Neonatal Multi-System Inflammatory Syndrome Associated With Covid-19 Exposure in Two Cases From Iran

Introduction:Immune dysregulation following exposure to Covid-19 results in MIS-N (Multi-system Inflammatory Syndrome in Neonates). MIS-N affects various systems in the body and is diagnosed with a positive history of PCR test, positive serologic test, and a history of contact with those vectors of COVID-19 infection. This case series aimed to differentiate from possible misdiagnosis about MIS-N.Case Presentation:Both cases are term neonates with positive serology of COVID -19 and the 2nd case with a mother's positive history of Covid-19 PCR at 30 weeks of pregnancy. The first case was admitted with diarrhea, dehydration, fever for three days, and rash on the 3rd day of hospitalization. We admitted the 2nd case on the 22nd day of birth with a cough, rashes on the head, palms, and soles for two days. Both cases responded to corticosteroid treatment that confirmed MIS-N. Finally, we discharged them with a stable and normal condition in follow-ups.Conclusions:In inflammatory syndromes, especially in delayed phases of COVID cytokine storms, the mortality and morbidity caused by infections diminish with proper interventions and inhibited cytokine cascade inflammations.

Patient Nutrition and Probiotic Therapy in COVID-19: What Do We Know in 2021?

Background: The main nutritional consequences of COVID-19 include reduced food intake, hypercatabolism, and rapid muscle wasting. Some studies showed that malnutrition is a significant problem among patients hospitalized due to COVID-19 infection, and the outcome of patients with SARS-CoV-2 is strongly associated with their nutritional status. The purpose of this study was to collect useful information about the possible elements of nutritional and probiotic therapy in patients infected with the SARS-CoV-2 virus. Methods: A narrative review of the literature, including studies published up to 13 September 2021. Results: Probiotics may support patients by inhibiting the ACE2 receptor, i.e., the passage of the virus into the cell, and may also be effective in suppressing the immune response caused by the proinflammatory cytokine cascade. In patients’ diet, it is crucial to ensure an adequate intake of micronutrients, such as omega-3 fatty acids (at 2–4 g/d), selenium (300–450 μg/d) and zinc (30–50 mg/d), and vitamins A (900–700 µg/d), E (135 mg/d), D (20,000–50,000 IU), C (1–2 g/d), B6, and B12. Moreover, the daily calorie intake should amount to ≥1500–2000 with 75–100 g of protein. Conclusion: In conclusion, the treatment of gut dysbiosis involving an adequate intake of prebiotic dietary fiber and probiotics could turn out to be an immensely helpful instrument for immunomodulation, both in COVID-19 patients and prophylactically in individuals with no history of infection.

Early use of cytokine adsorption in treatment of COVID-19 associated respiratory distress syndrome

Introduction. It is the recommendations for treatment of sepsis and septic shock combined with rheumatologists’ recommendations for monoclonal antibodies therapy that guide severe COVID-19 management in ICU. However, those recommendations may not be fully applied to patients with acute respiratory distress-syndrome associated with SARS-CoV-2, as there exists a difference in pathogenesis between sepsis and virus-associated pneumonias. Monoclonal antibodies therapy may contribute to cytokine cascade severity and promote lung injury. Cytokine storm aggravates the course of the disease. At present, there are two groups of methods described in literature for cytokine storm control and therapy: pharmacological and extracorporeal approaches.Materials and methods. We have performed a retrospective analysis of five COVID-19 patients with acute respiratory syndrome. Cytokine adsorption start criteria were respiratory insufficiency and IL-6 levels greater than 500 pg/ml. Adsorption therapy was initiated within 24 hours of ICU admission and continued for 48–120 hours in hemoperfusion mode on Multifiltrate machine (Fresenius Medical Care). The length of a single session of CytoSorb (Cytosorbents Inc.) therapy was 24 hours.Results. All patients demonstrated SpO2/FiO2 ratio growth and IL-6 concentration decrease by the end of hemoadsorption. We noted lymphocyte count rise as well as IgM и IgG SARS-CoV-2 antibodies titer substantial increase.Conclusions. Our observations suggest that the early start of hemoadsorption associates with gas-exchange stabilization and hinders respiratory distress progression. Hemoadsorption allows for pro-inflammatory cytokines concentrations decrease and prevents secondary lung injury. According to our data, hemoadsorption is beneficial to form a coronavirus infection specific immune response. Further research is needed for a detailed study of the results we here describe.

The Role of Th17 Response in COVID-19

COVID-19 is an acute infectious disease of the respiratory system caused by infection with the SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus 2). Transmission of SARS-CoV-2 infections occurs through droplets and contaminated objects. A rapid and well-coordinated immune system response is the first line of defense in a viral infection. However, a disturbed and over-activated immune response may be counterproductive, causing damage to the body. Severely ill patients hospitalised with COVID-19 exhibit increased levels of many cytokines, including Interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, IL-10, IL-17, granulocyte colony stimulating factor (G-CSF), monocyte chemoattractant protein 1 (MCP-1) and tumor necrosis factor (TNF). Increasing evidence suggests that Th17 cells play an important role in the pathogenesis of COVID-19, not only by activating cytokine cascade but also by inducing Th2 responses, inhibiting Th1 differentiation and suppressing Treg cells. This review focuses on a Th17 pathway in the course of the immune response in COVID-19, and explores plausible targets for therapeutic intervention.

Glycosylation is a key in SARS-CoV-2 infection

SARS-CoV-2 causes the respiratory syndrome COVID-19 and is responsible for the current pandemic. The S protein of SARS-CoV-2-mediating virus binding to target cells and subsequent viral uptake is extensively glycosylated. Here we focus on how glycosylation of both SARS-CoV-2 and target cells crucially impacts SARS-CoV-2 infection at different levels: (1) virus binding and entry to host cells, with glycosaminoglycans of host cells acting as a necessary co-factor for SARS-CoV-2 infection by interacting with the receptor-binding domain of the SARS-CoV-2 spike glycoprotein, (2) innate and adaptive immune response where glycosylation plays both a protective role and contributes to immune evasion by masking of viral polypeptide epitopes and may add to the cytokine cascade via non-fucosylated IgG, and (3) therapy and vaccination where a monoclonal antibody-neutralizing SARS-CoV-2 was shown to interact also with a distinct glycan epitope on the SARS-CoV-2 spike protein. These evidences highlight the importance of ensuring that glycans are considered when tackling this disease, particularly in the development of vaccines, therapeutic strategies and serological testing.

To kill two birds with a stone

Novel Corona virus 2019, its infectivity and pandemic around the world has earnestly garnered much panic, especially, with its new strain spreading across the UK and possibly its spread across borders. This has increased anxiety and stress levels to many folds mainly due to its robustness and resistance to treatment (1). The panic and paranoia of testing COVID-19 positive, restraining into isolation and being shunned by the society often lead to a vicious cycle of heightened stress, anxiety and depression levels in individuals that at times lead to the ugly consequences of COVID-19 rendering end stage in affected with admissions in the intensive care or even death upon arriving hospitals. China, the first ever country in world to announce COVID-19 infection, has successfully controlled and contained the infection (2). There the new cases are negligible and has shown its capacity of treatment of COVID-19 through utility of medicinal herbs and old traditional remedies that are long ago forgotten by the other nations. The commonest treatment modality against COVID-19 in China, Thailand and other Buddhist countries are through mere inhaling of steam and intake of herbal teas (3). Many studies have shown that any form of tea especially chamomile tea is beneficial in the treatment of COVID 19. We have also currently run a clinical trial at the Aga Khan University where chamomile and saffron tea was given in twice a day dose for a month to the depressed patients to treat their depression. To our pleasant surprise many participants of the trial knew that chamomile is also effective against viral infections. Our research has shown that saffron and chamomile in combination at reduced doses has synergistic antioxidant and anti-inflammatory and neuroprotective effects through modulation of neurotransmitters in brain (4,5). It is suggested that this synergism may benefit individuals against cytokine cascade, oxidant activity and inflammatory effects of the COVID 19 as well as alleviate neuropsychological deficits like anxiety, stress and depression that are associated with the fear of catching this communicable infection. This herbal tea may indeed help to kill two birds COVID-19 and neuropsychological illness with a stone. Continuous...

A Stochastic Petri Net-Based Model of the Involvement of Interleukin 18 in Atherosclerosis

Interleukin 18 (IL-18) is a proinflammatory and proatherogenic cytokine with pleiotropic properties, which is involved in T and NK cell maturation and the synthesis of other inflammatory cytokines and cell adhesion molecules. It plays a significant role in orchestrating the cytokine cascade, accelerates atherosclerosis and influences plaque vulnerability. To investigate the influence of IL-18 cytokine on atherosclerosis development, a stochastic Petri net model was built and then analyzed. First, MCT-sets and t-clusters were generated, then knockout and simulation-based analysis was conducted. The application of systems approach that was used in this research enabled an in-depth analysis of the studied phenomenon. Our results gave us better insight into the studied phenomenon and allow revealing that activation of macrophages by the classical pathway and IL-18-MyD88 signaling axis is crucial for the modeled process.