Pain Management During COVID-19 and Steroids: Striking a Balance

Cohen, Steven P.; Hooten, W. Michael; Phillips, Christopher R

doi:10.1093/pm/pnaa175

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…However, treatments that act broadly to suppress the immune system have the potential to impede the body's ability to control the viral infection. While corticosteroids reduce the formation of sPLA2 and may benefit severe cases of COVID-19, [43][44][45][46][47] their use has also been related to adverse events, 48 as shown among relatively healthy recipients in a large study from Taiwan. 49 More focused treatments that address specific inflammatory pathways, including blocking the effect of specific inflammatory factors may be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C)

Kuypers

Rostad

Anderson

et al. 2021

Exp Biol Med (Maywood)

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Secretory phospholipase 2 (sPLA2) acts as a mediator between proximal and distal events of the inflammatory cascade. Its role in SARS-CoV-2 infection is unknown, but could contribute to COVID-19 inflammasome activation and cellular damage. We present the first report of plasma sPLA2 levels in adults and children with COVID-19 compared with controls. Currently asymptomatic adults with a history of recent COVID-19 infection (≥4 weeks before) identified by SARS-CoV-2 IgG antibodies had sPLA2 levels similar to those who were seronegative (9 ± 6 vs.17 ± 28 ng/mL, P = 0.26). In contrast, children hospitalized with severe COVID-19 had significantly elevated sPLA2 compared with those with mild or asymptomatic SARS-CoV-2 infection (269 ± 137 vs. 2 ± 3 ng/mL, P = 0.01). Among children hospitalized with multisystem inflammatory syndrome in children (MIS-C), all had severe disease requiring pediatric intensive care unit (PICU) admission. sPLA2 levels were significantly higher in those with acute illness <10 days versus convalescent disease ≥10 days (540 ± 510 vs. 2 ± 1, P = 0.04). Thus, sPLA2 levels correlated with COVID-19 severity and acute MIS-C in children, implicating a role in inflammasome activation and disease pathogenesis. sPLA2 may be a useful biomarker to stratify risk and guide patient management for children with acute COVID-19 and MIS-C. Therapeutic compounds targeting sPLA2 and inflammasome activation warrant consideration.

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Section: Discussionmentioning

confidence: 99%

Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C)

Kuypers

Rostad

Anderson

et al. 2021

Exp Biol Med (Maywood)

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“…128 Since its discovery in the serum of patients with severe inflammation and in rheumatoid arthritic fluids, sPLA2 as a proinflammatory enzyme has invoked intense interest in selective inhibitors of sPLA2-IIA in the hope of developing new and efficient therapies for inflammatory diseases. 134 Corticosteroids reduce the formation of sPLA2 and thereby may benefit severe cases of COVID-19, 135–139 but their use has also been related to adverse effects, 140 as shown in a large cohort of relatively healthy patients from Taiwan. 140 Treatments that address specific inflammatory pathways may be more advantageous.…”

Section: Treatmentmentioning

confidence: 99%

Hyperinflammation, apoptosis, and organ damage

Kuypers

2022

Exp Biol Med (Maywood)

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The cytokine storm (CS) in hyperinflammation is characterized by high levels of cytokines, extreme activation of innate as well as adaptive immune cells and initiation of apoptosis. High levels of apoptotic cells overwhelm the proper recognition and removal system of these cells. Phosphatidylserine on the apoptotic cell surface, which normally provides a recognition signal for removal, becomes a target for hemostatic proteins and secretory phospholipase A2. The dysregulation of these normal pathways in hemostasis and the inflammasome result in a prothrombotic state, cellular death, and end-organ damage. In this review, we provide the argument that this imbalance in recognition and removal is a common denominator regardless of the inflammatory trigger. The complex reaction of the immune defense system in hyperinflammation leads to self-inflicted damage. This common endpoint may provide additional options to monitor the progression of the inflammatory syndrome, predict severity, and may add to possible treatment strategies.

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“…The tendency to seek more support underlies the fact that more disabled people need and seek most support. Therefore, while promoting and encouraging a more effective access to eHealth in the United States and across countries, [14][15][16]25,26,64 it is relevant to understand that psychobehavioral treatments cannot be limited to pain severity and interference. Through a broader approach, particularly pain psychology together with the multidisciplinary pain therapy, we can potentially help prevent unwanted mood disorders.…”

Section: Discussionmentioning

confidence: 99%