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G6PD deficiency and severity of COVID19 pneumonia and acute respiratory distress syndrome: tip of the iceberg?
Youssef, Jihad G; Zahiruddin, Faisal; Youssef, George; Padmanabhan, Sriram; Ensor, Joe; Pingali, Sai Ravi; Zu, Youli; Sahay, Sandeep; Iyer, Swaminathan P.
  • Youssef JG; Division of Pulmonary and Critical Care Medicine, Houston Methodist Pulmonary Transplant Center, Houston Methodist Hospital, Houston, TX, USA.
  • Zahiruddin F; Division of Pulmonary and Critical Care Medicine, Houston Methodist Pulmonary Transplant Center, Houston Methodist Hospital, Houston, TX, USA.
  • Youssef G; College of Natural Sciences and Mathematics, University of Houston, Houston, TX, USA.
  • Padmanabhan S; Collaborative Action for SARS-CoV-2 Eradication (CARE), Houston, TX, USA.
  • Ensor J; Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
  • Pingali SR; Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
  • Zu Y; Houston Methodist Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
  • Sahay S; Division of Pulmonary and Critical Care Medicine, Houston Methodist Lung Center, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
  • Iyer SP; Collaborative Action for SARS-CoV-2 Eradication (CARE), Houston, TX, USA. spiyer@mdanderson.org.
Ann Hematol ; 100(3): 667-673, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1030503
ABSTRACT
The severe pneumonia caused by the human coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy casualties, especially among the elderly and those with co-morbid illnesses irrespective of their age. The high mortality in African-Americans and males, in general, raises the concern for a possible X-linked mediated process that could affect the viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X-linked enzyme deficiency, associated with redox status, may have a role in severity of pneumonia. Retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated six with G6PD deficiency (G6PDd) and 11 with normal levels. The two groups (normal and G6PDd) were comparable in terms of age, sex, co-morbidities, and laboratory parameters-LDH, IL-6, CRP, and ferritin, respectively. Thirteen patients needed ventilatory support ; 8 in the normal group and 5 in the G6PDd group (72% vs.83%). The main differences indicating increasing severity in normal vs. G6PDd groups included G6PD levels (12.2 vs. 5.6, P = 0.0002), PaO2/FiO2 ratio (159 vs. 108, P = 0.05), days on mechanical ventilation (10.25 vs. 21 days P = 0.04), hemoglobin level (10 vs. 8.1 P = 0.03), and hematocrit (32 vs. 26 P = 0.015). Only one patient with G6PDd died; 16 were discharged home. Our clinical series ascribes a possible biological role for G6PDd in SARS-CoV2 viral proliferation. It is imperative that further studies are performed to understand the interplay between the viral and host factors in G6PDd that may lead to disparity in outcomes. KEY POINTS • COVID19 studies show higher mortality in men, due to severe pneumonia and ARDS, indicating possible X-linked mediated differences • G6PD, the most common X-linked enzymopathy, highly prevalent in African Americans and Italians, maintains redox homeostasis. • Preclinical studies using G6PD deficient (G6PDd) cells infected with human coronavirus (hCoV), show impaired cellular responses, viral proliferation and worsening oxidative damage. • Retrospective chart review in hospitalized patients with COVID19 pneumonia needing supplemental oxygen shows differences between the two groups (Normal and G6PDd) in hematological indices; the G6PDdgroup demonstrated prolonged PaO2/FiO2 ratio, and longer days on mechanical ventilation indicating the severity of the pneumonia.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / SARS-CoV-2 / COVID-19 / Glucosephosphate Dehydrogenase Deficiency Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Ann Hematol Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: S00277-021-04395-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / SARS-CoV-2 / COVID-19 / Glucosephosphate Dehydrogenase Deficiency Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Ann Hematol Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: S00277-021-04395-1