Evaluation of the efficacy and safety of icatibant and C1 esterase/kallikrein inhibitor in severe COVID-19: study protocol for a three-armed randomized controlled trial.

BACKGROUND: SARS-CoV-2, the virus that causes COVID-19, enters the cells through a mechanism dependent on its binding to angiotensin-converting enzyme 2 (ACE2), a protein highly expressed in the lungs. The putative viral-induced inhibition of ACE2 could result in the defective degradation of bradykinin, a potent inflammatory substance. We hypothesize that increased bradykinin in the lungs is an important mechanism driving the development of pneumonia and respiratory failure in COVID-19. METHODS: This is a phase II, single-center, three-armed parallel-group, open-label, active control superiority randomized clinical trial. One hundred eighty eligible patients will be randomly assigned in a 1:1:1 ratio to receive either the inhibitor of C1e/kallikrein 20 U/kg intravenously on day 1 and day 4 plus standard care; or icatibant 30 mg subcutaneously, three doses/day for 4 days plus standard care; or standard care alone, as recommended in the clinical trials published to date, which includes supplemental oxygen, non-invasive and invasive ventilation, antibiotic agents, anti-inflammatory agents, prophylactic antithrombotic therapy, vasopressor support, and renal replacement therapy. DISCUSSION: Accumulation of bradykinin in the lungs is a common side effect of ACE inhibitors leading to cough. In animal models, the inactivation of ACE2 leads to severe acute pneumonitis in response to lipopolysaccharide (LPS), and the inhibition of bradykinin almost completely restores the lung structure. We believe that inhibition of bradykinin in severe COVID-19 patients could reduce the lung inflammatory response, impacting positively on the severity of disease and mortality rates. TRIAL REGISTRATION: Brazilian Clinical Trials Registry Universal Trial Number (UTN) U1111-1250-1843. Registered on May/5/2020.

Long-term kinetics of Salmonella Typhimurium ATCC 14028 survival on peanuts and peanut confectionery products.

Due to recent large outbreaks, peanuts have been considered a product of potential risk for Salmonella. Usually, peanut products show a low water activity (aw) and high fat content, which contribute to increasing the thermal resistance and survival of Salmonella. This study evaluated the long-term kinetics of Salmonella survival on different peanut products under storage at 28°C for 420 days. Samples of raw in-shell peanuts (aw = 0.29), roasted peanuts (aw = 0.39), unblanched peanut kernel (aw = 0.54), peanut brittle (aw = 0.30), paçoca (aw = 0.40) and pé-de-moça (aw = 0.68) were inoculated with Salmonella Typhimurium ATCC 14028 at two inoculum levels (3 and 6 log cfu/ g). The Salmonella behavior was influenced (p<0.05) by aw, lipid, carbohydrate and protein content. In most cases for both inoculum levels, the greatest reductions were seen after the first two weeks of storage, followed by a slower decline phase. The lowest reductions were verified in paçoca and roasted peanuts, with counts of 1.01 and 0.87 log cfu/ g at low inoculum level and 2.53 and 3.82 log cfu/ g at high inoculum level at the end of the storage time. The highest loss of viability was observed in pé-de-moça, with absence of Salmonella in 10-g after 180 days at low inoculum level. The Weibull model provided a suitable fit to the data (R2≥0.81), with δ value ranging from 0.06 to 49.75 days. Therefore, the results demonstrated that Salmonella survives longer in peanut products, beyond the shelf life (>420 days), especially in products with aw around 0.40.