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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
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.
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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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