COVID, the Gut, and Nutritional Implications

Purpose of Review

The purpose of this review is to provide an overview of the current literature, recommendations, and practice guidelines on the nutritional management of and implications associated with COVID-19 infection.

Recent Findings

Particular attention should be paid to the screening, prevention, and treatment of malnutrition in critically ill individuals with COVID-19 infection given the significant risk for complications and poor outcomes. Extrapolation of existing literature for the nutritional support in the critically ill patient has demonstrated early enteral nutrition is safe and well-tolerated in patients with severe COVID-19 infection.

Summary

Futures studies should focus on the long-term nutritional outcomes for patients who have suffered COVID-19 infection, nutritional outcomes/recommendations for special populations with COVID-19, nutritional outcomes based on the current recommendations and guidelines for nutrition therapy, and the role for micronutrient supplementation in COVID-19 infection.

Transcripts involved in calcium signaling and telencephalic neuronal fate are altered in induced pluripotent stem cells from bipolar disorder patients

Bipolar disorder (BP) is a chronic psychiatric condition characterized by dynamic, pathological mood fluctuations from mania to depression. To date, a major challenge in studying human neuropsychiatric conditions such as BP has been limited access to viable central nervous system tissue to examine disease progression. Patient-derived induced pluripotent stem cells (iPSCs) now offer an opportunity to analyze the full compliment of neural tissues and the prospect of identifying novel disease mechanisms. We have examined changes in gene expression as iPSC derived from well-characterized patients differentiate into neurons; there was little difference in the transcriptome of iPSC, but BP neurons were significantly different than controls in their transcriptional profile. Expression of transcripts for membrane bound receptors and ion channels was significantly increased in BP-derived neurons compared with controls, and we found that lithium pretreatment of BP neurons significantly altered their calcium transient and wave amplitude. The expression of transcription factors involved in the specification of telencephalic neuronal identity was also altered. Control neurons expressed transcripts that confer dorsal telencephalic fate, whereas BP neurons expressed genes involved in the differentiation of ventral (medial ganglionic eminence) regions. Cells were responsive to dorsal/ventral patterning cues, as addition of the Hedgehog (ventral) pathway activator purmorphamine or a dorsalizing agent (lithium) stimulated expression of NKX2-1 (ventral identity) or EMX2 (dorsal) in both groups. Cell-based models should have a significant impact on our understanding of the genesis and therefore treatment of BP; the iPSC cell lines themselves provide an important resource for comparison with other neurodevelopmental disorders.

Intermodal attention modulates visual processing in dorsal and ventral streams

Attending to visual objects while ignoring information from other modalities is necessary for performing difficult visual discriminations, but it is unclear how selecting between sensory modalities alters processing within the visual system. We used an audio-visual intermodal selective attention paradigm with fMRI to study the effects of visual attention on cortical activity in the absence of competitive interactions between multiple visual stimuli. Complex stimuli (faces and words) activated higher visual areas even in the absence of visual attention. These stimulus-dependent activations (SDAs) covered foveal retinotopic cortex, extended ventrally to the anterior fusiform gyrus and dorsally to include multiple distinct foci in the intraparietal sulcus (IPS). Attention amplified the baseline response in posterior retinotopic regions and altered activity in different ways in the extrastriate dorsal and ventral pathways. The majority of the IPS was strongly and exclusively activated by visual attention: attention-related modulations (ARMs) encompassed and spread well beyond the focal SDAs. In contrast, in the fusiform gyrus only a small subset of the regions activated by unattended stimuli showed ARMs. Ventral cortex was also heterogeneous: we found a distinct ventrolateral region in the occipitotemporal sulcus (OTS) that was activated exclusively by attention, showing neither SDAs nor any significant stimulus preferences. Attention-dependent activations in the IPS and the OTS suggest that these regions play critical roles in intermodal visual attention.

Computerized analysis of error patterns in digit span recall

We analyzed error patterns during digit span (DS) testing in four experiments. In Experiment 1, error patterns analyzed from a community sample of 427 subjects revealed strong primacy and recency effects. Subjects with shorter DSs showed an increased incidence of transposition errors in comparison with other error types and a greater incidence of multiple errors on incorrect trials. Experiment 2 investigated 46 young subjects in three test sessions. The results replicated those of Experiment 1 and demonstrated that error patterns of individual subjects were consistent across repeated test administrations. Experiment 3 investigated 40 subjects from Experiment 2 who feigned symptoms of traumatic brain injury (TBI) with 80% of malingering subjects producing digit spans in the abnormal range. A digit span malingering index (DSMI) was developed to detect atypical error patterns in malingering subjects. Overall, 59% of malingering subjects with abnormal digit spans showed DSMIs in the abnormal range and DSMI values correlated significantly with the magnitude of malingering. Experiment 4 compared 29 patients with TBI with a new group of 38 control subjects. The TBI group showed significant reductions in digit span. Overall, 32% of the TBI patients showed DS abnormalities and 11% showed abnormal DSMIs. Computerized error-pattern analysis improves the sensitivity of DS assessment and can assist in the detection of malingering.

Power output is increased after phosphorylation of myofibrillar proteins in rat skinned cardiac myocytes

beta-Adrenergic stimulation increases stroke volume in mammalian hearts as a result of protein kinase A (PKA)-induced phosphorylation of several myocyte proteins. This study investigated whether PKA-induced phosphorylation of myofibrillar proteins directly affects myocyte contractility. To test this possibility, we compared isometric force, loaded shortening velocity, and power output in skinned rat cardiac myocytes before and after treatment with the catalytic subunit of PKA. Consistent with previous studies, PKA increased phosphorylation levels of myosin binding protein C and troponin I, and reduced Ca(2+) sensitivity of force. PKA also significantly increased both maximal force (25.4+/-8.3 versus 31.6+/-11.3 microN [P<0.001, n=12]) and peak absolute power output (2.48+/-1.33 versus 3.38+/-1.52 microW/mg [P<0.05, n=5]) during maximal Ca(2+) activations. Furthermore, PKA elevated power output at nearly all loads even after normalizing for the increase in force. After PKA treatment, peak normalized power output increased approximately 20% during maximal Ca(2+) activations (n=5) and approximately 33% during half-maximal Ca(2+) activations (n=9). These results indicate that PKA-induced phosphorylation of myofibrillar proteins increases the power output-generating capacity of skinned cardiac myocytes, in part, by speeding the step(s) in the crossbridge cycle that limit loaded shortening rates, and these changes likely contribute to greater contractility in hearts after beta-adrenergic stimulation.

Loaded shortening and power output in cardiac myocytes are dependent on myosin heavy chain isoform expression

The purpose of this study was to examine the role of myosin heavy chain (MHC) in determining loaded shortening velocities and power output in cardiac myocytes. Cardiac myocytes were obtained from euthyroid rats that expressed alpha-MHC or from thyroidectomized rats that expressed beta-MHC. Skinned myocytes were attached to a force transducer and a position motor, and isotonic shortening velocities were measured at several loads during steady-state maximal Ca(2+) activation (P(pCa4.5)). MHC expression was determined after mechanical measurements using SDS-PAGE. Both alpha-MHC and beta-MHC myocytes generated similar maximal Ca(2+)-activated force, but alpha-MHC myocytes shortened faster at all loads and generated approximately 170% greater peak normalized power output. Additionally, the curvature of force-velocity relationships was less, and therefore the relative load optimal for power output (F(opt)) was greater in alpha-MHC myocytes. F(opt) was 0.31 +/- 0.03 P(pCa4.5) and 0.20 +/- 0.06 P(pCa4.5) for alpha-MHC and beta-MHC myocytes, respectively. These results indicate that MHC expression is a primary determinant of the shape of force-velocity relationships, velocity of loaded shortening, and overall power output-generating capacity of individual cardiac myocytes.

The effect of anabolic-androgenic steroids on primary myocardial cell cultures

Although recent case reports suggest that anabolic-androgenic steroids may be directly injurious to the cardiovascular system, the direct myocardial cellular consequences of abuse of these drugs are not known. Therefore, the purpose of this study was to describe the concentration- and time-dependent effects of testosterone cypionate (TC), stanozolol (S), and fluoxymesterone (F) on primary myocardial cell cultures. Evaluation of drug effects were made in 4-d-old primary myocardial cell cultures obtained from 3- to 5-d-old Sprague-Dawley rats. The cultures were exposed to 1 x 10(-4) M, 1 x 10(-6) M, and 1 x 10(-8) M concentrations of TC, S, and F each for 1, 4, and 24 h. Cellular injury was evaluated by alterations in beating activity, induction of morphological alterations, lactate dehydrogenase (LDH) release, neutral red retention, and tetrazolium (MTT) formazan production. Significant alterations in beating activity were observed in the 1 x 10(-4) M TC group in which no beating activity was seen at 1, 4, and 24 h. Morphological integrity was disrupted for the 1 x 10(-4) M TC group at 24 h where destruction of the monolayer was observed. Unlike the cultures treated with the three concentrations of both S and F, significant LDH release was seen at 4 and 24 h with those cultures exposed to 1 x 10(-4) M TC. In the evaluation of neutral red retention, 1 x 10(-4) M TC at 24 h showed a significant decrease in ability to retain the dye.(ABSTRACT TRUNCATED AT 250 WORDS)