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Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC)
Post-acute sequelae of COVID (PASC), or long COVID, is a multisystem complication of SARS-CoV-2 infection that continues to debilitate millions worldwide thus highlighting the public health importance of identifying effective therapeutics to alleviate this illness. One explanation behind PASC may be...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944830/ https://www.ncbi.nlm.nih.gov/pubmed/36844201 http://dx.doi.org/10.3389/fmed.2023.1122529 |
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author | Patterson, Bruce K. Yogendra, Ram Guevara-Coto, Jose Mora-Rodriguez, Rodrigo A. Osgood, Eric Bream, John Parikh, Purvi Kreimer, Mark Jeffers, Devon Rutland, Cedric Kaplan, Gary Zgoda, Michael |
author_facet | Patterson, Bruce K. Yogendra, Ram Guevara-Coto, Jose Mora-Rodriguez, Rodrigo A. Osgood, Eric Bream, John Parikh, Purvi Kreimer, Mark Jeffers, Devon Rutland, Cedric Kaplan, Gary Zgoda, Michael |
author_sort | Patterson, Bruce K. |
collection | PubMed |
description | Post-acute sequelae of COVID (PASC), or long COVID, is a multisystem complication of SARS-CoV-2 infection that continues to debilitate millions worldwide thus highlighting the public health importance of identifying effective therapeutics to alleviate this illness. One explanation behind PASC may be attributed to the recent discovery of persistent S1 protein subunit of SARS-CoV-2 in CD16+ monocytes up to 15 months after infection. CD16+ monocytes, which express both CCR5 and fractalkine receptors (CX3CR1), play a role in vascular homeostasis and endothelial immune surveillance. We propose targeting these receptors using the CCR5 antagonist, maraviroc, along with pravastatin, a fractalkine inhibitor, could disrupt the monocytic-endothelial-platelet axis that may be central to the etiology of PASC. Using five validated clinical scales (NYHA, MRC Dyspnea, COMPASS-31, modified Rankin, and Fatigue Severity Score) to measure 18 participants’ response to treatment, we observed significant clinical improvement in 6 to 12 weeks on a combination of maraviroc 300 mg per oral twice a day and pravastatin 10 mg per oral daily. Subjective neurological, autonomic, respiratory, cardiac and fatigue symptoms scores all decreased which correlated with statistically significant decreases in vascular markers sCD40L and VEGF. These findings suggest that by interrupting the monocytic-endothelial-platelet axis, maraviroc and pravastatin may restore the immune dysregulation observed in PASC and could be potential therapeutic options. This sets the framework for a future double-blinded, placebo-controlled randomized trial to further investigate the drug efficacy of maraviroc and pravastatin in treating PASC. |
format | Online Article Text |
id | pubmed-9944830 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-99448302023-02-23 Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) Patterson, Bruce K. Yogendra, Ram Guevara-Coto, Jose Mora-Rodriguez, Rodrigo A. Osgood, Eric Bream, John Parikh, Purvi Kreimer, Mark Jeffers, Devon Rutland, Cedric Kaplan, Gary Zgoda, Michael Front Med (Lausanne) Medicine Post-acute sequelae of COVID (PASC), or long COVID, is a multisystem complication of SARS-CoV-2 infection that continues to debilitate millions worldwide thus highlighting the public health importance of identifying effective therapeutics to alleviate this illness. One explanation behind PASC may be attributed to the recent discovery of persistent S1 protein subunit of SARS-CoV-2 in CD16+ monocytes up to 15 months after infection. CD16+ monocytes, which express both CCR5 and fractalkine receptors (CX3CR1), play a role in vascular homeostasis and endothelial immune surveillance. We propose targeting these receptors using the CCR5 antagonist, maraviroc, along with pravastatin, a fractalkine inhibitor, could disrupt the monocytic-endothelial-platelet axis that may be central to the etiology of PASC. Using five validated clinical scales (NYHA, MRC Dyspnea, COMPASS-31, modified Rankin, and Fatigue Severity Score) to measure 18 participants’ response to treatment, we observed significant clinical improvement in 6 to 12 weeks on a combination of maraviroc 300 mg per oral twice a day and pravastatin 10 mg per oral daily. Subjective neurological, autonomic, respiratory, cardiac and fatigue symptoms scores all decreased which correlated with statistically significant decreases in vascular markers sCD40L and VEGF. These findings suggest that by interrupting the monocytic-endothelial-platelet axis, maraviroc and pravastatin may restore the immune dysregulation observed in PASC and could be potential therapeutic options. This sets the framework for a future double-blinded, placebo-controlled randomized trial to further investigate the drug efficacy of maraviroc and pravastatin in treating PASC. Frontiers Media S.A. 2023-02-08 /pmc/articles/PMC9944830/ /pubmed/36844201 http://dx.doi.org/10.3389/fmed.2023.1122529 Text en Copyright © 2023 Patterson, Yogendra, Guevara-Coto, Mora-Rodriguez, Osgood, Bream, Parikh, Kreimer, Jeffers, Rutland, Kaplan and Zgoda. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Patterson, Bruce K. Yogendra, Ram Guevara-Coto, Jose Mora-Rodriguez, Rodrigo A. Osgood, Eric Bream, John Parikh, Purvi Kreimer, Mark Jeffers, Devon Rutland, Cedric Kaplan, Gary Zgoda, Michael Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title | Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title_full | Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title_fullStr | Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title_full_unstemmed | Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title_short | Case series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequelae of COVID (PASC) |
title_sort | case series: maraviroc and pravastatin as a therapeutic option to treat long covid/post-acute sequelae of covid (pasc) |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944830/ https://www.ncbi.nlm.nih.gov/pubmed/36844201 http://dx.doi.org/10.3389/fmed.2023.1122529 |
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