Source : ResearchGate Auteur :Kassem Sharif, Charlie Bridgewood

ANALYSE

Commentateur : Dr Thomas LAVAUX

Thème : 

Mécanisme du syndrome d’activation macrophagique pulmonaire en lien avec l’IL-6

A noter : L’IL-6 semble jouer un rôle important dans la physiopathologie de l’infection à SARS-CoV-2. Différents modèles de pneumopathie virales ou toxiques ont montré une augmentation d’IL-6 dans une phase dite hyperinflammatoire. Cette phase hyperinflammatoire, qui ressemble à un syndrome d’activation macrophagique, est d’abord limitée à la sphère pulmonaire. Elle semble pouvoir s’étendre dans les formes de SARS-Cov-2 les plus sévères, induisant une tornade cytokinique extrêmement délétère. Le caractère biphasique de cette infection est également noté, en particulier pour définir des stratégies thérapeutiques adaptées. Des schémas et un résumé de la physiopathologie de ce syndrome d’activation macrophagique pulmonaire complète cette synthèse. Conclusion : une intervention thérapeutique anti-inflammatoire, basées par exemple sur des molécules bloquants l’IL-6 (anti-il6r) est envisageable compte-tenu de l’implication de cette interleukine dans les modèles de pneumopathies proches de celle du COVID19. La place des corticostéroïdes est également discutée.


Source : JAMA Auteur : Giacomo Grasselli and al.

ABSTRACT

IMPORTANCE In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. OBJECTIVE To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.


Source : The Liverpool Drug Interaction Group                              

 


ABSTRACT

Interferon beta added as new COVID-therapy; metamizole, pirfenidone and HCV DDAs added as new comedications.

Details of the nature of drug interactions with experimental COVID-19 therapies (atazanavir, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, ribavirin, tocilizumab, interferon beta) and many comedication classes are given in the PDF below. Please use your browser’s “find” function to search for drug names. [Note: Darunavir/cobicistat has been removed from the PDF following a statement by Janssen regarding lack of evidence to support the use of darunavir-based treatments for COVID-19.]

Click here to view PDF.

 


Télécharger l’article complet


Source : JAMA Network Open Auteur : Satoshi Shoji and al.

ABSTRACT

IMPORTANCE Prasugrel was approved at a lower dose in 2014 in Japan than in the West because East Asian patients are considered more susceptible to bleeding than Western patients. However, real-world outcomes with low-dose prasugrel treatment remain unclear. OBJECTIVE To investigate the association of low-dose prasugrel vs standard-dose clopidogrel administration with short-term outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI).


Source : JAMA Cardiology

Auteur : Chirag Bavishi and al.


ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already surpassed the combined mortality inflicted by the severe acute respiratory syndrome (SARS) epidemic of 2002 and 2003 and the Middle East respiratory syndrome (MERS) epidemic of 2013. The pandemic is spreading at an exponential rate, with millions of people across the globe at risk of contracting SARS-CoV-2. Initial reports suggest that hypertension, diabetes, and cardiovascular diseases were the most frequent comorbidities in affected patients, and case fatality rates tended to be high in these individuals.In the largest Chinese study to date,1 which included 44 672 confirmed cases, preexisting comorbidities that had high mortality rates included cardiovascular disease (10.5%), diabetes (7.3%), and hypertension (6.0%). Patients with such comorbidities are commonly treated with renin angiotensin system blockers, such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). However, the use of ACEIs/ARBs in patients with COVID-19 or at risk of COVID-19 infection is currently a subject of intense debate. Below, we outline the mechanisms by which ACEIs/ARBs may be of benefit in those with COVID-19, what the current recommendations are for their use in infected patients, and suggested areas for further research.

read more …..

 


Télécharger l’article complet


Source : medRxiv

Auteur : Kai Duan and al.


ABSTRACT

Currently, there are no approved specific antiviral agents for 2019 novel coronavirus disease (COVID-19). In this study, ten severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 days after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 days. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 days. Several parameters tended to improve as compared to pre-transfusion, including increased lymphocyte counts (0.65×109/L vs. 0.76×109/L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesionswithin 7 days. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was welltolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in larger well-controlled trials.

 


Télécharger l’article complet


Source : NATURE Medecine Auteur :Nancy H. L. Leung and al.

ANALYSE

Commentateur : Dr Marie MOITRY

Points clés :

  • L’étude montre que, en plus des gouttelettes, les aérosols de l’air expiré par les malades pourraient être un mode de transmission du SARS-Cov-2, même chez les patients asymptomatiques.
  • Les masques chirurgicaux sont efficaces pour réduire la détection du virus ainsi que sa charge virale dans les gouttelettes et les aérosols de l’air expiré et l’étude confirme leur utilité chez les personnes malades.
  • Les conditions expérimentales et le peu de données disponibles sont des limites à prendre en compte pour l’interprétation des résultats sur le potentiel infectieux de la charge virale dans l’air expiré en situation réelle, et ce d’autant plus que la contagiosité du SARS-CoV-2 reste à ce jour incertaine.


Source : CHU de Strasbourg

Auteur : Dr Thomas LAVAUX


ETUDE 

Le syndrome de réponse inflammatoire systémique, réponse inflammatoire excessive, est un mécanisme étudié depuis plus de trente ans dans les infections d’origine bactériennes. L’infection a SARS-CoV de 2003 a permis de comprendre un certain nombre de mécanismes de la réponse immunitaire innée à cette infection virale. Pour ce SARS-CoV, son caractère bi-phasique, une réponse antivirale initiale puis la tornade cytokinique secondaire avec l’atteinte pulmonaire grave sont des phénomènes qui ont été reproduits sur des modèles animaux. Le parallèle entre SARS-CoV et SARS-CoV-2 est utile en attendant plus de données fondamentales sur cette nouvelle souche virale, afin de mieux comprendre les mécanismes biologiques sous-jacents. Nous espérons que ces données compilées permettront d’éclairer le choix des stratégies thérapeutiques présentes et à venir. Ce document est amené à évoluer au fur et à mesure de la publications de nouveaux travaux scientifiques sur le sujet.

 


Télécharger l’article complet


Source : VoxSanguinis

Auteur : Dr. Pierre TIBERGHIEN and al.


ABSTRACT

Plasma provided by COVID‐19 convalescent patients may provide therapeutic relief as the number CODID‐19 cases escalate steeply world‐wide. Prior findings in various viral respiratory diseases including SARS‐CoV related pneumonia suggest that convalescent plasma can reduce mortality, although formal proof of efficacy is still lacking. By reducing viral spread early on, such an approach may possibly downplay subsequent immunopathology. Identifying, collecting, qualifying and preparing plasma from convalescent patients with adequate SARS‐CoV‐2 neutralizing Ab titers in an acute crisis setting may be challenging, although well within the remit of most blood establishments. Careful clinical evaluation should allow to quickly establish whether such passive immunotherapy, administered at early phases of the disease in patients at high risk of deleterious evolution may reduce the frequency of patient deterioration, and thereby COVID‐19 mortality.

https://doi.org/10.1111/vox.12926


Télécharger l’article complet

© Les Hôpitaux Universitaires de Strasbourg 2020 - Tous droits réservés