Retinal outcomes of COVID-19: Possible role of CD147 and cytokine storm in infected patients with diabetes mellitus

Raony, Ícaro; Figueiredo, Camila Saggioro de

doi:10.1016/j.diabres.2020.108280

Cited by 19 publications

(21 citation statements)

References 17 publications

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“…Some of these may relate to parainfectious processes, hypoxic injury or dysfunctional immune responses mediated by numerous immunomodulatory molecules like IL-6, IP-10, IFN γ, IL-2, IL-10, G-CSF, MIP1α, and TNF (widespread "cytokine storm") [26,27]. In fact, the inflammatory cytokine storm that marks the later stage of the disease in severe or critically ill patients, together with hypercoagulable state and decreased arterial blood oxygen tension, are closely related to the development of multiorgan damage including acute respiratory distress syndrome (ARDS), renal failure and cerebrovascular disease [28], and could also be associated with the retinal findings described in our study [29].…”

Section: Plos Onesupporting

confidence: 58%

Retinal changes in COVID-19 hospitalized cases

Lani-Louzada

Ramos

Cordeiro³

et al. 2020

PLoS ONE

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The main objective of this study was to evaluate the retinas of severely or critically ill COVID-19 patients during their hospital stay, at varying time points after symptoms onset. This was a case series observed during May 2020 in two referral centers for COVID-19 treatment in Rio de Janeiro, Brazil. 47 eyes from 25 hospitalized patients with severe or critical confirmed illness were evaluated. A handheld retinal camera was used to acquire bilateral fundus images at several time points after symptoms onset. Electronic health records were retrospectively analyzed and clinical data collected. Severe and critical diseases were noticed in 52% (13/25) and 48% (12/25) of enrolled patients, respectively. Retinal changes were present in 12% (3/25) of patients: a 35 year-old male demonstrated bilateral nerve fiber layer infarcts and microhemorrhages in the papillomacular bundle, but required mechanical ventilation and developed severe anemia and systemic hypotension, acute kidney injury and neurologic symptoms during the course of the disease (critical illness); a 56 year-old male, who required full enoxaparin anticoagulation due to particularly elevated D-dimer (>5.0 mcg/mL), demonstrated unilateral and isolated flame-shaped hemorrhages; and a 49 year-old hypertensive male showed bilateral and discrete retinal dot and blot microhemorrhages. The other 22 patients evaluated did not demonstrate convincing retinal changes upon examination. There was no correlation between disease severity and admission serum levels of CRP, D-dimer and ferritin. This was the first study to show that vascular retinal changes may be present in not insignificant numbers of severe or critical COVID-19 inpatients. These retinal changes, only seen after morbid developments, were likely secondary to clinical intercurrences or comorbidities instead of a direct damage by SARS-CoV-2, and may be important and easily accessible outcome measures of therapeutic interventions and sentinels of neurologic and systemic diseases during COVID-19 pandemic.

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Section: Plos Onesupporting

confidence: 58%

Retinal changes in COVID-19 hospitalized cases

Lani-Louzada

Ramos

Cordeiro³

et al. 2020

PLoS ONE

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“…diabetic retinopathy in diabetes mellitus), or even that such conditions are risk factors for COVID-19-associated retinal lesions. 24 Finally, we also drew attention here for the importance of studies using animal models as a tool to unveil the mechanisms related to retinal lesions associated with SARS-CoV-2 infection, along with clinical studies to better understand the extent of retinal outcomes caused by COVID-19.…”

Section: Authors (Year)mentioning

confidence: 99%

SARS-CoV-2 Targeting the Retina: Host–virus Interaction and Possible Mechanisms of Viral Tropism

Figueiredo

Raony

Giestal-de-Araujo

2020

Ocular Immunology and Inflammation

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Background: Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 10 (SARS-CoV-2). Recent studies demonstrated not only retinal impairments but also detected SARS-CoV-2 in the retina of patients with COVID-19. Purpose: This letter discusses the retinal tropism of SARS-CoV-2, describing possible routes for this coronavirus to reach the retina and cellular mechanisms involved in the retinal cell infection. Conclusions: Determining how SARS-CoV-2 can affect the retinal tissue is essential for the development of new therapeutic strategies and preventive measures, as well as for understanding the possible relationship between COVID-19 damage to the retina and to the brain.

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“…We read with great interest the correspondence by Dr. Raony and Dr. Saggioro de Figueiredo, describing the possible role of CD147 in retinal findings observed in coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) [1] . Recent experimental and clinical findings suggested transmembrane glycoprotein CD147, also termed Basigin, may represent a novel receptor for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry into host cells [2] .…”

mentioning

confidence: 99%

Retinal findings in COVID-19 patients with diabetes mellitus

Güemes-Villahoz

Burgos-Blasco

Donate-López

et al. 2020

Diabetes Research and Clinical Practice

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Saggioro de Figueiredo, describing the possible role of CD147 in retinal findings observed in coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) [1]. Recent experimental and clinical findings suggested transmembrane glycoprotein CD147, also termed Basigin, may represent a novel receptor for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry into host cells [2]. Since CD147 is expressed at moderate-to-high levels in human retina [3] and has also proven to be an essential molecule for blood-retinal barrier impairment in streptozotocininduced diabetic mice [4], the authors suggested an intriguing hypothesis.At present we are passing through a phase of slow and difficult understanding of the clinical spectrum and the emerging short-and long-term complications caused by SARS-CoV-2 infection. In this sense, the retinal involvement has drawn attention as a possible biomarker of microangiopathy in COVID-19 patients [5]. Marinho et al. reported cotton wool spots (CWS) and microhemorrhages in patients with . However, these findings have been strongly questioned by other authors [7]. Additionally, Landecho et al. recently reported CWS in 6 out of 27 patients evaluated 14 days after hospital discharge due to COVID-19 bilateral pneumonia [5].CWS represent retinal nerve fiber layer infarcts and may appear in a broad spectrum of diseases, such as diabetic

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Retinal outcomes of COVID-19: Possible role of CD147 and cytokine storm in infected patients with diabetes mellitus

Cited by 19 publications

References 17 publications

Retinal changes in COVID-19 hospitalized cases

Retinal changes in COVID-19 hospitalized cases

SARS-CoV-2 Targeting the Retina: Host–virus Interaction and Possible Mechanisms of Viral Tropism

Retinal findings in COVID-19 patients with diabetes mellitus

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