Increasing numbers of patients who recover from COVID-19 report lasting symptoms, such as fatigue, muscle weakness, dementia, and insomnia, known collectively as post-acute COVID syndrome or long COVID. These lasting symptoms have been examined in different studies and found to influence multiple organs, sometimes resulting in life-threating conditions. In this review, these symptoms are discussed in connection to the COVID-19 and long-COVID-19 immune changes, highlighting oral and psychiatric health, as this work focuses on the gut microbiota’s link to long-COVID-19 manifestations in the liver, heart, kidney, brain, and spleen. A model of this is presented to show the biological and clinical implications of gut microbiota in SARS-CoV-2 infection and how they could possibly affect the therapeutic aspects of the disease. Probiotics can support the body’s systems in fighting viral infections. This review focuses on current knowledge about the use of probiotics as adjuvant therapies for COVID-19 patients that might help to prevent long-COVID-19 complications.

Abatacept, an inhibitor of CD28 mediated T-cell activation, has been shown to be effective in controlling inflammation during rheumatoid arthritis (RA). However, its effects on immune regulatory B and T cells (Bregs and Tregs) has not been fully explored. Thirty-one RA patients treated with abatacept for ≥ 6 months along with 31 RA patients treated with other modalities as well as 30 healthy controls were recruited. Of these 62 RA patient, 49 (79%) were females with a mean age of 54 ± 12 years and disease duration of 10 ± 6 years. The blood levels of Tregs and Bregs and their production of immunosuppressive cytokines, were determined using FACS analysis and Luminex Multiplex assay. Treatment with abatacept significantly enhanced the blood level of IL-35+ IL-10+ Bregs (P = 0.0007). Their levels were higher in the blood of remitted patients (DAS28-CRP < 2.6) compared to the unremitted ones (P = 0.0173), 6 months following abatacept treatment initiation. Moreover, abatacept treatment significantly enhanced the blood levels of LAG3+ conventional and unconventional Tregs of RA patients. This increase in the blood levels of Bregs and Tregs was accompanied with an elevated serum level of IL-35 and IFN-β in abatacept-treated patients. Therefore, Abatacept efficiency to achieve remittance in RA could be attributed, in part, to its ability to enhance immune regulatory cells, especially IL-135+ IL-10+ Bregs.

Backgrounds Treating asthmatic rheumatoid arthritis patients with abatacept has been shown to associate with better control of asthma symptoms. However, the mechanism behind that is not investigated. Methods Ovalbumin (OVA)- sensitized BALB/c female mice were treated intranasally (IN) or intraperitoneally (IP) with abatacept 4 hrs before the OVA challenge. The effects of abatacept IN or IP on the lungs and blood levels of Tregs and Bregs and their production of immunosuppressive cytokines, were determined using FACS analysis and ELISA assay. Results Treating OVA- sensitized asthmatic mice model with abatacept, IN or IP, reduced lung inflammation. IN treatment with abatacept increased the frequency of IL-35 and IL-10 producing Bregs in the lung tissues to a higher level compared to IP treatment. Moreover, the frequency of lungs LAG3+ Tregs was significantly increased following treatment. This was also associated with a reduction in lung tissue and serum IL-17 levels of treated mice. Conclusions These results suggest that abatacept by enhancing IL-35+IL-10+ Bregs and LAG3+ Tregs might reverse IL-17 induced lung inflammation during asthma.

BackgroundCardiovascular diseases represent a major contributor to the increased mortality. Risk factors varies according to the subtypes of cardiovascular events and perhaps racial background. Little is known about the risk of major cardiovascular events (MACE) in Saudi lupus Population.ObjectivesThis study aim to examine the prevalence of MACE among Saudi SLE compared to general population and factors associated with such outcome.MethodsThis a cross-sectional study nested within two prospective cohorts to assess the period prevalence of any MACE among SLE patients who were enrolled in national prospective cohort of SLE, Saudi Arabia since its initiation in 2020. As a comparison, Prospective Urban Rural Epidemiology Study Saudi sub-cohort (PURE-Saudi) for participants who have been enrolled during the same follow up period. Participants in both studies were followed using standardized published protocol. MACE was defined as the diagnosis of Myocardial infraction, stroke or Angina. We adjust for demographics, traditional cardiovascular risk factors and the diagnosis of SLE using logistic regression models.ResultsA total of 488 with SLE and 746 from PURE were included. SLE patients were younger (40.7±12.5 compared to 49.5±8.6) and female predominant (90.6% compared to.41.6%). Prevalence of traditional risk factors were less in SLE patients including dyslipidemia (28.9% compared to 49.4%), obesity (63% compared to 85%) diabetes (7.8% compared to 27.2%) but not HTN (19.3 compared to 18.8%). Odds of MACE were significantly related to Age and Lupus diagnosis (OR: 1.08, 95% CI: 1.04-1.11, p=0.00) and (OR: 7.64, 95% CI: 2.65-22.07, p=0.00) but not CVS risk factors (OR: 0.8, 95% CI: 0.10-6.39, p=0.83).ConclusionSLE patients at significant risk of MACE compared to general population. This risk is not well explained by traditional risk factors which may explain the failure of CVS risk scores to adequately stratify SLE patients. Further work is needed to understand the pathogenesis of CVS risk in SLE and subsequently mitigate it.References[1]Yurkovich M, Vostretsova K, Chen W, Avina-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis care & research. 2014;66(4):608-616.[2]Rees F, Doherty M, Grainge MJ, Lanyon P, Davenport G, Zhang W. Mortality in systemic lupus erythematosus in the United Kingdom 1999–2012. Rheumatology. 2016;55(5):854-860.[3]Falasinnu T, Chaichian Y, Li J, et al. Does SLE widen or narrow race/ethnic disparities in the risk of five co-morbid conditions? Evidence from a community-based outpatient care system. Lupus. 2019;28(14):1619-1627.Acknowledgements:NIL.Disclosure of InterestsNone Declared.