Medical Bulletin 11/ November/ 2024 - Video

Three years after the most lethal period of the COVID-19 pandemic, a review of the scientific literature published in the American Journal of Reproductive Immunology emphasizes the pathophysiological similarities between preeclampsia and COVID-19.

During the COVID-19 pandemic, above all before vaccines were available, an alarm was sounded regarding a possible correlation between severe cases of COVID-19 in pregnant women and preeclampsia. It can entail dangerous complications for mother and baby. Preeclampsia was more frequent in pregnant women infected by SARS-CoV-2 and was associated with a heightened risk of complications and death.

The protocols for treating the two conditions are different. In the case of preeclampsia, the pregnancy must be interrupted and the baby delivered as soon as possible by cesarean section, whereas in a woman with COVID-19 the pregnancy can proceed, with clinical support until the infection improves.

The study was conducted by researchers at the State University of Campinas in São Paulo state, Brazil, and Baylor College of Medicine in Houston, Texas (USA). The similarities highlighted in the article include shared pathways involving the renin-angiotensin system and angiotensin-converting enzyme 2 (ACE2), the receptor to which SARS-CoV-2 binds to infect human cells.

“The two conditions do indeed have many similarities. Both severe COVID-19 and preeclampsia can involve multiple organ dysfunction and high blood pressure. There are also similarities in the mechanism, as angiotensin-converting enzyme 2 plays a key role in regulating blood pressure. It’s possible therefore that COVID-19 heightens the risk of preeclampsia, as suggested by several studies that point to a higher frequency of preeclampsia in COVID-19 patients,” Maria Laura Costa do Nascimento, last author of the review article and a professor of obstetrics at UNICAMP.

The rise in maternal mortality during the pandemic cannot be blamed on the rise in cases of preeclampsia. “This is due to lack of both epidemiological surveillance findings and a proper diagnosis of the condition,” Nascimento said. “What we can say, based on a multicenter study we conducted during the pandemic with data from 16 maternity hospitals across Brazil, is that the risk of death or severe disease increases when both conditions are present. Moreover, our review of the literature shows that the prevalence of preeclampsia rises among COVID-19 patients.”

Reference: Nobrega, G. M., Jones, B. R., Mysorekar, I. U., & Costa, M. L. (2024). Preeclampsia in the Context of COVID‐19: Mechanisms, Pathophysiology, and Clinical Outcomes. American Journal of Reproductive Immunology, 92(2), e13915.

A new study by the World Health Organization (WHO) lists 17 bacteria, viruses and parasites that regularly cause disease as top priorities for new vaccine development.

The study is the first global effort to systematically prioritize endemic pathogens based on their regional and global health impact.

It reconfirms longstanding priorities for vaccine research and development (R&D), including for HIV, malaria, and tuberculosis – three diseases that collectively cause nearly 2.5 million deaths each year. Attention is also given to pathogens such as Group A streptococcus, which causes severe infections and contributes to 280,000 deaths from rheumatic heart disease, mainly in lower-income countries.

Another new priority is Klebsiella pneumoniae — a bacteria that was associated with 790,000 deaths in 2019 and is responsible for 40 per cent of neonatal deaths due to blood infection in low-income countries. The new study supports the goal of ensuring that everyone, everywhere, can benefit from vaccines that provide protection against serious diseases. It aims to shift the focus in vaccine development away from commercial returns towards regional and global health needs, said WHO’s Dr. Mateusz Hasso-Agopsowicz, who works in vaccine research.

To carry out the study, WHO asked international and regional experts what they think is important when prioritizing pathogens for vaccines R&D. Criteria included deaths, disease and socioeconomic impact, or antimicrobial resistance. Analysis of those preferences, combined with regional data for each pathogen, resulted in top 10 priority pathogens for each of WHO’s six regions globally. The regional lists were then consolidated to form the global list, resulting in the 17 priority endemic pathogens for which new vaccines are urgently needed. To advance vaccine R&D, WHO has categorized each pathogen based on the stage of vaccine development and the technical challenges involved in creating effective vaccines.

Reference: https://news.un.org/en/story/2024/11/1156521

Bacteria associated with inflammation is found in the gut in higher amounts roughly ten months before patients develop clinical rheumatoid arthritis, a longitudinal study by Leeds researchers has found. Findings are published in the Annals of the Rheumatic Diseases.

Lead researcher Dr Christopher Rooney, NIHR Academic Clinical Lecturer at the University of Leeds and Leeds Teaching Hospitals NHS Trust, said: "Patients at risk of rheumatoid arthritis are already experiencing symptoms such as fatigue and joint pain, and they may know someone in their family who has developed the disease. As there is no known cure, at-risk patients often feel a sense of hopelessness, or even avoid getting tested.

"This new research might give us a major opportunity to act sooner to prevent rheumatoid arthritis."

The longitudinal study was conducted on 19 patients at risk of rheumatoid arthritis, with samples taken five times during a 15-month period. Five of these patients progressed to clinical arthritis, and the research showed they had gut instability with higher amounts of bacteria including Prevotella, which is associated with rheumatoid arthritis, about ten months before progression. The remaining 14, whose disease didn't progress, had largely stable amounts of bacteria in their gut.

The study initially took data from 124 individuals who had high levels of CCP+, an antibody that attacks healthy cells in the blood, which indicates risk of developing rheumatoid arthritis. The researchers compared their samples to 22 healthy individuals and seven people who had a new rheumatoid arthritis diagnosis.

The findings from this larger group showed that the gut microbiome was less diverse in the at-risk group, compared to the healthy control group. The longitudinal study, which took samples from 19 patients over 15 months, revealed the changes in bacteria at ten months before progression to rheumatoid arthritis.

Reference: Rooney CM, Jeffery IB, Mankia K, et al, Dynamics of the gut microbiome in individuals at risk of rheumatoid arthritis: a cross-sectional and longitudinal observational study, Annals of the Rheumatic Diseases Published Online First: 08 November 2024. doi: 10.1136/ard-2024-226362