ABSTRACT
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.
Subject(s)
COVID-19 , Transferrin , Male , Humans , Female , Aged , Transferrin/analysis , Hepcidins , Cross-Sectional Studies , Pandemics , SARS-CoV-2 , Iron/metabolism , Ferritins , Receptors, Transferrin , HomeostasisABSTRACT
Objectives: Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients. Materials and Methods: Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed. Results: Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95). Conclusion: In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.
ABSTRACT
Treatment of COVID-19 has been a major challenge during the current pandemic. Various parameters including clinical symptoms and laboratory markers were used for predicting severity of the disease. However, limited data has been available regarding role of inflammatory markers used for monitoring the progression of the disease. Current study aimed to investigate whether serum ferritin level can be used a marker of rapid progression of the disease and if it can predict mortality in COVID-19 cases. The present study included 40 qRT-PCR positive patients who succumbed to COVID-19 as severe group, and 40 patients who were hospitalized but recovered from the disease as the mild group. Demographic details and laboratory data of the patients were obtained and evaluated retrospectively. Spearman's rank correlation was done between serum ferritin and age in patients of differing severity of the disease. Receiver operating curve (ROC) was used for identifying best cut-off level of ferritin for classification of severity. The mean age of the non-survivor (severe/critically ill group) had a tendency to be higher than the mean age of those of the survivors (mild group). Serum ferritin was significantly higher among severe COVID-19 cases compared to mild (p<0.0001). In ROC analysis area under the curve was 0.790. Here we report for the first time, a cut off value for ferritin (277 ng/ml), which can differentiate between the various hospitalization outcomes of COVID-19 patients. There was no significant association observed in age distribution with severity of the disease. Circulating ferritin level not only reflect acute phase response but rather plays critical role in inflammation of COVID-19 disease. Ferritin a natural organometallic complex is a widely available marker, that can be used for monitoring and predicting disease progression thus it can guide clinicians for the effective management of COVID-19. © 2023 Author(s).
ABSTRACT
Background: The current Covid-19 pandemic has resulted in significant global impacts for healthcare systems and beyond. Age and or co-morbidities which are often chronic in nature are the main risk factors for severe Covid-19 infection with strong further associations with mortality. IL-6 is reported to be greatly elevated in patients with severe Covid-19 infection. As a key positive regulator for hepcidin biosynthesis this may suggest impacts for iron metabolism in these patients;elevated serum ferritin further reinforces this notion. Aim(s): To investigate the effects of IL-6 and hepcidin on ACE2 gene expression in pulmonary artery endothelial cells (PAECs). Method(s): PAECs were treated with IL-6 (1-10 ng/mL) and hepcidin (0.1-1 mug/mL). Gene expression was identified by RT-PCR and Western Blot (WB). Result(s): When challenged with either IL-6 or hepcidin, significant upregulation of ACE2 mRNA was observed in hPAECs (n= 3;*p<0.05). Significant elevated levels of ACE2 protein expression were also observed by western blot (n= 3;*p<0.05). In addition, knock-down of the ferroportin gene (SLC40A1) in these cells resulted in significant loss of ferroportin mRNA coupled with a strong significant up-regulation of ACE2 mRNA (n= 3;*p<0.05). Conclusion(s): Whilst our results demonstrate upregulation of ACE2 gene and protein in hPAECs in response to iron regulatory elements, such as hepcidin and IL-6, further studies need to be undertaken to establish if such effects result in enhanced SARS-CoV-2 infection and whether modulation of this axis may be protective.
ABSTRACT
Iron is a mineral that plays an important role, especially to prevent anaemia through the production of red blood cells. Iron also plays a role in physiological processes, such as the activation of enzymes and hormones, as well as increasing the immune system in warding off various viral infections. Therefore, iron bioavailability needs to be considered to take the greatest benefit of iron. This review discussed the factors that can affect the bioavailability of iron, various technologies to increase the bioavailability, and its potential in enhancing the immune system. Iron bioavailability can be increased by fortification, fermentation, the addition of vitamin C, and iron encapsulation. Under conditions of adequate iron intake, iron plays an important role in enhancing the immune system through controlling lymphocytes and T cell proliferation. However, excess iron consumption can be at risk of weakening the host's immune response to viruses. Therefore, the appropriate level of iron intake must be maintained accurately to be used optimally and has the potential to ward off viral infections, including the Sars-CoV-2 virus as the cause of COVID-19.Copyright © 2023, Rynnye Lyan Resources. All rights reserved.
ABSTRACT
Vaccination programmes are critically important to suppress the burden of infectious diseases, saving countless lives globally, as emphasised by the current COVID-19 pandemic. Effective adaptive immune responses are complex processes subject to multiple influences. Recent genetic, pre-clinical, and clinical studies have converged to show that availability of iron is a key factor regulating the development of T and B cell responses to infection and immunisation. Lymphocytes obtain iron from circulating transferrin. The amount of iron bound to transferrin is dependent on dietary iron availability and is decreased during inflammation via upregulation of the iron-regulatory hormone, hepcidin. As iron deficiency and chronic inflammatory states are both globally prevalent health problems, the potential impact of low iron availability on immune responses is significant. We describe the evidence supporting the importance of iron in immunity, highlight important unknowns, and discuss how therapeutic interventions to modulate iron availability might be implementable in the context of vaccination and infectious disease.
ABSTRACT
Feline Infectious Peritonitis (FIP)is a fatal disease caused by Feline coronaviruses. The causative agent is Feline Infectious Peritonitis Virus, a mutation of Feline Enteric Coronavirus. Feline Corona Virusinfection is very common in the cat population.In Feline Corona Virus infected cats, the development of FIP depends on the cat's immune response. FIP disease is more common in young and old cats because young and old animals have a weaker immune system. The acute phase response is a complex systemic reaction that occurs as a response to acute or chronic inflammatory processes such as infection, neoplasia or immunological disorders, tissue damage, trauma, and surgery. The study material was composed of15 cats with FIP (study group) and 10 healthy cats (control group). Serum amyloid A (SAA), haptoglobin (Hp), alpha1-acid glycoprotein (AGP), albumin, interleukin-6 (IL-6), hepcidin, alanine-amino transferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), blood urea nitrogen(BUN), and creatinine levels were measured in the serum collected from both groups. There was no difference between the wet and dry FIP in albumin values (p<0.05).Haptoglobin, alpha1-acid glycoprotein, SAA, IL-6, and hepcidin values were significantly different between the two groups (P<0.001). It was also concluded that hepcidinhas a potential for use as a biomarker in Feline Infectious Peritonitis disease like other acute phase proteins.Copyright © 2023, Sima Sahinduran, Metin Koray Albay, Mehmet Karaca, Mehmet Cagri Karakurum, Reyda Kiyici
ABSTRACT
OBJECTIVE: The aim: The purpose of this study is to find out the association between procalcitonin and hepcidin in patients with COVID-19, in addition to their role as diagnostic markers. PATIENTS AND METHODS: Materials and methods: A total of 75 patients infected with coronavirus were included in the current study, their age is ranging between 20 to 78 years. Those patients was hospitalized in Al-Sadr Teaching Hospital in Najaf, in Iraq. This study also included 50 healthy subjects which are volunteers and considered as a (control group). Biomarker (procalcitonin and hepcidin) measurements were achieved by electrochemiluminescent immunoassay (ECLIA) in the Elecsys immunoassay system. RESULTS: Results: The present study showed a significant increase the serum cencentration of hepcidin and procalcitonin in patients with COVID-19 as compared tohealthy subjects. There was a highly significant increasing(p < 0.01) in hepcidin and PCT level in patients with severe infection comparing to other catgaries.The current study also revealed that the sensitivity values of the markers were: 0.88%, 0.85 for procalcitonin and hepcidin respectively, which indicate high diagnostic power. CONCLUSION: Conclusions: Serum levels of hepcidin and procalcitonin are increased as inflammatory markers in COVID-19 patients with relatively high sensitivity. It seems that these imflammatory markers obviously elevate in the severe cases COVID-19dusease.
Subject(s)
COVID-19 , Hepcidins , Procalcitonin , Adult , Aged , Humans , Middle Aged , Young Adult , Biomarkers/blood , COVID-19/blood , COVID-19/diagnosis , COVID-19 Testing , Hepcidins/blood , Iraq , Procalcitonin/bloodABSTRACT
COVID-19 produces cytokine-mediated persistent inflammation and is associated with elevated iron stores and low circulating iron. It is believed that central to the pathophysiological mechanism is interleukin 6 and hepcidin. A state of iron overload, termed hyperferritinemia, and inflammatory anemia take place. Both conditions are linked to a worse result in critically ill patients. Blocking the interleukin 6-hepcidin pathway with Tocilizumab could present favorable outcomes. The aim of this study was to evaluate if Tocilizumab influences survival, the occurrence of sepsis, anemia and transfusions in critically ill patients suffering from COVID-19. This prospective observational study focused on levels of interleukin 6, hepcidin and blood iron parameters in patients treated with Tocilizumab. Data were compared before and after therapy as well as between treated and control groups. Results indicate that there is no difference in terms of survival nor in the rate of anemia or sepsis occurrence. Hepcidin was elevated and anemia ensued after treatment, which could indicate alternative pathways. In conclusion, when the classic interleukin 6-hepcidin pathway is blocked, inflammation seems to use alternative routes. Further understanding of these pathways is required and new pharmacological therapies need to be developed to treat persistent inflammation.
ABSTRACT
Introduction: Major clinically relevant inflammatory events such as septic shock and severe COVID-19 trigger dynamic changes in the host immune system, presenting promising candidates for new biomarkers to improve precision diagnostics and patient stratification. Hepcidin, a master regulator of iron metabolism, has been intensively studied in many pathologies associated with immune system activation, however these data have never been compared to other clinical settings. Thus, we aimed to reveal the dynamics of iron regulation in various clinical settings and to determine the suitability of hepcidin and/or ferritin levels as biomarkers of inflammatory disease severity. Cohorts: To investigate the overall predictive ability of hepcidin and ferritin, we enrolled the patients suffering with three different diagnoses - in detail 40 patients with COVID-19, 29 patients in septic shock and eight orthopedic patients who were compared to nine healthy donors and all cohorts to each other. Results: We showed that increased hepcidin levels reflect overall immune cell activation driven by intrinsic stimuli, without requiring direct involvement of infection vectors. Contrary to hepcidin, ferritin levels were more strongly boosted by pathogen-induced inflammation - in septic shock more than four-fold and in COVID-19 six-fold in comparison to sterile inflammation. We also defined the predictive capacity of hepcidin-to-ferritin ratio with AUC=0.79 and P = 0.03. Discussion: Our findings confirm that hepcidin is a potent marker of septic shock and other acute inflammation-associated pathologies and demonstrate the utility of the hepcidin-to-ferritin ratio as a predictor of mortality in septic shock, but not in COVID-19.
Subject(s)
COVID-19 , Shock, Septic , Humans , Hepcidins/metabolism , Iron/metabolism , Ferritins , Inflammation , BiomarkersABSTRACT
The hormone hepcidin present in saliva is a hyperinflammation markers for COVID-19 and other pathological states. Here we present DFT-based vibrational calculations that enabled assign the experimental vibrational spectra of hepcidin and predict its SERS-activiy. © Optica Publishing Group 2022 The Authors.
ABSTRACT
The hormone hepcidin present in saliva is a hyperinflammation markers for COVID-19 and other pathological states. Here we present DFT-based vibrational calculations that enabled assign the experimental vibrational spectra of hepcidin and predict its SERS-activiy. © Optica Publishing Group 2022 The Authors.
ABSTRACT
The main pathological conditions characterized by disturbances of iron metabolism have been analyzed, including anemias, hemochromatosis, inflammatory, autoimmune and neurodegenerative disorders, chronic renal insufficiency, infectious diseases (including COVID-19), etc. Strategies of their pharmacological correction and risks of common adverse effects development are considered for the potential targets of pharmacotherapy and possible groups of medications including inhibitors of prolyl-4-hydroxylase, inhibitors of bone morphogenetic proteins (BMP 6), ferroportin and hepcidin activity, inhibitors of hypoxia-inducible factor (HIF-1a) and divalent metal transporter (DMT-1). Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a systemic inflammatory disorder affects both hematopoietic system and haemostasis process. The better understanding the natural history of COVID-19 would open the fields of treatment and prevention of this disease. COVID-19 patients suffer a mild to severe failing in the respiratory system after short period upon infection. Our study is focused on the early prediction of inflammatory status and respiratory impairment through the usage of inflammatory markers in COVID-19 patients. The current clinical study has included 60 COVID-19 patients and the results were controlled with 30 healthy people. The parameters of this case-control study was included white blood cells (WBCs), lymphocytes percentage (LYM %), D-dimer, interleukine-6 (IL-6), ferritin, hepcidin, vitamin D3 (Vit D), prothrombin time, and INR. The study was also included the IgG and IgM antibodies detection of COVID-19, and the other variables were statistically compared according to the quartiles of these antibodies, which enables a better elucidation for each parameter from onset of the disease up to the severe conditions, then down to the recovery. The predominant decrease was observed significantly in Vit D and non-significantly in LYM%. Areas under (AUC) the receiver operating characteristic (ROC) curve of WBCs, D-dimer, IL-6, Ferritin, PT, INR, Hepcidin, Vit D, LYM% and PTT had been analyzed. ROC analysis identified that Hepcidin and D-dimer has the excellent sensitivity and specificity (100%) with AUC value =1;cut off values were (72.28 and 53.37, respectively). Results appeared that there was a significant variation in the levels of D-dimer, IL-6, Hepcidin in four divided groups depend on IgM classification, on other direction, IgM shows a significant variation between four groups depend on IgG classification with non-significant changes in the other parameters. This study also confirmed that IgG titers in severe COVID-19 patients were significantly higher than those in non severe patient’s post-symptom onset, and showed that Q2 group according to IgG was the worst case among other groups depend on hematological and immunological tests, whereas the Q4 group was the worst according to IgM. Pearson correlation coefficient (r) revealed the following results: There was a significant negative correlation between LYM% and WBC (r=-0.413), Hepcidin and VitD (r=-0.387), IL-6 and LYM% (r=-0.419), PT and LYM% (r=-0.465), INR and LYM% (r=-0.458), as well as, a significant positive correlation between IL-6 and INR (r=0.433), PT and INR (r=0.957), PT and PTT (r=0.623), Hepcidin and D-dimer (r=0.537), IL-6 and WBC (r=0.579), ferritin and VitD (r= 0.370). In conclusion, COVID-19 is accompanied with inflammatory increasing from the moment of onset to its severity influences, yet the inflammatory status remains elevated a while post-recovery and does not decrease in fast rhythm. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.
ABSTRACT
Covid-19 is a genus of enveloped, positive-sense, single-stranded RNA viruses with a high degree of genetic diversity. They induce a variety of disorders affecting the respiratory, gastrointestinal, hepatic, and nervous systems in humans and animals, with different manifestation and severity. Obesity is the result of the accumulation of an excessive amount of fat in the body and the condition arises from an imbalance between the amount of energy stored by increased food intake and the amount of energy expended as physical activity. The aims of study are evaluate the effect of covid-19 on iron levels in obese patients and study there correlations. As well as, study the association of hepcidin gene polymorphism to the risk of infection with covid-19 in obese patients. This study is cross sectional. Which include conducted in isolation wards at Al-Amal Hospital and Al-Hakim hospital in Al-Najaf City for the period extending from November 2021 to the end of March 2022, 60 sample were collected from diagnosed patients with covd-19 and obese (BMI more than 30). On the other hand 60 sample of individuals that suffering from obesity (BMI more than 30) and recovered from covid-19 for more than six months. The variables was measured in this research are: Ferritin, serum iron, unsaturated iron binding capacity (UIBC) and total iron binding capacity (TIBC). Also gene polymorphism of hepcidin hormone G71D (HAMP).The results showed that there were significant differences for (ferritin, serum iron, UIBC and TIBC), in obese patients with covid-19 compared to recovery from covid-19. The gene polymorphism of hepcidin show no significant difference between obese patients with covid-19 and obese recovery from covid-19. the conclusion obese people are the most risk factor to covid-19 infection due to association of obesity with change in BMI and increase Adipose tissue mass in obese individuals, As well as Ferritin test is the most accurate biomarker to covid-19 infection while Gene polymorphism study of SNPs hepcidin G71D (HAMP) gene represent a weak maker for covid-19 disease. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.
ABSTRACT
Our study aims to determine the relationship between hepcidin, aquaporin (AQP-1), copper (Cu), zinc (Zn), iron (Fe) levels, and oxidative stress in the sera of seriously ill COVID-19 patients with invasive mechanical ventilation. Ninety persons with and without COVID-19 were taken up and separated into two groups. The first group included seriously COVID-19 inpatients having endotracheal intubation in the intensive care unit (n = 45). The second group included individuals who had negative PCR tests and had no chronic disease (the healthy control group n = 45). AQP-1, hepcidin, Zn, Cu, Fe, total antioxidant status (TAS), and total oxidant status (TOS) were studied in the sera of both groups, and the relations of these levels with oxidative stress were determined. When the COVID-19 patient and the control groups were compared, all studied parameters were found to be statistically significant (p < 0.01). Total oxidant status (TOS), oxidative stress index (OSI), and AQP-1, hepcidin, and Cu levels were increased in patients with COVID-19 compared to healthy people. Serum TAC, Zn, and Fe levels were found to be lower in the patient group than in the control group. Significant correlations were detected between the studied parameters in COVID-19 patients. Results indicated that oxidative stress may play an important role in viral infection due to SARS-CoV-2. We think that oxidative stress parameters as well as some trace elements at the onset of COVID-19 disease will provide a better triage in terms of disease severity.
Subject(s)
COVID-19 , Trace Elements , Antioxidants/metabolism , Copper , Critical Illness , Hepcidins , Humans , Iron , Oxidants , Oxidative Stress , SARS-CoV-2 , ZincABSTRACT
Coronavirus disease 2019 (COVID-19) presents a clinical spectrum that ranges from a mild condition to critical illness. Patients with critical illness present respiratory failure, septic shock and/or multi-organ failure induced by the so called "cytokine storm". Inflammatory cytokines affect iron metabolism, mainly inducing the synthesis of hepcidin, a hormone peptide not routinely measured. High levels of hepcidin have been associated with the severity of COVID-19. The aim of this study was to analyze, retrospectively, the levels of hepcidin in a group of COVID-19 patients admitted to the intensive care unit (ICU) of the Policlinico Tor Vergata of Rome, Italy. Thirty-eight patients from November 2020 to May 2021 were enrolled in the study. Based on the clinical outcome, the patients were assigned to two groups: survivors and non-survivors. Moreover, a series of routine laboratory parameters were monitored during the stay of the patients in the ICU and their levels correlated to the outcome. Statistical differences in the level of hepcidin, D-dimer, IL-6, LDH, NLR, neutrophils level, CRP, TNF-α and transferrin were observed between the groups. In particular, hepcidin values showed significantly different median concentrations (88 ng/mL vs. 146 ng/mL) between survivors and non-survivors. In addition, ROC curves analysis revealed sensitivity and specificity values of 74% and 76%, respectively, at a cut-off of 127 (ng/mL), indicating hepcidin as a good biomarker in predicting the severity and mortality of COVID-19 in ICU patients.
ABSTRACT
BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) needs iron to replicate itself. Coronaviruses are able to upregulate Chop/Gadd153 and Arg1 genes, consequently leading to CD8 lymphocytes decrease, degradation of asparagine and decreased nitric oxide (NO), thus impairing immune response and antithrombotic functions. Little is known about regulation of genes involved in iron metabolism in paucisymptomatic patients with COVID-19 disease or in patients with iron deficiency treated with sucrosomial iron. METHODS: Whole blood was taken from the COVID-19 patients and from patients with sideropenic anemia, treated or not (control group) with iron supplementations. Enrolled patients were: affected by COVID19 under sucrosomal iron support (group A), affected by COVID-19 not under oral iron support (group B), iron deficiency not under treatment, not affected by COVID19 (control group). After RNA extraction and complementary DNA (cDNA) synthesis of Arg1, Hepcidin and Chop/Gadd153, gene expression from the 3 groups was measured by qRT-PCR. M2 macrophages were detected by cytofluorimetry using CD163 and CD14 markers. RESULTS: Forty patients with COVID-19 (group A), 20 patients with iron deficiency treated with sucrosomial iron (group B) and 20 patients with iron deficiency not under treatment (control group) were enrolled. In all the patients supported with oral sucrosomial iron, the gene expression of Chop, Arg1 and Hepcidin genes was lower than in sideropenic patients not supported with iron, M1 macrophages polarization and functional iron deficiency was also lower in group A and B, than observed in the control group. CONCLUSIONS: New oral iron formulations, as sucrosomial iron, are able to influence the expression of genes like Chop and Arg1 and to influence M2 macrophage polarization mainly in the early phase of COVID-19 disease.
Subject(s)
COVID-19 , Ferric Compounds , Iron Deficiencies , Iron , Humans , COVID-19/complications , Homeostasis , Iron/metabolism , Iron Deficiencies/complications , Iron Deficiencies/drug therapy , SARS-CoV-2 , Ferric Compounds/therapeutic use , MacrophagesABSTRACT
The second wave of coronavirus disease 2019 (COVID-19) caused severe infections with high mortality. An increase in the cases of COVID-19-associated mucormycosis (CAM) was reported predominantly in India. Commonly present in immunocompromised individuals, mucormycosis is often a life-threatening condition. Confounding factors and molecular mechanisms associated with CAM are still not well understood, and there is a need for careful research in this direction. In this review, a brief account of the diagnosis, management, and advancement in drug discovery for mucormycosis has been provided. Here, we summarize major factors that dictate the occurrence of mucormycosis in COVID-19 patients through the analysis of published literature and case reports. Major predisposing factors to mucormycosis appear to be uncontrolled diabetes, steroid therapy, and certain cancers. At the molecular level, increased levels of iron in COVID-19 might contribute to mucormycosis. We have also discussed the potential role and regulation of iron metabolism in COVID-19 patients in establishing fungal growth. Other factors including diabetes prevalence and fungal spore burden in India as contributing factors have also been discussed.
Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , COVID-19/complications , Humans , Immunocompromised Host , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiologyABSTRACT
PURPOSE: We sought to determine the effects of heat acclimation on endurance exercise-induced hepcidin elevation under hot conditions. METHODS: Fifteen healthy men were divided into two groups: endurance training under hot conditions (HOT, 35 °C, n = 8) and endurance training under cool conditions (CON, 18 °C, n = 7). All subjects completed 10 days of endurance training (8 sessions in total), consisting of 60 min of continuous exercise at 50% of maximal oxygen uptake ([Formula: see text]) under their assigned environment condition. Subjects completed a heat stress exercise test (HST, 60 min exercise at 60% [Formula: see text]) to evaluate the exercise-induced thermoregulatory and hepcidin responses under hot conditions (35 °C) before (pre-HST) and after (post-HST) the training period. RESULTS: Core temperature during exercise in the post-HST decreased significantly in the HOT group compared to pre-HST (P = 0.004), but not in the CON group. The HOT and CON groups showed augmented exercise-induced plasma interleukin-6 (IL-6) elevation in the pre-HST (P = 0.002). Both groups had significantly attenuated increases in exercise-induced IL-6 in the post-HST; however, the reduction of exercise-induced IL-6 elevation was not different significantly between both groups. Serum hepcidin concentrations increased significantly in the pre-HST and post-HST in both groups (P = 0.001), no significant difference was observed between both groups during each test or over the study period. CONCLUSION: 10 days of endurance training period under hot conditions improved thermoregulation, whereas exercise-induced hepcidin elevation under hot conditions was not attenuated following the training.