Effect of Remote Ischaemic Conditioning on the Inflammatory Cytokine Cascade of COVID-19 (RIC in COVID-19): a Randomized Controlled Trial.

Autor: Lukhna K; Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa., do Carmo HRP; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Castillo AR; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Davidson SM; The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK., Geffen H; Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa., Giesz S; The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK., Golforoush P; The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK., Bovi TG; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Gorag D; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Salama A; Cape Heart Institute, University of Cape Town, Cape Town, South Africa.; The Royal Free Hospital, University College London, Pond St, London, NW3 2QG, UK., Imamdin A; Cape Heart Institute, University of Cape Town, Cape Town, South Africa., Kalkhoran S; The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK., Lecour S; Cape Heart Institute, University of Cape Town, Cape Town, South Africa., Perroud MW Jr; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Ntsekhe M; Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa., Sposito AC; Atherosclerosis and Vascular Biology Laboratory, State University of Campinas, Campinas, Brazil., Yellon DM; The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK. d.yellon@ucl.ac.uk.
Jazyk: angličtina
Zdroj: Cardiovascular drugs and therapy [Cardiovasc Drugs Ther] 2024 Jun; Vol. 38 (3), pp. 433-445. Date of Electronic Publication: 2022 Nov 29.
DOI: 10.1007/s10557-022-07411-2
Abstrakt: Purpose: Patients hospitalized with COVID-19 may develop a hyperinflammatory, dysregulated cytokine "storm" that rapidly progresses to acute respiratory distress syndrome, multiple organ dysfunction, and even death. Remote ischaemic conditioning (RIC) has elicited anti-inflammatory and cytoprotective benefits by reducing cytokines following sepsis in animal studies. Therefore, we investigated whether RIC would mitigate the inflammatory cytokine cascade induced by COVID-19.
Methods: We conducted a prospective, multicentre, randomized, sham-controlled, single-blind trial in Brazil and South Africa. Non-critically ill adult patients with COVID-19 pneumonia were randomly allocated (1:1) to receive either RIC (intermittent ischaemia/reperfusion applied through four 5-min cycles of inflation (20 mmHg above systolic blood pressure) and deflation of an automated blood-pressure cuff) or sham for approximately 15 days. Serum was collected following RIC/sham administration and analyzed for inflammatory cytokines using flow cytometry. The endpoint was the change in serum cytokine concentrations. Participants were followed for 30 days.
Results: Eighty randomized participants (40 RIC and 40 sham) completed the trial. Baseline characteristics according to trial intervention were overall balanced. Despite downward trajectories of all cytokines across hospitalization, we observed no substantial changes in cytokine concentrations after successive days of RIC. Time to clinical improvement was similar in both groups (HR 1.66; 95% CI, 0.938-2.948, p 0.08). Overall RIC did not demonstrate a significant impact on the composite outcome of all-cause death or clinical deterioration (HR 1.19; 95% CI, 0.616-2.295, p = 0.61).
Conclusion: RIC did not reduce the hypercytokinaemia induced by COVID-19 or prevent clinical deterioration to critical care.
Trial Registration: ClinicalTrials.gov Identifier: NCT04699227.
(© 2022. The Author(s).)
Databáze: MEDLINE
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