Unraveling the Secrets of COVID-19's Impact on the Heart: An Exciting New Discovery About The Role Of Necroptosis

COVID-19 News: The COVID-19 pandemic has wreaked havoc on healthcare systems worldwide and left millions of lives lost in its wake. As researchers race to understand the virus and its impacts on various organs, a new study by scientists from   J Craig Venter Institute, Maryland-USA and Universidad de La Sabana, Chía-Colombia sheds light on the mechanisms that lead to major adverse cardiac events (MACE) in patients with severe COVID-19.


 
MACE, which includes heart attacks, arrhythmias, heart failure, and strokes, has been shown to occur both during acute hospitalization and after a patient has been discharged, leading to worse clinical outcomes and higher mortality rates as covered in many past studies, case reports and COVID-19 News coverages.
 
Although researchers have identified an association between COVID-19 and MACE, the exact mechanisms driving this relationship have remained elusive – until now.
 
The American and Colombian study team from a recent observational prospective cohort study aimed to determine if SARS-CoV-2, the virus responsible for COVID-19, could induce necrotic cell death, promoting MACE in patients with severe COVID-19. The study team conducted experiments with hamsters and analyzed human samples from patients with severe COVID-19 to identify any links between the virus and MACE.
 
The study found that patients who developed MACE had higher levels of SARS-CoV-2, troponin-I, and pro-BNP in their serum. Additionally, they observed an increase in IP-10 and a major decrease in IL-17ɑ, IL-6, and IL-1rɑ levels.
 
Interestingly, there were no significant differences in the ability of serum antibodies to neutralize viral spike proteins in pseudoviruses from variants of concern.
 
In hamster models, the study team discovered a significant increase in viral titters in the hearts four days post-infection. The cardiac transcriptome evaluation revealed the differential expression of approximately 9% of the total transcripts.
Detailed analysis of transcriptional changes in the effectors of necroptosis and pyroptosis showed that necroptosis, but not pyroptosis, was elevated.
 
The study team also found an active form of MLKL (phosphorylated MLKL, pMLKL) to be elevated in hamster hearts and, more importantly, in the serum of MACE patients.
 
These findings suggest that the presence of SARS-CoV-2 in the systemic circulation is associated with MACE and necroptosis activity. The increased pMLKL and troponin-I levels indicate the occurrence of necroptosis in the heart, implying that necroptosis effectors could serve as potential biomarkers and therapeutic targets.
 
This groundbreaking study offers a new perspective on the relationship between COVID-19 and MACE, highlighting the potential of necroptosis as a therapeutic target to reduce acute and long-term cardiac damage associated with COVID-19.
 
By identifying necroptosis and circulating viral particles as primary drivers of MACE in severe COVID-19 patients, researchers may be able to develop more targeted and effective treatments to prevent MACE and improve patient outcomes.
 
For those who are not aware, necroptosis is an alternative mode of regulated cell death mimicking features of apoptosis and necrosis. Necroptosis is a programmed form of necrosis, or inflammatory cell death. Conventionally, necrosis is associated with unprogrammed cell death resulting from cellular damage or infiltration by pathogens, in contrast to orderly, programmed cell death via apoptosis.
 
The study team proposes that pMLKL, troponin-I, and pro-BNP may be more accurate biomarkers for predicting acute and future development of MACE and disease outcomes.
 
However, further studies with larger patient cohorts and longitudinal analyses are needed to validate these findings and develop high-accuracy predictive models using these serum biomarkers.
 
Despite the limitations of this study, such as the small number of patients included and the lack of access to heart tissue from patients who developed MACE, the findings represent a significant leap forward in understanding the mechanisms behind MACE in patients with COVID-19.
 
The discovery that necroptosis and circulating viral particles are primary drivers of MACE in severe COVID-19 patients offers an exciting new avenue for future research and therapeutic development. The identification of more accurate biomarkers, such as pMLKL, Troponin-I, and pro-BNP, may lead to improved risk stratification and personalized treatment strategies for patients at high risk of developing MACE. By targeting the specific mechanisms behind MACE in COVID-19 patients, novel therapies can be developed to prevent or mitigate the severity of these life-threatening cardiac events.
 
One potential approach to targeting necroptosis is the development of small molecule inhibitors that selectively block MLKL activity. These inhibitors could be administered to patients with severe COVID-19 who are at high risk of developing MACE, thereby preventing or reducing cardiac injury. Research in this area is still in its infancy, but the identification of necroptosis as a key mechanism in MACE development provides a solid foundation for the design and testing of such inhibitors.
 
Another area of interest lies in the development of novel diagnostic tools to better predict MACE in patients with COVID-19. The identification of pMLKL, Troponin-I, and pro-BNP as more accurate biomarkers for MACE risk could lead to the development of point-of-care tests that enable clinicians to quickly identify patients at higher risk and adjust their treatment plans accordingly. This could significantly improve patient outcomes and reduce the burden on healthcare systems.
 
It is also crucial to investigate the long-term effects of necroptosis-related MACE in COVID-19 patients, especially in the context of long-COVID syndrome. Further research is needed to determine whether inhibiting necroptosis during the acute phase of infection could prevent or alleviate the development of long-term cardiac complications. Additionally, understanding the specific mechanisms driving long-COVID-associated MACE could help identify new therapeutic targets and interventions to improve the quality of life for patients suffering from this debilitating condition.
 
Lastly, the findings of this study could have implications for the development of COVID-19 vaccines and treatment strategies. Understanding the role of circulating viral particles in driving MACE risk suggests that treatments aimed at reducing viral burden in patients with severe COVID-19 could potentially mitigate the risk of MACE. This insight could guide the development of antiviral therapies and inform vaccination strategies, particularly in high-risk populations with pre-existing cardiovascular conditions.
 
In summary, the discovery that necroptosis and circulating viral particles are primary drivers of MACE in severe COVID-19 patients provides a promising direction for future research and therapeutic development. By identifying more accurate biomarkers and investigating the potential of targeting necroptosis and viral burden, researchers can work towards improving patient outcomes and reducing the overall impact of COVID-19 on global health.
 
The study findings were published in the peer reviewed journal: Critical Care
https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04423-8
 
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