The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

Santos, Patty Karina dos; Sigoli, Emilly; Bragança, Lorenna J.G.; Cornachione, Anabelle S.

doi:10.3389/fphys.2022.813924

Cited by 33 publications

(36 citation statements)

References 187 publications

(254 reference statements)

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“…These symptoms often persist after recovery. Indeed, the most prevalent muscle manifestations of long COVID-19 are myalgia, muscle weakness, decreased muscular strength and a decline in physical performance, which affects the ability to perform daily activities and quality of life [ 44 , 45 ]. Muscle dysfunction may give rise to muscle atrophy characterized by a decrease in muscle mass, a decrease in capillarization, and mitochondrial impairment [ 44 ].…”

Section: Clinical Symptoms and Laboratory Findings Of Long Covid-19mentioning

confidence: 99%

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

Scurati

Papini

Giussani

et al. 2022

IJMS

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Long coronavirus disease 19 (COVID-19) is the designation given to a novel syndrome that develops within a few months after infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and that is presenting with increasing incidence because of the numerous cases of infection. Long COVID-19 is characterized by a sequela of clinical symptoms that concern different organs and tissues, from nervous, respiratory, gastrointestinal, and renal systems to skeletal muscle and cardiovascular apparatus. The main common molecular cause for all long COVID-19 facets appears to be related to immune dysregulations, the persistence of inflammatory status, epigenetic modifications, and alterations of neurotrophin release. The prevention and management of long COVID-19 are still inappropriate because many aspects need further clarification. Exercise is known to exert a deep action on molecular dysfunctions elicited by long COVID-19 depending on training intensity, duration, and continuity. Evidence suggests that it could improve the quality of life of long COVID-19 patients. This review explores the main clinical features and the known molecular mechanisms underlying long COVID-19 in the perspective of considering exercise as a co-medication in long COVID-19 management.

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Section: Clinical Symptoms and Laboratory Findings Of Long Covid-19mentioning

confidence: 99%

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

Scurati

Papini

Giussani

et al. 2022

IJMS

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“…ACE2 is the entry receptor of Sars-Cov-2, a virus responsible for the Coronavirus Disease 2019 (COVID-19) [32]. Considering the fact that numerous publications indicate musculoskeletal problems and low back pain in patients affected by COVID-19 [15][16][17][18] and that degeneration of the IVD leads to the "access" to the vasculature raises the question of whether Sars-Cov-2 is also found in IVD and might target the ACE2 available here. Hence, it would be interesting to evaluate whether IVD degeneration might predict musculoskeletal outcomes in COVID-19 infections.…”

Section: Translation Of the Main Findings In The Context Of Previous ...mentioning

confidence: 99%

“…The ACE/An-gII/AGTR1 axis is currently considered the pathological axis, whereas the ACE2/AGTR2/MasR axis is considered the protective axis of the renin-angiotensin system [11,13]. Interestingly, numerous publications indicate musculoskeletal problems and low back pain in patients affected by COVID-19, although evidence to date is lacking regarding the existence of ACE2 in IVDs [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Characterization of a Tissue Renin-Angiotensin System in Human Nucleus Pulposus Cells

Saravi¹,

Li²,

Basoli³

et al. 2022

Preprint

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Low back pain is a clinically highly relevant musculoskeletal burden and is associated with inflammatory as well as degenerative processes of the intervertebral disc. However, the pathophysiology and cellular pathways contributing to this devastating condition are still poorly understood. Based on previous evidence, we hypothesize that tissue renin-angiotensin system (tRAS) components, including the SARS-CoV-2 entry receptor angiotensin-converting enzyme 2 (ACE2), are present in human nucleus pulposus (NP) cells and associated with inflammatory and degenerative processes. Experiments were performed with NP cells from 4 human donors. The existence of angiotensin II, angiotensin II type 1 receptor (AGTR1), AGTR2, MAS-receptor (MasR), and ACE2 in human NP cells was validated with immunofluorescent staining and gene expression analysis. Hereafter the cell viability was assessed after adding agonists and antagonists of the target receptors as well as angiotensin II in different concentrations for up to 48 hours of exposure. A TNF-α-induced inflammatory in vitro model was employed to assess the impact of angiotensin II addition and the stimulation or inhibition of the tRAS receptors on inflammation, tissue remodeling, expression of tRAS markers, and the release of nitric oxide (NO) into the medium. Further, protein levels of IL-6, IL-8, IL-10, and intracellular as well as secreted angiotensin II were assessed after exposing the cells to the substances, and inducible nitric oxide synthase (iNOS) levels were evaluated utilizing Western Blot. The existence of tRAS receptors and angiotensin II were validated in human NP cells. Cell viability analysis revealed no cytotoxic effects of angiotensin II. The AGTR1 inhibitor Candesartan and the MAS receptors AVE0991 showed cytotoxic effects at high concentrations (100 µM). The addition of angiotensin II only showed a mild impact on gene expression markers. However, there was a significant increase in NO secreted by the cells. The gene expression ratios of pro-inflammatory/anti-inflammatory cytokines IL-6/IL--10, IL-8/IL-10, and TNF-α /IL-10 were positively correlated with the AGTR1/AGTR2 and AGTR1/MAS1 ratios, respectively. The stimulation of the AGTR2 MAS-receptor and the inhibition of the AGTR1 receptor revealed beneficial effects on the gene expression of inflammatory and tissue remodeling markers. This finding was also present at the protein level. We did not find alterations in iNOS protein concentrations after adding the drugs. The current data showed that tRAS components are expressed in human NP cells and are associated with inflammatory and degenerative processes. Further characterization of the associated pathways is warranted. The findings indicate that tRAS modulation might be a novel therapeutic approach to intervertebral disc disease.

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“…The mechanisms of how SARS-CoV-2 triggers muscle inflammation include direct viral entry into the muscle from a viral spike protein attached to the ACE-2 receptor and virus-triggered immune activation/inflammation [ 13 ]. The alpha-SARS-CoV-2 community outbreak occurred in northern Taiwan from May to July 2021, and it was controlled successfully by combined non-pharmaceutical interventions, including contact tracing, quarantine, universal facial masking, and school closures [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Rhabdomyolysis in Pediatric Patients with SARS-CoV-2 Infection

Wong

Cheng

et al. 2022

Children

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Background: Rhabdomyolysis is a rare but severe complication in adult patients with Coronavirus disease 2019 (COVID-19), which can result in acute kidney injury and death; however, it is rarely reported in pediatric patients. Methods: In this study, we retrospectively reviewed the clinical features and outcomes of rhabdomyolysis in pediatric patients aged 0–18 years with COVID-19 who were hospitalized at Taipei Tzu Chi Hospital, an epicenter of COVID-19 in northern Taiwan. Results: We treated eight patients with rhabdomyolysis during the omicron variant-Severe acute respiratory syndrome coronavirus 2 (omicron variant-SARS-CoV-2) community outbreak and none during the alpha variant endemic. These eight patients shared stereotypical presentations, including the presence of bilateral calf pain after defervescence. The creatinine kinase (CK) levels were between 1346 and 6937 U/L on admission, and clinical course was uneventful after aggressive saline hydration. Conclusion: Rhabdomyolysis is not a rare complication in pediatric patients with the omicron-SARS-CoV-2 infection, and reassurance of a good prognosis is important to alleviate family anxiety.

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The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

Cited by 33 publications

References 187 publications

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

In Vitro Characterization of a Tissue Renin-Angiotensin System in Human Nucleus Pulposus Cells

Rhabdomyolysis in Pediatric Patients with SARS-CoV-2 Infection

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