Subject(s)
Alopecia/etiology , COVID-19/complications , DNA, Viral/analysis , SARS-CoV-2/genetics , Scalp/pathology , Adult , Alopecia/diagnosis , Female , Fibrosis/diagnosis , Fibrosis/etiology , HumansABSTRACT
The emergence of the novel SARS coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in an unprecedented pandemic that has been accompanied by a global health crisis. Although the lungs are the main organs involved in COVID-19, systemic disease with a wide range of clinical manifestations also develops in patients infected with SARS-CoV-2. One of the major systems affected by this virus is the cardiovascular system. The presence of preexisting cardiovascular disease increases mortality in patients with COVID-19, and cardiovascular injuries, including myocarditis, cardiac rhythm abnormalities, endothelial cell injury, thrombotic events, and myocardial interstitial fibrosis, are observed in some patients with COVID-19. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of myocardium and cytokine storm have been suggested as possible mechanisms of myocarditis. In this Review, we summarize available data on SARS-CoV-2-related cardiac damage and discuss potential mechanisms of cardiovascular implications of this rapidly spreading virus.
Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Cardiovascular Diseases/diagnosis , Fibrosis/diagnosis , Fibrosis/etiology , Humans , Myocarditis/diagnosis , Myocarditis/etiology , Primary Dysautonomias/diagnosis , Primary Dysautonomias/etiology , Thrombosis/diagnosis , Thrombosis/etiology , Vasculitis/diagnosis , Vasculitis/etiology , COVID-19 Drug TreatmentABSTRACT
Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...
Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Glycated Hemoglobin/analysis , Lung , Oxygen Inhalation Therapy/methods , Aged , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Fatal Outcome , Fibrosis/diagnosis , Fibrosis/etiology , Fibrosis/therapy , Glycemic Control/standards , Home Care Services , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Risk Factors , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
COVID-19 , Cardiomyopathies , Magnetic Resonance Imaging, Cine/methods , Myocardium/pathology , Pericardial Effusion , Tomography, X-Ray Computed/methods , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Cardiomyopathies/physiopathology , Echocardiography/methods , Electrocardiography/methods , Female , Fibrosis/diagnostic imaging , Fibrosis/etiology , Heart Function Tests/methods , Humans , Middle Aged , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Symptom AssessmentABSTRACT
Covid-19 is the acute illness caused by SARS-CoV-2 with initial clinical symptoms such as cough, fever, malaise, headache, and anosmia. After entry into cells, corona viruses (CoV) activate aryl hydrocarbon receptors (AhRs) by an indoleamine 2,3-dioxygenase (IDO1)-independent mechanism, bypassing the IDO1-kynurenine-AhR pathway. The IDO1-kynurenine-AhR signaling pathway is used by multiple viral, microbial and parasitic pathogens to activate AhRs and to establish infections. AhRs enhance their own activity through an IDO1-AhR-IDO1 positive feedback loop prolonging activation induced by pathogens. Direct activation of AhRs by CoV induces immediate and simultaneous up-regulation of diverse AhR-dependent downstream effectors, and this, in turn, results in a "Systemic AhR Activation Syndrome" (SAAS) consisting of inflammation, thromboembolism, and fibrosis, culminating in multiple organ injuries, and death. Activation of AhRs by CoV may lead to diverse sets of phenotypic disease pictures depending on time after infection, overall state of health, hormonal balance, age, gender, comorbidities, but also diet and environmental factors modulating AhRs. We hypothesize that elimination of factors known to up-regulate AhRs, or implementation of measures known to down-regulate AhRs, should decrease severity of infection. Although therapies selectively down-regulating both AhR and IDO1 are currently lacking, medications in clinical use such as dexamethasone may down-regulate both AhR and IDO1 genes, as calcitriol/vitamin D3 may down-regulate the AhR gene, and tocopherol/vitamin E may down-regulate the IDO1 gene. Supplementation of calcitriol should therefore be subjected to epidemiological studies and tested in prospective trials for prevention of CoV infections, as should tocopherol, whereas dexamethasone could be tried in interventional trials. Because lack of physical exercise activates AhRs via the IDO1-kynurenine-AhR signaling pathway increasing risk of infection, physical exercise should be encouraged during quarantines and stay-at-home orders during pandemic outbreaks. Understanding which factors affect gene expression of both AhR and IDO1 may help in designing therapies to prevent and treat humans suffering from Covid-19.