Aviptadil: Class Effect of a Synthetic Vasoactive Intestinal Peptide as a Treatment Option in Patients with COVID-19 with Severe Respiratory Failure

Despite dynamic drug and vaccine development processes to reduce the disease burden of COVID-19, the treatment options are still very limited. Vasoactive intestinal peptide (VIP) has a diversified physiological action with specific features of lung protection-related activities. VIP inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gene replication in human monocytes and the viral replication in Calu-3 cells, thus further reducing the generation of proinflammatory mediators. Aviptadil, a synthetic form of VIP, is the only pulmonary therapeutic agent to have been granted ‘fast track’ status by the U.S. Food and Drug Administration (FDA) and to be allowed into both Phase II and III clinical trials. Initial binding of Aviptadil with non-structural protein (nsp) 10 and nsp16, which may inhibit the 2’-O-methyltransferase activity of the SARS-CoV-2 nsp10 and nsp16 complex. Aviptadil has already proved to be an effective option in the treatment of severe respiratory failures due to sepsis and other related lung injuries. Interim analysis results of this drug used in respiratory failure caused by SARS-CoV-2 has evolved a new hope in regard to safety and efficacy. The final results from a recently completed trial, as well as all currently ongoing trials, will clarify the class effect of this drug in the treatment of COVID-19 in future days.

Chest CT findings and experience in 100 COVID19 patients in Mosul city, Iraq

Introduction: Due to lack of PCR kits in our area, as well as the extensive dissemination and peaking of COVID-19 since March 2020, our knowledge as radiologists has become increasingly relevant for recognizing CT patterns in order to diagnose and isolate COVID-19-infected patients. In 100 instances, the investigation began with the most prevalent CT chest abnormalities and the CT severity score index in relation to sex. The goal of this study is to better diagnose COVID-19-related lung injuries, enhance the diagnostic accuracy of chest CT scans, and track disease development in Mosul City. Materials and Methods: From June 2020 to January 2021, one hundred patients were enrolled in this cross-sectional study in Mosul, with 71 males (71%) and 29 females (29%) ranging in age from 15 to 85 years, mean SD (53.2317.80). Non contrast chest CT were done as part of investigation tool on patients were suspected COVID-19 infection. Results: A radiologist gathered data between 4 and 10 days after the onset of symptoms and evaluated it for lesion pattern, location, and severity. The commonest CT changes (ground glass opacity 55.23%, consolidation 17.44%, broncho vascular thickening 9.88%, crazy paving 5.81% and tree in bud 5.23%) were seen, along with less common pattern (bronchiectasis 1.74%, nodules 2.33%, reversed halo sign and pleural effusion 1.17%), and no lymphadenopathy were seen. Multilobe involvement was detected in 52/100 instances (68.92%), while peripheral affection was seen in 52/100 cases (65%). The higher CT severity score 4 and 5 with male gender were found to have a significant link (P value 0.002). Conclusion: CT pulmonary are useful as a physician's helper for management and as an excellent predictor of disease severity and patient outcome. In patients with COVID-19 positive infection, the CT scan severity score is highly linked to laboratory findings, hospital stay, and oxygen demands.

Computed tomography with 6-year follow-up demonstrates the evolution of HTLV-1 related lung injuries: A cohort study

Previous observational studies have demonstrated the development of pulmonary impairments in human T-lymphotropic virus type 1 (HTLV-1) infected individuals. The main observed lesions due to chronic inflammation of viral infection in situ are bronchiectasis and lung-scarring injuries. This lung inflammation may be the causal agent of restrictive and obstructive lung diseases, primarily in tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP-HAM) patients. We conducted a prospective cohort study to compare spirometry and high-resolution computed tomography (HRCT) findings among 28 HTLV-1-carrier patients over the course of 6 years (2014–2019) (male/female: 7/21; mean age: 54.7 ± 9.5, range: 41–68 years). Chest HRCT exams revealed the development and evolution of lung lesions related to TSP-HAM: including centrilobular nodules, parenchymal bands, lung cysts, bronchiectasis, ground-glass opacity, mosaic attenuation, and pleural thickening. Spirometry exams showed maintenance of respiratory function, with few alterations in parameters suggestive of obstructive and restrictive disorders primarily in individuals with lung lesions and TSP-HAM. The findings of the present study indicate that pulmonary disease related to HTLV-1 is a progressive disease, with development of new lung lesions, mainly in individuals with TSP-HAM. To improve clinical management of these individuals, we recommend that individuals diagnosed with PET-MAH undergo pulmonary evaluation.

The anti-inflammatory feature of glucagon-like peptide-1 and its based diabetes drugs -- Therapeutic potential exploration in lung injury

Since 2005, GLP-1 receptor (GLP-1R) agonists (GLP-1RAs) have been developed as therapeutic agents for Type 2 diabetes. GLP-1R is not only expressed in pancreatic islets but also in other organs, especially the lung. Extra-pancreatic expression of GLP-1R triggered intensive investigations on extra-pancreatic functions of GLP-1RAs, aiming to repurpose them into therapeutic agents for other disorders. Intensive studies have demonstrated promising anti-inflammatory features of GLP-1RAs. Whether those features are directly mediated by GLP-1R expressed in majority of immune cells remains controversial. Following a brief review on GLP-1 as incretin and the development of GLP-1RAs as therapeutic agents, we summarized our current understanding on anti-inflammatory features of GLP-1RAs. The main part of this review is literature discussions on GLP-1RA utilization in chronic and acute lung injuries, including studies on combined use of MSC-based therapy and the GLP-1RA liraglutide in LPS-induced acute lung injury. This is followed by a summary and perspective.

Serum HMGB1, DKK1, and ACE2 as a Function of Lung Injuries in COVID-19 Patients

There is a need for a biomarker for lung injury in COVID-19 patients. In the present study, an attempt was carried out to examine the role of Dickkopf-related protein 1 (DKK1), High-mobility group box 1 protein (HMGB1), angiotensin-converting enzyme 2 (ACE2) as a function for the lung abnormalities in CT-scan (LACTS). To perform the goals, DKK1, HMGB1, and ACE2 were measured in patients and controls using the ELISA technique. In contrast, other parameters were measured spectrophotometrically. The results showed decreased SpO2 and albumin and an increase in the serum biochemical parameters (glucose, urea, creatinine, D-dimer, ACE2, DKK1, and HMGB1) in COVID-19 patients compared with the control group. In COVID-19 patients, the percentages of the lung abnormalities in CT-scan% are 40.67±11.84. The results showed that those patients with LACTS patients are slightly older and have lower SpO2 than the patients without the LACTS group. ACE2 shows a significant correlation with SpO2 (ρ = 0.336, p<0.01) and a negative correlation with albumin (ρ = -0.197, p<0.05). Other parameters showed no significant correlation with the measured biomarkers. In conclusion, COVID-19 patients have higher ACE, DKK1, and HMGB1 indicating the involvement of the pathways of these biomarkers in the disease progression including lung injury.

Vitamin D and mental health during the Covid-19 outbreak

The relationship between hypovitaminosis D and depressive disorder is well documented in the medical literature. However, the biological mechanisms by which vitamin D can modulate psychological distress are still unclear. Containment measures can decrease individual’s exposure to the sun, significantly increasing their needs for vitamin D, a nutrient already deficient in patients with depression. Therefore, it can be inferred that by ingesting the same amount of vitamin D, depressive individuals seem to obtain a lesser amount of this nutrient from the sun's rays when compared to healthy people. We found the relationship between vitamin D and COVID-19 has been increasingly studied, mainly due to the changes that this substance can cause in the inflammatory process - especially in the release of cytokines, in SARS and in lung injuries. Despite the benefits, the existing observational studies on this exchange are not enough to definitively associate vitamin D as a protective factor for COVID-19.

Immunomodulation and Regenerative Capacity of MSCs for Long-COVID

The rapid mutation of the SARS-CoV-2 virus is now a major concern with no effective drugs and treatments. The severity of the disease is linked to the induction of a cytokine storm that promotes extensive inflammation in the lung, leading to many acute lung injuries, pulmonary edema, and eventually death. Mesenchymal stem cells (MSCs) might prove to be a treatment option as they have immunomodulation and regenerative properties. Clinical trials utilizing MSCs in treating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) have provided a basis in treating post-COVID-19 patients. In this review, we discussed the effects of MSCs as an immunomodulator to reduce the severity and death in patients with COVID-19, including the usage of MSCs as an alternative regenerative therapy in post-COVID-19 patients. This review also includes the current clinical trials in utilizing MSCs and their potential future utilization for long-COVID treatments.