ABSTRACT
The pandemic caused by the severe acute respiratory syndrome coronavirus (SARSCoV2), responsible for coronavirus disease 2019 (COVID19) has posed a major challenge for global health. In order to successfully combat SARSCoV2, the development of effective COVID19 vaccines is crucial. In this context, recent studies have highlighted a high COVID19 mortality rate in patients affected by ßthalassemia, probably due to their coexistent immune deficiencies. In addition to a role in the severity of SARSCoV2 infection and in the mortality rate of COVID19infected patients with thalassemia, immunosuppression is expected to deeply affect the effectivity of antiCOVID19 vaccines. In the context of the interplay between thalassemiaassociated immunosuppression and the effectiveness of COVID19 vaccines, the employment of immunomodulatory molecules is hypothesized. For instance, shortterm treatment with mammalian target of rapamycin inhibitors (such as everolimus and sirolimus) has been found to improve responses to influenza vaccination in adults, with benefits possibly persisting for a year following treatment. Recently, sirolimus has been considered for the therapy of hemoglobinopathies (including ßthalassemia). Sirolimus induces the expression of fetal hemoglobin (and this may contribute to the amelioration of the clinical parameters of patients with ßthalassemia) and induces autophagy (thereby reducing the excessive levels of αglobin). It may also finally contribute to the mobilization of erythroid cells from the bone marrow (thereby reducing anemia). In the present study, the authors present the hypothesis that sirolimus treatment, in addition to its beneficial effects on erythroidrelated parameters, may play a crucial role in sustaining the effects of COVID19 vaccination in patients with ßthalassemia. This hypothesis is based on several publications demonstrating the effects of sirolimus treatment on the immune system.
Subject(s)
COVID-19 Vaccines/therapeutic use , Sirolimus/therapeutic use , beta-Thalassemia/therapy , COVID-19/complications , COVID-19/mortality , COVID-19/pathology , COVID-19/prevention & control , Combined Modality Therapy , Humans , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , Severity of Illness Index , Sirolimus/pharmacology , Treatment Outcome , Vaccination/methods , beta-Thalassemia/complications , beta-Thalassemia/immunologySubject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , beta-Thalassemia/epidemiology , Activin Receptors, Type II/therapeutic use , Adult , Asymptomatic Infections , COVID-19/complications , Cardiovascular Diseases/etiology , Chelation Therapy/adverse effects , Clinical Trials as Topic , Comorbidity , Dietary Supplements , Female , Hospitalization/statistics & numerical data , Humans , Immunocompromised Host , Immunoglobulin Fc Fragments/therapeutic use , Iron Chelating Agents/adverse effects , Iron Chelating Agents/therapeutic use , Iron Overload/epidemiology , Iron Overload/etiology , Lebanon/epidemiology , Male , Obesity/epidemiology , Phosphodiesterase Inhibitors/therapeutic use , Prevalence , Recombinant Fusion Proteins/therapeutic use , Severity of Illness Index , Splenectomy , Tertiary Care Centers , Vitamins , beta-Thalassemia/complications , beta-Thalassemia/drug therapy , beta-Thalassemia/immunologyABSTRACT
The novel coronavirus pneumonia (COVID-19) is a contagious acute respiratory infectious disease whose causative agent has been demonstrated to be a novel virus of the coronavirus family, SARSCoV-2. A recent PRE-print study has showed a heme attack on the 1-beta chain of hemoglobin by COVID19. Beta-thalassemia results of a default in the hemoglobin beta-chain synthesis. 1,5% global population are heterozygotes for this disease. In this study, by a multiple linear regression, we have analyzed the evolution of COVID-19 infection in three Italian regions (Puglia, Sardinia, Sicilia) with different beta-thalassemic prevalences, in order to search a link. The results have showed that betathalassemic heterozygote population prevalence is correlated to immunity against COVID-19, by a regression. This paper is only for academic discussion, the hypotheses and conclusions needs to be confirmed by further research.