Background The covid 19 positive patient who is subject to a hyperinflammatory condition associated with lung injury with the development of pneumonia is hospitalized in the intensive care unit. Before resolving and overcoming the “cytokine storm”, with overexpression of pro-inflammatory interleukins (IL-, Il-6), this patient will be intubated for more than 48 hours and therefore needs adequate nutrition. Experimental approach Malnutrition can lead to sarcopenia with a decrease in lean body mass and worsening of the inflammatory state underway. In addition, severe debilitation, if not corrected with adequate nutrition, can greatly lengthen rehabilitation times with prolonged hospitalization, increased costs and reduced turn over already in crisis due to the health emergency caused by coronavirus. Key Results The aim of this study is to focus attention on the nutritional importance that must be provided in case of covid 19 together with pharmacological treatments to lower the number of circulating proinflammatory cytokines. Conclusions Oral, enteral and parenteral nutrition should always be carried out according to the patient’s condition and, in the case of a hyperinflammatory patient, such as the one affected by covid 19, it has been shown that the supplementation of amino acids helps to lower the inflammatory state and promotes normal recovery physiological. Keywords: amino acids, nutrition, covid, glutamine, hyperinflammatory, sarcopenia, cytokine.
The first cases of patients infected with SARS-Cov-2 virus were recorded in China in November 2019, and then rapidly spread to all countries around the world, causing a global pandemic. Much is known about the pathophysiology of this virus infection, but perhaps not enough. One of the aspects still to be investigated is the correlation between the renin-angiotensin system (RAS) and SARS-Cov-2 infection. RAS is a physiological system with a key role in regulating the different functions of the human body. SARS-CoV-2, uses the enzyme ACE-2 as a potential factor of cell penetration and infectivity, moreover in the different stages of infection a functional variation of the RAS system has been noted in different targets and at different times. In particular, in this article, we discuss the role of RAS on SARS-Cov-2 infection, and possible therapies that acting modifiers the system.
Several studies have shown a high correlation between concentration and development of low-density lipoprotein cholesterol (LDL-C)and the evolution of atherosclerosis and cardiovascular disease. Therefore, the reduction of LDL-C levels through lifestyle modification and/or pharmacological interventions has universally shown a decrease in cardiovascular events and mortality. In most cases, elevated blood lipid levels may be caused by alterations in certain genes encoding proteins involved in LDL metabolism, such as those associated with loss of function of the LDLr receptor gene , loss of function of the apoB gene or increased function of a PCSK9 protein .Family hypercholesterolemia is a hereditary disease in which a genetic alteration causes an increase in blood cholesterol. Therapy is based on dietary control and drugs such as statins, ezetimibe or PCSK9 inhibitory monoclonal antibodies. An important scientific breakthrough in recent years is the ability to identify the genetic basis of diseases and possibly correct the defective gene by interfering with small interfering RNA (siRNA) or antisense oligonucleotides (ASO). The technologies of antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs) have also been developed for the treatment of hypercholesterolemia with the aim of controlling the expression of specific genes that play key roles in lipid metabolism. Anti-sense oligonucleotides have been developed to target apolipoprotein B, the main structural protein of VLDL,LDL and chylomicrons,apolipoproteinCIII or angiopoietin 3, both of which play a role in the regulation of triglyceridesorapo(a). The siRNA approach works on the expression of PCSK9, a key modulator in LDL receptor catabolism. The purpose of this review is to present and discuss current clinical and scientific data on therapeutic evidence for new gene therapies in the treatment of hypercholesterolemia.
Glyphozines also called SGLT2 inhibitors, are a new class of agents that inhibit reabsorption of glucose in the kidney, in proxinal tubules, and therefore lower blood sugar. They act by inhibiting sodium-glucose transport protein 2 (SGLT2). Glyphozines are used in the treatment of type II diabetes mellitus (T2DM). In studies with canagliflozin, a member of this class, the medication was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure. In addition to regulate blood glucose, recent studies have shown that glyphozines have important positive cardiovascular benefits, such as weight loss, decreased volaemia and PA, reduced triglycerides, natriuresis and improved endothelial wall dysfunction. Clinical studies have shown reduction in deaths from cardiovascular events among diabetic patients treated with glyphozines. At the moment these drugs are being studied for an extension of the therapeutic indication also for cardiovascular diseases such as heart failure. In this review, we discuss the class of SGLT2 inhibitors in the treatment of diabetes, and studies focused on their possible role in the treatment of cardiac disease.
In recent years, new classes of drugs have entered the market for the treatment of type 2 diabetes mellitus (T2DM) with good efficacy on the normalization of blood glucoseandwithareductionin the risk of hypoglycaemia and with significant effects on weight reduction. One of the most promising classes in achieving these goals was that of the agonists(GLP)-1.However,adifficulty in using these drugs arisesfromsubcutaneousadministration,aroutethatisnotveryconvenientfor users and with the risk of infections. More recently, a GLP-1 agonist, semaglutide, has been developedwhichcanbeadministeredorally.Inthisreviewarticle,wediscussedtheeffectivenessof GLP-1 agonists, oral semaglutide and its therapeutic potential.