RESUMO
IMPORTANCE: Since the beginning of the COVID-19 pandemic, numerous metabolic alterations have been observed in individuals with this disease. It is known that SARS-CoV-2 can mimic the action of hepcidin, altering intracellular iron metabolism, but gaps remain in the understanding of possible outcomes in other pathways involved in the iron cycle. OBJECTIVE: To profile iron, ferritin and hepcidin levels and transferrin receptor gene expression in patients diagnosed with COVID-19 between June 2020 and September 2020. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study that evaluated iron metabolism markers in 427 participants, 218 with COVID-19 and 209 without the disease. EXPOSURES: The primary exposure was positive diagnose to COVID-19 in general population of Santo André and São Bernardo cities. The positive and negative diagnose were determinate through RT-qPCR. MAIN OUTCOMES AND MEASURES: Devido a evidências de alterações do ciclo do ferro em pacientes diagnosticados com COVID-19 e devido a corregulação entre hepcidina e receptor de transferrina, uma análise da expressão gênica deste último, poderia trazer insights sobre o estado de ferro celular. A hipótese foi confirmada, mostrando aumento da expressão de receptor de transferrina concomitante com redução do nível de hepcidina circulante. RESULTS: Serum iron presented lower values in individuals diagnosed with COVID-19, whereas serum ferritin presented much higher values in infected patients. Elderly subjects had lower serum iron levels and higher ferritin levels, and men with COVID-19 had higher ferritin values than women. Serum hepcidin was lower in the COVID-19 patient group and transferrin receptor gene expression was higher in the infected patient group compared to controls. CONCLUSIONS AND RELEVANCE: COVID-19 causes changes in several iron cycle pathways, with iron and ferritin levels being markers that reflect the state and evolution of infection, as well as the prognosis of the disease. The increased expression of the transferrin receptor gene suggests increased iron internalization and the mimicry of hepcidin action by SARS-CoV-2, reduces iron export via ferroportin, which would explain the low circulating levels of iron by intracellular trapping.
Assuntos
COVID-19 , Transferrina , Masculino , Humanos , Feminino , Idoso , Transferrina/análise , Hepcidinas , Estudos Transversais , Pandemias , SARS-CoV-2 , Ferro/metabolismo , Ferritinas , Receptores da Transferrina , HomeostaseRESUMO
A doença causada pelo novo coronavírus (COVID-19) teve início em dezembro de 2019 na China e rapidamente adquiriu grande importância epidemiológica, com um crescente número de casos e mortes no Brasil e no mundo. Entre os diversos estudos sobre a doença causada pelo SARS-CoV-2, foram relatados casos de crianças infectadas que apresentaram inflamação multissistêmica, mimetizando a doença de Kawasaki, o que instigou a possibilidade de uma associação entre esta e a COVID-19. O presente artigo de revisão visa destacar esta nova possibilidade diagnóstica, discutindo principalmente os sintomas, exames laboratoriais e a epidemiologia que podem diferenciar a síndrome inflamatória multissistêmica em crianças (MIS-C) como decorrente da COVID- 19 ou desencadeante da doença de Kawasaki. O banco de dados eletrônico PubMed foi utilizado para a pesquisa de artigos originais e de revisão de 2020 e 2021, selecionados de acordo com critérios de atualidade e menção a descritores científicos como infecções por coronavírus, síndrome de linfonodos mucocutâneos e inflamação. A revisão dos sintomas da MIS-C e achados de exames laboratoriais relacionados à COVID-19 foi feita por meio de artigos com estudos realizados com mais de 10 pacientes. Entre os principais resultados obtidos tem-se a diferença entre a faixa etária e etnia acometidas, presença de sintomas gastrointestinais, mecanismos de lesão cardíaca envolvidos e alterações de exames laboratoriais na doença de Kawasaki e na MIS-C. Assim, a conclusão é que a MIS-C está relacionada à infecção prévia pelo SARS-CoV-2, compartilhando dos sintomas da doença de Kawasaki, sem atuar como um desencadeante desta doença.
Coronavirus disease 2019 (COVID-19) arose in December 2019 in China and quickly assumed great epidemiological importance, with an increasing number of cases and deaths in Brazil and worldwide. Among the several studies on this disease, cases of children infected with SARS-CoV-2 who had multisystem inflammation, mimicking Kawasaki disease, were reported, which raised the possibility of an association between Kawasaki disease and COVID-19. This review article aims to highlight this new diagnostic possibility and mainly discusses the symptoms, laboratory tests, and epidemiology that may differentiate multisystem inflammatory syndrome in children (MIS-C) as a result of COVID-19 or as a Kawasaki disease trigger. Original and review articles from 2020 and 2021 that were current and mentioned keywords such as coronavirus infections, mucocutaneous lymph node syndrome, and inflammation were selected from the electronic database PubMed. The review of MIS-C symptoms and laboratory findings related to COVID-19 was based on articles of studies that included more than 10 patients. The main results obtained were differences between the affected age group and ethnicity, presence of gastrointestinal tract symptoms, different mechanisms of cardiac injury involved, and changes in laboratory tests in Kawasaki disease and MIS-C. In conclusion, MIS-C is related to previous SARS-CoV-2 infection and leads to the same symptoms of Kawasaki disease, without acting as a trigger for this disease.