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1.
Proc Natl Acad Sci U S A ; 118(18)2021 05 04.
Article in English | MEDLINE | ID: covidwho-1189344

ABSTRACT

As the coronavirus disease 2019 (COVID-19) pandemic rages on, it is important to explore new evolution-resistant vaccine antigens and new vaccine platforms that can produce readily scalable, inexpensive vaccines with easier storage and transport. We report here a synthetic biology-based vaccine platform that employs an expression vector with an inducible gram-negative autotransporter to express vaccine antigens on the surface of genome-reduced bacteria to enhance interaction of vaccine antigen with the immune system. As a proof-of-principle, we utilized genome-reduced Escherichia coli to express SARS-CoV-2 and porcine epidemic diarrhea virus (PEDV) fusion peptide (FP) on the cell surface, and evaluated their use as killed whole-cell vaccines. The FP sequence is highly conserved across coronaviruses; the six FP core amino acid residues, along with the four adjacent residues upstream and the three residues downstream from the core, are identical between SARS-CoV-2 and PEDV. We tested the efficacy of PEDV FP and SARS-CoV-2 FP vaccines in a PEDV challenge pig model. We demonstrated that both vaccines induced potent anamnestic responses upon virus challenge, potentiated interferon-γ responses, reduced viral RNA loads in jejunum tissue, and provided significant protection against clinical disease. However, neither vaccines elicited sterilizing immunity. Since SARS-CoV-2 FP and PEDV FP vaccines provided similar clinical protection, the coronavirus FP could be a target for a broadly protective vaccine using any platform. Importantly, the genome-reduced bacterial surface-expressed vaccine platform, when using a vaccine-appropriate bacterial vector, has potential utility as an inexpensive, readily manufactured, and rapid vaccine platform for other pathogens.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/prevention & control , Porcine epidemic diarrhea virus/immunology , SARS-CoV-2/immunology , Viral Fusion Proteins/immunology , Viral Vaccines/immunology , Animals , Antibodies, Viral/blood , Disease Models, Animal , Escherichia coli/genetics , Genome, Bacterial , Interferon-gamma/blood , RNA, Viral/analysis , Swine , Vaccines, Inactivated/immunology , Vaccines, Synthetic/immunology
2.
Int J Pept Res Ther ; 27(3): 1875-1883, 2021.
Article in English | MEDLINE | ID: covidwho-1188143

ABSTRACT

The current COVID-19 pandemic is one of the most devastating events in recent history. The respiratory effects of this disease include acute respiratory distress syndrome, systemic inflammation, cytokine storm, and pulmonary fibrosis. Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, is a peptide hormone secreted mainly by the stomach. Interestingly, ghrelin possesses promising antioxidant, anti-and inflammatory effects, making it an attractive agent to reduce the complications of the SARS-CoV-2. In addition, ghrelin exerts a wide range of immunomodulatory and anti-inflammatory effects and can mitigate the uncontrolled cytokine production responsible for acute lung injury by upregulating PPARγ and down-regulating NF-κB expression. Ghrelin has also been reported to enhance Nrf2 expression in inflammatory conditions which led to the suppression of oxidative stress. The current opinion summarizes the evidence for the possible pharmacological benefits of ghrelin in the therapeutic management of SARS-CoV-2 infection.

3.
Nat Rev Immunol ; 21(5): 330-335, 2021 05.
Article in English | MEDLINE | ID: covidwho-1164868

ABSTRACT

When vaccines are in limited supply, expanding the number of people who receive some vaccine, such as by halving doses or increasing the interval between doses, can reduce disease and mortality compared with concentrating available vaccine doses in a subset of the population. A corollary of such dose-sparing strategies is that the vaccinated individuals may have less protective immunity. Concerns have been raised that expanding the fraction of the population with partial immunity to SARS-CoV-2 could increase selection for vaccine-escape variants, ultimately undermining vaccine effectiveness. We argue that, although this is possible, preliminary evidence instead suggests such strategies should slow the rate of viral escape from vaccine or naturally induced immunity. As long as vaccination provides some protection against escape variants, the corresponding reduction in prevalence and incidence should reduce the rate at which new variants are generated and the speed of adaptation. Because there is little evidence of efficient immune selection of SARS-CoV-2 during typical infections, these population-level effects are likely to dominate vaccine-induced evolution.


Subject(s)
COVID-19/prevention & control , Off-Label Use , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Vaccination/methods , Vaccines/administration & dosage , Biological Evolution , COVID-19/immunology , Humans , Immune Evasion/genetics , Immune Evasion/immunology , Vaccination/psychology
4.
Nephron ; 145(3): 256-264, 2021.
Article in English | MEDLINE | ID: covidwho-1156029

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) in coronavirus infection disease (COVID-19) is associated with disease severity. We aimed to evaluate risk factors associated with AKI beyond COVID-19 severity. METHODS: A retrospective observational study of COVID-19 patients admitted to a tertiary hospital in Singapore. Logistic regression was used to evaluate associations between risk factors and AKI (based on Kidney Disease Improving Global Outcomes criteria). Dominance analysis was performed to evaluate the relative importance of individual factors. RESULTS: Seven hundred seven patients were included. Median age was 46 years (interquartile range [IQR]: 29-57) and 57% were male with few comorbidities (93%, Charlson Comorbidity Index [CCI] <1). AKI occurred in 57 patients (8.1%); 39 were in AKI stage 1 (68%), 9 in stage 2 (16%), and 9 in stage 3 (16%). Older age (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI]: 1.01-1.07), baseline use of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (aOR 2.86; 95% CI: 1.20-6.83), exposure to vancomycin (aOR 5.84; 95% CI: 2.10-16.19), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aOR 3.04; 95% CI: 1.15-8.05), and severe COVID-19 with hypoxia (aOR 13.94; 95% CI: 6.07-31.98) were associated with AKI in the multivariable logistic regression model. The 3 highest ranked predictors were severe COVID-19 with hypoxia, vancomycin exposure, and age, accounting for 79.6% of the predicted variance (41.6, 23.1, and 14.9%, respectively) on dominance analysis. CONCLUSION: Severe COVID-19 is independently associated with increased risk of AKI beyond premorbid conditions and age. Appropriate avoidance of vancomycin and NSAIDs are potentially modifiable means to prevent AKI in patients with COVID-19.


Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/epidemiology , Adult , Age Factors , Aged , Anti-Bacterial Agents/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cohort Studies , Comorbidity , Drug-Related Side Effects and Adverse Reactions/epidemiology , Female , Humans , Hypoxia/epidemiology , Hypoxia/etiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome , Vancomycin/adverse effects
5.
J Biol Dyn ; 15(1): 137-150, 2021 12.
Article in English | MEDLINE | ID: covidwho-1062817

ABSTRACT

Self-medication is an important initial response to illness in Africa. This mode of medication is often done with the help of African traditional medicines. Because of the misconception that African traditional medicines can cure/prevent all diseases, some Africans may opt for COVID-19 prevention and management by self-medicating. Thus to efficiently predict the dynamics of COVID-19 in Africa, the role of the self-medicated population needs to be taken into account. In this paper, we formulate and analyse a mathematical model for the dynamics of COVID-19 in Cameroon. The model is represented by a system of compartmental age-structured ODEs that takes into account the self-medicated population and subdivides the human population into two age classes relative to their current immune system strength. We use our model to propose policy measures that could be implemented in the course of an epidemic in order to better handle cases of self-medication.


Subject(s)
COVID-19/therapy , Models, Statistical , Self Medication , COVID-19/epidemiology , COVID-19/virology , Cameroon , Humans , Medicine, African Traditional , SARS-CoV-2/isolation & purification
6.
In Silico Pharmacol ; 9(1): 8, 2021.
Article in English | MEDLINE | ID: covidwho-1009227

ABSTRACT

The widespread of coronavirus (COVID-19) is a new global health crisis that poses a threat to the world. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in bats and was discovered first in Wuhan, Hubei province, China in December 2019. Immunoinformatics and bioinformatics tools were employed for the construction of a multi-epitope subunit vaccine to prevent the diseases. The antigenicity, toxicity and allergenicity of all epitopes used in the construction of the vaccine were predicted and then conjugated with adjuvants and linkers. Vaccine Toll-Like Receptors (2, 3, 4, 8 and 9) complex was also evaluated. The vaccine construct was antigenic, non-toxic and non-allergic, which indicates the vaccines ability to induce antibodies in the host, making it an effective vaccine candidate. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40203-020-00062-x.

7.
PLoS One ; 15(12): e0243410, 2020.
Article in English | MEDLINE | ID: covidwho-968899

ABSTRACT

BACKGROUND: Until now, no vaccine or effective drug is available for the control, prevention, and treatment of COVID-19. Preventive measures are the only ways to be protected from the disease and knowledge of the people about the preventive measures is a vital matter. OBJECTIVES: The aim of the study was to assess the knowledge of the general people in Rajshahi district, Bangladesh regarding the COVID-19 preventive measures. METHODOLOGY: This cross sectional study was conducted from March 10 to April 25, 2020. Data were collected with a semi-structured questionnaire from 436 adult respondents selected by using a mixed sampling technique. Frequency analysis, chi-square test, and logistic regression model were utilized in this study. SPSS (IBM, Version 22) was used for data analysis. 95% confidence interval and p-value = 0.05 were accepted for statistical significance. RESULTS: Only 21.6% of the respondents had good knowledge of the COVID-19 preventive measures. The highest 67.2% of them knew that washing hands with soap could prevent the disease, but contrarily, the highest 72.5% did not know that avoidance of touching mouth, nose, and eyes without washing hands was a preventive measure. Only 28.4% and 36.9% of the respondents knew that maintaining physical distancing and avoiding mass gatherings were measures of prevention of COVID-19 respectively. The younger age (≤25 years), low family income (≤15,000 Bangladeshi Taka (BDT), occupation others than business and service, and nuclear family had the lower odds of having no/less knowledge about the preventive measures. CONCLUSIONS: The knowledge level of the general people regarding prevention of COVID-19 was alarmingly low in Bangladesh. The government of Bangladesh, health policy makers and donor agencies should consider the findings and take immediate steps for improving knowledge of the public about prevention of the disease.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , SARS-CoV-2 , Surveys and Questionnaires , Bangladesh/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Young Adult
8.
J Transl Med ; 18(1): 441, 2020 11 20.
Article in English | MEDLINE | ID: covidwho-940022

ABSTRACT

The novel coronavirus disease (COVID-19) is posing a serious challenge to the health-care systems worldwide, with an enormous impact on health conditions and loss of lives. Notably, obesity and its related comorbidities are strictly related with worse clinical outcomes of COVID-19 disease. Recently, there is a growing interest in the clinical use of ketogenic diets (KDs), particularly in the context of severe obesity with related metabolic complications. KDs have been proven effective for a rapid reduction of fat mass, preserving lean mass and providing an adequate nutritional status. In particular, the physiological increase in plasma levels of ketone bodies exerts important anti-inflammatory and immunomodulating effects, which may reveal as precious tools to prevent infection and potential adverse outcomes of COVID-19 disease. We discuss here the importance of KDs for a rapid reduction of several critical risk factors for COVID-19, such as obesity, type 2 diabetes and hypertension, based on the known effects of ketone bodies on inflammation, immunity, metabolic profile and cardiovascular function. We do believe that a rapid reduction of all modifiable risk factors, especially obesity with its metabolic complications, should be a pillar of public health policies and interventions, in view of future waves of SARS-CoV-2 infection.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/metabolism , Diet, Ketogenic , Glucose/metabolism , Ketones/metabolism , Pneumonia, Viral/metabolism , COVID-19 , Coronavirus Infections/immunology , Humans , Inflammation/pathology , Pandemics , Pneumonia, Viral/immunology , SARS-CoV-2
9.
Risk Manag Healthc Policy ; 13: 2301-2308, 2020.
Article in English | MEDLINE | ID: covidwho-904765

ABSTRACT

BACKGROUND: The novel corona virus disease 2019 (COVID-19) presents an important and urgent threat to global health and its effect is expected to get even worse in the middle- and low-income countries where the health system is weak and fragile. Timely access to accurate information and public awareness on prevention methods is one of the feasible interventions in these countries. Identifying level of public awareness on disease prevention is important to mitigate the pandemic. The aim of this study was to explore the level of awareness and prevention methods of COVID-19 among residents in Wolaita Zone, Southern Ethiopia. METHODS: A qualitative study using a qualitative descriptive approach was conducted. Community members engaged in different service sectors were selected purposively. A total of 22 in-depth interviews were done. The transcripts were imported into OpenCode version 4.02 software packages. A qualitative thematic analysis approach was used to analyze the data. RESULTS: The findings revealed that 95.5% of the participants had heard about the disease COVID-19 and realized common modes of transmission. Some participants linked the disease with resentment of God on people or anger of God towards human kind. Importance of consuming hot drinks, ginger or garlic to prevent the disease was reported by participants. Negative attitude towards quarantine and isolation centers and stigmatizing people with a cough were documented in this assessment. Stigma and fear of isolation centers may prevent people from reporting the symptom of the disease and this can create favorable ground for the transmission. Challenges like problem of consistent availability of water supply, affordability of materials used to keep hygiene by rural poor, and keeping physical distancing in different public gathering places were reported. CONCLUSION: Concerned bodies need to address gaps in public awareness by providing health education and continuous awareness creation.

10.
Adv Ther (Weinh) ; 4(2): 2000172, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-891195

ABSTRACT

The deadly pandemic, coronavirus disease 2019 (COVID-19), caused due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has paralyzed the world. Although significant methodological advances have been made in the field of viral detection/diagnosis with 251 in vitro diagnostic tests receiving emergency use approval by the US-FDA, little progress has been made in identifying curative or preventive therapies. This review discusses the current trends and potential future approaches for developing COVID-19 therapeutics, including repurposed drugs, vaccine candidates, immune-modulators, convalescent plasma therapy, and antiviral nanoparticles/nanovaccines/combinatorial nanotherapeutics to surmount the pandemic viral strain. Many potent therapeutic candidates emerging via drug-repurposing could significantly reduce the cost and duration of anti-COVID-19 drug development. Gene/protein-based vaccine candidates that could elicit both humoral and cell-based immunity would be on the frontlines to prevent the disease. Many emerging nanotechnology-based interventions will be critical in the fight against the deadly virus by facilitating early detection and enabling target oriented multidrug therapeutics. The therapeutic candidates discussed in this article include remdesivir, dexamethasone, hydroxychloroquine, favilavir, lopinavir/ritonavir, antibody therapeutics like gimsilumab and TJM2, anti-viral nanoparticles, and nanoparticle-based DNA and mRNA vaccines.

11.
Front Nutr ; 7: 583080, 2020.
Article in English | MEDLINE | ID: covidwho-878931

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease (COVID-19), is a contagion that has rapidly spread around the globe. COVID-19 has caused significant loss of life and disrupted global society at a level never before encountered. While the disease was predominantly characterized by respiratory symptoms initially, it became clear that other systems including the cardiovascular and neurological systems were also involved. Several thrombotic complications were reported including venous thrombosis, vasculitis, cardiomyopathy, and stroke. Thrombosis and inflammation are implicated in various non-communicable diseases (NCDs). This is of significant concern as people with pre-existing conditions such as cardiovascular disorders, renal disorders, obesity, metabolic syndrome, and diabetes are at greater risk of severe COVID-19 infection. Consequently, the research surrounding the use of anticoagulants, antiplatelet, and antithrombotic strategies for prophylaxis and treatment of COVID-19 is of critical importance. The adoption of a healthy diet, physical exercise, and lifestyle choices can reduce the risk factors associated with NCDs and the thrombo-inflammatory complications. In this review, these thrombotic complications and potential foods, nutraceuticals, and the antithrombotic constituents within that may prevent the onset of severe thrombotic complications as a result of infection are discussed. While nutrition is not a panacea to tackle COVID-19, it is apparent that a patient's nutritional status may affect patient outcomes. Further intensive research is warranted to reduce to incidence of thrombotic complications.

12.
AIMS Public Health ; 7(3): 650-663, 2020.
Article in English | MEDLINE | ID: covidwho-792338

ABSTRACT

COVID-19 pandemic currently affects nearly all countries and regions in the world. Washing hands, together with other preventive measures, to be considered one of the most important measures to prevent the disease. This study aimed to characterize reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors. Kobo Toolbox platform was used to design the online survey. There were 837 people participating in this survey. All independent variables were described by calculating frequencies and percentages. Univariate linear regression was used with a significant level of 0.05. Multiple linear regression was conducted to provide a theoretical model with collected predictors. Seventy-nine percent of the respondents used soap as the primary choice when washing their hands. Sixty percent of the participants washed their hands at all essential times, however, only 26.3% practiced washing their hands correctly, and only 28.4% washed their hands for at least 20 seconds. Although 92.1% washed hands after contacting with surfaces at public places (e.g., lifts, knob doors), only 66.3% practiced handwashing after removing masks. Females had better reported handwashing practices than male participants (OR = 1.88; 95% CI: 1.15-3.09). Better knowledge of handwashing contributed to improving reported handwashing practice (OR = 1.30; 95% CI: 1.20-1.41). Poorer handwashing practices were likely due, at least in part, to the COVID-19 pandemic information on the internet, social media, newspapers, and television. Although the number of people reported practicing their handwashing was rather high, only a quarter of them had corrected reported handwashing practices. Communication strategy on handwashing should emphasize on the minimum time required for handwashing as well as the six handwashing steps.

13.
Int Angiol ; 39(6): 445-451, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-745642

ABSTRACT

The SARS-CoV-2 infection (COVID-19) is causing an ongoing pandemic and potentially fatal disease. Development of coagulopathy with thrombotic complications such as deep vein thrombosis and pulmonary embolism are emerging as factors for progression to severe disease and death. Also, a markedly increased level of D-dimer, a protein product of fibrin degradation, has been associated to mortality. Furthermore, activation of immune response due to virus infection may led to uncontrolled severe inflammation with damage to host cells and induction of endotheliitis and cellular apoptosis and pyroptosis. The use of low molecular weight heparin in early stage of the disease could prevent vascular complications and reduce the progression to severe stage of the disease. Aim of this paper was to summarize current evidence about vascular involvement in COVID-19 disease and potential antithrombotic therapy.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/epidemiology , Cardiology , Consensus , Pandemics , Societies, Medical , Thrombosis/etiology , COVID-19/complications , COVID-19/drug therapy , Humans , SARS-CoV-2 , Thrombosis/blood , Thrombosis/prevention & control
14.
Front Med (Lausanne) ; 7: 372, 2020.
Article in English | MEDLINE | ID: covidwho-697537

ABSTRACT

The severe respiratory distress syndrome linked to the new coronavirus disease (COVID-19) includes unbearable dyspneic suffering which contributes to the deterioration of the prognosis of patients in intensive care unit (ICU). Patients are put on mechanical ventilation to reduce respiratory suffering and preserve life. Despite this mechanical ventilation, most patients continue to suffer from dyspnea. Dyspnea is a major source of suffering in intensive care and one of the main factors that affect the prognosis of patients. The development of innovative methods for its management, especially non-drug management is more than necessary. In recent years, numerous studies have shown that transcranial direct current stimulation (tDCS) could modulate the perception of acute or chronic pain. In the other hand, it has been shown that the brain zones activated during pain and dyspnea are close and/or superimposed, suggesting that brain structures involved in the integration of aversive emotional component are shared by these two complex sensory experiences. Therefore, it can be hypothesized that stimulation by tDCS with regard to the areas which, in the case of pain have activated one or more of these brain structures, may also have an effect on dyspnea. In addition, our team recently demonstrated that the application of tDCS on the primary cortical motor area can modulate the excitability of the respiratory neurological pathways. Indeed, tDCS in anodal or cathodal modality reduced the excitability of the diaphragmatic cortico-spinal pathways in healthy subjects. We therefore hypothesized that tDCS could relieve dyspnea in COVID-19 patients under mechanical ventilation in ICU. This study was designed to evaluate effects of two modalities of tDCS (anodal and cathodal) vs. placebo, on the relief of dyspnea in COVID-19 patients requiring mechanical ventilation in ICU. Trial Registration: This protocol is derived from the tDCS-DYSP-REA project registered on ClinicalTrials.gov NCT03640455. It will however be registered under its own NCT number.

15.
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e14-e25, 2020 06 27.
Article in English | MEDLINE | ID: covidwho-638400

ABSTRACT

COVID-19 disease is the most recent pandemic, since it has affected more than four and a half million people and caused more than 300,000 deaths. It is a very complex systemic disease in terms of pathogenesis, treatment, and prognosis. Pharmacological treatment may include antiviral and antimalarial drugs, antibiotics, monoclonal antibodies, corticosteroids as well as low-molecular-weight heparins to prevent the evolution of the disease from reaching the severe inflammatory phase that can lead to respiratory complications, multiple organ failure, disseminated intravascular coagulation (DIC), and finally death. Therefore, pending the development of the much sought-after vaccine, there needs to be a multidisciplinary approach to tackling this disease, and it is essential to use different medical treatments at the correct pathogenic moment. The aim of this article is to evaluate the rationale and reason behind the use of antirheumatic drugs, by expert point of view, in the various phases of the disease. Another important aspect in the management of the disease is to identify patients at high risk, both to change their lifestyle and to correct the state of their health through non-pharmacological measures for improving their immuno-balance. Our literature review reveals the important role and the therapeutic potential of antirheumatic agents in preventing the progression of the disease and aiding recovery from the disease. However, there is a lack of clinical evidence to support the use of these agents, indicating that further randomized controlled studies are required.


Subject(s)
Antirheumatic Agents/therapeutic use , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Antibodies, Monoclonal/therapeutic use , Antimalarials/therapeutic use , COVID-19 , Coronavirus Infections/pathology , Humans , Pandemics , Pneumonia, Viral/pathology
16.
Int J Antimicrob Agents ; 56(2): 105974, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-637982

ABSTRACT

Here we report a case of a laboratory-confirmed 2019 novel coronavirus (2019-nCoV)-infected patient with COVID-19 (coronavirus disease 2019) who developed respiratory failure and shock accompanied by persistent diarrhoea despite conventional therapeutic interventions. The patient avoided mechanical ventilation and showed an immediate clinical and radiological improvement following treatment with intensive plasma exchange (PE) followed by intravenous immunoglobulin (IVIG). Successful therapeutic strategies in this case suggest that timely initiation of PE treatment followed by IVIG in critically ill patients with COVID-19 may prevent the disease from worsening and help to reduce the requirement for mechanical ventilation and intensive supportive care. Moreover, it may improve poor clinical outcomes of these patients.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/therapy , Critical Illness/therapy , Immunoglobulins, Intravenous/administration & dosage , Plasma Exchange , Pneumonia, Viral/therapy , COVID-19 , Coronavirus Infections/virology , Critical Care , Humans , Pandemics , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome
17.
Allergy ; 75(7): 1564-1581, 2020 07.
Article in English | MEDLINE | ID: covidwho-245787

ABSTRACT

As a zoonotic disease that has already spread globally to several million human beings and possibly to domestic and wild animals, eradication of coronavirus disease 2019 (COVID-19) appears practically impossible. There is a pressing need to improve our understanding of the immunology of this disease to contain the pandemic by developing vaccines and medicines for the prevention and treatment of patients. In this review, we aim to improve our understanding on the immune response and immunopathological changes in patients linked to deteriorating clinical conditions such as cytokine storm, acute respiratory distress syndrome, autopsy findings and changes in acute-phase reactants, and serum biochemistry in COVID-19. Similar to many other viral infections, asymptomatic disease is present in a significant but currently unknown fraction of the affected individuals. In the majority of the patients, a 1-week, self-limiting viral respiratory disease typically occurs, which ends with the development of neutralizing antiviral T cell and antibody immunity. The IgM-, IgA-, and IgG-type virus-specific antibodies levels are important measurements to predict population immunity against this disease and whether cross-reactivity with other coronaviruses is taking place. High viral load during the first infection and repeated exposure to virus especially in healthcare workers can be an important factor for severity of disease. It should be noted that many aspects of severe patients are unique to COVID-19 and are rarely observed in other respiratory viral infections, such as severe lymphopenia and eosinopenia, extensive pneumonia and lung tissue damage, a cytokine storm leading to acute respiratory distress syndrome, and multiorgan failure. Lymphopenia causes a defect in antiviral and immune regulatory immunity. At the same time, a cytokine storm starts with extensive activation of cytokine-secreting cells with innate and adaptive immune mechanisms both of which contribute to a poor prognosis. Elevated levels of acute-phase reactants and lymphopenia are early predictors of high disease severity. Prevention of development to severe disease, cytokine storm, acute respiratory distress syndrome, and novel approaches to prevent their development will be main routes for future research areas. As we learn to live amidst the virus, understanding the immunology of the disease can assist in containing the pandemic and in developing vaccines and medicines to prevent and treat individual patients.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Immunity, Innate , Pneumonia, Viral/immunology , Animals , Antibodies, Viral/immunology , Betacoronavirus/chemistry , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/virology , Cytokines/immunology , Eosinophils/immunology , Epitopes, B-Lymphocyte/immunology , Epitopes, T-Lymphocyte/immunology , Humans , Lymphocytes/immunology , Lymphopenia , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/virology , SARS-CoV-2 , Zoonoses/immunology , Zoonoses/virology
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