Circulating markers of extracellular matrix remodelling in severe COVID-19 patients

BACKGROUND

Abnormal remodelling of the extracellular matrix (ECM) has generally been linked to pulmonary inflammation and fibrosis and may also play a role in the pathogenesis of severe COVID-19. To further elucidate the role of ECM remodelling and excessive fibrogenesis in severe COVID-19, we examined circulating levels of mediators involved in various aspects of these processes in COVID-19 patients.

METHODS

Serial blood samples were obtained from two cohorts of hospitalised COVID-19 patients (n = 414). Circulating levels of ECM remodelling mediators were quantified by enzyme immunoassays in samples collected during hospitalisation and at 3-month follow-up. Samples were related to disease severity (respiratory failure and/or treatment at the intensive care unit), 60-day total mortality and pulmonary pathology after 3-months. We also evaluated the direct effect of inactivated SARS-CoV-2 on the release of the different ECM mediators in relevant cell lines.

RESULTS

Several of the measured markers were associated with adverse outcomes, notably osteopontin (OPN), S100 calcium-binding protein A12 and YKL-40 were associated with disease severity and mortality. High levels of ECM mediators during hospitalisation were associated with computed tomography thorax pathology after 3-months. Some markers (i.e. growth differential factor 15, galectin 3 and matrix metalloproteinase 9) were released from various relevant cell lines (i.e. macrophages and lung cell lines) in vitro after exposure to inactivated SARS-CoV-2 suggesting a direct link between these mediators and the causal agent of COVID-19.

CONCLUSION

Our findings highlight changes to ECM remodelling and particularly a possible role of OPN, S100A12 and YKL-40 in the pathogenesis of severe COVID-19.

DNA Repair Mechanisms are Activated in Circulating Lymphocytes of Hospitalized Covid-19 Patients

Purpose

Reactive oxygen species (ROS) are an important part of the inflammatory response during infection but can also promote DNA damage. Due to the sustained inflammation in severe Covid-19, we hypothesized that hospitalized Covid-19 patients would be characterized by increased levels of oxidative DNA damage and dysregulation of the DNA repair machinery.

Patients and Methods

Levels of the oxidative DNA lesion 8-oxoG and levels of base excision repair (BER) proteins were measured in peripheral blood mononuclear cells (PBMC) from patients (8-oxoG, n = 22; BER, n = 17) and healthy controls (n = 10) (Cohort 1). Gene expression related to DNA repair was investigated in two independent cohorts of hospitalized Covid-19 patients (Cohort 1; 15 patents and 5 controls, Cohort 2; 15 patients and 6 controls), and by publicly available datasets.

Results

Patients and healthy controls showed comparable amounts of oxidative DNA damage as assessed by 8-oxoG while levels of several BER proteins were increased in Covid-19 patients, indicating enhanced DNA repair in acute Covid-19 disease. Furthermore, gene expression analysis demonstrated regulation of genes involved in BER and double strand break repair (DSBR) in PBMC of Covid-19 patients and expression level of several DSBR genes correlated with the degree of respiratory failure. Finally, by re-analyzing publicly available data, we found that the pathway Hallmark DNA repair was significantly more regulated in circulating immune cells during Covid-19 compared to influenza virus infection, bacterial pneumonia or acute respiratory infection due to seasonal coronavirus.

Conclusion

Although beneficial by protecting against DNA damage, long-term activation of the DNA repair machinery could also contribute to persistent inflammation, potentially through mechanisms such as the induction of cellular senescence. However, further studies that also include measurements of additional markers of DNA damage are required to determine the role and precise molecular mechanisms for DNA repair in SARS-CoV-2 infection.

Markers of cellular senescence is associated with persistent pulmonary pathology after COVID-19 infection

BACKGROUND

The lungs are the organ most likely to sustain serious injury from coronavirus disease 2019 (COVID-19). However, the mechanisms for long-term complications are not clear. Patients with severe COVID-19 have shorter telomere lengths and higher levels of cellular senescence, and we hypothesized that circulating levels of the telomere-associated senescence markers chitotriosidase, β-galactosidase, cathelicidin antimicrobial peptide and stathmin 1 (STMN1) were elevated in hospitalized COVID-19 patients compared to controls and could be associated with pulmonary sequelae following hospitalization.

METHODS

Ninety-seven hospitalized patients with COVID-19 who underwent assessment for pulmonary sequelae at three-month follow-up were included in the study. β-Galactosidase and chitotriosidase were analysed by fluorescence; stathmin 1 and cathelicidin antimicrobial peptide were analysed by enzyme immuno-assay in plasma samples from the acute phase and after three-months. In addition, the classical senescence markers cyclin-dependent kinase inhibitor 1A and 2A were analysed by enzyme immuno-assay in peripheral blood mononuclear cell lysate after three months.

RESULTS

We found elevated plasma levels of the senescence markers chitotriosidase and stathmin 1 in patients three months after hospitalization with COVID-19, and these markers in addition to protein levels of cyclin-dependent kinase inhibitor 2A in cell lysate, were associated with pulmonary pathology. The elevated levels of these markers seem to reflect both age-dependent (chitotriosidase) and age-independent (stathmin 1, cyclin-dependent kinase inhibitor 2A) processes.

CONCLUSIONS

We suggest that accelerated ageing or senescence could be important for long-term pulmonary complications of COVID-19, and our findings may be relevant for future research exploring the pathophysiology and management of these patients.

High Circulating Levels of the Homeostatic Chemokines CCL19 and CCL21 Predict Mortality and Disease Severity in COVID-19

BACKGROUND

Immune dysregulation is a major factor in the development of severe coronavirus disease 2019 (COVID-19). The homeostatic chemokines CCL19 and CCL21 have been implicated as mediators of tissue inflammation, but data on their regulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited. We thus investigated the levels of these chemokines in COVID-19 patients.

METHODS

Serial blood samples were obtained from patients hospitalized with COVID-19 (n = 414). Circulating CCL19 and CCL21 levels during hospitalization and 3-month follow-up were analyzed. In vitro assays and analysis of RNAseq data from public repositories were performed to further explore possible regulatory mechanisms.

RESULTS

A consistent increase in circulating levels of CCL19 and CCL21 was observed, with high levels correlating with disease severity measures, including respiratory failure, need for intensive care, and 60-day all-cause mortality. High levels of CCL21 at admission were associated with persisting impairment of pulmonary function at the 3-month follow-up.

CONCLUSIONS

Our findings highlight CCL19 and CCL21 as markers of immune dysregulation in COVID-19. This may reflect aberrant regulation triggered by tissue inflammation, as observed in other chronic inflammatory and autoimmune conditions. Determination of the source and regulation of these chemokines and their effects on lung tissue is warranted to further clarify their role in COVID-19.

CLINICAL TRIALS REGISTRATION

NCT04321616 and NCT04381819.

Abstract PD4-06: Acupressure for persistent fatigue in breast cancer survivors

Background: Persistent fatigue is a common and debilitating symptom in breast cancer survivors (BCS), yet treatments remain limited. The purpose of this study was to examine the effect of two types of self-administered acupressure on fatigue versus usual care in BCS.

Methods: This was a 10-week randomized trial that enrolled adult female BCS (stage 0-III), who had completed cancer treatments at least 12 months previously and who reported persistent mild-moderate fatigue (≥ 4 on the Brief Fatigue Inventory [BFI]). BCS were randomized equally into relaxation acupressure (RA), stimulating acupressure (SA) or usual care (UC). The primary endpoint was change in BFI from baseline to week 6 when acupressure was stopped and at week 10 to assess carryover effects of acupressure. Secondary analyses were conducted on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and 14-day sleep diaries; quality of life was assessed with the Long-Term Quality of Life in BCS (LTQL). Intent-to-treat analyses were conducted using linear mixed models.

Results: 288 BCS were randomized (98 RA, 94 SA, and 96 UC). 228 BCS completed the 6-week visit and 223 the 10-week visit (71 RA, 69 SA, and 83 UC). There were no significant group differences on baseline sociodemographic, clinical characteristics, BFI, PSQI, sleep diary parameters, or LTQL. At week 6 the mean change in BFI from baseline was significantly lower in the RA and SA arms than UC (RA = -2.57 ± 1.5, SA = -1.98 ± 1.5, and UC = -1.07 ± 1.6; p < 0.001 for both RA and SA vs. UC), but there was no significant difference between acupressure arms (p = 0.29). At week 10 the mean change in BFI from baseline ± SD was maintained and continued to be lower in RA and SA arms than UC (RA = -2.27 ± 1.4, SA = -1.96 ± 1.5, and UC = -0.99 ± 1.5; p < 0.001 for both RA and SA vs. UC), but no significant difference between acupressure arms (p >0.99). At week 6 the mean change in PSQI from baseline mean ± SD for RA = -1.93 ± 3.3 was significantly different from UC = -0.46 ± 3.1 (p = 0.03) but not SA = -1.34 ± 3.2 (p = 0.96). At week10 there was no significant difference on the PSQI between arms (RA vs. UC, p = 0.40; SA vs. UC, p <= .99; RA vs. SA, p = 0.79); however PSQI scores remained lower and stable in the RA arm. There were no significant differences between the three arms at any time point for the sleep diary parameters sleep efficiency, total sleep time, sleep onset latency, or wake after sleep onset. Women in the RA arm were significantly improved versus UC for three of four quality of life subscales at both 6- and 10-week visits (somatic, p=0.03week 6, p=0.04 week 10; physical fitness, p=0.04 week 6, p=0.01 week 10; and social support, p=0.03 week 6, p=0.04 week 10; spirituality, p=0.55 week 6, p=0.17 week 10). The SA group was not significantly different from UC for any subscale at any time point.

Conclusions: Both acupressure arms significantly reduced fatigue compared to UC, but only RA had a significant effect on improving sleep quality and quality of life in BCS. Improvements in fatigue, sleep, and quality of life continued to persist for 4 weeks after cessation of acupressure. Self-administered RA offers an inexpensive easy to learn method to manage fatigue, sleep quality and overall quality of life in BCS with persistent fatigue.

Citation Format: Zick SM, Wyatt GK, Murphy SL, Arnedt JT, Sen A, Harris RE. Acupressure for persistent fatigue in breast cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-06.

Deaths: final data for 1999

OBJECTIVES

This report presents final 1999 data on U.S. deaths and death rates according to demographic and medical characteristics. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1999.

METHODS

In 1999 a total of 2,391,399 deaths were reported in the United States. This report presents tabulations of information reported on the death certificates completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. For the first time in a final mortality data report, age-adjusted death rates are based upon the year 2000 population and causes of death are processed in accordance with the Tenth Revision of the International Classification of Diseases (ICD-10).

RESULTS

The 1999 age-adjusted death rate for the United States was 881.9 deaths per 100,000 standard population, a 0.7 percent increase from the 1998 rate, and life expectancy at birth remained the same at 76.7 years. For all causes of death, age-specific death rates rose for those 45-54 years, 75-84 years, and 85 years and over and declined for a number of age groups including those 5-14 years, 55-64 years, and 65-74 years. Aortic aneurysm and dissection made its debut in the list of leading causes of death and atherosclerosis exited from the list. Heart disease and cancer continued to be the leading and second leading causes of death. The age-adjusted death rate for firearm injuries decreased for the sixth consecutive year, declining 6.2 percent between 1998 and 1999. The infant mortality rate, 7.1 infant deaths per 1,000 live births, was not statistically different from the rate in 1998.

CONCLUSIONS

Generally, mortality continued long-term trends. Life expectancy in 1999 was unchanged from 1998 despite a slight increase in the age-adjusted death rate from the record low achieved in 1998. Although statistically unchanged from 1998, the trend in infant mortality has been of a steady but slowing decline. Some mortality measures for women and persons 85 years and over worsened between 1998 and 1999.

Deaths: final data for 1998

OBJECTIVES

This report presents final 1998 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1998.

METHODS

In 1998 a total of 2,337,256 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention.

RESULTS

The 1998 age-adjusted death rate for the United States decreased to an all-time low of 471.7 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.7 years. Of the 15 leading causes of death in 1998, the largest decline from the previous year--9.5 percent--in age-adjusted death rates was for Atherosclerosis (atherosclerosis). Human immunodeficiency virus (HIV) infection dropped from among the 15 leading causes for the first time since 1987. The age-adjusted death rate for firearm injuries decreased for the fifth consecutive year, declining 7.4 percent between 1997 and 1998. Among all causes of death, age-specific death rates rose for those under 1 year but declined for all other age groups, although the decline for children aged 1-4 years was not significant. The infant mortality rate was unchanged from 1997 at 7.2 infant deaths per 1,000 live births.

CONCLUSIONS

The overall improvements in general mortality and life expectancy in 1998 continue the long-term downward trend in U.S. mortality. Although unchanged from 1997, the trend in U.S. infant mortality is of steady declines over the past four decades.

Gainsharing: a call for guidance

Gainsharing is a device by which hospitals and physicians share in the development, implementation, and proceeds resulting from the mechanisms to make the provision of healthcare more efficient and cost effective. The goal of gainsharing programs is to save hospitals money while maintaining the same or better quality of care--a goal that will ultimately result in both better care and lower expenses for payors and for society as a whole. Nevertheless, the OIG has ruled that gainsharing programs are per se illegal. This Article analyzes the reasons behind the OIG's determination and argues that, contrary to the OIG's conclusion, the advisory opinion process is legally and practically the best way to deal with the issues raised by gainsharing programs.

Bone marrow CD34(+) cells and megakaryoblasts secrete beta-chemokines that block infection of hematopoietic cells by M-tropic R5 HIV

CD34(+) cells are nonpermissive to infection by HIV strains X4 and R5, despite the fact that many CD34(+) cells express high levels of the viral receptor protein CD4 and the coreceptor CXCR4 on their surface. In these cells, the co-receptor CCR5 protein, which, like CXCR4, is a chemokine receptor, is detected mainly intracellularly. We hypothesized that CD34(+) cells secrete CCR5-binding chemokines and that these factors interfere with HIV R5 interactions with these cells, possibly by binding CCR5 or by inducing its internalization. We found that human CD34(+) cells and CD34(+)KIT(+) cells, which are enriched in myeloid progenitor cells, expressed and secreted the CCR5 ligands RANTES, MIP-1alpha, and MIP-1beta and that IFN-gamma stimulated expression of these chemokines. In contrast, SDF-1, a CXCR4 ligand, was not detectable in the CD34(+)KIT(+) cells, even by RT-PCR. Conditioned media from CD34(+) cell culture significantly protected the T lymphocyte cell line PB-1 from infection by R5 but not X4 strains of HIV. Interestingly, the secretion of endogenous chemokines decreased with the maturation of CD34(+) cells, although ex vivo, expanded megakaryoblasts still secreted a significant amount of RANTES. Synthesis of CCR5-binding chemokines by human CD34(+) cells and megakaryoblasts therefore largely determines the susceptibility of these cells to infection by R5 HIV strains. We postulate that therapeutic agents that induce the endogenous synthesis of chemokines in human hematopoietic cells may protect these cells from HIV infection.

Deaths: final data for 1997

OBJECTIVES

This report presents final 1997 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1997.

METHODS

In 1997 a total of 2,314,245 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention.

RESULTS

The 1997 age-adjusted death rate for the United States decreased to an all-time low of 479.1 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.5 years. The 15 leading causes of death remained the same as in 1996, although Human immunodeficiency virus (HIV) infection plummeted from the 8th leading cause of death to the 14th leading cause. Some of the 8th-14th leading causes of death shifted positions. HIV infection remained the leading cause of death for black persons aged 25-44 years. The largest decline in age-adjusted death rates among the leading causes of death was for HIV infection, which dropped 47.7 percent between 1996 and 1997. Mortality declined for all age groups, except for persons aged 85 and over. The infant mortality rate reached a record low of 7.2 infant deaths per 1,000 live births in 1997 although the decline in the rate from 1996 was not statistically significant.

CONCLUSIONS

The overall improvements in general mortality and life expectancy in 1997 continue the long-term downward trend in U.S. mortality. The trend in U.S. infant mortality is of steady declines over the past four decades.

Deaths: final data for 1996

OBJECTIVES

This report presents 1996 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described.

METHODS

In 1996 a total of 2,314,690 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the state registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics, Centers for Disease Control and Prevention. Changes between 1995 and 1996 in death rates and differences in death rates across demographic groups in 1996 are tested for statistical significance. Unless otherwise specified reported differences are statistically significant.

RESULTS

The 1996 age-adjusted death rate for the United States decreased, reaching an all-time low of 491.6 deaths per 100,000 standard population, and life expectancy at birth increased by 0.3 years to 76.1 years, a record high. The 15 leading causes of death remained the same as in 1995, although there were changes in the ranking of some causes. Replacing homicide, septicemia became the 12th leading cause of death, and Alzheimer's disease moved from the 14th to the 13th leading cause. For the third consecutive year, the number of homicide deaths dropped, making it the 14th leading cause of death. Mortality declined for all age groups, including persons aged 85 and over. The largest decline in age-adjusted death rates among the leading causes of death was for Human immunodeficiency virus infection, which dropped 28.8 percent in 1996, compared with the previous year. The infant mortality rate declined by 4 percent to a record low of 7.3 infant deaths per 1,000 live births in 1996. Neonatal and postneonatal mortality rates declined for all races combined as well as for postneonatal white infants. Although not statistically significant, mortality rates for white and black neonatal infants and black postneonatal infants also declined.

CONCLUSIONS

The overall improvements in general mortality and life expectancy in 1996 continue the long-term downward trend in U.S. mortality. The drop in U.S. infant mortality continues the steady declines of the past four decades.

Correlation of behavioral and cerebrovascular functions in the aging rat

Regional cerebral blood flow (rCBF), maze performance and the influence of environmental enrichment on these parameters were studied in Sprague-Dawley rats aged 6, 12 and 24 months. Learning ability in a complex sequential T-maze (Stone maze) progressively declined with increasing age in rats which were normally housed in standard caging. Environmental enrichment significantly improved maze performance but did not prevent the age-dependent impairment. Following completion of the learning studies, rCBF was measured in each of 13 brain regions in conscious, unrestrained, resting animals. In the absence of any significant change in cardiac output over the entire age range, rCBF was lower in all brain regions by an average of 16% in 12-14 month old rats and 8% in aged rats (24-26 months old); the occipital cortex, inferior and superior colliculi and hypothalamus were particularly affected regions in both age groups. The sharp reduction of rCBF that occurred between 6 and 12 months of age did not reflect, and probably preceded the progressive decline in maze performance. Such highly significant age-related changes in rCBF were not affected, however, by environmental enrichment procedures. This contrasts with the substantial influence of enrichment on maze performance. Finally, mean brain blood flow and mean cortical blood flow correlated inversely and significantly with average daily numbers of errors made by 24 month old rats during Stone maze acquisition.