Liu Qidong, Ruan Huitong, Sheng Zhihao, Sun Xiaoru, Li Siguang, Cui Wenguo, Li Cheng
Department of Anesthesiology and Perioperative Medicine Shanghai Fourth People's Hospital, School of Medicine, Tongji University Shanghai P. R. China.
Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education Orthopedic Department, Tongji Hospital, School of Medicine, Tongji University Shanghai P. R. China.
View (Beijing). 2022 Jul;3(4):20220004. doi: 10.1002/VIW.20220004. Epub 2022 May 1.
Acidosis, such as respiratory acidosis and metabolic acidosis, can be induced by coronavirus disease 2019 (COVID-19) infection and is associated with increased mortality in critically ill COVID-19 patients. It remains unclear whether acidosis further promotes SARS-CoV-2 infection in patients, making virus removal difficult. For antacid therapy, sodium bicarbonate poses great risks caused by sodium overload, bicarbonate side effects, and hypocalcemia. Therefore, new antacid antidote is urgently needed. Our study showed that an acidosis-related pH of 6.8 increases SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) expression on the cell membrane by regulating intracellular microfilament polymerization, promoting SARS-CoV-2 pseudovirus infection. Based on this, we synthesized polyglutamic acid-PEG materials, used complexation of calcium ions and carboxyl groups to form the core, and adopted biomineralization methods to form a calcium carbonate nanoparticles (CaCO-NPs) nanoantidote to neutralize excess hydrogen ions (H), and restored the pH from 6.8 to approximately 7.4 (normal blood pH). CaCO-NPs effectively prevented the heightened SARS-CoV-2 infection efficiency due to pH 6.8. Our study reveals that acidosis-related pH promotes SARS-CoV-2 infection, which suggests the existence of a positive feedback loop in which SARS-CoV-2 infection-induced acidosis enhances SARS-CoV-2 infection. Therefore, antacid therapy for acidosis COVID-19 patients is necessary. CaCO-NPs may become an effective antacid nanoantidote superior to sodium bicarbonate.
酸中毒,如呼吸性酸中毒和代谢性酸中毒,可由2019冠状病毒病(COVID-19)感染诱发,并且与危重症COVID-19患者死亡率增加相关。目前尚不清楚酸中毒是否会进一步促进患者感染严重急性呼吸综合征冠状病毒2型(SARS-CoV-2),导致病毒清除困难。对于抗酸治疗,碳酸氢钠会因钠超载、碳酸氢盐副作用和低钙血症带来巨大风险。因此,迫切需要新型抗酸解毒剂。我们的研究表明,与酸中毒相关的pH值6.8通过调节细胞内微丝聚合增加细胞膜上SARS-CoV-2受体血管紧张素转换酶2(ACE2)的表达,促进SARS-CoV-2假病毒感染。基于此,我们合成了聚谷氨酸-聚乙二醇材料,利用钙离子与羧基络合形成核心,并采用生物矿化方法形成碳酸钙纳米颗粒(CaCO-NPs)纳米解毒剂来中和过量氢离子(H),并将pH值从6.8恢复到约7.4(正常血液pH值)。CaCO-NPs有效防止了因pH值6.8导致的SARS-CoV-2感染效率升高。我们的研究揭示了与酸中毒相关的pH值促进SARS-CoV-2感染,这表明存在一个正反馈回路,即SARS-CoV-2感染诱发的酸中毒会增强SARS-CoV-2感染。因此,对酸中毒的COVID-19患者进行抗酸治疗是必要的。CaCO-NPs可能成为一种优于碳酸氢钠的有效抗酸纳米解毒剂。