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ObjectiveThis study explored the application of Yiqi Zengmian prescription as a vaccine adjuvant， aiming to provide a new scheme for the prevention and control of corona virus disease 2019（COVID-19） with traditional Chinese medicine （TCM）. By analyzing the compatibility and efficacy， this paper examines the compatibility effect of Yiqi Zengmian prescription， which is modified from the classic tonifying agent Si Junzitang， as a vaccine adjuvant. MethodUsing the Database of Ancient Classical Prescriptions， this paper analyzed the composition of Yiqi Zengmian prescription and probed into the theoretical basis for the compatibility of this prescription from the properties， medicine combination， and efficacy. Furthermore， the compatibility effect of this prescription with vaccines was analyzed. ResultAs a TCM prescription， Yiqi Zengmian prescription focuses on the lung and spleen and enhances the Qi in the two organs. The lung governs Qi movement. The body breathes fresh air through the lungs and exchanges the turbid gas in the lungs， and the gas circulates alternately in the lungs to ensure the normal breathing of the human body. The spleen governing transportation and transformation is the hub for Qi movement， and Qi is the embodiment of metabolic function. By regulating qi movement and enhancing the functions of Qi and blood， Yiqi Zengmian prescription can enhance the immunogenicity of the vaccine， which provides a theoretical basis for enhancing the immune effects of vaccines. ConclusionYiqi Zengmian prescription has the effects of replenishing Qi and invigorating spleen， regulating Qi and drying dampness， and enhancing immunity. The in-depth analysis of the TCM theory of Yiqi Zengmian prescription as a vaccine adjuvant and the results of clinical and laboratory studies suggest that Yiqi Zengmian prescription may enhance the induction of immune response after vaccination and maintain the immune memory. However， the mechanism of Yiqi Zengmian prescription in regulating the complex immune network remains to be elucidated.
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@#The rapid spread of Coronavirus Disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has had a devastating impact on public health and the global economy. Tremendous efforts had been put on urgent development of prophylactic or therapeutic drugs against SARS-CoV-2,mainly smallmolecule antiviral drugs and monoclonal antibodies,to reduce the impact and burden of COVID-19. Currently,National Medical Products Administration(NMPA)of China or Food and Drug Administration(FDA)of the United States have approved three small-molecule drugs and three monoclonal antibodies for use. This paper reviews the clinical research progress and challenges of the main drugs against SARS-CoV-2 on the market at present.
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@#Objective To prepare and verify a uniform antigen content detection kit for recombinant protein vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Methods Using goat anti-S protein polyclonal antibody prepared by National Institutes for Food and Drug Control(NIFDC) as coating antibody,one of four monoclonal antibodies(14C8,15F9,17A7 and 20D8)with high receptor-binding domain(RBD)binding activity and broad-spectrum resistance against major variants as HRP-labeled antibody,a uniform double-antibody sandwich ELISA kit for antigen content detection of recombinant SARS-CoV-2 vaccine was prepared,and the dilution of coating antibody(1∶125 ～ 1∶4 000)and enzymelabeled antibody(1∶250 ～ 1∶32 000)were optimized by chessboard titration. The specificity,linear range,accuracy,precision and durability of the kit were verified. The prepared uniform detection kits were distributed to 12 laboratories to detect15 batches of recombinant SARS-CoV-2 protein vaccine stock solutions(including 11 batches of stock solutions designed with WT strain and 4 batches of designed with Beta,Gamma and Delta variants as reference sequence)from different expression systems(CHO cells,Pichia pastoris,Sf9 cells or E. coli)and target proteins(RBD or S protein)prepared by each laboratory.Results Monoclonal antibody 20D8 was used as the enzyme-labeled antibody with the optimal dilution of 1 : 4 000,and the optimal dilution of coating antibody was 1 : 500. The uniform detection kit showed no cross reaction with recombinant S protein of severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS). The first generation national standard for recombinant SARS-CoV-2 protein vaccine antigen(national standard for short)showed a concentration of 0. 16 ～ 2. 50 U/mL with a good linear relationship with A450/630,and the linear equation was:y = 0. 791 x-0. 100 4,R2= 0. 993 7;The recoveries of 0. 16 ～ 2. 50 U/mL national standard in 6 repeated tests were 95% ～ 104% and the coefficients of variation(CVs)were less than 15%;The CVs in 3 repeated tests by 2 experimenters at different time were 4. 4% ～6. 6% and the recoveries were in the range of 80% ～ 120% under different temperature and time conditions. The antigen content of 15 batches of recombinant SARS-CoV-2 protein vaccine stock solutions showed good parallelism with the national standard. Conclusion The uniform detection kit for antigen content developed in this study had good specificity,accuracy,precision and durability,and might be used for the detection of antigen content of recombinant SARS-CoV-2 protein vaccines.
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@#Objective To construct a single-chain fragment variable(scFv)phage display library against receptor-binding domain(RBD)of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)spike protein(S)to screen specific scFv and identify the function.Methods m RNA was extracted from spleen cells of mice immunized with RBD protein and reversely transcribed into c DNA,with which as template,genes of the hight chain fragment of variable(VH)and light chain fragment of variable(VL)of scFv were amplified and then assembled into scFv gene fragment through splicing overlap extension PCR(SOE-PCR).The scFv gene fragment was inserted to phage vector to construct scFv phage display library.After four rounds of biopanning,the scFv gene with strong binding ability to RBD was screened and expressed recombinantly,purified and identified for biological activity.Results The constructed scFv phage library showed a titer of 6.0×10(11)pfu/m L.After four rounds of biopanning,four scFv strains with strong binding to RBD were selected,namely scFv11,scFv12,scFv25and scFv28.scFv was mainly expressed in the form of inclusion body with a relative molecular mass of about 27 000,a concentration of 2.4 mg/m L and a purity of about 90%,which bound specifically to mouse monoclonal antibody against His labeled by HRP after purification.All four scFv strains bound specifically to RBD recombinant protein,among which the other 3 scFv strains bound to the S protein of wild type and multiple mutant strains except scFv28.All four strains showed dose-dependent interaction with RBD,with affinity dynamic fitting dissociation constants(K_Ds)8.9,5.92,10.67and 2.36 nmol/L,and steady-state fitting dissociation constants(K_Ds)of 5.3,6.5,8.7 and 5.8 nmol/L,respectively.scFv11,scFv12 and scFv25 simultaneously identified three independent RBD polypeptides,including RBD2(S(11)pfu/m L.After four rounds of biopanning,four scFv strains with strong binding to RBD were selected,namely scFv11,scFv12,scFv25and scFv28.scFv was mainly expressed in the form of inclusion body with a relative molecular mass of about 27 000,a concentration of 2.4 mg/m L and a purity of about 90%,which bound specifically to mouse monoclonal antibody against His labeled by HRP after purification.All four scFv strains bound specifically to RBD recombinant protein,among which the other 3 scFv strains bound to the S protein of wild type and multiple mutant strains except scFv28.All four strains showed dose-dependent interaction with RBD,with affinity dynamic fitting dissociation constants(K_Ds)8.9,5.92,10.67and 2.36 nmol/L,and steady-state fitting dissociation constants(K_Ds)of 5.3,6.5,8.7 and 5.8 nmol/L,respectively.scFv11,scFv12 and scFv25 simultaneously identified three independent RBD polypeptides,including RBD2(S(334～353)),RBD9(S(334～353)),RBD9(S(439～458))and RBD13(S(439～458))and RBD13(S(499～518)).Homologous model of scFv constructed by online server SWISS-MODEL showed a good quality and was used for molecular docking.The interface at which scFv11 interacted with RBD only partially coincided with the interaction interface of human angiotensin converting enzyme 2(ACE2)and RBD,and the interaction interfaces of scFv12 and scFv25 with RBD were quite different from that of ACE2.Conclusion In this study,scFv specifically bound to SARS-Co V-2 RBD was screened and prepared through constructing scFv phage library against SARS-CoV-2 RBD,which provided experimental basis for further development of anti-SARS-CoV-2 drugs and detection reagents.
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@#Coronavirus Disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)seriously threatens human health and public health safety.Vaccination plays an important role in effectively controlling the epidemic situation.More than 150 SARS-CoV-2 vaccines have entered the clinical trial stage and 38 have been approved for emergency use or marketing.Neutralizing antibody level is the main index for evaluation of the immunogenicity of vaccines,but there has been no standardized detection method for SARS-CoV-2 neutralizing antibody till now,which makes it difficult to compare the neutralizing antibody levels among different laboratories and different products horizontally,and seriously restricts the development and evaluation of vaccines and antibody therapeutic drugs.With the rapid sale of the first generation of standards for SARS-CoV-2 antibody and the emergence of variants of concern(VOC)of SARS-CoV-2,WHO and China carried out the development of the second generation of standards simultaneously in 2022.This paper reviews the development and application progress of the standards for SARS-CoV-2 antibody in WHO and China.
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@#Coronavirus Disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)seriously threatens human health and public health safety.Vaccination plays an important role in effectively controlling the epidemic situation.More than 150 SARS-CoV-2 vaccines have entered the clinical trial stage and 38 have been approved for emergency use or marketing.Neutralizing antibody level is the main index for evaluation of the immunogenicity of vaccines,but there has been no standardized detection method for SARS-CoV-2 neutralizing antibody till now,which makes it difficult to compare the neutralizing antibody levels among different laboratories and different products horizontally,and seriously restricts the development and evaluation of vaccines and antibody therapeutic drugs.With the rapid sale of the first generation of standards for SARS-CoV-2 antibody and the emergence of variants of concern(VOC)of SARS-CoV-2,WHO and China carried out the development of the second generation of standards simultaneously in 2022.This paper reviews the development and application progress of the standards for SARS-CoV-2 antibody in WHO and China.
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@#Objective To evaluate the pharmacodynamics of human interferon(IFN)α1b against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron strain in vitro.Methods Total four drugs human IFNα1b bulk,human IFNα1b eye drops,human IFNα1b spray and Remdesivir were detected for cytotoxicity by CCK-8 assay.The inhibitory effect of human IFNα1b on SARS-CoV-2 Omicron strains(BA.5/BA.2/BA.1)was determined by qPCR.Results Human IFNα1b bulk of the maximum concentration(1 × 107IU/mL)and Remdesivir of the maximum concentration(150 μmol/L)did not achieve half cytotoxicity to Vero cells;The median cytotoxicity concentrations(CC_(50))of human IFNα1b eye drops and human IFNα1b sprays were 29 958 and 37 550 IU/mL,respectively,showing toxicity to Vero cells.The median effective concentrations(EC_(50))of human IFNα1b against virus strains BA.1,BA.2 and BA.5 after incubation for 2 h in advance were 9.30,13.38 and 12.33 IU/mL and those of Remdesivir were 0.314 7,0.291 0 and0.300 3 μmol/L.When incubation with virus simultaneously,the EC_(50)of human IFNα1b to BA.1,BA.2 and BA.5 were19.68,10.91 and 18.84 IU/mL and those of the control drug Remdesivir were 0.320 5,0.274 4 and 0.304 1 μmol/L,respectively.Conclusion At the cell level in vitro,human IFNα1b of very low activity showed a good inhibitory effect on SARS-CoV-2 Omicron strain,which was expected to be a clinical specific drug for the treatment of SARS-CoV-2 Omicron strain infection.
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@#Abstract：Objective To prepare human monoclonal antibody against spike protein（S protein）of severe acute respiratory syndrome coronavirus 2（SARS⁃CoV⁃2）by using single B cell，and determine its neutralizing activity. Methods Venous blood with high antibody level was collected from people immunized with inactivated SARS⁃CoV⁃2 vaccine（Vero cells） twice，of which peripheral blood mononuclear cells（PBMCs）were isolated by lymphocyte stratified fluid and used to isolate single B cell expressing S protein antibody by magnetic beads coupled with S1 protein. Variable region genes of IgG heavy chain and light chain were amplified by nested PCR after reverse transcription of single B cell，which were connected with CMV promoter，IgG leader sequence，IgG constant region and polyA sequence by overlapping PCR to construct antibody linear expression cassette. Linear expression cassette of the heavy chain and light chain from the same B cell was transfected to HEK293T cells to express human monoclonal antibody of SARS⁃CoV⁃2 S protein. Immunoreactivity was detected by immuno⁃ fluorescence while neutralizing activity by pseudovirus neutralization test. Results A total of 26 monoclonal antibodies against SARS⁃CoV⁃2 S protein were expressed，which showed heavy chain and light chain protein bands of IgG antibody at
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Coronavirus disease 2019 (COVID-19) has continued to spread globally since late 2019, representing a formidable challenge to the world's healthcare systems, wreaking havoc, and spreading rapidly through human contact. With fever, fatigue, and a persistent dry cough being the hallmark symptoms, this disease threatened to destabilize the delicate balance of our global community. Rapid and accurate diagnosis of COVID-19 is a prerequisite for understanding the number of confirmed cases in the world or a region, and an important factor in epidemic assessment and the development of control measures. It also plays a crucial role in ensuring that patients receive the appropriate medical treatment, leading to optimal patient care. Reverse transcription-polymerase chain reaction (RT-PCR) technology is currently the most mature method for detecting viral nucleic acids, but it has many drawbacks. Meanwhile, a variety of COVID-19 detection methods, including molecular biological diagnostic, immunodiagnostic, imaging, and artificial intelligence methods have been developed and applied in clinical practice to meet diverse scenarios and needs. These methods can help clinicians diagnose and treat COVID-19 patients. This review describes the variety of such methods used in China, providing an important reference in the field of the clinical diagnosis of COVID-19.
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Humans , Artificial Intelligence , China , COVID-19/diagnosis , COVID-19 TestingABSTRACT
AIM: To observe the clinical features of acute macular neuroretinopathy(AMN)induced by Omicron.METHODS: A retrospective study. A total of 9 patients(18 eyes)diagnosed with AMN from December 2022 to January 2023 in the Hospital of Chengdu University of Traditional Chinese Medicine were included. Patients underwent spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), fundus photography, autofluorescence(AF), infrared reflectance(IR), optical coherence tomography angiography(OCTA)and multicolor, etc. Furthermore, they were followed up for 1～3mo and observed the prognosis.RESULTS: The initial symptom of the Omicron-induced AMN was the sudden onset of central/paracentral scotoma in the eyes with or without impaired vision and metamorphopsia, and the scotoma could persist for at least 3mo. The image features of AMN are as follows. First, the SD-OCT examination showed the rupture of outer retinal layers, scattered hyperreflective lesions, and atrophy of outer retinal layers. In severe cases, hyperreflective lesions were seen in the inner nuclear layer(INL)or with microcystic cavities under the retinal pigment epithelium(RPE). Second, the OCTA examination demonstrated the decreased blood flow density of the deep capillary plexus(DCP)of the macula. Third, the IR examination showed the weak reflection of lesion areas. Fourth, the fundus photography demonstrated the localized brown wedge-shaped lesion.CONCLUSIONS: The Omicron-induced AMN is mostly found in young females, and the characteristic manifestation of fundus is damage to the outer retinal layers. The extent of fundus lesions is related to the systemic inflammatory response and ocular microcirculatory changes after infection. The multimodal fundus image examination and a history of Omicron infection are helpful to diagnose the Omicron-induced AMN.
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【Objective】 To analyze the results of different methods for reactive samples screened by the enzyme linked immunosorbent assay (ELISA) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in blood donors. 【Methods】 From March to April 2020, a total of 8 632 blood samples in Shenzhen were screened for SARS-CoV-2 total antibodies (TAb, including IgG, IgM, IgA) in plasma using ELISA(PC group), the antibody reactivity samples and their follow up plasma samples (FC group), and samples of disease control group(DC group) from January to April 2020 were detected using the following methods: 1) ELISA method for detecting IgG, IgM, and (or without detection) TAb; 2) pseudovirus neutralizing antibody test(pVNT); 3) western blot (WB) of SARS-CoV-2 antibody. The negative control group(NC group) from February to April 2020 performed ELISA and WB testing. 【Results】 Among the 34 total antibody positive samples, 2 were positive for pVNT test, and the total antibody, IgG and WB in the initial screening and tracking testing were positive. Thereafter, it was determined to be confirmed positive. The other 2 cases were positive for pVNT test, while the samples with positive WB results were in the follow-up stage. The TAb, IgG, and pVNT results did not conform to the dynamic evolution of antibodies, and cannot be determined as confirmed positive. 【Conclusion】 The infection status of antibody reactivity samples screened by SARS-CoV-2 ELISA can be judged by the logic of pVNT, WB and the dynamic change of antibody.
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@#Objective To prepare monoclonal antibody IgA against severe acute respiratory syndrome coronavirus 2(SARSCoV-2),optimize relevant expression conditions to increase the expression level,and preliminarily explore the effect of IgA antibody on anti-SARS-CoV-2.Methods The plasmid encoding IgAl-F61 antibody sequence was mixed with polyethyleneimine(PEI) transfection reagent and then transfected into EXPi293F~(TM) cells to transiently express antibody protein;The optimal culture conditions and expression levels of monomeric IgAl(mIgAl)-F61 and dimeric IgAl(dIgAl)-F61 in EXPi293F~(TM) cells were determined by optimizing the ratio of heavy chain(Hc),light chain(Lc) and joining chain(Jc),the proportion of plasmid and PEI,and the harvest time after transfection.The supernatant after transfection was purified by affinity chromatography,and then determined for the concentration by BCA,analyzed for the expression integrity and purity of antibody by SDS-PAGE and size exclusion chromatography-high performance liquid chromatography(SEC-HPLC),and detected for the neutralizing activity of antibody by pseudovirus neutralization assay.Results The optimal expression level of mIgAl-F61 was 123.45 μg/mL and the purity of purified antibody was over 95% when the ratio of Hc to Lc was 1:2,the ratio of plasmid to PEI was 1:3,and the supernatant was harvested 5 d after transfection;The highest purity of dIgAlF61 was more than 90% when the ratio of Hc:Lc:Jc was 1:2:1.The results of pseudovirus neutrali-zation assay against Omicron BA.4/5 showed that dIgAl-F61 exhibited better neutralizing activity than IgG-F61,and the value of half maximum inhibitory concentration(IC_(50)) was reduced by about 4 times.Conclusion Recombinant monoclonal antibodies mIgAl-F61 and dIgAl-F61 against SARS-CoV-2 were successfully expressed with high purity and dIgAl showed better neutralizing activity than IgG in vitro.
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@#Objective To prepare monoclonal antibody IgA against severe acute respiratory syndrome coronavirus 2(SARSCoV-2),optimize relevant expression conditions to increase the expression level,and preliminarily explore the effect of IgA antibody on anti-SARS-CoV-2.Methods The plasmid encoding IgAl-F61 antibody sequence was mixed with polyethyleneimine(PEI) transfection reagent and then transfected into EXPi293F~(TM) cells to transiently express antibody protein;The optimal culture conditions and expression levels of monomeric IgAl(mIgAl)-F61 and dimeric IgAl(dIgAl)-F61 in EXPi293F~(TM) cells were determined by optimizing the ratio of heavy chain(Hc),light chain(Lc) and joining chain(Jc),the proportion of plasmid and PEI,and the harvest time after transfection.The supernatant after transfection was purified by affinity chromatography,and then determined for the concentration by BCA,analyzed for the expression integrity and purity of antibody by SDS-PAGE and size exclusion chromatography-high performance liquid chromatography(SEC-HPLC),and detected for the neutralizing activity of antibody by pseudovirus neutralization assay.Results The optimal expression level of mIgAl-F61 was 123.45 μg/mL and the purity of purified antibody was over 95% when the ratio of Hc to Lc was 1:2,the ratio of plasmid to PEI was 1:3,and the supernatant was harvested 5 d after transfection;The highest purity of dIgAlF61 was more than 90% when the ratio of Hc:Lc:Jc was 1:2:1.The results of pseudovirus neutrali-zation assay against Omicron BA.4/5 showed that dIgAl-F61 exhibited better neutralizing activity than IgG-F61,and the value of half maximum inhibitory concentration(IC_(50)) was reduced by about 4 times.Conclusion Recombinant monoclonal antibodies mIgAl-F61 and dIgAl-F61 against SARS-CoV-2 were successfully expressed with high purity and dIgAl showed better neutralizing activity than IgG in vitro.
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@#Since the first case of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019, the virus has spread rapidly around the world and has become a global public health problem. In the process of this virus epidemic, compared with the general population, cancer patients are considered to be highly susceptible people, especially the lung cancer patients. Some studies have shown that angiotensin converting enzyme 2 (ACE2) may be the pathway for SARS-CoV-2 to infect the host. At the same time, ACE2 is often abnormally expressed in non-small cell lung cancer. Therefore, understanding the respective mechanisms of ACE2 in COVID-19 and non-small cell lung cancer has extremely important reference value for the study of vaccines and therapeutic drugs, and also provides meaningful guidance for the protection of patients with lung cancer during the epidemic. This article reviews the possible invasive mechanism of ACE2 in SARS-CoV-2 and its abnormal expression in non-small cell lung cancer.
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The Omicron variant of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious, but compared to early virus typing has milder symptoms and better prognosis.This article reviewed and analyzed the clinical characteristics, treatment, prognosis and vaccination effect of Omicron infection in Kidney transplant recipients (KTR) in recent years.The clinical manifestations of KTR infected with Omicron and the comparison with early variants, the clinical characteristics of KTR infected with Omicron compared with the general population, the treatment of KTR infected with Omicron after foreign countries, the effect of vaccination on KTR to prevent Omicron and the measures to increase the ted of vaccine, the summary of the prevention and treatment of KTR infected with Omicron abroad and the experience and the shortcomings of the current researches were analyzed and summarized.
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Although the coronavirus disease 2019 (COVID-19) epidemic is still ongoing, vaccination rates are rising slowly and related treatments and drugs are being developed. At the same time, there is increasing evidence of preexisting immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in humans, mainly consisting of preexisting antibodies and immune cells (including T cells and B cells). The presence of these antibodies is mainly due to the seasonal prevalence of four common coronavirus types, especially OC43 and HKU1. The accumulated relevant evidence has suggested that the target of antibodies is mainly the S2 subunit of S protein, followed by evolutionary conservative regions such as the nucleocapsid (N) protein. Additionally, preexisting memory T and B cells are also present in the population. Preexisting antibodies can help the body protect against SARS-CoV-2 infection, reduce the severity of COVID-19, and rapidly increase the immune response post-infection. These multiple effects can directly affect disease progression and even the likelihood of death in certain individuals. Besides the positive effects, preexisting immunity may also have negative consequences, such as antibody-dependent enhancement (ADE) and original antigenic sin (OAS), the prevalence of which needs to be further established. In the future, more research should be focused on evaluating the role of preexisting immunity in COVID-19 outcomes, adopting appropriate policies and strategies for fighting the pandemic, and vaccine development that considers preexisting immunity.
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Humans , COVID-19 , Pandemics , SARS-CoV-2 , Seasons , Spike Glycoprotein, CoronavirusABSTRACT
Objective:To analyze a family clustering of coronavirus disease 2019 （COVID-19） associated with the exposure to an asymptomatic case， and to provide evidences of developing strategies for COVID-19 prevention. Methods:Epidemiological investigation was conducted on a COVID-19 family cluster （1 confirmed case and 2 asymptomatic cases）. The specimens of the cases were tested for 2019 novel coronavirus nucleic acid with real-time fluorescence quantitative polymerase chain reaction. Results:The clustering epidemic occurred in a family. Two asymptomatic cases B and C （B’s son） had Wuhan residential history. After arrival in Beijing on January 24， 2020， B stayed in his mother's house. One family member A （B’s mother） developed the disease on February 7， 2020， while the other two family members D and E （B’s wife and brother） did not develop the disease， and they were managed as close contacts. Conclusion:Thisfamily COVID-19 clustering is induced by the exposure to an asymptomatic case. Identification of asymptomatic cases is very important for the control of COVID-19 epidemic.
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Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at increased risk of acute lung injury. However, it is still not clear whether this increased risk is related to the usage of renin-angiotensin system (RAS) blockers. We collected medical records of coronavirus disease 2019 (COVID-19) patients from the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China), and evaluated the potential impact of an angiotensin II receptor blocker (ARB) on the clinical outcomes of COVID-19 patients with hypertension. A total of 30 hypertensive COVID-19 patients were enrolled, of which 17 were classified as non-ARB group and the remaining 13 as ARB group based on the antihypertensive therapies they received. Compared with the non-ARB group, patients in the ARB group had a lower proportion of severe cases and intensive care unit (ICU) admission as well as shortened length of hospital stay, and manifested favorable results in most of the laboratory testing. Viral loads in the ARB group were lower than those in the non-ARB group throughout the disease course. No significant difference in the time of seroconversion or antibody levels was observed between the two groups. The median levels of soluble angiotensin-converting enzyme 2 (sACE2) in serum and urine samples were similar in both groups, and there were no significant correlations between serum sACE2 and biomarkers of disease severity. Transcriptional analysis showed 125 differentially expressed genes which mainly were enriched in oxygen transport, bicarbonate transport, and blood coagulation. Our results suggest that ARB usage is not associated with aggravation of COVID-19. These findings support the maintenance of ARB treatment in hypertensive patients diagnosed with COVID-19.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme 2/blood , Antibodies, Viral/blood , Antihypertensive Agents/therapeutic use , Biomarkers , COVID-19/complications , China , Hypertension/drug therapy , Intensive Care Units , Length of Stay , Retrospective Studies , Transcriptome , Viral LoadABSTRACT
With the number of cases of coronavirus disease-2019 (COVID-19) increasing rapidly, the World Health Organization (WHO) has recommended that patients with mild or moderate symptoms could be released from quarantine without nucleic acid retesting, and self-isolate in the community. This may pose a potential virus transmission risk. We aimed to develop a nomogram to predict the duration of viral shedding for individual COVID-19 patients. This retrospective multicentric study enrolled 135 patients as a training cohort and 102 patients as a validation cohort. Significant factors associated with the duration of viral shedding were identified by multivariate Cox modeling in the training cohort and combined to develop a nomogram to predict the probability of viral shedding at 9, 13, 17, and 21 d after admission. The nomogram was validated in the validation cohort and evaluated by concordance index (C-index), area under the curve (AUC), and calibration curve. A higher absolute lymphocyte count (
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antibodies, Viral/blood , Area Under Curve , COVID-19/virology , Lymphocyte Count , Nomograms , Proportional Hazards Models , Retrospective Studies , Viral Load , Virus SheddingABSTRACT
Since December 2019, the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) has spread to many countries around the world, developing into a global pandemic with increasing numbers of deaths reported worldwide. To data, although some vaccines have been developed, there are no ideal drugs to treat novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)). By examining the structure of the coronavirus and briefly describing its possible pathogenesis based on recent autopsy reports conducted by various teams worldwide, this review analyzes the possible structural and functional changes of the human body upon infection with SARS-CoV-2. We observed that the most prominent pathological changes in COVID-19 patients are diffuse alveolar damage (DAD) of the lungs and microthrombus formation, resulting in an imbalance of the ventilation/perfusion ratio and respiratory failure. Although direct evidence of viral infection can also be found in other organs and tissues, the viral load is relatively small. The conclusion that the injuries of the extra-pulmonary organs are directly caused by the virus needs further investigation.