Are Iranian Sulfur Mustard Gas-Exposed Survivors More Vulnerable to SARS-CoV-2? Some Similarity in Their Pathogenesis

Farnoosh, Gholamreza; Ghanei, Mostafa; Khorramdelazad, Hossein; Alishiri, Gholam Hossein; Farahani, Alireza Jalali; Shahriary, Alireza; Zijoud, Seyed Reza Hosseini

doi:10.1017/dmp.2020.156

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…All evidence suggests a possible destructive role for IL-6 in patients with SARS-COV-2 infection [71]. Shock and organ failure in several organs, such as the kidneys, heart, lungs, and liver, are severely damaged by cytokine storms caused by an increase in inflammatory cytokines, including IL-6, IL-1β, TNF-α, IL-8, IL-2, IL-17, G-CSF, GM-CSF, CXCL10, CCL2, CCL3 in patients with COVID-19 [14]. These cytokines can also cause extensive pulmonary damage through the accumulation of neutrophils and macrophages in lung tissue, leading to the development of hyaline membranes and diffuse thickening of the alveolar barrier and ultimately diffuse alveolar damage [72].…”

Section: Role Of Il-6 In Tissue Damagementioning

confidence: 99%

“…However, there is no accurate information on how other immune cells, such as T-cells, a type of lymphocytes, and DCs, are infected. Following SARS-CoV-2 infection, dysregulated inflammatory responses, infiltration of neutrophils, monocytes, and macrophages, as well as uncontrolled release of inflammatory cytokines and chemokines are taken into account as critical factors in the development of severe pneumonia, acute respiratory distress syndrome (ARDS), or MOF [11][12][13][14]. Several studies have correspondingly demonstrated a significant increase in IL-6 serum levels in patients suffering from COVID-19 [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The bio-mission of interleukin-6 in the pathogenesis of COVID-19: A brief look at potential therapeutic tactics

Abbasifard

Khorramdelazad

2020

Life Sciences

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Interleukin-6 (IL-6), known as an inflammatory cytokine, can be involved in many innate and adaptive immune responses. The role of IL-6 in the pathogenesis of the novel coronavirus disease 2019 (COVID-19) has recently received much more attention due to the spread of the virus and its pandemic potential. Cytokine storm is among the most critical pathological events in patients affected with coronaviruses (CoVs), i.e., severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and COVID-19, causing inflammation-induced lung injury and also occurring as a result of dysregulation of immune responses to the mentioned viruses. IL-6, along with some other inflammatory cytokines, including IL-1 beta (β), IL-8, and tumor necrosis factor-alpha (TNF-α), as well as inflammatory chemokines, can significantly contribute to, fever, lymphopenia, coagulation, lung injury, and multi-organ failure (MOF). Therefore, researchers are to explore novel approaches to treat the disease through targeting of IL-6 and its receptors based on prior experience of other disorders. In this review article, the latest findings on the role of IL-6 in the pathogenesis of COVID-19, as well as therapeutic perspectives, were summarized and discussed.

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Section: Role Of Il-6 In Tissue Damagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The bio-mission of interleukin-6 in the pathogenesis of COVID-19: A brief look at potential therapeutic tactics

Abbasifard

Khorramdelazad

2020

Life Sciences

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“…Over time, these problems may become chronic 7 . Our observations that a past history of a chemical war injury does not add to the risk of COVID-19 and does not modify its clinical picture are intriguing and should be replicated in other studies.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Patients With a Past History of Chemical War Injury: A Cross-Sectional Study in Southern Iran

Emami

Pezeshkian

Javanmardi

et al. 2021

Disaster med. public health prep.

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OBJECTIVES: This study aimed to determine whether COVID-19 is associated with a different presenting clinical picture or a more severe course of illness in people with a past history of chemical war injury. METHODS: This is a multicenter retrospective study in Fars province, Iran, from 22 August to 4 October 2020. People with a past history of chemical war injury and COVID-19 were studied. Two age- and sex-matched control groups, double the size of the patient group each, from the same database of patients with COVID-19 who were hospitalized at the same time [i.e., healthy controls and pseudocontrols]. RESULTS: 46 people with a past history of chemical war injury, 92 healthy controls, and 92 pseudocontrols were studied. People with COVID-19 and a past history of chemical war injury had a significantly higher rate of chest pain compared to others. There were no other clinical differences between the groups. Mortality rate was 17.39%, 15.21%, and 27.17% in people with a past history of chemical war injury, the control group, and the pseudocontrol group, respectively. CONCLUSION: A past history of a chemical war injury does not add to the risk of COVID-19 and does not significantly modify its clinical picture either.

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“…N-acetylcysteine has also recently been proposed as both a preventative and therapeutic agent against COVID-19 due to its abilities to reduce the excessive mucus production, GSH depletion, oxidative stress and inflammation in the lungs that this virus causes [ [122] , [123] , [124] , [125] , [126] , [127] ], and several clinical trials are being carried out to assess NAC’s efficacy against this disease [ [128] , [129] , [130] , [131] ]. Interestingly, it has also been noted “that there are some similarities in the pathogenesis of SARS-CoV-2 and mustard gas in immune system disruption and pulmonary infection” [ 132 ], including up-regulation of lung angiotensin-converting enzyme (ACE2), the receptor for SARS-CoV-2. The authors speculate that these commonalities will lead to increased susceptibility and more severe outcomes in Iranian survivors of H exposure to COVID-19 [ 132 ].…”

Section: Nac In Other Clinical Applications and Safetymentioning

confidence: 99%

“…Interestingly, it has also been noted “that there are some similarities in the pathogenesis of SARS-CoV-2 and mustard gas in immune system disruption and pulmonary infection” [ 132 ], including up-regulation of lung angiotensin-converting enzyme (ACE2), the receptor for SARS-CoV-2. The authors speculate that these commonalities will lead to increased susceptibility and more severe outcomes in Iranian survivors of H exposure to COVID-19 [ 132 ].…”

Section: Nac In Other Clinical Applications and Safetymentioning

confidence: 99%

N-Acetylcysteine as a treatment for sulphur mustard poisoning

Sawyer

2020

Free Radical Biology and Medicine

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In the long and intensive search for effective treatments to counteract the toxicity of the chemical warfare (CW) agent sulphur mustard (H; bis(2-chloroethyl) sulphide), the most auspicious and consistent results have been obtained with the drug N-acetylcysteine (NAC), particularly with respect to its therapeutic use against the effects of inhaled H. It is a synthetic cysteine derivative that has been used in a wide variety of clinical applications for decades and a wealth of information exists on its safety and protective properties against a broad range of toxicants and disease states. Its primary mechanism of action is as a pro-drug for the synthesis of the antioxidant glutathione (GSH), particularly in those circumstances where oxidative stress has exhausted intracellular GSH stores. It impacts a number of pathways either directly or through its GSH-related antioxidant and anti-inflammatory properties, which make it a prime candidate as a potential treatment for the wide range of deleterious cellular effects that H is acknowledged to cause in exposed individuals. This report reviews the available literature on the protection afforded by NAC against the toxicity of H in a variety of model systems, including its efficacy in treating the long-term chronic lung effects of H that have been demonstrated in Iranian veterans exposed during the Iran-Iraq War (1980-1988). Although there is overwhelming evidence supporting this drug as a potential medical countermeasure against this CW agent, there is a requirement for carefully controlled clinical trials to determine the safety, efficacy and optimal NAC dosage regimens for the treatment of inhaled H.

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Are Iranian Sulfur Mustard Gas-Exposed Survivors More Vulnerable to SARS-CoV-2? Some Similarity in Their Pathogenesis

Cited by 22 publications

References 40 publications

The bio-mission of interleukin-6 in the pathogenesis of COVID-19: A brief look at potential therapeutic tactics

The bio-mission of interleukin-6 in the pathogenesis of COVID-19: A brief look at potential therapeutic tactics

COVID-19 in Patients With a Past History of Chemical War Injury: A Cross-Sectional Study in Southern Iran

N-Acetylcysteine as a treatment for sulphur mustard poisoning

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