 nAChR subunit expression. Finally, blood ACE2 levels did not differ with exposure, indicating that blood sampling is not a sufficient indicator of lung ACE2 changes. Together, these data indicate a direct link between e-cigarette vaping and increased ACE2 expression in male lung tissue, which thereby reveals an underlying mechanism of increased vulnerability to coronavirus infection in individuals vaping nicotine.
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Affiliation(s)
- Valeria Lallai
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Letizia Manca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Christie D Fowler
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA.
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13
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Files DC, Gibbs KW, Schaich CL, Collins SP, Gwathmey TM, Casey JD, Self WH, Chappell MC. A pilot study to assess the circulating renin-angiotensin system in COVID-19 acute respiratory failure. Am J Physiol Lung Cell Mol Physiol 2021; 321:L213-L218. [PMID: 34009036 PMCID: PMC8270515 DOI: 10.1152/ajplung.00129.2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 01/28/2023] Open
Abstract
The renin-angiotensin system (RAS) is fundamental to COVID-19 pathobiology, due to the interaction between the SARS-CoV-2 virus and the angiotensin-converting enzyme 2 (ACE2) coreceptor for cellular entry. The prevailing hypothesis is that SARS-CoV-2-ACE2 interactions lead to an imbalance of the RAS, favoring proinflammatory angiotensin II (ANG II)-related signaling at the expense of the anti-inflammatory ANG-(1-7)-mediated alternative pathway. Indeed, multiple clinical trials targeting this pathway in COVID-19 are underway. Therefore, precise measurement of circulating RAS components is critical to understand the interplay of the RAS on COVID-19 outcomes. Multiple challenges exist in measuring the RAS in COVID-19, including improper patient controls, ex vivo degradation and low concentrations of angiotensins, and unvalidated laboratory assays. Here, we conducted a prospective pilot study to enroll 33 patients with moderate and severe COVID-19 and physiologically matched COVID-19-negative controls to quantify the circulating RAS. Our enrollment strategy led to physiological matching of COVID-19-negative and COVID-19-positive moderate hypoxic respiratory failure cohorts, in contrast to the severe COVID-19 cohort, which had increased severity of illness, prolonged intensive care unit (ICU) stay, and increased mortality. Circulating ANG II and ANG-(1-7) levels were measured in the low picomolar (pM) range. We found no significant differences in circulating RAS peptides or peptidases between these three cohorts. The combined moderate and severe COVID-19-positive cohorts demonstrated a mild reduction in ACE activity compared with COVID-19-negative controls (2.2 ± 0.9 × 105 vs. 2.9 ± 0.8 × 105 RFU/mL, P = 0.03). These methods may be useful in designing larger studies to physiologically match patients and quantify the RAS in COVID-19 RAS augmenting clinical trials.
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Affiliation(s)
- D Clark Files
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kevin W Gibbs
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark C Chappell
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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14
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Osman IO, Melenotte C, Brouqui P, Million M, Lagier JC, Parola P, Stein A, La Scola B, Meddeb L, Mege JL, Raoult D, Devaux CA. Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients. Front Immunol 2021; 12:625732. [PMID: 34194422 PMCID: PMC8236950 DOI: 10.3389/fimmu.2021.625732] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
The etiological agent of COVID-19 SARS-CoV-2, is primarily a pulmonary-tropic coronavirus. Infection of alveolar pneumocytes by SARS-CoV-2 requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase. ACE2, present on the surface of many cell types, is known to be a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (Ang II) into Angiotensin-(1-7) [Ang-(1-7)]. We therefore hypothesized that SARS-CoV-2 could trigger variations of ACE2 expression and Ang II plasma concentration in SARS-CoV-2-infected patients. We report here, that circulating blood cells from COVID-19 patients express less ACE2 mRNA than cells from healthy volunteers. At the level of circulating cells, this ACE2 gene dysregulation mainly affects the monocytes, which also show a lower expression of membrane ACE2 protein. Moreover, soluble ACE2 (sACE2) plasma concentrations are lower in prolonged viral shedders than in healthy controls, while the concentration of sACE2 returns to normal levels in short viral shedders. In the plasma of prolonged viral shedders, we also found higher concentrations of Ang II and angiotensin I (Ang I). On the other hand, the plasma levels of Ang-(1-7) remains almost stable in prolonged viral shedders but seems insufficient to prevent the adverse effects of Ang II accumulation. Altogether, these data evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.
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Affiliation(s)
- Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Cléa Melenotte
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Brouqui
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Philippe Parola
- Aix-Marseille Univ, IRD, APHM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Andréas Stein
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Bernard La Scola
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Line Meddeb
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christian A. Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- Centre National de la Recherche Scientifique (CNRS), Marseille, France
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15
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Sajeev JK, Dewey H, Kalman JM, Chou B, Roberts L, Cooke JC, Koshy AN, Patel SK, Gould M, Ngoh J, Burrell LM, Teh AW. Angiotensin-Converting Enzyme 2 Activity Is Associated With Embolic Stroke of Undetermined Source. Stroke 2021; 52:e324-e325. [PMID: 34111949 DOI: 10.1161/strokeaha.121.034135] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jithin K Sajeev
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Helen Dewey
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | | | - Bon Chou
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Louise Roberts
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Jennifer C Cooke
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Anoop N Koshy
- Department of Medicine, University of Melbourne, Victoria, Australia (A.N.K., S.K.P., L.M.B., A.W.T.)
| | - Sheila K Patel
- Department of Medicine, University of Melbourne, Victoria, Australia (A.N.K., S.K.P., L.M.B., A.W.T.)
| | - Merryn Gould
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Jeremy Ngoh
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
| | - Louise M Burrell
- Department of Medicine, University of Melbourne, Victoria, Australia (A.N.K., S.K.P., L.M.B., A.W.T.)
| | - Andrew W Teh
- Eastern Health, Monash University, Melbourne, Victoria, Australia (J.K.S., H.D., B.C., L.R., J.C.C., M.G., J.N., A.W.T.)
- Department of Medicine, University of Melbourne, Victoria, Australia (A.N.K., S.K.P., L.M.B., A.W.T.)
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16
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Mongelli A, Barbi V, Gottardi Zamperla M, Atlante S, Forleo L, Nesta M, Massetti M, Pontecorvi A, Nanni S, Farsetti A, Catalano O, Bussotti M, Dalla Vecchia LA, Bachetti T, Martelli F, La Rovere MT, Gaetano C. Evidence for Biological Age Acceleration and Telomere Shortening in COVID-19 Survivors. Int J Mol Sci 2021; 22:ijms22116151. [PMID: 34200325 PMCID: PMC8201243 DOI: 10.3390/ijms22116151] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022] Open
Abstract
The SARS-CoV-2 infection determines the COVID-19 syndrome characterized, in the worst cases, by severe respiratory distress, pulmonary and cardiac fibrosis, inflammatory cytokine release, and immunosuppression. This condition has led to the death of about 2.15% of the total infected world population so far. Among survivors, the presence of the so-called persistent post-COVID-19 syndrome (PPCS) is a common finding. In COVID-19 survivors, PPCS presents one or more symptoms: fatigue, dyspnea, memory loss, sleep disorders, and difficulty concentrating. In this study, a cohort of 117 COVID-19 survivors (post-COVID-19) and 144 non-infected volunteers (COVID-19-free) was analyzed using pyrosequencing of defined CpG islands previously identified as suitable for biological age determination. The results show a consistent biological age increase in the post-COVID-19 population, determining a DeltaAge acceleration of 10.45 ± 7.29 years (+5.25 years above the range of normality) compared with 3.68 ± 8.17 years for the COVID-19-free population (p < 0.0001). A significant telomere shortening parallels this finding in the post-COVID-19 cohort compared with COVID-19-free subjects (p < 0.0001). Additionally, ACE2 expression was decreased in post-COVID-19 patients, compared with the COVID-19-free population, while DPP-4 did not change. In light of these observations, we hypothesize that some epigenetic alterations are associated with the post-COVID-19 condition, particularly in younger patients (< 60 years).
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Affiliation(s)
- Alessia Mongelli
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
| | - Veronica Barbi
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
| | - Michela Gottardi Zamperla
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
| | - Sandra Atlante
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
| | - Luana Forleo
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
| | - Marialisa Nesta
- Foundation “Policlinico Universitario A. Gemelli IRCCS”, Department of Translational Medicine & Surgery, Faculty of Medicine, and Department of Cardiovascular Science, Catholic University of the Sacred Heart, 00168 Rome, Italy; (M.N.); (M.M.); (A.P.); (S.N.)
| | - Massimo Massetti
- Foundation “Policlinico Universitario A. Gemelli IRCCS”, Department of Translational Medicine & Surgery, Faculty of Medicine, and Department of Cardiovascular Science, Catholic University of the Sacred Heart, 00168 Rome, Italy; (M.N.); (M.M.); (A.P.); (S.N.)
| | - Alfredo Pontecorvi
- Foundation “Policlinico Universitario A. Gemelli IRCCS”, Department of Translational Medicine & Surgery, Faculty of Medicine, and Department of Cardiovascular Science, Catholic University of the Sacred Heart, 00168 Rome, Italy; (M.N.); (M.M.); (A.P.); (S.N.)
| | - Simona Nanni
- Foundation “Policlinico Universitario A. Gemelli IRCCS”, Department of Translational Medicine & Surgery, Faculty of Medicine, and Department of Cardiovascular Science, Catholic University of the Sacred Heart, 00168 Rome, Italy; (M.N.); (M.M.); (A.P.); (S.N.)
| | - Antonella Farsetti
- Institute for Systems Analysis and Computer Science “A. Ruberti” (IASI), National Research Council (CNR), 00185 Rome, Italy;
| | - Oronzo Catalano
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy;
| | - Maurizio Bussotti
- Cardiorespiratory Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, 20097 Milan, Italy; (M.B.); (L.A.D.V.)
| | - Laura Adelaide Dalla Vecchia
- Cardiorespiratory Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, 20097 Milan, Italy; (M.B.); (L.A.D.V.)
| | - Tiziana Bachetti
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, 27100 Pavia, Italy; (T.B.); (M.T.L.R.)
| | - Fabio Martelli
- Laboratory of Molecular Cardiology, Policlinico San Donato IRCCS, San Donato Milanese, 20097 Milan, Italy;
| | - Maria Teresa La Rovere
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, 27100 Pavia, Italy; (T.B.); (M.T.L.R.)
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy
| | - Carlo Gaetano
- Laboratory of Epigenetics, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 10, 27100 Pavia, Italy; (A.M.); (V.B.); (M.G.Z.); (S.A.); (L.F.)
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy
- Correspondence: ; Tel.: +39-038-259-2262
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17
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Kragstrup TW, Singh HS, Grundberg I, Nielsen ALL, Rivellese F, Mehta A, Goldberg MB, Filbin MR, Qvist P, Bibby BM. Plasma ACE2 predicts outcome of COVID-19 in hospitalized patients. PLoS One 2021; 16:e0252799. [PMID: 34086837 PMCID: PMC8177449 DOI: 10.1371/journal.pone.0252799] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/21/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to angiotensin converting enzyme 2 (ACE2) enabling entrance of the virus into cells and causing the infection termed coronavirus disease of 2019 (COVID-19). Here, we investigate associations between plasma ACE2 and outcome of COVID-19. METHODS AND RESULTS This analysis used data from a large longitudinal study of 306 COVID-19 positive patients and 78 COVID-19 negative patients (MGH Emergency Department COVID-19 Cohort). Comprehensive clinical data were collected on this cohort, including 28-day outcomes. The samples were run on the Olink® Explore 1536 platform which includes measurement of the ACE2 protein. High admission plasma ACE2 in COVID-19 patients was associated with increased maximal illness severity within 28 days with OR = 1.8, 95%-CI: 1.4-2.3 (P < 0.0001). Plasma ACE2 was significantly higher in COVID-19 patients with hypertension compared with patients without hypertension (P = 0.0045). Circulating ACE2 was also significantly higher in COVID-19 patients with pre-existing heart conditions and kidney disease compared with patients without these pre-existing conditions (P = 0.0363 and P = 0.0303, respectively). CONCLUSION This study suggests that measuring plasma ACE2 is potentially valuable in predicting COVID-19 outcomes. Further, ACE2 could be a link between COVID-19 illness severity and its established risk factors hypertension, pre-existing heart disease and pre-existing kidney disease.
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Affiliation(s)
- Tue W. Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Arnav Mehta
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Marcia B. Goldberg
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael R. Filbin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Per Qvist
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Genomics and Personalized Medicine, CGPM, Aarhus University, Aarhus, Denmark
| | - Bo Martin Bibby
- Department of Biostatistics, Aarhus University, Aarhus, Denmark
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18
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Hussain A, Tang O, Sun C, Jia X, Selvin E, Nambi V, Folsom A, Heiss G, Zannad F, Mosley T, Virani SS, Coresh J, Boerwinkle E, Yu B, Cunningham JW, Shah AM, Solomon SD, de Lemos JA, Hoogeveen RC, Ballantyne CM. Soluble Angiotensin-Converting Enzyme 2, Cardiac Biomarkers, Structure, and Function, and Cardiovascular Events (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2021; 146:15-21. [PMID: 33539861 PMCID: PMC8038970 DOI: 10.1016/j.amjcard.2021.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 11/30/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022]
Abstract
Membrane-bound angiotensin-converting enzyme 2 is important in regulation of the renin-angiotensin-aldosterone system, but the association of cleaved soluble ACE2 (sACE2) with cardiovascular disease (CVD) is unclear. We evaluated the association of sACE2 with cardiac biomarkers, structure, and function and cardiovascular events in the Atherosclerosis Risk in Communities Study. sACE2 was measured in a subset of 497 participants (mean age 78±5.4 years, 53% men, 27% black); Cox regression analyses assessed prospective associations of sACE2 with time to first CVD event at median 6.1-year follow-up. sACE2 was higher in men, blacks, and participants with prevalent CVD, diabetes, or hypertension. Higher sACE2 levels were associated with significantly higher biomarkers of cardiac injury (high-sensitivity cardiac troponin I and T, N-terminal pro-B-type natriuretic peptide), greater left ventricular mass index, and impaired diastolic function in linear regression analyses, and with increased risk for heart failure hospitalization (adjusted hazard ratio per natural log unit increase [HR] 1.32, 95% confidence interval [CI] 1.10 to 1.58), CVD events (HR 1.34, 95% CI 1.13 to 1.60), and all-cause death (HR 1.26, 95% CI 1.01 to 1.57). In an elderly biracial cohort, sACE2 was positively associated with biomarkers reflecting myocardial injury and neurohormonal activation, left ventricular mass index, impaired diastolic function, CVD, events and all-cause death.
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Affiliation(s)
- Aliza Hussain
- Department of Medicine, Baylor College of Medicine, Houston, Texax; Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas
| | - Olive Tang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Caroline Sun
- Department of Medicine, Baylor College of Medicine, Houston, Texax
| | - Xiaoming Jia
- Department of Medicine, Baylor College of Medicine, Houston, Texax
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texax; Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas; Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Aaron Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Faiez Zannad
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Université de Lorraine, Nancy, France
| | - Thomas Mosley
- Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, Texax; Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas; Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric Boerwinkle
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Bing Yu
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jonathan W Cunningham
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - James A de Lemos
- Division of Cardiology, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, Texax; Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Texax; Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas.
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19
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Abstract
BACKGROUND The recent emergence of COVID-19 poses a global health emergency. One of the most frequently reported data is sex-related severity and mortality: according to the last available analysis on 239,709 patients in Italy, lethality is 17.7% in men and 10.8% in women, with 59% of total deaths being men. Interestingly, the infection rate is lower in males than in females, with 45.8% and 54.2% of positive cases, respectively, suggesting that gender-related factor may worsen disease evolution. A tentative hypothesis to explain these findings is the role of angiotensin-converting enzyme 2 (ACE2) and serine protease TMPRSS2 involved in viral infection. PURPOSE In this review, we summarize the available evidence pointing to gender-related differences in ACE2 and TMPRSS2 expression, from both genetic and endocrine points of view. RESULTS Altogether, available evidence points toward two not-mutually exclusive mechanisms in gender susceptibility to COVID-19 by sex hormonal regulation of ACE2 and TMPRSS2. On one hand, ACE2 expression could be increased in women, either by estrogens or constitutively by X chromosome inactivation escape or by reduced methylation, providing a larger reservoir of ACE2 to maintain the fundamental equilibrium of RAS regulatory axis. On the other, low levels of androgens in women may keep at low levels TMPRSS2 expression, representing a further protective factor for the development of COVID-19 infection, despite the increased expression of ACE2, which represents the Trojan horse for SARS-CoV-2 entry. CONCLUSIONS Both mechanisms consistently point to the role of sex hormones and sex chromosomes in the differential severity and lethality of COVID-19 in men and women.
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Affiliation(s)
- C Foresta
- Department of Medicine, Unit of Andrology and Medicine of Human Reproduction, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - M S Rocca
- Department of Medicine, Unit of Andrology and Medicine of Human Reproduction, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - A Di Nisio
- Department of Medicine, Unit of Andrology and Medicine of Human Reproduction, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
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20
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Huffman AM, Rezq S, Basnet J, Yanes Cardozo LL, Romero DG. SARS-CoV-2 Viral Entry Proteins in Hyperandrogenemic Female Mice: Implications for Women with PCOS and COVID-19. Int J Mol Sci 2021; 22:4472. [PMID: 33922918 PMCID: PMC8123333 DOI: 10.3390/ijms22094472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2, the causative agent of COVID-19, infects host cells using the angiotensin I converting enzyme 2 (ACE2) as its receptor after priming by host proteases, including TMPRSS2. COVID-19 affects multiple organ systems, and male patients suffer increased severity and mortality. Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in reproductive-age women and is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. PCOS is associated with obesity and cardiometabolic comorbidities, both being risk factors associated with severe COVID-19 pathology. We hypothesize that elevated androgens in PCOS regulate SARS-CoV-2 entry proteins in multiple tissues increasing the risk for this population. Female mice were treated with dihydrotestosterone (DHT) for 90 days. Body composition was measured by EchoMRI. Fasting glucose was determined by an enzymatic method. mRNA and protein levels of ACE2, Tmprss2, Cathepsin L, Furin, Tmprss4, and Adam17 were quantified by RT-qPCR, Western-blot, or ELISA in tissues, serum, and urine. DHT treatment increased body weight, fat and lean mass, and fasting glucose. Ace2 mRNA was upregulated in the lung, cecum, heart, and kidney, while downregulated in the brain by DHT. ACE2 protein was upregulated by DHT in the small intestine, heart, and kidney. The SARS-CoV-2 priming proteases Tmprss2, Cathepsin L, and Furin mRNA were upregulated by DHT in the kidney. ACE2 sheddase Adam17 mRNA was upregulated by DHT in the kidney, which corresponded with increased urinary ACE2 in DHT treated mice. Our results highlight the potential for increased cardiac, renal, and gastrointestinal dysfunction in PCOS women with COVID-19.
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Affiliation(s)
- Alexandra M. Huffman
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.H.); (S.R.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Samar Rezq
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.H.); (S.R.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jelina Basnet
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.H.); (S.R.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.H.); (S.R.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.H.); (S.R.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
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21
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Bellamine A, Pham TNQ, Jain J, Wilson J, Sahin K, Dallaire F, Seidah NG, Durkee S, Radošević K, Cohen ÉA. L-Carnitine Tartrate Downregulates the ACE2 Receptor and Limits SARS-CoV-2 Infection. Nutrients 2021; 13:nu13041297. [PMID: 33919991 PMCID: PMC8071056 DOI: 10.3390/nu13041297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for one of the worst pandemics in modern history. Several prevention and treatment strategies have been designed and evaluated in recent months either through the repurposing of existing treatments or the development of new drugs and vaccines. In this study, we show that L-carnitine tartrate supplementation in humans and rodents led to significant decreases of key host dependency factors, notably angiotensin-converting enzyme 2 (ACE2), transmembrane protease serine 2 (TMPRSS2), and Furin, which are responsible for viral attachment, viral spike S-protein cleavage, and priming for viral fusion and entry. Interestingly, pre-treatment of Calu-3, human lung epithelial cells, with L-carnitine tartrate led to a significant and dose-dependent inhibition of the infection by SARS-CoV-2. Infection inhibition coincided with a significant decrease in ACE2 mRNA expression levels. These data suggest that L-carnitine tartrate should be tested with appropriate trials in humans for the possibility to limit SARS-CoV-2 infection.
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Affiliation(s)
- Aouatef Bellamine
- Lonza Consumer Health, Morristown, NJ 07960, USA;
- Correspondence: (A.B.); (É.A.C.)
| | - Tram N. Q. Pham
- Institut de Recherche Clinique de Montreal, Montreal, QC H2W1R7, Canada; (T.N.Q.P.); (J.J.); (F.D.); (N.G.S.)
| | - Jaspreet Jain
- Institut de Recherche Clinique de Montreal, Montreal, QC H2W1R7, Canada; (T.N.Q.P.); (J.J.); (F.D.); (N.G.S.)
| | - Jacob Wilson
- Applied Science and Performance Institute, Tampa, FL 33607, USA;
| | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig 23119, Turkey;
| | - Frederic Dallaire
- Institut de Recherche Clinique de Montreal, Montreal, QC H2W1R7, Canada; (T.N.Q.P.); (J.J.); (F.D.); (N.G.S.)
| | - Nabil G. Seidah
- Institut de Recherche Clinique de Montreal, Montreal, QC H2W1R7, Canada; (T.N.Q.P.); (J.J.); (F.D.); (N.G.S.)
| | - Shane Durkee
- Lonza Consumer Health, Morristown, NJ 07960, USA;
| | | | - Éric A. Cohen
- Institut de Recherche Clinique de Montreal, Montreal, QC H2W1R7, Canada; (T.N.Q.P.); (J.J.); (F.D.); (N.G.S.)
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence: (A.B.); (É.A.C.)
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22
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Kutz A, Conen A, Gregoriano C, Haubitz S, Koch D, Domenig O, Bernasconi L, Mueller B, Schuetz P. Renin-angiotensin-aldosterone system peptide profiles in patients with COVID-19. Eur J Endocrinol 2021; 184:543-552. [PMID: 33539316 PMCID: PMC9494311 DOI: 10.1530/eje-20-1445] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE While evidence on the interface between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the renin-angiotensin-aldosterone-system (RAAS) is accumulating, clinical data on RAAS peptide alteration among coronavirus disease-19 (COVID-19) patients is missing. DESIGN AND METHODS In this exploratory study, we prospectively included adult patients (aged ≥ 18 years) admitted between February 26 and April 30, 2020 to a tertiary care hospital in Switzerland. We assessed the association of an underlying SARS-CoV-2 infection and equilibrium serum levels of RAAS peptides in hospitalized COVID-19 patients 1:1 propensity-score matched with patients suffering from SARS-CoV-2-negative respiratory infections. Subgroup analyses involved stratification for taking RAAS inhibitors. RESULTS COVID-19 patients had about 50% lower equilibrium serum RAAS peptide levels as compared with matched controls (angiotensin I: 31.6 vs 66.8 pmol/L, -52.7% (95%CI: -68.5% to -36.9%); angiotensin II: 37.7 vs 92.5 pmol/L, -59.2% (95%CI: -72.1% to -46.3%); angiotensin (1-5): 3.3 vs 6.6 pmol/L, -49.7% (95%CI: -59.2% to -40.2%); angiotensin (1-7): 4.8 vs 7.6 pmol/L, -64.9% (95%CI: -84.5% to -45.3%)). While the plasma renin activity was lower in COVID-19 patients (88.6 vs 207.9 pmol/L, -58.5% (95%CI: -71.4% to -45.6%)), there was no difference of angiotensin-converting enzyme (ACE) and ACE2 plasma activity between the groups. Subgroup analyses revealed a pronounced RAAS peptide profile depression in COVID-19 patients among those not on RAAS inhibitors. CONCLUSIONS As compared with SARS-CoV-2-negative patients, we found a downregulated RAAS in presence of a SARS-CoV-2 infection. Whether the lower levels of the protective angiotensin (1-5) and (1-7) are linked to adverse outcomes in COVID-19 warrants further investigation.
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Affiliation(s)
- Alexander Kutz
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
- Division of Endocrinology, Diabetes, and Metabolism
- Correspondence should be addressed to A Kutz;
| | - Anna Conen
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
- Division of Infectious Diseases and Hospital Hygiene, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Claudia Gregoriano
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
| | - Sebastian Haubitz
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
- Division of Infectious Diseases and Hospital Hygiene, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
| | - Oliver Domenig
- Attoquant Diagnostics GmbH, Campus-Vienna-Biocenter, Vienna, Austria
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
- Division of Endocrinology, Diabetes, and Metabolism
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Diabetes, and Metabolism
- Division of Endocrinology, Diabetes, and Metabolism
- Faculty of Medicine, University of Basel, Basel, Switzerland
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23
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Kuznetsova T, Cauwenberghs N. Determinants of circulating angiotensin-converting enzyme 2 protein levels in the general population. Eur J Intern Med 2021; 84:104-105. [PMID: 33087295 PMCID: PMC7569021 DOI: 10.1016/j.ejim.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
Abstract
• ACE2 receptor is a crucial for effective replication of infectious SARS-CoV. • We detect a higher ACE2 levels in males, elderly, and those with insulin resistance. • Our findings are in line with clinical reports on severity of SARS‐CoV‐2 in patients.
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Affiliation(s)
- Tatiana Kuznetsova
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium..
| | - Nicholas Cauwenberghs
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
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24
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Campbell RA, Boilard E, Rondina MT. Is there a role for the ACE2 receptor in SARS-CoV-2 interactions with platelets? J Thromb Haemost 2021; 19:46-50. [PMID: 33119197 PMCID: PMC7899240 DOI: 10.1111/jth.15156] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 01/11/2023]
Abstract
There is an urgent need to understand the underlying mechanisms contributing to thrombotic and inflammatory complications during COVID-19. Data from independent groups have identified that platelets are hyperreactive during COVID-19. Platelet hyperreactivity is accompanied by changes in platelet gene expression, and enhanced interactions between platelets and leukocytes. In some patients, SARS-CoV-2 mRNA has been detected in platelets. Together, this suggests that SARS-CoV-2 may interact with platelets. However, controversy remains on which receptors mediate SARS-CoV-2 platelet interactions. Most, but not all, transcriptomic and proteomic analyses fail to observe the putative SARS-CoV-2 receptor, angiotensin converting enzyme-2, or the cellular serine protease necessary for viral entry, TMPRSS2, on platelets and megakaryocytes. Interestingly, platelets express other known SARS-CoV-2 receptors, which induce similar patterns of activation to those observed when platelets are incubated with SARS-CoV-2. This article explores these findings and discusses ongoing areas of controversy and uncertainty with regard to SARS-CoV-2 platelet interactions.
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Affiliation(s)
- Robert A Campbell
- University of Utah Molecular Medicine Program, Salt Lake City, UT, USA
- Departments of Internal Medicine & Pathology, University of Utah, Salt Lake City, UT, USA
| | - Eric Boilard
- Centre de Recherche du Centre Hospitalier,, Universitaire de Québec- Université Laval, Québec, QC, Canada
- Département de Microbiologie-Infectiologie et d'immunologie, Université Laval, Québec, QC, Canada
| | - Matthew T Rondina
- University of Utah Molecular Medicine Program, Salt Lake City, UT, USA
- Departments of Internal Medicine & Pathology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen VAMC Department of Internal Medicine and GRECC, Salt Lake City, UT, USA
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25
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Röltgen K, Powell AE, Wirz OF, Stevens BA, Hogan CA, Najeeb J, Hunter M, Wang H, Sahoo MK, Huang C, Yamamoto F, Manohar M, Manalac J, Otrelo-Cardoso AR, Pham TD, Rustagi A, Rogers AJ, Shah NH, Blish CA, Cochran JR, Jardetzky TS, Zehnder JL, Wang TT, Narasimhan B, Gombar S, Tibshirani R, Nadeau KC, Kim PS, Pinsky BA, Boyd SD. Defining the features and duration of antibody responses to SARS-CoV-2 infection associated with disease severity and outcome. Sci Immunol 2020; 5:eabe0240. [PMID: 33288645 PMCID: PMC7857392 DOI: 10.1126/sciimmunol.abe0240] [Citation(s) in RCA: 325] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/05/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2-specific antibodies, particularly those preventing viral spike receptor binding domain (RBD) interaction with host angiotensin-converting enzyme 2 (ACE2) receptor, can neutralize the virus. It is, however, unknown which features of the serological response may affect clinical outcomes of COVID-19 patients. We analyzed 983 longitudinal plasma samples from 79 hospitalized COVID-19 patients and 175 SARS-CoV-2-infected outpatients and asymptomatic individuals. Within this cohort, 25 patients died of their illness. Higher ratios of IgG antibodies targeting S1 or RBD domains of spike compared to nucleocapsid antigen were seen in outpatients who had mild illness versus severely ill patients. Plasma antibody increases correlated with decreases in viral RNAemia, but antibody responses in acute illness were insufficient to predict inpatient outcomes. Pseudovirus neutralization assays and a scalable ELISA measuring antibodies blocking RBD-ACE2 interaction were well correlated with patient IgG titers to RBD. Outpatient and asymptomatic individuals' SARS-CoV-2 antibodies, including IgG, progressively decreased during observation up to five months post-infection.
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Affiliation(s)
- Katharina Röltgen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Abigail E Powell
- Stanford ChEM-H and Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Oliver F Wirz
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bryan A Stevens
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine A Hogan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Javaria Najeeb
- Department of Structural Biology, Stanford University, Stanford, USA
| | | | - Hannah Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Fumiko Yamamoto
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Monali Manohar
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, USA
| | - Justin Manalac
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Tho D Pham
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Blood Center, Palo Alto, CA, USA
| | - Arjun Rustagi
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Angela J Rogers
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Catherine A Blish
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | | | - James L Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Taia T Wang
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Balasubramanian Narasimhan
- Department of Statistics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Saurabh Gombar
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Tibshirani
- Department of Statistics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Kari C Nadeau
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, USA
| | - Peter S Kim
- Stanford ChEM-H and Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, USA
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26
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Conti V, Corbi G, Polito MV, Ciccarelli M, Manzo V, Torsiello M, De Bellis E, D’Auria F, Vitulano G, Piscione F, Carrizzo A, Di Pietro P, Vecchione C, Ferrara N, Filippelli A. Sirt1 Activity in PBMCs as a Biomarker of Different Heart Failure Phenotypes. Biomolecules 2020; 10:biom10111590. [PMID: 33238655 PMCID: PMC7700185 DOI: 10.3390/biom10111590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
Heart Failure (HF) is a syndrome, which implies the existence of different phenotypes. The new categorization includes patients with preserved ejection fraction (HFpEF), mid-range EF (HFmrEF), and reduced EF (HFrEF) but the molecular mechanisms involved in these HF phenotypes have not yet been exhaustively investigated. Sirt1 plays a crucial role in biological processes strongly related to HF. This study aimed to evaluate whether Sirt1 activity was correlated with EF and other parameters in HFpEF, HFmrEF, and HFrEF. Seventy patients, HFpEF (n = 23), HFmrEF (n = 23) and HFrEF (n = 24), were enrolled at the Cardiology Unit of the University Hospital of Salerno. Sirt1 activity was measured in peripheral blood mononuclear cells (PBMCs). Angiotensin-Converting Enzyme 2 (ACE2) activity, Tumor Necrosis Factor-alpha (TNF-α) and Brain Natriuretic Peptide (BNP) levels were quantified in plasma. HFpEF showed lower Sirt1 and ACE2 activities than both HFmrEF and HFrEF (p < 0.0001), without difference compared to No HF controls. In HFmrEF and HFrEF a very strong correlation was found between Sirt1 activity and EF (r2 = 0.899 and r2 = 0.909, respectively), and between ACE2 activity and Sirt1 (r2 = 0.801 and r2 = 0.802, respectively). HFrEF showed the highest TNF-α levels without reaching statistical significance. Significant differences in BNP were found among the groups, with the highest levels in the HFrEF. Determining Sirt1 activity in PBMCs is useful to distinguish the HF patients’ phenotypes from each other, especially HFmrEF/HFrEF from HFpEF.
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Affiliation(s)
- Valeria Conti
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Maria Vincenza Polito
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Valentina Manzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Correspondence: ; Tel.: +39-089-672-424
| | - Martina Torsiello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Emanuela De Bellis
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Federica D’Auria
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Gennaro Vitulano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Federico Piscione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Department of Vascular Physiopathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Department of Vascular Physiopathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy;
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme (BN), Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
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27
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Abstract
Obese individuals seem to be at the highest risk of contracting COVID-19 infection. Furthermore, severity of morbidity and mortality rates are higher in the developed world as compared to the developing world. One probable reason for this difference could be the difference in living conditions and exposure to other infections. Secondly, the difference in food especially, alcohol use may have deteriorating effects superimposed with obesity. Our hypothesis suggests that a combination of alcohol consumption and obesity causes low immunity and makes the individual prone to develop 'cytokine storm' and 'acute respiratory distress syndrome'; the hallmark of COVID-19 mortality and morbidity. Thus, we propose that reducing any one trigger can have a beneficial effect in combating the disease severity.
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Affiliation(s)
- Bushra Bilal
- Muhammad Ali Jinnah University, Karachi, Pakistan
| | | | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
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28
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Denis PA. COVID-19-related complications and decompression illness share main features.: Could the SARS-CoV2-related complications rely on blood foaming? Med Hypotheses 2020; 144:109918. [PMID: 32512491 PMCID: PMC7262501 DOI: 10.1016/j.mehy.2020.109918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 01/30/2023]
Abstract
A study by Saraiva et al. (2011) demonstrated the presence of Angiotensin II receptors on the erythrocyte membrane. This little-known information should be deemed as crucial as the SARS-CoV-2 relationships with oxygen saturation and the Renine Angiotensin System but it currently remains unexploited. The pulmonary and cardiovascular systems are involved in any typical complications of COVID-19 but numerous other unrelated symptoms may occur. To fill the gap, we shall first emphasize some similarities between the complications of this infectious disease and Decompression Illness (DCI), which involves bubble formation. We theorized that the Angiotensin II clearance by the red blood cells could trigger the release of its oxygen content in the bloodstream. The resulting foam would worsen the widespread endotheliitis, worsen the gas exchange, trigger the coagulation process, the inflammation process and the complement pathway as typically occurs in DCI. At the end, we propose a plausible mechanism.
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Affiliation(s)
- Pierre A Denis
- Occupational Medicine, Mutualité Sociale Agricole (M.S.A.), 12 rue de Paimpont 22025 Saint-Brieuc Cedex, France.
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29
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Han W, Wei Z, Dang R, Guo Y, Zhang H, Geng C, Wang C, Feng Q, Jiang P. Angiotensin-Ⅱ and angiotensin-(1-7) imbalance affects comorbidity of depression and coronary heart disease. Peptides 2020; 131:170353. [PMID: 32599080 DOI: 10.1016/j.peptides.2020.170353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 01/03/2023]
Abstract
A large body of evidence suggests a relationship between depression and coronary heart disease (CHD). Angiotensin-Ⅱ (Ang-Ⅱ) and angiotensin-(1-7) [Ang-(1-7)] are considered to exert biological effects in both conditions. Here, we aimed to determine the role of Ang-Ⅱ and Ang-(1-7) in the occurrence of comorbid depression in patients with CHD. Our study included 214 CHD patients and 100 matched healthy controls. Serum Ang-Ⅱ and Ang-(1-7) levels were assessed by ELISA, and the depression symptoms were evaluated by the nine-item Patient Health Questionnaire (PHQ-9). Linear regression and correlation analyses were used to estimate the associations between PHQ-9 scores and Ang-Ⅱ and Ang-(1-7) serum levels. Six single-nucleotide polymorphisms (SNPs) spanning the angiotensin converting enzyme 2 (ACE2) and MAS1 genes were genotyped. The associations between SNPs and depression risk in CHD patients were examined using logistic regression analysis with adjustment for age and gender. Decreased Ang-(1-7) (P < 0.05) and an elevated Ang-Ⅱ/Ang-(1-7) ratio (P < 0.01) were observed in CHD patients with depression compared to CHD patients without depression. PHQ-9 scores were negatively correlated with Ang-(1-7) level (r=-0.44, P < 0.01) and positively correlated with the Ang-Ⅱ/Ang-(1-7) ratio (r = 0.33, P < 0.05). Furthermore, carriers of risk allele T for CHD with depression had significantly higher PHQ-9 scores (P < 0.05), lower Ang-(1-7) level (P < 0.01), and higher Ang-Ⅱ/Ang-(1-7) ratio (P < 0.05) than those CC carriers. Collectively, our results firstly showed that Ang-(1-7) serum level in CHD patients may protect against comorbid depression. Moreover, the imbalance between Ang-Ⅱ and Ang-(1-7) may contribute to depression in CHD patients.
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Affiliation(s)
- Wenxiu Han
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Zhijie Wei
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Ruili Dang
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Yujin Guo
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Hailiang Zhang
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Chunmei Geng
- Jining First People's Hospital, Jining Medical University, Jining 272000, China
| | - Changshui Wang
- Department of Clinical & Translational Medicine, Jining Life Science Center, Jining 272000, China
| | - Qingyan Feng
- Jining First People's Hospital, Jining Medical University, Jining 272000, China.
| | - Pei Jiang
- Jining First People's Hospital, Jining Medical University, Jining 272000, China.
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30
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Bernardi S, Toffoli B, Tonon F, Francica M, Campagnolo E, Ferretti T, Comar S, Giudici F, Stenner E, Fabris B. Sex Differences in Proatherogenic Cytokine Levels. Int J Mol Sci 2020; 21:ijms21113861. [PMID: 32485823 PMCID: PMC7311959 DOI: 10.3390/ijms21113861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been shown that sex affects immunity, including cytokine production. Given that atherosclerosis is an inflammatory disease promoted by specific cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, we aimed at evaluating whether sex could affect the levels of these proatherogenic cytokines in a group of healthy adults. In this analysis, we also included other cytokines and peptides that have been implicated in atherosclerosis development and progression. METHODS A total of 104 healthy adults were recruited; we measured circulating levels of IL-1β, IL-6, TNF-α, angiotensins and angiotensin-converting enzyme-2 (ACE2), as well as osteoprotegerin and receptor activator of nuclear factor κB ligand (RANKL). RESULTS IL-1β, IL-6, and TNF-α were significantly higher in men as compared to women. They were all associated with testosterone and the testosterone/estradiol ratio. They remained significantly associated with sex (but not with hormones) after being tested for potential confounders. CONCLUSIONS Sex seems to influence the levels of proatherogenic cytokines. This is consistent not only with sex differences in vulnerability to infections but also with the higher cardiovascular risk exhibited by the male gender as compared to the female gender. Nevertheless, this association is only partly explained by hormone levels.
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Affiliation(s)
- Stella Bernardi
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
- ASUGI Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, UCO Medicina Clinica, 34100 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4318
| | - Barbara Toffoli
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy;
| | - Federica Tonon
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
| | - Morena Francica
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
| | - Elena Campagnolo
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
| | - Tommaso Ferretti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
| | - Sarah Comar
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
- ASUGI Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, UCO Medicina Clinica, 34100 Trieste, Italy
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy;
- Department of Life Sciences, University of Trieste, 34100 Trieste, Italy
| | - Fabiola Giudici
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
- ASUGI Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, UCO Medicina Clinica, 34100 Trieste, Italy
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy;
- Department of Life Sciences, University of Trieste, 34100 Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35100 Padova, Italy
| | - Elisabetta Stenner
- Department of Diagnostics, Azienda USL Toscana Nordovest, 57100 Livorno, Italy;
| | - Bruno Fabris
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital UCO Medicina Clinica, 34100 Trieste, Italy; (F.T.); (M.F.); (E.C.); (T.F.); (S.C.); (F.G.); (B.F.)
- ASUGI Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, UCO Medicina Clinica, 34100 Trieste, Italy
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