Search

Effective treatment strategies for severe coronavirus disease (COVID-19) remain scarce. Hydrolysis of membrane-embedded, inert sphingomyelin by stress responsive sphingomyelinases is a hallmark of adaptive responses and cellular repair. As demonstrated in experimental and observational clinical studies, the transient and stress-triggered release of a sphingomyelinase, SMPD1, into circulation and subsequent ceramide generation provides a promising target for FDA-approved drugs. Here, we report the activation of sphingomyelinase-ceramide pathway in 23 intensive care patients with severe COVID-19. We observed an increase of circulating activity of sphingomyelinase with subsequent derangement of sphingolipids in serum lipoproteins and from red blood cells (RBC). Consistent with increased ceramide levels derived from the inert membrane constituent sphingomyelin, increased activity of acid sphingomyelinase (ASM) accurately distinguished the patient cohort undergoing intensive care from healthy controls. Positive correlational analyses with biomarkers of severe clinical phenotype support the concept of an essential pathophysiological role of ASM in the course of SARS-CoV-2 infection as well as of a promising role for functional inhibition with anti-inflammatory agents in SARS-CoV-2 infection as also proposed in independent observational studies. We conclude that large-sized multicenter, interventional trials are now needed to evaluate the potential benefit of functional inhibition of this sphingomyelinase in critically ill patients with COVID-19.

is presenting the timing of endpoints. (DOC 28 kb)

is presenting the SI score. (DOCX 16 kb)

is presenting the primer sequences. (DOCX 16 kb)

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNg/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNg/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNg and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNg/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNg/IL10 may become a suitable theranostic marker for an urging clinical need.

The admixture of CeO2 , Ce, CeCl3 , and MoO3 with an excess of LiCl as flux in evacuated silica ampules leads to large black single crystals as well as a black microcrystalline powder of Ce3 Cl3 [MoO6 ] after tempering at 850 °C for three days. The title compound crystallizes in the hexagonal space group P63 /m (a=934.93(4), c=538.86(2) pm) with two formula units per unit cell. The crystal structure consists of rather unusual trigonal-prismatic [MoO6 ]6- units besides Ce3+ ions in a tetra-capped trigonal-prismatic coordination, formed by four Cl- and six O2- ions. The black color is related to an optical band gap of 1.35(2) eV, which was determined by diffuse reflectance spectroscopy and confirmed by theoretical calculations. The low band gap between the 4f1 state of cerium (HOMO) and the 5d0 state of molybdenum (LUMO) gave rise to the idea of electronic excitation between these two states by IR irradiation, creating a drop in the resistivity of the material, which was detected by appropriate measurements.

European journal of inflammation 15(2), 66-77 (2017). doi:10.1177/1721727X17721088, Published by Sage, London [u.a.]

Lists of pairwise overlaps. Table S2. – List of biomarker genes from each type of classifier. Table S3. List of genes selected from the combined approach and their respective adjusted p-values (