Camostat Mesylate May Reduce Severity of Coronavirus Disease 2019 Sepsis: A First Observation.
Camostat Mesylate May Reduce Severity of Coronavirus Disease 2019 Sepsis: A First Observation.
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DOI：
10.1097/cce.0000000000000284
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发表时间：
2020-11
影响因子：
--
通讯作者：
Winkler MS
中科院分区：
文献类型：
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作者：
Hofmann-Winkler H;Moerer O;Alt-Epping S;Bräuer A;Büttner B;Müller M;Fricke T;Grundmann J;Harnisch LO;Heise D;Kernchen A;Pressler M;Stephani C;Tampe B;Kaul A;Gärtner S;Kramer S;Pöhlmann S;Winkler MS
严重急性呼吸综合征冠状病毒2的细胞进入依赖于血管紧张素转换酶2和跨膜丝氨酸蛋白酶2，在细胞培养中被甲磺酸卡莫司他阻断，甲磺酸卡莫司他是一种临床证实的蛋白酶抑制剂。甲磺酸卡莫他酯是否能够降低2019冠状病毒病败血症的疾病负担目前尚不清楚。回顾性观察病例系列。患者在德国Göttingen大学医院ICU治疗。11例新冠肺炎重症患者合并器官衰竭在ICU治疗。体恤使用甲磺酸卡莫他酯（6例，卡莫他组）或羟氯喹（5例，羟氯喹组）。在第1、3、8天用败血症相关器官衰竭评分评估临床病程。此外，还测定了病毒载量、氧合和炎症标志物。在ICU入院时，卡莫他组和羟氯喹组败血症相关器官衰竭评估评分具有可比性。观察期间，卡莫他组败血症相关脏器衰竭评分降低，羟氯喹组仍升高。甲磺酸卡莫他酯治疗患者疾病严重程度的下降与炎症标志物的下降和氧合的改善是平行的。甲磺酸卡莫他在8天内治疗后，2019冠状病毒病的严重程度降低，而在接受羟氯喹治疗的患者中未观察到类似的效果。甲磺酸卡莫他因此值得在随机临床试验中进一步评估。
Severe acute respiratory syndrome coronavirus 2 cell entry depends on angiotensin-converting enzyme 2 and transmembrane serine protease 2 and is blocked in cell culture by camostat mesylate, a clinically proven protease inhibitor. Whether camostat mesylate is able to lower disease burden in coronavirus disease 2019 sepsis is currently unknown. Retrospective observational case series. Patient treated in ICU of University hospital Göttingen, Germany. Eleven critical ill coronavirus disease 2019 patients with organ failure were treated in ICU. Compassionate use of camostat mesylate (six patients, camostat group) or hydroxychloroquine (five patients, hydroxychloroquine group). Clinical courses were assessed by Sepsis-related Organ Failure Assessment score at days 1, 3, and 8. Further, viral load, oxygenation, and inflammatory markers were determined. Sepsis-related Organ Failure Assessment score was comparable between camostat and hydroxychloroquine groups upon ICU admission. During observation, the Sepsis-related Organ Failure Assessment score decreased in the camostat group but remained elevated in the hydroxychloroquine group. The decline in disease severity in camostat mesylate treated patients was paralleled by a decline in inflammatory markers and improvement of oxygenation. The severity of coronavirus disease 2019 decreased upon camostat mesylate treatment within a period of 8 days and a similar effect was not observed in patients receiving hydroxychloroquine. Camostat mesylate thus warrants further evaluation within randomized clinical trials.