Evaluation of a Functional Single Nucleotide Polymorphism of the SARS-CoV-2 Receptor ACE2 That Is Potentially Involved in Long COVID.

Since the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, SARS-CoV-2 has led to a global coronavirus disease 2019 (COVID-19) pandemic. A better understanding of the SARS-CoV-2 receptor ACE2 at the genetic level would help combat COVID-19, particularly for long COVID. We performed a genetic analysis of ACE2 and searched for its common potential single nucleotide polymorphisms (SNPs) with minor allele frequency >0.05 in both European and Chinese populations that would contribute to ACE2 gene expression variation. We thought that the variation of the ACE2 expression would be an important biological feature that would strongly affect COVID-19 symptoms, such as "brain fog", which is highlighted by the fact that ACE2 acts as a major cellular receptor for SARS-CoV-2 attachment and is highly expressed in brain tissues. Based on the human GTEx gene expression database, we found rs2106809 exhibited a significant correlation with the ACE2 expression among multiple brain and artery tissues. This expression correlation was replicated in an independent European brain eQTL database, Braineac. rs2106809*G also displays significantly higher frequency in Asian populations than in Europeans and displays a protective effect (p = 0.047) against COVID-19 hospitalization when comparing hospitalized COVID-19 cases with non-hospitalized COVID-19 or SARS-CoV-2 test-negative samples with European ancestry from the UK Biobank. Furthermore, we experimentally demonstrated that rs2106809*G could upregulate the transcriptional activity of ACE2. Therefore, integrative analysis and functional experiment strongly support that ACE2 SNP rs2106809 is a functional brain eQTL and its potential involvement in long COVID, which warrants further investigation.

Genetic screening for hypertension and COVID-19 reveals functional variation of SPEG potentially associated with severe COVID-19 in women.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to more than 6.4 million deaths worldwide. The prevalent comorbidity between hypertension and severe COVID-19 suggests common genetic factors may affect the outcome of both diseases. As both hypertension and severe COVID-19 demonstrate sex-biased prevalence, common genetic factors between the two diseases may display sex-biased differential associations. By evaluating COVID-19 association signals of 172-candidate hypertension single nucleotide polymorphisms (SNPs) derived from more than 1 million European individuals in two sex-stratified severe COVID-19 genome-wide association studies from UK BioBank with European ancestry, we revealed one functional cis expression quantitative trait locus of SPEG (rs12474050) showing sex-biased association with severe COVID-19 in women. The risk allele rs12474050*T associates with higher blood pressure. In our study, we found it is significantly correlated with lower SPEG expression in muscle-skeletal but with higher expression in both brain cerebellum and cerebellar hemisphere. Additionally, nominal significances were detected for the association between rs12474050*T and lower SPEG expression in both heart left ventricle and atrial appendage; among these tissues, the SPEG expression is nominally significantly higher in females than in males. Further analysis revealed SPEG is mainly expressed in cardiomyocytes in heart and is upregulated upon SARS-CoV-2 infection, with significantly higher upregulation of SPEG only observed in female but not in male COVID-19 patients compared to both normal female and male individuals, suggesting upregulation of SPEG is a female-specific protective mechanism against COVID-19 induced heart damage. Taken together, our analyses suggest the involvement of SPEG in both hypertension and severe COVID-19 in women, which provides new insights for sex-biased effect of severe COVID-19 in women.

Effects of high temperature and high humidity stress on the negative feedback regulation of hippocampus on HPA axis in rats.

OBJECTIVE: To investigate the negative feedback regulation from rat hippocampus on hypothalamic-pituitary-adrenal (HPA) axis under high temperature and high humidity stress. METHODS: Thirty (30) SD male rats were randomly divided into three groups: control group, high temperature and high humidity group, drug intervention group. The rats in control group were kept in the environment with temperature of 24 ± 1°C and humidity of 50 ± 5%, without any stimulation. The rats in the other groups were exposed to high temperature and high humidity environment for 4 h each day, with temperature of 35±1 °C and humidity of 85±5%. The rats in drug intervention group were intragastrically administered with the glucocorticoid receptor antagonist mifepristone. The administration was continued for 3 weeks. After 3 weeks, the serum levels of corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and corticosterone (CORT) were detected by ELISA.The protein and mRNA levels of corticosteroid receptors (MR), glucocorticoid receptors (GR) and inducible nitric oxide synthase (iNOS), transient receptor potential vanilloid 1 (TRPV1) and 11ß-hydroxysteroid dehydrogenase 1 (11ß-HSD1) in hippocampus were determined by immunohistochemistry and in situ hybridization, respectively. The apoptosis of hippocampal cells was examined with TUNEL apoptosis staining. RESULTS: After stimulation with high temperature and high humidity stress for 3 weeks, the serum levels of CRH, ACTH and CORT in the high temperature and high humidity group were significantly increased compared to that of control group; the levels of these indicators in drug intervention group were decreased compared to that of high temperature and high humidity group (P<0.05). In high temperature and high humidity group, the protein and mRNA levels of MR, GR, iNOS in hippocampus of rats were significantly increased compared with that of control group (p<0.05); and the levels of these indicators in drug intervention group were lower than that of high temperature and high humidity group (p<0.05). In addition, compared with the control group, the TRPV1 protein level in hippocampus of rats in high temperature and high humidity group was not significantly changed (p>0.05), while the TRPV1 mRNA level was significantly increased (p<0.05). Neither the protein nor mRNA levels of 11ß-HSD1 showed significant difference compared to control group (p>0.05). The apoptosis of hippocampus cells in the high temperature and high humidity group was significantly increased compared with that of control group (p<0.05); and it was lower in the drug intervention group than that of in high temperature and high humidity group while the result was not significant (p>0.05). CONCLUSION: High temperature and high humidity stress may up-regulate the local expression of iNOS in hippocampus and decrease the activity of glucocorticoids (GC) receptor, then the effective binding of GR-GC would be decreased and the negative feedback regulation of hippocampus on HPA axis would be inhibited. The glucocorticoid receptor antagonist can improve the negative feedback regulation of hippocampus on HPA axis in rat.

Effect of Artemisia annua extract on treating active rheumatoid arthritis: A randomized controlled trial.

OBJECTIVE: To investigate the effect and safety of the complementary use of the extract of Artemisia annua L. (EAA) on treating active rheumatoid arthritis (RA). METHODS: A randomized controlled clinical trial was performed. All the 159 participates with active RA were randomly assigned to the control group (80 cases) and EAA group (79 cases) using concealed random allocation method. In the control group, patients were medicated with leflflunomide and methotrexate for 48 weeks; and patients in the EAA group were administrated with leflflunomide, methotrexate plus EAA (30 g/d). At the time points of 0, 12, 24 and 48 weeks, the clinical outcome measures, including objective pain score, tenderness score, number of painful joints, number of swollen joints, health assessment questionnaire (HAQ) score for quality of life, levels of serum rheumatoid factor (RF), anti-cyclic citrullinated protein antibodies (CCP-Ab), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue score for pain (VAS), and the overall effificacy were detected and recorded. RESULTS: The objective pain score, number of painful joints and ESR at 12 weeks, tenderness score and HAQ at 24 weeks, and the tenderness score, number of painfull joints, number of swollen joints, HAQ, CRP, RF and CCP-Ab at 48 weeks were signifificantly improved in the EAA group compared with the control group (P<0.01 or P<0.05). At 24 and 48 weeks, the overall effificacy of the EAA group was signifificantly higher than the control group (P<0.01). There were signifificantly higher withdrawal rate of corticosteroids within 12 weeks post-treatment and lower incidence rate of adverse effects in the EAA group compared with the control group (P<0.01 or P<0.05). CONCLUSION: EAA plus methotrexate and leflflunomide were more effective and safer than the routine use of methotrexate and leflflunomide in the treatment of active RA.

[Correlation study between interleukin-17 and ESR and CRP in serum and the synovial fluid of rheumatoid arthritis patients of accumulated dampness-heat obstruction in joints syndrome].

OBJECTIVE: To probe the function of interleukin-17 (IL-17) in rheumatoid arthritis (RA) patients of accumulated dampness-heat obstruction in joints syndrome (ADOJS) by detecting levels of IL-17 in serum and the synovial fluid and analyzing its correlation with erythrocyte sedimentation rate (ESR) and C reactive protein (CRP). METHODS: From January 2011 to January 2013, recruited were 90 RA inpatients of ADOJS at Department of Integrative Medical Rheumatism, General Hospital of Chengdu Military Region, of which 28 patients had knee joint effusion. Besides, 30 healthy volunteers who received physical examination at our hospital were recruited as the normal control group, and 30 patients with osteoarthritis (OA) who had knee joint effusion were recruited as the synovial fluid control group. The expression levels of IL-17 in serum and the synovial fluid were detected by enzyme linked immunosorbent assay (ELISA), and contents of ESR and CRP were detected in RA patients. Then correlation analyses were performed between levels of IL-17 and contents of ESR and CRP. RESULTS: Compared with the normal serum control group, the expression levels of IL-17 in serum of RA patients significantly increased (P < 0.05). Compared with the serum of RA patients and the synovial fluid of OA patients, the expression levels of IL-17 in the synovial fluid of RA patients significantly increased (P < 0.05). The expression levels of IL-17 in serum of RA patients were not correlated with ESR or CRP (r = 0.092, -0.082; P > 0.05), and the expressional levels of IL-17 in the synovial fluid of RA patients were not correlated with ESR or CRP (r = 0.113, -0.034; P > 0.05). CONCLUSIONS: IL-17 was the main effector cytokine of Th17 cells. The expressional levels of IL-17 significantly increased in serum and the synovial fluid of RA patients of ADOJS, but with no correlation to ESR or CRP. It indicated that IL-17 participated in the occurrence and development of RA. Concrete mechanisms needed to be further proved in larger samples.

[Treatment of active rheumatoid arthritis by sanhuang yilong decoction].

OBJECTIVE: To observe the clinical effect of Sanhuang Yilong Decoction (SYD) in treating active rheumatoid arthritis (RA). METHODS: Ninety patients of active RA were equally assigned to the treated group and the control group, they were treated by SYD and non-steroid anti-inflammatory drugs respectively. The effects on both clinical and laboratory indexes of patients were observed and compared. RESULTS: The improvement of clinical and laboratory indexes in the treated group was superior and initiated earlier, as compared with those in the control group, and the total effective rate after 2-week, 4-week and 8-week medication was 49.76%, 80.98% and 85.27% respectively, all were better than those in the control group (all P < 0.05). CONCLUSION: SYD is a scientifically prescribed recipe. As used in treating active RA, it displays an initiating time shorter than non-steroid drugs, and could abate the inflammation of joint synovial membrane and adjust the immunity of patients better, so as to enhance the total effectiveness.