scholarly journals Potential Therapeutic Role of Purinergic Receptors in Cardiovascular Disease Mediated by SARS-CoV-2

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Fernanda dos Anjos ◽  
Júlia Leão Batista Simões ◽  
Charles Elias Assmann ◽  
Fabiano Barbosa Carvalho ◽  
Margarete Dulce Bagatini
Keyword(s):  
Immune Response ◽  
Myocardial Injury ◽  
Cardiac Biomarkers ◽  
Purinergic Signalling ◽  
Cytokine Storm ◽  
Therapeutic Role ◽  
Host Immune Responses ◽  
Coronary Syndrome ◽  
Novel Coronavirus

Novel coronavirus disease 2019 (COVID-19) causes pulmonary and cardiovascular disorders and has become a worldwide emergency. Myocardial injury can be caused by direct or indirect damage, particularly mediated by a cytokine storm, a disordered immune response that can cause myocarditis, abnormal coagulation, arrhythmia, acute coronary syndrome, and myocardial infarction. The present review focuses on the mechanisms of this viral infection, cardiac biomarkers, consequences, and the possible therapeutic role of purinergic and adenosinergic signalling systems. In particular, we focus on the interaction of the extracellular nucleotide adenosine triphosphate (ATP) with its receptors P2X1, P2X4, P2X7, P2Y1, and P2Y2 and of adenosine (Ado) with A2A and A3 receptors, as well as their roles in host immune responses. We suggest that receptors of purinergic signalling could be ideal candidates for pharmacological targeting to protect against myocardial injury caused by a cytokine storm in COVID-19, in order to reduce systemic inflammatory damage to cells and tissues, preventing the progression of the disease by modulating the immune response and improving patient quality of life.

scholarly journals Cytokine Storms, Evolution, and COVID-19

2021 ◽  
Author(s):  
Joe Alcock ◽  
Alix Masters
Keyword(s):  
Immune Response ◽  
Evolutionary Medicine ◽  
Severe Illness ◽  
Host Immune System ◽  
The Novel ◽  
Cytokine Storm ◽  
Medical Interventions ◽  
Experimental Therapies ◽  
Novel Coronavirus

Abstract Since the identification of severe illness caused by the novel coronavirus SARS-CoV-2, the role of the host immune system in causing disease has attracted widespread attention, along with intense interest in medical interventions that target the host immune response. A wide variety of agents have been proposed to treat a cytokine storm in COVID-19, but so far, only one class of medications, corticosteroids, has proved useful. In recent decades, experimental therapies for cytokine storms have been tried and mostly failed to help patients with severe sepsis and other infections. We summarize this history in order to frame expectations for novel interventions in COVID-19 and to bring an evolutionary medicine perspective to the concept of cytokine storms and their treatment.

scholarly journals Trace Elements as Immunoregulators in SARS-CoV-2 and Other Viral Infections

2021 ◽  
Author(s):  
Karthick Dharmalingam ◽  
Amandeep Birdi ◽  
Sojit Tomo ◽  
Karli Sreenivasulu ◽  
Jaykaran Charan ◽  
...  
Keyword(s):  
Immune Response ◽  
Trace Elements ◽  
Viral Entry ◽  
Viral Infections ◽  
Inhibitory Effect ◽  
Antioxidants Activity ◽  
Host Immune Responses ◽  
Complex Interactions ◽  
Downstream Processes

AbstractNutritional deficiency is associated with impaired immunity and increased susceptibility to infections. The complex interactions of trace elements with the macromolecules trigger the effective immune response against the viral diseases. The outcome of various viral infections along with susceptibility is affected by trace elements such as zinc, selenium, iron, copper, etc. due to their immuno-modulatory effects. Available electronic databases have been comprehensively searched for articles published with full text available and with the key words “Trace elements”, “COVID-19”, “Viral Infections” and “Immune Response” (i.e. separately Zn, Se, Fe, Cu, Mn, Mo, Cr, Li, Ni, Co) appearing in the title and abstract. On the basis of available articles we have explored the role of trace elements in viral infections with special reference to COVID-19 and their interactions with the immune system. Zinc, selenium and other trace elements are vital to triggerTH1 cells and cytokine-mediated immune response for substantial production of proinflammatory cytokines. The antiviral activity of some trace elements is attributed to their inhibitory effect on viral entry, replication and other downstream processes. Trace elements having antioxidants activity not only regulate host immune responses, but also modify the viral genome. Adequate dietary intake of trace elements is essential for activation, development, differentiation and numerous functions.

scholarly journals Estradiol, Progesterone, Immunomodulation, and COVID-19 Outcomes

Endocrinology ◽  
2020 ◽  
Vol 161 (9) ◽  
Author(s):  
Franck Mauvais-Jarvis ◽  
Sabra L Klein ◽  
Ellis R Levin
Keyword(s):  
Immune Response ◽  
Distress Syndrome ◽  
Immune Dysregulation ◽  
Innate Immune ◽  
The Novel ◽  
Cytokine Storm ◽  
Inflammatory Infiltration ◽  
Biological Sex ◽  
17Β Estradiol ◽  
Novel Coronavirus

Abstract Severe outcomes and death from the novel coronavirus disease 2019 (COVID-19) appear to be characterized by an exaggerated immune response with hypercytokinemia leading to inflammatory infiltration of the lungs and acute respiratory distress syndrome. Risk of severe COVID-19 outcomes is consistently lower in women than men worldwide, suggesting that female biological sex is instrumental in protection. This mini-review discusses the immunomodulatory and anti-inflammatory actions of high physiological concentrations of the steroids 17β-estradiol (E2) and progesterone (P4). We review how E2 and P4 favor a state of decreased innate immune inflammatory response while enhancing immune tolerance and antibody production. We discuss how the combination of E2 and P4 may improve the immune dysregulation that leads to the COVID-19 cytokine storm. It is intended to stimulate novel consideration of the biological forces that are protective in women compared to men, and to therapeutically harness these factors to mitigate COVID-19 morbidity and mortality.

scholarly journals COVID-19 and Cytokine Storm

2020 ◽  
Author(s):  
Mustafa Kurtuluş ◽  
İbrahim Pirim
Keyword(s):  
Immune Response ◽  
Host Response ◽  
Distress Syndrome ◽  
Multiple Organ ◽  
Past Century ◽  
Viral Agent ◽  
Disease Course ◽  
Cytokine Storm ◽  
The Past ◽  
Novel Coronavirus

Although the etiopathogenesis of infections has been largely illuminated by technical and scientific developments in the past century; many issues are still not clear today. The word “there is no disease, there is a patient” is stil valid today. Because the immune response of the host is as important as the virulence of the pathogen in infections and disease course can vary a lot according to the person. Cytokine Storm is seen exactly in a group of diseases where the host response is very prominent. For this reason, Cytokine Storm Syndrome (CSS) is mostly mentioned. CSS emerging due to different inflammatory etiologies; it is an overwhelming systemic inflammation, hemodynamic imbalance, multiple organ failure, and potentially leading to death. After being first seen in Influenza in 2003 as a viral agent, CSS was seen in SARS-Cov, MERS-CoV and SARS-CoV2, which were found to be the las thuman disease from the Corona viridea family.The novel coronavirus SARS-CoV2 causes COVID-19, a pandemic threatening millions. Uncontrolled production of pro-inflammatory mediators contributes to, acut respiratory distress syndrome (ARDS) and cytokine storm syndrome in COVID-19.

scholarly journals COVID-19 and Hyperinflammation: Role of Steroid in Mild Disease

2020 ◽  
pp. 18-22
Author(s):  
Jhasaketan Meher ◽  
Manish Kumar Nayak
Keyword(s):  
Immune Response ◽  
Wide Spectrum ◽  
Case Series ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Cytokine Storm ◽  
Multiorgan Dysfunction ◽  
Mild Disease ◽  
Persistent Symptoms

Current COVID-19 has become a major public health problem because of its pandemicity, with wide spectrum of disease manifestation. SARS-COV-2 can have a varied clinical manifestation ranging from asymptomatic, mild symptomatic to severe disease like acute respiratory distress syndrome, cytokine storm, and multiorgan dysfunction. It has been described in literature that cytokine storm/hyperinflammation arises as result of dysregulated immune response leading to excessive release of various cytokines which causes multiorgan dysfunction. But there is paucity of literature describing the immune response and hyperinflammation in mild disease which may cause unremitting symptoms. Here we describe a case series of three patients with mild disease, who had persistent symptoms beyond 1 week and managed with low dose steroid after confirming it to be hyperinflammation. So it is imperative to detect the hyperinflammatory phase to halt the disease progression. Also we have discussed the role of immune system and role of steroid in COVID-19.

scholarly journals The role of the Advanced Clinical Practitioner (ACP) in triaging patients with Non ST-Elevation acute coronary syndromes (NSTE-ACS) patients for coronary angiographic procedures

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Comer
Keyword(s):  
Patient Outcomes ◽  
Patient Group ◽  
Statistical Significance ◽  
Economic Benefits ◽  
Cardiac Biomarkers ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
Hospital Transfer ◽  
Effective Transfer

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The introduction of the ACP role to a cardiology service with emphasis on measuring the effect of this role on improving the Inter-hospital transfer pathway for patients with ACS by improving patient outcomes ACPs triage a large number (estimated n = 2500 per year) of cardiology IHT referrals from these hospitals and ensure effective transfer to our centre for ACS treatment whilst supporting staff in the care of  those patients who do not meet our transfer criteria or are acutely unwell for transfer but cardiovascular stable Patients are listed in order of presenting symptoms, presence or absence of chest pain on admission, relevant blood results such as infection markers, kidney function, and troponin a cardiac biomarkers, ECG findings, drug history ,  past medical history and arrival to hospital rather than clinical urgency . Purpose Therefore the purpose of this evaluation was to measure the patient outcomes of introduction of an ACP in triaging patients with NSTE-ACS)patients for coronary angiographic procedures. Methods Quantitative design approach with a specialist cardiology setting using a 2-year observational analysis of the data.The study population included all patients referred for angioplasty or PCI via the Inter-hospital transfer acute coronary syndrome network including all patients referred for PCI following NSTE-ACS. Results : There were a total of n= 4976 patients referred for coronary angiogram +/-proceed procedures  between Feb 2018 and Feb 2020. Overall significant positive outcomes were noted across a consistent patient group based on presenting symptoms and patient characteristics when comparing data in the year preceding ACP led triage. A 2-sided p-value <0.05 defined statistical significance and to reject the null hypothesis. There was a significant reduction in waiting time post introduction of ACP led triage (p < 0.0001) equating to one day Comparison from pre ACP to post ACP led triage and clinical cancellation rates was reduced significantly (p = 0.0062). Rates of revascularisation were significantly higher post ACP led triage with a corresponding decrease in those managed medically (47.2% pre vs 43.1% post, p = 0.0037). These higher rates consisted of increased rates of both CABG (12.4% pre vs 13.5% post, p = 0.04) and PCI 40.4% vs 43.4%, p = 0.0216) Conclusion ACP led triage of ACS patients requiring urgent treatment demonstrates improved patient outcomes with economic benefits for healthcare providers, enhancing the service provided and opens up discussions for further quality improvement and implications to practice. Evidence of the benefits of advanced practice and the role of the advanced clinical practitioner is demonstrated within the cardiology setting and for the clinical triage of a patient group.

scholarly journals Cytokine Storm in the Novel Coronavirus Infection and Methods of its Correction

2021 ◽  
Vol 65 (11-12) ◽  
pp. 27-37
Author(s):  
A. V. Ershov ◽  
V. D. Surova ◽  
V. T. Dolgikh ◽  
T. I. Dolgikh
Keyword(s):  
Fatal Outcome ◽  
Lung Damage ◽  
The Novel ◽  
Cytokine Storm ◽  
Leading Role ◽  
Average Impact ◽  
Average Impact Factor ◽  
Coronavirus Infection ◽  
Novel Coronavirus

The aim of the study was to identify the role of cytokine storm in COVID-19, that emerged at the end of 2019, based on the analysis of 80 publications, including 17.4% Russian and 82.6% foreign publications for 2014–2020 with an average impact factor of 11.94 and a maximum of 74.699. This review includes an in-depth discussion of the possible causes and pathogenetic factors of cytokine storm syndrome development caused by COVID-19. The results of research on the use of various principles of cytokine storm correction are provided. It has been established that lung damage and the development of a fatal outcome are caused not by the virus itself, but by the hyperreaction of the body's immune system. The leading role in this process belongs to the cytokine storm, including the action of IL-6.

scholarly journals SeXX and COVID-19: Tussle between the Two

2020 ◽  
Author(s):  
Ashlesh Patil ◽  
Jaya Prasad Tripathy ◽  
Vishwajit Deshmukh ◽  
Bharat Sontakke ◽  
Satyendra C. Tripathi
Keyword(s):  
Immune Responses ◽  
Current Knowledge ◽  
Occupational Exposures ◽  
Point Of View ◽  
Host Immune Responses ◽  
Social Inequities ◽  
Biological Explanation ◽  
Novel Coronavirus ◽  
Biological Differences

Novel coronavirus disease (COVID-19) has affected nearly 7 million individuals and claimed more than 0.4 million lives to date. There are several reports of gender differences related to infection and death due to COVID-19. This raises important questions such as “Whether there are differences based on gender in risk and severity of infection or mortality rate?” and “What are the biological explanation and mechanisms underlying these differences?” Emerging evidence has proposed sex-based immunological, genetic, and hormonal differences to explain this ambiguity. Besides biological differences, women have also faced social inequities and economic hardships due to this pandemic. Several recent studies have shown that independent of age males are at higher risk for severity and mortality in COVID-19 patients. Although susceptibility to SARS-CoV-2 was found to be similar across both genders in several disease cohorts, a disproportionate death ratio in men can be partly explained by the higher burden of pre-existing diseases and occupational exposures among men. From an immunological point of view, females can engage a more active immune response, which may protect them and counter infectious diseases as compared to men. This attribute of better immune responses towards pathogens is thought to be due to high estrogen levels in females. Here we review the current knowledge about sex differences in susceptibility, the severity of infection and mortality, host immune responses, and the role of sex hormones in COVID-19 disease.

Abstract 14455: Hidden in Plain Sight: An Elusive Cause of Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah Chuzi ◽  
Anjan Tibrewala ◽  
Fei Li Kuang ◽  
Benjamin Freed ◽  
Esther Vorovich ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Myocardial Injury ◽  
Hypereosinophilic Syndrome ◽  
Cardiac Biomarkers ◽  
Primary Data ◽  
Circulatory Support ◽  
Chronic Obstructive ◽  
Coronary Syndrome

A 54-year-old man with chronic obstructive pulmonary disease (COPD) presented with three days of chest pain, dyspnea on exertion, and orthopnea. Physical examination revealed jugular venous distention and lower extremity edema. Cardiac biomarkers were elevated. The differential diagnosis for the clinical presentation included: acute coronary syndrome, and type II myocardial infarction or myocardial injury due to acute decompensated heart failure. External records demonstrated recurrent admissions for similar signs and symptoms, with negative coronary angiogram. Shortly after admission, the patient developed acute cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Echocardiogram revealed biventricular failure and a possible mitral valve vegetation. The differential diagnosis was refined to include myocarditis (infectious and noninfectious causes), bacterial versus marantic endocarditis, and infiltrative cardiomyopathies. Transesophageal echocardiography revealed mass-like, bileaflet thickening of the mitral valve, not consistent with true vegetation. Infectious, rheumatologic, and hypercoagulable workups were negative. Given the lack of a unifying diagnosis, a right ventricular (RV) endomyocardial biopsy was pursued. This revealed myocardial necrosis and fibrosis, and a mural thrombus with extensive eosinophils. The primary data was then revisited, which revealed history of peripheral eosinophilia that was intermittently suppressed by steroids given for COPD. Cardiac magnetic resonance imaging (MRI) demonstrated diffuse biventricular subendocardial late gadolinium enhancement and RV thrombi. Evaluation for underlying causes of eosinophilia was negative leading to the diagnosis of Loeffler’s endocarditis due to idiopathic hypereosinophilic syndrome. This case demonstrates: (1) the important role of cardiac MRI in the evaluation of both unexplained myocardial injury and new cardiomyopathy, (2) a rare case of Loeffler’s endocarditis requiring mechanical circulatory support, and (3) the consequences of both availability bias and failure to fully “unpack” the primary diagnostic data, which rendered the true etiology of the patient’s cardiogenic shock “hidden in plain sight.”

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