Vascular Inflammation as a Therapeutic Target in COVID-19 “Long Haulers”: HIITing the Spot?

Christensen, Regitse Højgaard; Berg, Ronan M. G.

doi:10.3389/fcvm.2021.643626

Cited by 13 publications

(11 citation statements)

References 60 publications

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“…25 Potentially, this may be specifically counteracted with HIIT, where the pronounced changes in vascular shear stress that occur between intervals combined with the effects of antiinflammatory myokines that are released from working skeletal muscle in an intensity-dependent manner may enhance endothelial repair and dampen proinflammatory processes within the vascular wall. 5 The high composite intensity achieved is the bestdocumented means for increasing maximal oxygen consumption (V ̇O2max ) and exerting beneficial cardiovascular effects. HIIT has thus been reported to be superior to continuous endurance training in several patient groups.…”

Section: Discussionmentioning

confidence: 99%

“…16 Furthermore, in contrast to low-intensity and classical endurance exercise training, HIIT may more specifically target residual vascular inflammation, a putative central mechanism of long COVID-19. 5 However, it is unknown to which extent it is feasible to implement HIIT in recently discharged patients with COVID-19, that is, whether they can tolerate HIIT without adverse effects.…”

Section: What Are the New Findingsmentioning

confidence: 99%

“…[1][2][3][4] The underlying mechanisms of long COVID-19 are unknown but likely involve residual inflammation in the heart, lungs and vasculature. 5 While the need for implementing evidence-based rehabilitation schemes that include exercise training following COVID-19 is imminent, no consensus exists as to how such programmes should be designed.…”

Section: Introductionmentioning

confidence: 99%

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Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial

Foged

Rasmussen

Budde

et al. 2021

BMJ Open Sport Exerc Med

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Objectives. Many patients with COVID-19 suffer from persistent symptoms, many of which may potentially be reversed by high-intensity interval training (HIIT). Yet, the safety and tolerability of HIIT after COVID-19 is controversial. This study aimed to investigate the fidelity, tolerability and safety of three different HIIT protocols in individuals that had recently been hospitalised due to COVID-19. Methods. The study was a randomised cross-over trial. We compared three supervised HIIT protocols (4×4, 6×1, 10-20-30) in 10 individuals recently discharged after hospitalisation for severe COVID-19. Each HIIT protocol had a duration of 38 min and was performed with a 1-week washout between them. Outcomes included adverse events, exercise training intensity and tolerability assessed by the Likert scale (1–10). Results. All 10 participants aged 61 (mean, SD 8) years (5 males) completed all three HIIT protocols with no adverse events. High intensities were achieved in all three protocols, although they differed in terms of time spent with a heart rate ≥85% of maximum (mean (SD); 4×4: 13.7 (6.4) min; 10-20-30: 12.1 (3.8) min; 6×1: 6.1 (5.6) min; p=0.03). The three protocols were all well tolerated with similar Likert scale scores (mean (SD); 4×4: 8 (2), 10-20-30: 8 (2), 6×1: 9 (2), p=0.72). Conclusion. Our findings indicate that recently hospitalised individuals for severe COVID-19 may safely tolerate acute bouts of supervised HIIT as per protocol. This warrants future studies testing the potential of regular HIIT as a rehabilitation strategy in this context.

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Section: Discussionmentioning

confidence: 99%

Section: What Are the New Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial

Foged

Rasmussen

Budde

et al. 2021

BMJ Open Sport Exerc Med

Self Cite

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“…The severe course of the infection can often lead to complications in other organs, including heart damage, renal failure, and gastrointestinal disorders [1] . SARS CoV‐2 infection is known to affect the vascular system and coagulation properties of the blood, injuring vessel walls and causing blood clots to form in both large and microscopic blood vessels [ 2 , 3 ]. Very little is known about the complications in the facial area including osteonecrosis of the maxilla, which can a result from impaired microcirculation in this area [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment

Slavkova

Nedevska

2022

Radiology Case Reports

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“…Furthermore, LCS can occur no matter which SARS-CoV-2 virus variant has been involved, since there is no evidence yet that there are any differences in the subsequent development of LCS between beta and delta or the present omicron infections (Su et al, 2022). Currently there is no clear unified idea on the pathogenesis of these syndromes (Maltezou et al, 2021;Yoo et al, 2022;Zhao et al, 2022), but the general idea is emerging that these are principally vascular diseases; judging by aspects of the active SARS-CoV-2 viral infection of COVID-19 patients (Kalafatis, 2021;Lei et al, 2021;Ostergaard, 2021;Siddiqi et al, 2021) and elements of the subsequent LCS (Charfeddine et al, 2021;Christensen and Berg, 2021). In fact, brain single-photon emission-computed tomography in fourteen LCS Long COVID patients seen in family practice with severe neurocognitive problems demonstrated vascular encephalopathy that was thought due to persistent coagulation disorders (Jamoulle et al, 2021).…”

Section: Introduction To Long Covid Syndromesmentioning

confidence: 99%

Recommendation: Treatment of clinical long COVID encephalopathies with nasal administered mesenchymal stromal cell extracellular vesicles

Askenase

2022

Front. Nanotechnol.

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We propose therapy with extracellular vesicles (EVs) for dominant central nervous system aspects of chronic Long COVID Syndromes (LCS). These clinical conditions have a delayed onset of 1–3 months following the cessation of active SARS-CoV-2 virus infections that cause an acute disease called COVID-19. The therapy of LCS will be achieved by direct access to the central nervous system (CNS) by nasal administration of small EVs derived from Mesenchymal Stromal Cells (MSC). When administered nasally, they target CNS microglia and endothelia involved in LCS encephalopathy, as indicated by experimental animal models and human autopsy and spinal fluid studies. Underlying this approach is the discovery that MSC-sEV treatment for healing neuro injury targets, microglia, and macrophages that then likely release secondary trophic EVs that affect the local capillary endothelial cells to restore vascular integrity. It is postulated that the pathways of endothelial and neural pathologies in acute SARS-CoV-2 virus infections may carry over to produce underlying vascular and neurological defects mediating LCS that are susceptible to this proposed nasal therapy with MSC-sEVs.

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Vascular Inflammation as a Therapeutic Target in COVID-19 “Long Haulers”: HIITing the Spot?

Cited by 13 publications

References 60 publications

Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial

Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial

Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment

Recommendation: Treatment of clinical long COVID encephalopathies with nasal administered mesenchymal stromal cell extracellular vesicles

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