Biomarkers of cell damage, neutrophil and macrophage activation associated with in-hospital mortality in geriatric COVID-19 patients.

BACKGROUND: The risk for symptomatic COVID-19 requiring hospitalization is higher in the older population. The course of the disease in hospitalised older patients may show significant variation, from mild to severe illness, ultimately leading to death in the most critical cases. The analysis of circulating biomolecules involved in mechanisms of inflammation, cell damage and innate immunity could lead to identify new biomarkers of COVID-19 severity, aimed to improve the clinical management of subjects at higher risk of severe outcomes. In a cohort of COVID-19 geriatric patients (n= 156) who required hospitalization we analysed, on-admission, a series of circulating biomarkers related to neutrophil activation (neutrophil elastase, LL-37), macrophage activation (sCD163) and cell damage (nuclear cfDNA, mithocondrial cfDNA and nuclear cfDNA integrity). The above reported biomarkers were tested for their association with in-hospital mortality and with clinical, inflammatory and routine hematological parameters. Aim of the study was to unravel prognostic parameters for risk stratification of COVID-19 patients. RESULTS: Lower n-cfDNA integrity, higher neutrophil elastase and higher sCD163 levels were significantly associated with an increased risk of in-hospital decease. Median (IQR) values observed in discharged vs. deceased patients were: 0.50 (0.30-0.72) vs. 0.33 (0.22-0.62) for n-cfDNA integrity; 94.0 (47.7-154.0) ng/ml vs. 115.7 (84.2-212.7) ng/ml for neutrophil elastase; 614.0 (370.0-821.0) ng/ml vs. 787.0 (560.0-1304.0) ng/ml for sCD163. The analysis of survival curves in patients stratified for tertiles of each biomarker showed that patients with n-cfDNA integrity < 0.32 or sCD163 in the range 492-811 ng/ml had higher risk of in-hospital decease than, respectively, patients with higher n-cfDNA integrity or lower sCD163. These associations were further confirmed in multivariate models adjusted for age, sex and outcome-related clinical variables. In these models also high levels of neutrophil elastase (>150 ng/ml) appeared to be independent predictor of in-hospital death. An additional analysis of neutrophil elastase in patients stratified for n-cfDNA integrity levels was conducted to better describe the association of the studied parameters with the outcome. CONCLUSIONS: On the whole, biomarkers of cell-free DNA integrity, neutrophil and macrophage activation might provide a valuable contribution to identify geriatric patients with high risk of COVID-19 in-hospital mortality.

Bretylium-induced voltage-gated sodium current in human lymphocytes.

Using the whole-cell variation of the patch-clamp technique it has been determined that 0.25-3 mM bretylium tosylate (BT) exerts a repolarizing effect on partially depolarized human lymphocytes. The repolarizing effect was ouabain (40 microM)-sensitive, and was inhibited by the removal of external Na+ or by the Na(+)-channel-blocker amiloride (10-44 microM), but K(+)-channel-blockers 4-aminopyridine (0.1-5 mM) and quinine (100 microM) had no effect. The drug induced a sodium dependent, amiloride-sensitive transient inward current reaching its maximum value approx. 20-30 s after the administration of BT and lasting for 6-10 min. This current was activated by depolarization within 25 ms at around -42 mV, its inactivation took about 2 s and its reversal potential was +24 +/- 5 mV. An increase in the intracellular sodium concentration (1.8-3.2 mM) has been observed upon the addition of BT by monitoring the SBFI fluorescence of the dye-loaded cells. It has been shown that whole-cell K+ currents are significantly decreased by BT. The existence of voltage and ligand (BT)-gated sodium channels has been postulated in human lymphocytes. These channels are thought to participate in the initiation of membrane repolarization in human lymphocytes, and thereby influence mitogenic or antigen-induced cell-activation processes.

A sodium channel opener inhibits stimulation of human peripheral blood mononuclear cells.

The role of membrane potential changes in T cell activation was studied on human peripheral blood lymphocytes stimulated with phytohemagglutinin. Addition of bretylium tosylate, a sodium channels opener, to PHA treated lymphocytes modified the membrane potential and consequently blocked cell activation in a dose-dependent fashion. BT was non-toxic even in long-term (72 hr) incubations. It was reversibly removable, and the removal restored the stimulatory effect of PHA. 3H-thymidine incorporation was blocked if BT was present during the first 20-24 hr of the mitogenic activation. The later BT was added after PHA, the less inhibition of proliferation was observed. BT hyperpolarized the lymphocytes also in the presence of PHA. BT hindered the depolarizing effect of high extracellular potassium concns. The sustained polarized state of the lymphocytes did not influence the intracellular calcium increase upon PHA treatment. IL-2 and transferrin receptor expression was not hindered by BT during PHA stimulation of lymphocytes. Addition of rIL-2 did not abolish the inhibitory effect of BT. According to cell-cycle analysis BT arrested the majority of the cells in G1 phase. It is suggested that cell activation demands the flexible maintenance of a relatively narrow membrane potential "window". Any sustained and significant hyper-, or depolarization, may dramatically decrease the effectivity of transmembrane signalling.

Vitamin E deficiency impairs the modifications of mitochondrial membrane potential and mass in rat splenocytes stimulated to proliferate.

This study was designed to evaluate the time-dependent changes of mitochondrial membrane potential and mass during Con-A-induced proliferation of splenic lymphocytes from rat fed a normal or a vitamin E deficient diet. Rhodamine 123 and Nonyl Acridine Orange were used as specific probes to monitor the membrane potential and mass of mitochondria, respectively, by means of flow cytometry. The results demonstrate that the increase of Rh-123 and NAO uptake observed in cells from normally fed rats was prevented by vitamin E deficiency, at any time considered. After 72 h from Con A stimulation, 62% of cells from controls, as against 16% of cells from vitamin E deficient rats, showed hyperpolarized mitochondria. At the same time, in this last group, 60% of cells had depolarized organelles. The same pattern was observed considering the changes of mitochondrial mass, measured using NAO as a probe. These data support that mitogenic stimulation induced an increase of the respiratory activity of mitochondria with subsequent production of superoxide radicals. This resulted in depolarization and loss of mass of the organelles if the intracellular level of vitamin E is not adequate.

Age-dependent modifications of mitochondrial trans-membrane potential and mass in rat splenic lymphocytes during proliferation.

The specific fluorescent probes, Rhodamine 123 (Rh-123) and Nonyl-Acridine Orange (NAO) were, respectively, used to monitor the changes in membrane potential and mass of lymphocyte mitochondria during aging and proliferation. An age-dependent increase of the uptake of both fluorochromes was observed in resting cells; however, NAO fluorescence increased to a greater extent when compared with the Rh-123 probe. This resulted in a lower respiratory activity per unit of mitochondrial mass in old cells than in the young ones. Following mitogenic stimulation, most of the lymphocytes from young rats showed an increase in their membrane potential and mass. On the contrary about 50% of cells from old rats had depolarized mitochondria after 72 h from the stimulation. Present data support that mitochondria of lymphocytes from old rats are extremely sensitive to the stressing conditions resulting from mitogenic stimulation.

Phytohemagglutinin induced changes of membrane lipid packing, c-myc and c-myb encoded protein expression in human lymphocytes during aging.

Three parameters which signal different stages of cell activation were analyzed in lymphocytes from young and old subjects. Merocyanine 540 (MC-540) incorporation into the membrane lipid phase was used as a very early marker of activation and was measured after 1 h of phytohemagglutinin (PHA) stimulation. The proteins coded by c-myc and c-myb protooncogenes were determined by appropriate antibodies and were taken as markers of the G0/G1 and G1/S phase transition, respectively. The number of cells which increased the uptake of MC-540 following PHA stimulation did not differ when comparing young and old individuals. Both the number of the responding cells and the size of the response were decreased during aging when the presence of the c-myc protein was taken into account. A consistent decrease of the percentage of lymphocytes able to express the c-myb protein was observed in the cells from old donors as compared to those from the young ones, but the amount of detectable protein per cell remained unchanged. Our data suggest that the deficiency of responsiveness which accompanies aging is due to impairments at different points of the cell cycle. The very low number of cells expressing the c-myb protein is likely the result of step by step elimination of those cells not able to fulfill the requirements to progress along the cell cycle.

Cholesterol-rich rabbit serum modulates beta-adrenergic receptor density of human lymphocytes. A possible role of LDL-cholesterol.

The effect of in vitro treatment of human lymphocytes with rabbit cholesterol-rich serum (RCS) on the membrane microviscosity as well as on the beta-adrenergic receptor density has been investigated. RCS treatment of cells resulted in a 30% decrease of receptor density without any effect on membrane microviscosity. A complete recovery was observed incubating the RCS cells either with the "Active Lipids" (AL) or with heparin. The AL are a mixture of neutral lipids, phosphatidylcholine and phosphatidylethanolamine from hen egg yolk known to fluidify the cell membrane. The AL modified membrane microviscosity of control lymphocytes without altering their beta-receptor number. These observations support the proposition that beta-receptor density of human lymphocytes is not regulated by membrane microviscosity and suggest that probably low density lipoprotein-cholesterol complex is involved in such a regulation.

The response of human lymphocytes to phytohemagglutinin is impaired at different levels during aging.

Several parameters generally believed to be necessary for the activation and progression of proliferation of human lymphocytes have been investigated and compared with special reference to aging. The responding capacity of plasma membrane potential to depolarizing and also repolarizing conditions induced by exposure to mitogens like PHA was lower in lymphocytes from old donors as compared to those of young ones. This indicates a significant age-dependent difference in the readiness to respond to channel-activating perturbations. As an early signal of activation, after one hour PHA stimulation the merocyanine 540 uptake by the lipid regions was chosen, based on the property of this fluorescent probe to bind to loosely packed lipids of the plasma membrane. The proteins encoded by the c-myc and c-myb genes were chosen as markers of the G0/G1 and G1/S phased transition, respectively. The mean number of cells that increased the uptake of MC 540 following mitogenic stimulation did not differ in young vs. old individuals. However, 4 samples out of 10 from the old population showed lower MC 540 fluorescence than the lowest signal from the young population. The number of responding cells was decreased during aging when the presence of the c-myc protein was taken as its measure; and this decrease was further accentuated, determining the expression of the c-myb protein. This frequently encountered age-dependent pattern, however, was not followed by the lymphocytes of all old donors. One example is reported in which the MC 540 uptake, the c-myc and c-myb expression in the cells from one old subject fell in the range of the young subjects. However, even in this case, the response of the lymphocytes as measured by 3H-thymidine incorporation was only 64% of that of young subjects. For this sample, we found an impairment of the response at the mitochondrial level. In addition to these parameters, the amount of 3H-thymidine incorporated by the cells expressing the c-myb protein was calculated. The values in old individuals were lower than those in the young, suggesting that not all the cells expressing the c-myb protein were able to synthesize DNA in lymphocyte populations from the elderly. Our data support the view that the age-dependent decline of lymphocyte responsiveness to mitogens can be accounted for by impairments at different levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Melatonin: a peroxyl radical scavenger more effective than vitamin E.

We have compared the peroxyl radical scavenger ability to melatonin with that of vitamin E, vitamin C and reduced glutathione (GSH). In the assay system, beta-phycoerythrin (beta-PE) was used as fluorescent indicator protein, 2-2'-azo-bis(2-amidinopropane)dihydrochloride as a peroxyl radical generator and the water soluble vitamin E analogue. Trolox, as reference standard. Results are expressed as oxygen radical absorbing capacity (ORAC(perox)) units, where 1 ORAC unit equals the net protection produced by 1 microM Trolox. A linear correlation of ORAC values with concentration (0.5-4 microM) of all the substances tested has been observed. However, on molar basis, the relative ORAC(perox) of Trolox, vitamin C, GSH and melatonin was 1:1.12:0:68:2.04, respectively. Thus, melatonin, which is a lipid-soluble compound, was twice more active than vitamin E, believed to be the most effective lipophilic antioxidant.

Reduced glutathione recovers the impairment of the proliferative response of splenic lymphocytes from vitamin E-deficient rats.

The effect of reduced glutathione (GSH) on the Con A induce proliferative response of splenic lymphocytes from rats fed a normal or vitamin E-deficient diet has been investigated. The animals were killed when they were 12 months old and after 11 months of dietary treatment. As was expected, a decreased response, measured in terms of blast transformation or [(3)H]thymidine incorporation, was observed in vitamin E-deficient animals when compared with the control group. This pattern can be accounted for by the large number of dead cells found in deficient animals. GSH addition into the culture medium resulted in a strong increase of the response in both groups and it eliminated the difference caused by the different dietary regimens. Taking into account that, during proliferation, an increase of respiration occurs which increases the risk of free radical production, present data suggest that GSH may substitute vitamin E in protecting the cells.

Food restriction in female Wistar rats. VI. Effect of reduced glutathione on the proliferative response of splenic lymphocytes from ad libitum fed and food restricted animals.

The effect of reduced glutathione (GSH) on the proliferative response of splenic lymphocytes from young, adult and old ad libitum (AL) fed as well as from old food-restricted rats was investigated. Food restriction was applied on an every-other-day schedule (EOD) starting from the age of 3.5 months. As was expected, the cells from EOD fed animals responded to concanavalin A (Con A) much better than those from age-matched ad libitum fed rats. The presence of the antioxidant GSH in the culture medium increased the response of lymphocytes in all the models taken into account; furthermore, it decreased the differences due to aging and application of food restriction. According to present knowledge, mitogenic stimulation induces free radical production, and GSH has, among others, a strong antioxidant activity. Thus, present data suggest that splenocytes from EOD animals tolerated the peroxidative stress resulting from mitogenic stimulation better than those from AL fed ones.

Food restriction in female Wistar rats, IV. Morphometric parameters of cerebellar synapses.

The effect of food restriction on morphometric parameters of cerebellar synapses has been evaluated. A decrease in the number and surface density of synapses has been observed comparing 6 and 27-28 month old rats. Food restriction prevented the loss of the number and attenuated the reduction of the surface density of synaptic contacts occurring during aging. Present data support the idea that food restriction delays the appearance of age-related modifications of synaptic structures and may explain the improvement of motoric coordination and performance found in dietary restricted old animals.

Diet restriction, body temperature and physicochemical properties of cell membranes.

This paper summarizes some recent results of the effect of diet restriction upon body temperature and membrane microviscosity of lymphocytes, hepatocytes and cerebellar cells of diet-restricted female Wistar rats. The treated animals were fed on an every-other-day schedule starting from the age of 3.5 months. It is suggested that a decrease in average body temperature (-1 degree C) of diet-restricted animals as compared to the ad libitum fed ones may stimulate the cells to synthesize more fluid membranes. Together with these the maintenance of the activity of protective enzymes is another key event which helps to prevent the age-dependent deterioration of cell membrane functions.

Parameters to monitor aging with a possible perspective for intervention - an immunological approach.

Reliable aging markers are very rare, which are better than the chronological age or those symptoms which have such great individual variability that their scientific value is questionable. The effect of aging on immunological behavior of human (and animal) individuals is reasonably well established. In this communication an attempt is made to find an immunological marker of aging at the level of cell surface phenomena. It was observed that ion-channel activities, having a complex regulation, loose their flexible responsiveness in lymphocyte membranes during aging. A recently discovered voltage regulation of the calcium-activated potassium channels showed a distinct change with aging of human lymphocytes. A possibility to find a better marker system in complex regulatory processes is also discussed.

Food restriction in female Wistar rats. II. Beta-adrenoceptor density in the cerebellum and in the splenic lymphocytes.

The effect of diet restriction, applied on an every-other-day schedule from 3.5 months of age on, has been investigated on the beta-adrenoceptor density in the cerebellum and in the splenic lymphocytes of old female Wistar rats. Comparing animals 6 months and 24 months old fed ad libitum, a 75% age-dependent reduction in specific binding of the agonist dihydroalprenolol was observed in cerebellar membrane preparations, while the beta-adrenoceptor density of lymphocytes remained unaltered. Diet restriction induced a partial recovery of the age-related decrease of this parameter in the cerebellum without affecting the receptor density of lymphocytes. Present results suggest that undernutrition delays the appearance of those alterations related to aging.

Food restriction in female Wistar rats. III. Thermotropic transition of membrane lipid and 5'-nucleotidase activity in hepatocytes.

The effect of diet restriction was measured on the anisotropy parameter of 1,6-diphenyl-1,3,5-hexatriene (DPH) and 5'-nucleotidase enzyme activity in liver plasma membrane preparates. Diet restriction was applied to rats 3.5 months old on an every-other-day schedule (EOD) and the rats were killed at the age of 28-29 months. Six months and 24 months rats, fed ad libitum (AL), were used as controls. The Arrhenius plots of anisotropy parameter of liver membranes from young, old AL and old EOD animals exhibited well defined breakpoints at 16.3 degrees C, 19.5 degrees C and 16.7 degrees C, respectively. The breakpoint temperature of 5'-nucleotidase activity was lower in samples from young rats as compared to those from old AL rats, whereas no difference was observed comparing young and EOD fed rats. Present results support the hypothesis that diet restriction modifies lipid composition of liver plasma membranes in such a way that the appearance of age-dependent alterations is delayed.

Effect of reduced glutathione on mitochondrial parameters of proliferating splenocytes from young and old rats.

The time-dependent changes of mitochondrial membrane potential and mass have been investigated on splenocytes from young, adult and old rats stimulated with Con A in the presence and absence of reduced glutathione (GSH). In addition, the basal level as well as the level of GSH during a 3-day culture period has been determined. No age-dependent changes of cellular GSH content were observed in freshly prepared splenocytes; however, in proliferating cells from old animals the expected increase in GSH levels was delayed. As regards the mitochondrial parameters, their membrane potential and mass were measured by means of the fluorescent probes rhodamine-123 (Rh-123) and nonyl acridine orange (NAO), respectively, and flow cytometry. During aging and with time of culture, an increased number of cells showed depolarization and loss of mitochondrial mass. This age-dependent impairment was completely prevented by addition of GSH to the culture medium, which resulted in a sharp increase in intracellular GSH. The present findings support the view that an impairment of the antioxidant defense system may be responsible for the damage observed in the mitochondria of proliferating splenocytes from old animals.

Food restriction in female Wistar rats. VII. Mitochondrial parameters in resting and proliferating splenic lymphocytes.

The effect of food restriction on the mitochondria of resting and proliferating rat splenocytes was examined, measuring the membrane potential and mass of these organelles, by means of the specific fluorescent probes Rhodamine-123 and Nonyl Acridine Orange, respectively. Food restriction was applied on an every-other-day schedule (EOD) starting at the age of 3.5 months. The ad libitum fed (AL) animals were killed when they were 4, 11 and 24 months old, whereas the EOD rats were killed at 11 and 26 months. Resting lymphocytes from AL rats showed an age-dependent increase of both membrane potential and mass of their mitochondria. However, the mitochondrial mass increased to a larger extent when compared with the membrane potential resulting in a decrease of the respiratory quotient (RQ), i.e. of the respiratory activity per unit of mitochondrial mass. In EOD animals, the mitochondrial membrane potential was lower and the mitochondrial mass was higher in the corresponding age-matched controls, resulting in a further decrease of RQ. Following mitogenic stimulation, most of the cells from young and adult AL rat showed an increase of membrane potential and mass of their mitochondria. In contrast about 50% of cells from old AL rats had depolarized organelles after 72 h from the stimulation. Food restriction was able to prevent these alterations allowing the majority of cells, including those from old animals, to maintain the hyperpolarization of their mitochondria during the 3-day culture. In light of the well known sensitivity of mitochondrial membrane potential to peroxidative stress, present data suggest that the increase of respiration occurring during mitogenesis may increase free radical production, which is better tolerated by cells from EOD animals than by those from AL animals.

Melatonin is an efficient antioxidant.

We have compared the peroxyl radical scavenger ability of melatonin with that of vitamin E, ascorbic acid (As.A.), reduced glutathione (GSH) and mannitol. All the antioxidants, except mannitol, prevented the lysis of human erythrocytes exposed to an azo-initiator of peroxyl radicals (2,2'-azo-bis(2-amidinopropane)dihydrochloride) at 37 degrees C. The percentage of this inhibition of erythrocyte lysis varied with the concentration of antioxidants, but the efficiency was melatonin > vitamin E > As.A. > GSH. Based on the assumption that each molecule of vitamin E scavenges two peroxyl radicals, the scavenging capacity of melatonin was four peroxyl radicals/molecule.