Host-Based Treatments for Severe COVID-19

Mondini, Lucrezia; Salton, Francesco; Trotta, Liliana; Bozzi, Chiara; Pozzan, Riccardo; Barbieri, Mariangela; Tavano, Stefano; Lerda, Selene; Hughes, Michael; Confalonieri, Marco; Confalonieri, Paola; Ruaro, Barbara

doi:10.3390/cimb45040203

Cited by 3 publications

(5 citation statements)

References 73 publications

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“…Once glucocorticoids were validated by numerous studies and international guidelines, the attention of the scientific community focused on the use of additional therapeutic protocols for the treatment of COVID-19. Regarding severe SARS-CoV-2 infection forms, Tocilizumab, Baricitinib, Anakinra and Remdesevir are approved for use in combination with the standard of care that includes steroids [ 114 , 115 ].…”

Section: Advantages and Disadvantages Of Other Standardized Protocols...mentioning

confidence: 99%

“…Other drugs have been tested, either alone or in combination with glucocorticoids, for the treatment of SARS-CoV-2 infection, including interferon and granulocyte–macrophage colony-stimulating factor (Anti-GM-CSF) but none of these is currently included in the guidelines. However, there is no therapy to date that is superior to the use of steroids, but several treatment protocols are proposed as combination therapy and have shown improved patient outcomes [ 114 ].…”

Section: Advantages and Disadvantages Of Other Standardized Protocols...mentioning

confidence: 99%

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Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints

et al. 2023

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Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization’s recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach.

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Section: Advantages and Disadvantages Of Other Standardized Protocols...mentioning

confidence: 99%

Section: Advantages and Disadvantages Of Other Standardized Protocols...mentioning

confidence: 99%

Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints

et al. 2023

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“…The most severe forms of SARS-CoV-2 interstitial pneumonia, associated with acute respiratory distress syndrome (ARDS) and the need to manage patients in intensive care, are characterized by an aberrant inflammatory response, called a cytokine storm [4]. Understanding these mechanisms has made therapeutic protocols possible that are aimed at controlling the inflammatory pattern and predicting disease progression [5,6]. COVID-19 is characterized not only by pulmonary involvement but also by systemic involvement, including renal injury, myocardial damage, and pro-thrombotic evaluation.…”

Section: Introductionmentioning

confidence: 99%

“…COVID-19 is characterized not only by pulmonary involvement but also by systemic involvement, including renal injury, myocardial damage, and pro-thrombotic evaluation. Based on this assumption, several studies highlighted the involvement of the endothelium in the development of the signs and symptoms of this disease, emphasizing that endothelial damage and microvascular dysfunction are central to its pathogenesis and the multiorgan are aimed at controlling the inflammatory pattern and predicting disease progression [5,6]. COVID-19 is characterized not only by pulmonary involvement but also by systemic involvement, including renal injury, myocardial damage, and pro-thrombotic evaluation.…”

Section: Introductionmentioning

confidence: 99%

Microvascular Alteration in COVID-19 Documented by Nailfold Capillaroscopy

et al. 2023

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COVID-19 is a multisystemic disease that mainly affects and causes dysregulation of the endothelium, causing systemic manifestations. A nailfold video capillaroscopy is a safe, easy, and noninvasive method to evaluate microcirculation alteration. In this review, we analyzed the literature available to date regarding the object of nailfold video capillaroscopy (NVC) use in patients with a SARS-CoV-2 infection, both in the acute phase and after discharge. The scientific evidence pointed out the main alterations in capillary circulation shown by NVC, so reviewing the findings of each article allowed us to define and analyze the future prospects and needs for possibly including NVC within the management of patients with COVID-19, both during and after the acute phase.

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“…COVID-19 is primarily a respiratory disease that produces a broad spectrum of symptoms, ranging from asymptomatic patients to critically ill patients with respiratory failure, shock, or multiorgan failure [ 11 ] with Ground glass opacity and parenchymal bands/fibrous stripe were the most frequent Chest computed tomography abnormalities [ 3 ]. Glucocorticoids have become the mainstay and standard of care for severe COVID-19 according to Mondini, Salton [ 12 ]. Glucocorticoids have been shown to reduce mortality and the need for invasive mechanical ventilation in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan

Al-Momani,

Mashal,

Al Balawi

et al. 2023

BMC Pulm Med

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19. Methods This is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients’ saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients. Results A total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection. Conclusion The study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.

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Host-Based Treatments for Severe COVID-19

Cited by 3 publications

References 73 publications

Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints

Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints

Microvascular Alteration in COVID-19 Documented by Nailfold Capillaroscopy

A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan

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