Leukocyte surface expression of the endoplasmic reticulum chaperone GRP78 is increased in severe COVID-19.

Hyperinflammation present in individuals with severe COVID-19 has been associated with an exacerbated cytokine production and hyperactivated immune cells. Endoplasmic reticulum stress leading to the unfolded protein response has been recently reported as an active player in inducing inflammatory responses. Once unfolded protein response is activated, GRP78, an endoplasmic reticulum-resident chaperone, is translocated to the cell surface (sGRP78), where it is considered a cell stress marker; however, its presence has not been evaluated in immune cells during disease. Here we assessed the presence of sGRP78 on different cell subsets in blood samples from severe or convalescent COVID-19 patients. The frequency of CD45+sGRP78+ cells was higher in patients with the disease compared to convalescent patients. The latter showed similar frequencies to healthy controls. In patients with COVID-19, the lymphoid compartment showed the highest presence of sGRP78+ cells versus the myeloid compartment. CCL2, TNF-α, C-reactive protein, and international normalized ratio measurements showed a positive correlation with the frequency of CD45+sGRP78+ cells. Finally, gene expression microarray data showed that activated T and B cells increased the expression of GRP78, and peripheral blood mononuclear cells from healthy donors acquired sGRP78 upon activation with ionomycin and PMA. Thus, our data highlight the association of sGRP78 on immune cells in patients with severe COVID-19.

Total control of asthma: an evaluation in patients of a tertiary hospital.

BACKGROUND: Asthma control is an important goal of international asthma guidelines, but in most reports total control is reached in a small proportion of cases. OBJECTIVE: To know the degree of asthma control, the percentage of ER visits and hospitalizations in the last month and in the last year, and the type of pharmacologic treatment for asthma in a tertiary hospital. PATIENTS AND METHOD: This is an observational study in asthmatic patients from 12 to 60 years old, with more than one year of treatment, who answered the questionnaire of Asthma Control Test (ACT). RESULTS: A total of 204 patients were included, 116 women and 88 men, with an average age of 24 years. We observed that 19 patients (9.3%) were in total control of asthma: scored 25 ACT points, 88 patients (43.1%) scored 20-24 points (non total control) and 97 patients (47.5%) less than 20 points (asthma not controlled). According to the asthma severity index, 125 patients had intermittent symptoms (61.3%), and persistent symptoms were present in 79 patients. In the previous month 8.3% of patients had ER visits and 2.9% were hospitalized; in the previous year the ER visits and hospitalizations percentages were 33.3% and 14.2%, respectively. Inhaled steroids were used by 12.2% of the patients, long-action beta2 agonists by 9.8% and daily short action beta2 agonists by 28%. CONCLUSIONS: Total control of asthma was observed in less than 10% of our patients-sample; the majority of them had intermittent asthma; the pattern of medication was inadequate, with misuse of inhaled steroids and an elevated use of inhaled rescue medications.