Serveur d'exploration Stress et Covid

Attention, ce site est en cours de développement !
Attention, site généré par des moyens informatiques à partir de corpus bruts.
Les informations ne sont donc pas validées.

Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?

Identifieur interne : 000773 ( Pmc/Corpus ); précédent : 000772; suivant : 000774

Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?

Auteurs : Elena Carboni ; Anna Rosa Carta ; Ezio Carboni

Source :

RBID : PMC:7175844

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic disease (COVID-19) that has spread globally causing more than 30,000 deaths. Despite the immense and ongoing global effort, no efficacious drugs to fight this plague have been identified and patients admitted to the intensive care units (ICU), for respiratory distress, are managed mostly by means of supportive care based on oxygen maintenance. Several authors have reported that the prevalence of hypertension, diabetes, cardiovascular and cerebrovascular diseases comorbidities were indeed frequent among patients with COVID-19, which suggests that these conditions are likely to aggravate and complicate the prognosis. What the aforementioned diseases have in common is a latent chronic inflammatory state that may be associated with the alteration of laboratory parameters that are typical of the metabolic syndrome and insulin resistance. In severe COVID-19 patients laboratory markers of inflammation such as C-reactive protein, IL-6, D-dimer, serum ferritin and lactate dehydrogenase are elevated in many patients; assessed since the 4th-6th day of illness onset, such increases seem to be predictive of an adverse prognosis. Our hypothesis is that drugs belonging to the family of thiazolidinediones (TZD) such as pioglitazone or rosiglitazone, approved for treating the condition of insulin resistance and the accompanying inflammation, could ameliorate the prognosis of those COVID-19 patients with diabetes, hypertension and cardiovascular disorders comorbidities. TZD are PPARγ agonists that act on nuclear receptors, thereby triggering certain transcription factors. TZD were widely used for type-2 diabetes in the first decade of this century and although concerns have been raised for possible side effects associated with long-term treatment, their use has been recently revaluated for their anti-inflammatory properties in numerous medical conditions.


Url:
DOI: 10.1016/j.mehy.2020.109776
PubMed: 32344313
PubMed Central: 7175844

Links to Exploration step

PMC:7175844

Le document en format XML

<record>
<TEI>
<teiHeader>
<fileDesc>
<titleStmt>
<title xml:lang="en">Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?</title>
<author>
<name sortKey="Carboni, Elena" sort="Carboni, Elena" uniqKey="Carboni E" first="Elena" last="Carboni">Elena Carboni</name>
<affiliation>
<nlm:aff id="af015">Ezio Carboni, Dept. of Bimedical Sciences, Cittadella Universitaria di Monserrato, Blocco A, S.P. Monserrato Sestu km 0,7, 09042 Monserrato. CA, Italy</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Carta, Anna Rosa" sort="Carta, Anna Rosa" uniqKey="Carta A" first="Anna Rosa" last="Carta">Anna Rosa Carta</name>
<affiliation>
<nlm:aff id="af005">Department of Biomedical Sciences, University of Cagliari, Italy</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Carboni, Ezio" sort="Carboni, Ezio" uniqKey="Carboni E" first="Ezio" last="Carboni">Ezio Carboni</name>
<affiliation>
<nlm:aff id="af005">Department of Biomedical Sciences, University of Cagliari, Italy</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af010">Department of Paediatrics, Magna Graecia University of Catanzaro, Italy</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt>
<idno type="wicri:source">PMC</idno>
<idno type="pmid">32344313</idno>
<idno type="pmc">7175844</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175844</idno>
<idno type="RBID">PMC:7175844</idno>
<idno type="doi">10.1016/j.mehy.2020.109776</idno>
<date when="2020">2020</date>
<idno type="wicri:Area/Pmc/Corpus">000773</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000773</idno>
</publicationStmt>
<sourceDesc>
<biblStruct>
<analytic>
<title xml:lang="en" level="a" type="main">Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?</title>
<author>
<name sortKey="Carboni, Elena" sort="Carboni, Elena" uniqKey="Carboni E" first="Elena" last="Carboni">Elena Carboni</name>
<affiliation>
<nlm:aff id="af015">Ezio Carboni, Dept. of Bimedical Sciences, Cittadella Universitaria di Monserrato, Blocco A, S.P. Monserrato Sestu km 0,7, 09042 Monserrato. CA, Italy</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Carta, Anna Rosa" sort="Carta, Anna Rosa" uniqKey="Carta A" first="Anna Rosa" last="Carta">Anna Rosa Carta</name>
<affiliation>
<nlm:aff id="af005">Department of Biomedical Sciences, University of Cagliari, Italy</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Carboni, Ezio" sort="Carboni, Ezio" uniqKey="Carboni E" first="Ezio" last="Carboni">Ezio Carboni</name>
<affiliation>
<nlm:aff id="af005">Department of Biomedical Sciences, University of Cagliari, Italy</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af010">Department of Paediatrics, Magna Graecia University of Catanzaro, Italy</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Medical Hypotheses</title>
<idno type="ISSN">0306-9877</idno>
<idno type="eISSN">1532-2777</idno>
<imprint>
<date when="2020">2020</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic disease (COVID-19) that has spread globally causing more than 30,000 deaths. Despite the immense and ongoing global effort, no efficacious drugs to fight this plague have been identified and patients admitted to the intensive care units (ICU), for respiratory distress, are managed mostly by means of supportive care based on oxygen maintenance. Several authors have reported that the prevalence of hypertension, diabetes, cardiovascular and cerebrovascular diseases comorbidities were indeed frequent among patients with COVID-19, which suggests that these conditions are likely to aggravate and complicate the prognosis. What the aforementioned diseases have in common is a latent chronic inflammatory state that may be associated with the alteration of laboratory parameters that are typical of the metabolic syndrome and insulin resistance. In severe COVID-19 patients laboratory markers of inflammation such as C-reactive protein, IL-6, D-dimer, serum ferritin and lactate dehydrogenase are elevated in many patients; assessed since the 4th-6th day of illness onset, such increases seem to be predictive of an adverse prognosis. Our hypothesis is that drugs belonging to the family of thiazolidinediones (TZD) such as pioglitazone or rosiglitazone, approved for treating the condition of insulin resistance and the accompanying inflammation, could ameliorate the prognosis of those COVID-19 patients with diabetes, hypertension and cardiovascular disorders comorbidities. TZD are PPARγ agonists that act on nuclear receptors, thereby triggering certain transcription factors. TZD were widely used for type-2 diabetes in the first decade of this century and although concerns have been raised for possible side effects associated with long-term treatment, their use has been recently revaluated for their anti-inflammatory properties in numerous medical conditions.</p>
</div>
</front>
<back>
<div1 type="bibliography">
<listBibl>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Guo, Y R" uniqKey="Guo Y">Y.R. Guo</name>
</author>
<author>
<name sortKey="Cao, Q D" uniqKey="Cao Q">Q.D. Cao</name>
</author>
<author>
<name sortKey="Hong, Z S" uniqKey="Hong Z">Z.S. Hong</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Li, B" uniqKey="Li B">B. Li</name>
</author>
<author>
<name sortKey="Yang, J" uniqKey="Yang J">J. Yang</name>
</author>
<author>
<name sortKey="Zhao, F" uniqKey="Zhao F">F. Zhao</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Zhang, J J" uniqKey="Zhang J">J.J. Zhang</name>
</author>
<author>
<name sortKey="Dong, X" uniqKey="Dong X">X. Dong</name>
</author>
<author>
<name sortKey="Cao, Y Y" uniqKey="Cao Y">Y.Y. Cao</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Peng, Y D" uniqKey="Peng Y">Y.D. Peng</name>
</author>
<author>
<name sortKey="Meng, K" uniqKey="Meng K">K. Meng</name>
</author>
<author>
<name sortKey="Guan, H Q" uniqKey="Guan H">H.Q. Guan</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Li, L Q" uniqKey="Li L">L.Q. Li</name>
</author>
<author>
<name sortKey="Huang, T" uniqKey="Huang T">T. Huang</name>
</author>
<author>
<name sortKey="Wang, Y Q" uniqKey="Wang Y">Y.Q. Wang</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Kanda, Y" uniqKey="Kanda Y">Y. Kanda</name>
</author>
<author>
<name sortKey="Shimoda, M" uniqKey="Shimoda M">M. Shimoda</name>
</author>
<author>
<name sortKey="Hamamoto, S" uniqKey="Hamamoto S">S. Hamamoto</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Liu, W" uniqKey="Liu W">W. Liu</name>
</author>
<author>
<name sortKey="Tao, Z W" uniqKey="Tao Z">Z.W. Tao</name>
</author>
<author>
<name sortKey="Lei, W" uniqKey="Lei W">W. Lei</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Liu, Y" uniqKey="Liu Y">Y. Liu</name>
</author>
<author>
<name sortKey="Yang, Y" uniqKey="Yang Y">Y. Yang</name>
</author>
<author>
<name sortKey="Zhang, C" uniqKey="Zhang C">C. Zhang</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Huang, C" uniqKey="Huang C">C. Huang</name>
</author>
<author>
<name sortKey="Wang, Y" uniqKey="Wang Y">Y. Wang</name>
</author>
<author>
<name sortKey="Li, X" uniqKey="Li X">X. Li</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gao, Y" uniqKey="Gao Y">Y. Gao</name>
</author>
<author>
<name sortKey="Li, T" uniqKey="Li T">T. Li</name>
</author>
<author>
<name sortKey="Han, M" uniqKey="Han M">M. Han</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Fu, Y" uniqKey="Fu Y">Y. Fu</name>
</author>
<author>
<name sortKey="Cheng, Y" uniqKey="Cheng Y">Y. Cheng</name>
</author>
<author>
<name sortKey="Wu, Y" uniqKey="Wu Y">Y. Wu</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Chen, L" uniqKey="Chen L">L. Chen</name>
</author>
<author>
<name sortKey="Liu, H G" uniqKey="Liu H">H.G. Liu</name>
</author>
<author>
<name sortKey="Liu, W" uniqKey="Liu W">W. Liu</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Yu, F" uniqKey="Yu F">F. Yu</name>
</author>
<author>
<name sortKey="Du, L" uniqKey="Du L">L. Du</name>
</author>
<author>
<name sortKey="Ojcius, D M" uniqKey="Ojcius D">D.M. Ojcius</name>
</author>
<author>
<name sortKey="Pan, C" uniqKey="Pan C">C. Pan</name>
</author>
<author>
<name sortKey="Jiang, S" uniqKey="Jiang S">S. Jiang</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gu, J" uniqKey="Gu J">J. Gu</name>
</author>
<author>
<name sortKey="Gong, E" uniqKey="Gong E">E. Gong</name>
</author>
<author>
<name sortKey="Zhang, B" uniqKey="Zhang B">B. Zhang</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Li, Y C" uniqKey="Li Y">Y.C. Li</name>
</author>
<author>
<name sortKey="Bai, W Z" uniqKey="Bai W">W.Z. Bai</name>
</author>
<author>
<name sortKey="Hashikawa, T" uniqKey="Hashikawa T">T. Hashikawa</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Chen, T" uniqKey="Chen T">T. Chen</name>
</author>
<author>
<name sortKey="Wu, D" uniqKey="Wu D">D. Wu</name>
</author>
<author>
<name sortKey="Chen, H" uniqKey="Chen H">H. Chen</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mori, I" uniqKey="Mori I">I. Mori</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Netland, J" uniqKey="Netland J">J. Netland</name>
</author>
<author>
<name sortKey="Meyerholz, D K" uniqKey="Meyerholz D">D.K. Meyerholz</name>
</author>
<author>
<name sortKey="Moore, S" uniqKey="Moore S">S. Moore</name>
</author>
<author>
<name sortKey="Cassell, M" uniqKey="Cassell M">M. Cassell</name>
</author>
<author>
<name sortKey="Perlman, S" uniqKey="Perlman S">S. Perlman</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bloomgarden, Z T" uniqKey="Bloomgarden Z">Z.T. Bloomgarden</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lebovitz, H E" uniqKey="Lebovitz H">H.E. Lebovitz</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Esser, N" uniqKey="Esser N">N. Esser</name>
</author>
<author>
<name sortKey="Legrand Poels, S" uniqKey="Legrand Poels S">S. Legrand-Poels</name>
</author>
<author>
<name sortKey="Piette, J" uniqKey="Piette J">J. Piette</name>
</author>
<author>
<name sortKey="Scheen, A J" uniqKey="Scheen A">A.J. Scheen</name>
</author>
<author>
<name sortKey="Paquot, N" uniqKey="Paquot N">N. Paquot</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Laakso, M" uniqKey="Laakso M">M. Laakso</name>
</author>
<author>
<name sortKey="Kuusisto, J" uniqKey="Kuusisto J">J. Kuusisto</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Liu, C" uniqKey="Liu C">C. Liu</name>
</author>
<author>
<name sortKey="Feng, X" uniqKey="Feng X">X. Feng</name>
</author>
<author>
<name sortKey="Li, Q" uniqKey="Li Q">Q. Li</name>
</author>
<author>
<name sortKey="Wang, Y" uniqKey="Wang Y">Y. Wang</name>
</author>
<author>
<name sortKey="Li, Q" uniqKey="Li Q">Q. Li</name>
</author>
<author>
<name sortKey="Hua, M" uniqKey="Hua M">M. Hua</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="King, G L" uniqKey="King G">G.L. King</name>
</author>
<author>
<name sortKey="Park, K" uniqKey="Park K">K. Park</name>
</author>
<author>
<name sortKey="Li, Q" uniqKey="Li Q">Q. Li</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Pfutzner, A" uniqKey="Pfutzner A">A. Pfützner</name>
</author>
<author>
<name sortKey="Schondorf, T" uniqKey="Schondorf T">T. Schöndorf</name>
</author>
<author>
<name sortKey="Hanefeld, M" uniqKey="Hanefeld M">M. Hanefeld</name>
</author>
<author>
<name sortKey="Forst, T" uniqKey="Forst T">T. Forst</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Xie, X" uniqKey="Xie X">X. Xie</name>
</author>
<author>
<name sortKey="Sinha, S" uniqKey="Sinha S">S. Sinha</name>
</author>
<author>
<name sortKey="Yi, Z" uniqKey="Yi Z">Z. Yi</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Zhang, W Y" uniqKey="Zhang W">W.Y. Zhang</name>
</author>
<author>
<name sortKey="Schwartz, E A" uniqKey="Schwartz E">E.A. Schwartz</name>
</author>
<author>
<name sortKey="Permana, P A" uniqKey="Permana P">P.A. Permana</name>
</author>
<author>
<name sortKey="Reaven, P D" uniqKey="Reaven P">P.D. Reaven</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Qiu, D" uniqKey="Qiu D">D. Qiu</name>
</author>
<author>
<name sortKey="Li, X N" uniqKey="Li X">X.N. Li</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sakamoto, A" uniqKey="Sakamoto A">A. Sakamoto</name>
</author>
<author>
<name sortKey="Hongo, M" uniqKey="Hongo M">M. Hongo</name>
</author>
<author>
<name sortKey="Saito, K" uniqKey="Saito K">K. Saito</name>
</author>
<author>
<name sortKey="Nagai, R" uniqKey="Nagai R">R. Nagai</name>
</author>
<author>
<name sortKey="Ishizaka, N" uniqKey="Ishizaka N">N. Ishizaka</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Kutsukake, M" uniqKey="Kutsukake M">M. Kutsukake</name>
</author>
<author>
<name sortKey="Matsutani, T" uniqKey="Matsutani T">T. Matsutani</name>
</author>
<author>
<name sortKey="Tamura, K" uniqKey="Tamura K">K. Tamura</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Aoki, Y" uniqKey="Aoki Y">Y. Aoki</name>
</author>
<author>
<name sortKey="Maeno, T" uniqKey="Maeno T">T. Maeno</name>
</author>
<author>
<name sortKey="Aoyagi, K" uniqKey="Aoyagi K">K. Aoyagi</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Barbarin, V" uniqKey="Barbarin V">V. Barbarin</name>
</author>
<author>
<name sortKey="Nihoul, A" uniqKey="Nihoul A">A. Nihoul</name>
</author>
<author>
<name sortKey="Misson, P" uniqKey="Misson P">P. Misson</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Colle, R" uniqKey="Colle R">R. Colle</name>
</author>
<author>
<name sortKey="De Larminat, D" uniqKey="De Larminat D">D. de Larminat</name>
</author>
<author>
<name sortKey="Rotenberg, S" uniqKey="Rotenberg S">S. Rotenberg</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Galimberti, D" uniqKey="Galimberti D">D. Galimberti</name>
</author>
<author>
<name sortKey="Scarpini, E" uniqKey="Scarpini E">E. Scarpini</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Carta, A R" uniqKey="Carta A">A.R. Carta</name>
</author>
<author>
<name sortKey="Pisanu, A" uniqKey="Pisanu A">A. Pisanu</name>
</author>
<author>
<name sortKey="Carboni, E" uniqKey="Carboni E">E. Carboni</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Carta, A R" uniqKey="Carta A">A.R. Carta</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Simon, D K" uniqKey="Simon D">D.K. Simon</name>
</author>
<author>
<name sortKey="Simuni, T" uniqKey="Simuni T">T. Simuni</name>
</author>
<author>
<name sortKey="Elm, J N I N D S N E T P D" uniqKey="Elm J">J.N.I.N.D.S.N.E.T.-P.D. Elm</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Omeragic, A" uniqKey="Omeragic A">A. Omeragic</name>
</author>
<author>
<name sortKey="Hoque, M T" uniqKey="Hoque M">M.T. Hoque</name>
</author>
<author>
<name sortKey="Choi, U Y" uniqKey="Choi U">U.Y. Choi</name>
</author>
<author>
<name sortKey="Bendayan, R" uniqKey="Bendayan R">R. Bendayan</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Patel, S P" uniqKey="Patel S">S.P. Patel</name>
</author>
<author>
<name sortKey="Cox, D H" uniqKey="Cox D">D.H. Cox</name>
</author>
<author>
<name sortKey="Gollihue, J L" uniqKey="Gollihue J">J.L. Gollihue</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Shafaroodi, H" uniqKey="Shafaroodi H">H. Shafaroodi</name>
</author>
<author>
<name sortKey="Moezi, L" uniqKey="Moezi L">L. Moezi</name>
</author>
<author>
<name sortKey="Ghorbani, H" uniqKey="Ghorbani H">H. Ghorbani</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Agarwal, R" uniqKey="Agarwal R">R. Agarwal</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sharma, R" uniqKey="Sharma R">R. Sharma</name>
</author>
<author>
<name sortKey="Kaundal, R K" uniqKey="Kaundal R">R.K. Kaundal</name>
</author>
<author>
<name sortKey="Sharma, S S" uniqKey="Sharma S">S.S. Sharma</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Forst, T" uniqKey="Forst T">T. Forst</name>
</author>
<author>
<name sortKey="Wilhelm, B" uniqKey="Wilhelm B">B. Wilhelm</name>
</author>
<author>
<name sortKey="Pfutzner, A" uniqKey="Pfutzner A">A. Pfützner</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Med Hypotheses</journal-id>
<journal-id journal-id-type="iso-abbrev">Med. Hypotheses</journal-id>
<journal-title-group>
<journal-title>Medical Hypotheses</journal-title>
</journal-title-group>
<issn pub-type="ppub">0306-9877</issn>
<issn pub-type="epub">1532-2777</issn>
<publisher>
<publisher-name>Elsevier Ltd.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">32344313</article-id>
<article-id pub-id-type="pmc">7175844</article-id>
<article-id pub-id-type="publisher-id">S0306-9877(20)30618-6</article-id>
<article-id pub-id-type="doi">10.1016/j.mehy.2020.109776</article-id>
<article-id pub-id-type="publisher-id">109776</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" id="au005">
<name>
<surname>Carboni</surname>
<given-names>Elena</given-names>
</name>
<email>ecarboni@unica.it</email>
<xref rid="af015" ref-type="aff">c</xref>
<xref rid="cor1" ref-type="corresp"></xref>
</contrib>
<contrib contrib-type="author" id="au010">
<name>
<surname>Carta</surname>
<given-names>Anna Rosa</given-names>
</name>
<xref rid="af005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="au015">
<name>
<surname>Carboni</surname>
<given-names>Ezio</given-names>
</name>
<xref rid="af005" ref-type="aff">a</xref>
<xref rid="af010" ref-type="aff">b</xref>
</contrib>
<aff id="af005">
<label>a</label>
Department of Biomedical Sciences, University of Cagliari, Italy</aff>
<aff id="af010">
<label>b</label>
Department of Paediatrics, Magna Graecia University of Catanzaro, Italy</aff>
<aff id="af015">
<label>c</label>
Ezio Carboni, Dept. of Bimedical Sciences, Cittadella Universitaria di Monserrato, Blocco A, S.P. Monserrato Sestu km 0,7, 09042 Monserrato. CA, Italy</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<label></label>
Corresponding author.
<email>ecarboni@unica.it</email>
</corresp>
</author-notes>
<pub-date pub-type="pmc-release">
<day>22</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub">
<day>22</day>
<month>4</month>
<year>2020</year>
</pub-date>
<elocation-id>109776</elocation-id>
<history>
<date date-type="received">
<day>1</day>
<month>4</month>
<year>2020</year>
</date>
<date date-type="accepted">
<day>21</day>
<month>4</month>
<year>2020</year>
</date>
</history>
<permissions>
<copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder></copyright-holder>
<license>
<license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
</permissions>
<abstract id="ab005">
<p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic disease (COVID-19) that has spread globally causing more than 30,000 deaths. Despite the immense and ongoing global effort, no efficacious drugs to fight this plague have been identified and patients admitted to the intensive care units (ICU), for respiratory distress, are managed mostly by means of supportive care based on oxygen maintenance. Several authors have reported that the prevalence of hypertension, diabetes, cardiovascular and cerebrovascular diseases comorbidities were indeed frequent among patients with COVID-19, which suggests that these conditions are likely to aggravate and complicate the prognosis. What the aforementioned diseases have in common is a latent chronic inflammatory state that may be associated with the alteration of laboratory parameters that are typical of the metabolic syndrome and insulin resistance. In severe COVID-19 patients laboratory markers of inflammation such as C-reactive protein, IL-6, D-dimer, serum ferritin and lactate dehydrogenase are elevated in many patients; assessed since the 4th-6th day of illness onset, such increases seem to be predictive of an adverse prognosis. Our hypothesis is that drugs belonging to the family of thiazolidinediones (TZD) such as pioglitazone or rosiglitazone, approved for treating the condition of insulin resistance and the accompanying inflammation, could ameliorate the prognosis of those COVID-19 patients with diabetes, hypertension and cardiovascular disorders comorbidities. TZD are PPARγ agonists that act on nuclear receptors, thereby triggering certain transcription factors. TZD were widely used for type-2 diabetes in the first decade of this century and although concerns have been raised for possible side effects associated with long-term treatment, their use has been recently revaluated for their anti-inflammatory properties in numerous medical conditions.</p>
</abstract>
</article-meta>
</front>
<body>
<sec id="s0005">
<title>Introduction</title>
<sec id="s0010">
<title>COVID-19: comorbidities</title>
<p id="p0005">The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic disease that has spread globally causing more than 30,000 deaths. Although several treatment trials are under clinical evaluation, no specific and efficacious therapy is available at the moment
<xref rid="b0005" ref-type="bibr">[1]</xref>
and patients admitted to the intensive care units (ICU), for respiratory distress, are managed mostly by means of supportive care based on oxygen maintenance
<xref rid="b0010" ref-type="bibr">[2]</xref>
. Moreover, the dramatic situation currently facing hospitals in Europe in particular, has hindered any accurate or critical evaluation of the published clinical data and the therapeutical response of treatments utilized during the China’s COVID-19 experience
<xref rid="b0015" ref-type="bibr">[3]</xref>
. Nevertheless, although initial reports come with certain limitations, it has emerged that patients with previous cardiovascular or metabolic diseases could be at higher risk of developing severe acute respiratory distress syndrome as well as suffering a worsening of their cardiovascular condition. Evaluating 1527 patients, Li et al.,
<xref rid="b0020" ref-type="bibr">[4]</xref>
reported that 17 % had hypertension, 10 % diabetes and 16 % had cardiovascular and cerebrovascular comorbidities
<xref rid="b0020" ref-type="bibr">[4]</xref>
. Moreover, based on a detailed clinical investigation on 140 hospitalized COVID-19 patients Zhang et al.
<xref rid="b0025" ref-type="bibr">[5]</xref>
similarly reported a 30 % prevalence of hypertension and 12 % of diabetes mellitus, though surprisingly asthma and other allergic diseases were not reported by any of the patients. Furthermore, chronic obstructive-pulmonary disease (CODP 1,4 %) and present smokers (1,4 %) were rare
<xref rid="b0025" ref-type="bibr">[5]</xref>
. In addition a meta-analysis that aimed to show the prevalence of comorbidities in COVID-19 patients, reported that hypertension (17 %), diabetes (8 %), cardiovascular diseases (5 %) and respiratory system disease (2 %) were present and that these comorbidities may be a risk factor for severe patients as compared with non-severe patients
<xref rid="b0030" ref-type="bibr">[6]</xref>
. The presence of these conditions suggests there is a frequent incidence of a metabolic syndrome condition and although it is not systematically reported, it does appear that an adverse prognosis is likely when associated with COVID-19. Peng et al.,
<xref rid="b0035" ref-type="bibr">[7]</xref>
reported that among non-surviving COVID-19 patients, 88 % had BMI > 25 kg/m
<sup>2</sup>
. In addition, C-reactive protein was elevated in most COVID-19 patients
<xref rid="b0035" ref-type="bibr">[7]</xref>
,
<xref rid="b0040" ref-type="bibr">[8]</xref>
,
<xref rid="b0045" ref-type="bibr">[9]</xref>
,
<xref rid="b0050" ref-type="bibr">[10]</xref>
,
<xref rid="b0055" ref-type="bibr">[11]</xref>
. In particular C-reactive protein was more elevated in those who progressed toward worse condition
<xref rid="b0060" ref-type="bibr">[12]</xref>
,
<xref rid="b0065" ref-type="bibr">[13]</xref>
.</p>
</sec>
<sec id="s0015">
<title>COVID-19: inflammation parameters</title>
<p id="p0010">Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome
<xref rid="b0070" ref-type="bibr">[14]</xref>
, thus the identification and treatment of hyperinflammation is recommended in order to reduce mortality
<xref rid="b0075" ref-type="bibr">[15]</xref>
. In this regard, the drug tocilizumab (IL-6 receptor blocker) has been approved in patients with COVID-19 pneumonia and elevated IL-6 in China
<xref rid="b0080" ref-type="bibr">[16]</xref>
. In particular, SARS-CoV-2 infection increased plasma IL1B, IL1RA, IL7, IL8, IL9, IL10, basic FGF, GMCSF, IFNγ, IP10,MCP1, MIP1A, MIP1B, PDGF, TNFα, and VEGF concentrations), while ICU (intensive care unit) patients at severe stage of disease had higher plasma level of IL2, IL7, IL10, GCSF, IP10, MCP-1, MIP1A and TNFα than non-ICU patients, suggesting a hyper-inflammatory condition also known as a cytokine storm
<xref rid="b0070" ref-type="bibr">[14]</xref>
,
<xref rid="b0075" ref-type="bibr">[15]</xref>
. In addition, the specificity of predicting the severity of COVID-19 in adult patients, by assessing IL-6 and D-Dimer concentrations in parallel has been proposed
<xref rid="b0085" ref-type="bibr">[17]</xref>
. The mechanisms by which this strong inflammatory response could be linked with the uncontrolled pulmonary inflammation and consequent COVID-19 lethality have been recently discussed
<xref rid="b0090" ref-type="bibr">[18]</xref>
,
<xref rid="b0095" ref-type="bibr">[19]</xref>
.</p>
</sec>
<sec id="s0020">
<title>COVID-19: Neurological implications</title>
<p id="p0015">The neuro-invasive potential of SARS-CoV2 in the respiratory failure of COVID-19 patients, has been recently debated
<xref rid="b0040" ref-type="bibr">[8]</xref>
,
<xref rid="b0045" ref-type="bibr">[9]</xref>
,
<xref rid="b0050" ref-type="bibr">[10]</xref>
,
<xref rid="b0055" ref-type="bibr">[11]</xref>
,
<xref rid="b0060" ref-type="bibr">[12]</xref>
,
<xref rid="b0065" ref-type="bibr">[13]</xref>
,
<xref rid="b0070" ref-type="bibr">[14]</xref>
,
<xref rid="b0075" ref-type="bibr">[15]</xref>
,
<xref rid="b0080" ref-type="bibr">[16]</xref>
,
<xref rid="b0085" ref-type="bibr">[17]</xref>
,
<xref rid="b0090" ref-type="bibr">[18]</xref>
,
<xref rid="b0095" ref-type="bibr">[19]</xref>
,
<xref rid="b0100" ref-type="bibr">[20]</xref>
. Although the evidence of this possibility is based mostly on studies of other Corona viruses
<xref rid="b0105" ref-type="bibr">[21]</xref>
, the similarities of SARS-CoV2 with the other SARS CoV Yu F et al.
<xref rid="b0110" ref-type="bibr">[22]</xref>
, suggest it is conceivable that the rapid respiratory failure observed in a number of patients could be due to the spreading of SARS-CoV2 to the brain, either through the olfactory nerve or the vagus nerve. However, the hematic or the lymphatic route should also be considered
<xref rid="b0115" ref-type="bibr">[23]</xref>
. Once in the brain, the virus may reach the brainstem and the important cardio-respiratory functions located therein, affecting them with unpredictable consequences. This hypothesis is supported by a study reporting that a high number of COVID-19 severely affected patients reported neurological manifestation headache and impaired consciousness
<xref rid="b0120" ref-type="bibr">[24]</xref>
,
<xref rid="b0125" ref-type="bibr">[25]</xref>
.</p>
<p id="p0020">A further consideration that may be worth highlighting is that many patients report losing their olfactory and gustatory senses
<xref rid="b0130" ref-type="bibr">[26]</xref>
. Although, to the best of our knowledge, this problem has not been accurately documented, it is well known that a number of viruses such as H3N2 and H5N1 can enter the brain through the olfactory route and at the same time, antiviral antibodies can directly access the olfactory neuron [see
<xref rid="b0135" ref-type="bibr">[27]</xref>
for a review]. In addition SARS-CoV-2 shares a notable homological sequence with SARS-CoV and since SARS-CoV has been reported in the brain, it is likely that the hyposmia could be due to the a passage to the brain of the SARS-CoV-2 through the olfactory route
<xref rid="b0140" ref-type="bibr">[28]</xref>
. Moreover, it is also possible that the passage of SARS-CoV-2 into the brain could be at least partially responsible for the acute respiratory failure of patients with COVID-19
<xref rid="b0120" ref-type="bibr">[24]</xref>
.</p>
</sec>
<sec id="s0025">
<title>COVID-19: treatments</title>
<p id="p0025">Among the treatments used in COVID-19, it is known that antiviral, antibiotics for secondary sepsis, and sometimes corticosteroids are the most frequently used drugs
<xref rid="b0015" ref-type="bibr">[3]</xref>
,
<xref rid="b0020" ref-type="bibr">[4]</xref>
,
<xref rid="b0025" ref-type="bibr">[5]</xref>
,
<xref rid="b0030" ref-type="bibr">[6]</xref>
,
<xref rid="b0035" ref-type="bibr">[7]</xref>
,
<xref rid="b0040" ref-type="bibr">[8]</xref>
,
<xref rid="b0045" ref-type="bibr">[9]</xref>
,
<xref rid="b0050" ref-type="bibr">[10]</xref>
,
<xref rid="b0055" ref-type="bibr">[11]</xref>
,
<xref rid="b0060" ref-type="bibr">[12]</xref>
,
<xref rid="b0065" ref-type="bibr">[13]</xref>
,
<xref rid="b0070" ref-type="bibr">[14]</xref>
,
<xref rid="b0075" ref-type="bibr">[15]</xref>
,
<xref rid="b0080" ref-type="bibr">[16]</xref>
,
<xref rid="b0085" ref-type="bibr">[17]</xref>
,
<xref rid="b0090" ref-type="bibr">[18]</xref>
,
<xref rid="b0095" ref-type="bibr">[19]</xref>
,
<xref rid="b0100" ref-type="bibr">[20]</xref>
,
<xref rid="b0105" ref-type="bibr">[21]</xref>
,
<xref rid="b0110" ref-type="bibr">[22]</xref>
,
<xref rid="b0115" ref-type="bibr">[23]</xref>
,
<xref rid="b0120" ref-type="bibr">[24]</xref>
,
<xref rid="b0125" ref-type="bibr">[25]</xref>
,
<xref rid="b0130" ref-type="bibr">[26]</xref>
,
<xref rid="b0135" ref-type="bibr">[27]</xref>
,
<xref rid="b0140" ref-type="bibr">[28]</xref>
,
<xref rid="b0145" ref-type="bibr">[29]</xref>
. Nevertheless it appears that the condition that most likely exposes patients to a higher vulnerability has not yet been considered as a therapeutical target
<xref rid="b0150" ref-type="bibr">[30]</xref>
,
<xref rid="b0155" ref-type="bibr">[31]</xref>
. On the other hand it seems that in the last stages of pulmonary damage, a state of hyper inflammation sustained by a cytokine storm may overwhelm the immune defence response leading to a multiple organ failure and decease
<xref rid="b0075" ref-type="bibr">[15]</xref>
.</p>
<p id="p0030">To handle the elevated levels of IL-6, tests have been carried out using Tocilizumab, a monoclonal antibody that targets IL-6 and it seems that it can improve the prognosis in Covid-19 infected patients with severe respiratory distress
<xref rid="b0160" ref-type="bibr">[32]</xref>
. On the other hand, the efficacy of glucocorticoid and other anti-inflammatory drugs that have often been used often for handling the condition of COVID-19 patients has been questioned
<xref rid="b0145" ref-type="bibr">[29]</xref>
. Moreover, it seems that there is no indication for assessing the condition of overweight, metabolic syndrome or insulin resistance, as a guide to selecting a suitable treatment for such patients
<xref rid="b0015" ref-type="bibr">[3]</xref>
,
<xref rid="b0150" ref-type="bibr">[30]</xref>
,
<xref rid="b0155" ref-type="bibr">[31]</xref>
.</p>
</sec>
</sec>
<sec id="s0030">
<title>Hypothesis</title>
<p id="p0035">In the light of the above, our hypothesis is that the drug pioglitazone could potentially be used to reduce the inflammation and the consequent risk of death that is associated with COVID-19, at least in those patients that have a manifest condition of metabolic syndrome. Pioglitazone belongs to the family of thiazolidinediones (TZDs), i.e. drugs that are commonly used for treating insulin resistance
<xref rid="b0165" ref-type="bibr">[33]</xref>
. We know the following facts about insulin resistance: it amplifies inflammation
<xref rid="b0170" ref-type="bibr">[34]</xref>
. it is associated with several cardiovascular risk factors
<xref rid="b0175" ref-type="bibr">[35]</xref>
. it is associated with an increase in C-reactive protein, IL-6, and TNF-α
<xref rid="b0180" ref-type="bibr">[36]</xref>
and produces a pro-coagulant state with increased fibrinogen and plasminogen activator inhibitor, (PAI-1)
<xref rid="b0185" ref-type="bibr">[37]</xref>
. All this raises many concerns regarding the ability of patients with type-2 diabetes to respond properly to the infection with SARS-CoV-2. For these reasons and considering also that inflammatory laboratory markers are elevated in COVID-19
<xref rid="b0070" ref-type="bibr">[14]</xref>
, it is of great interest that pioglitazone can produce an anti-inflammatory effect as has been assayed through high sensitive C-reactive protein within short term intervals after starting therapy
<xref rid="b0190" ref-type="bibr">[38]</xref>
.</p>
<p id="p0040">Specifically, pioglitazone (30-45 mg/day for three months) can significantly reduce IL-6 and TNFα in insulin resistant individuals without manifest hyperglycaemia matched for age, gender and adiposity
<xref rid="b0195" ref-type="bibr">[39]</xref>
. Four months (45 mg/day) treatment with pioglitazone reduced the monocyte gene and protein expression of IL-1b, IL-6, IL-8 and lymphocyte IL-2, IL-6 and IL-8
<xref rid="b0200" ref-type="bibr">[40]</xref>
. It has also been reported that pioglitazone inhibits the secretion of pro-inflammatory cytokines (e.g. IL-1b, IL-6, and IL-8) and can increase the anti-inflammatory ones (e.g. IL-4 and IL-10) in astrocytes stimulated with lipopolysaccharide
<xref rid="b0205" ref-type="bibr">[41]</xref>
. It has also been shown to have a potential in decreasing ferritin in a rat model of angiotensin II induced hypertension
<xref rid="b0210" ref-type="bibr">[42]</xref>
.</p>
<p id="p0045">Finally we wondered whether pioglitazone can have a direct action on lung inflammation and fibrosis. We found that pioglitazone attenuates lung injury when modulating adipose inflammation in a cecal ligation puncture (CLP) model in mice. In this study, pioglitazone (7 days) significantly reduced TNFα and IL-6 mRNA expression in the peritoneal lavage fluid of CLP group
<xref rid="b0215" ref-type="bibr">[43]</xref>
. Additionally it has been reported that pioglitazone may exert a direct effect on lung inflammation and fibrosis
<xref rid="b0220" ref-type="bibr">[44]</xref>
, and can reduce the lung fibrotic reaction to silica in rats, which is normally characterized by overproduction of TNFa
<xref rid="b0225" ref-type="bibr">[45]</xref>
.</p>
<p id="p0050">As for the hypothesis that either the SARS-CoV-2 or the consequent inflammation response has spread to the brain is concerned, we believe there to be compelling evidence that TZD display central anti-inflammatory properties in neurological disorders and it has been reported that they have a therapeutically usefulness in psychiatric and neurological conditions such as depression
<xref rid="b0230" ref-type="bibr">[46]</xref>
, in Alzheimer’s disease
<xref rid="b0235" ref-type="bibr">[47]</xref>
, and in animal models of Parkinson
<xref rid="b0240" ref-type="bibr">[48]</xref>
,
<xref rid="b0245" ref-type="bibr">[49]</xref>
, although in Parkinson’s patients, pioglitazone did not significantly altered levels of inflammatory biomarkers at 16 and 45 weeks of treatment with 15 and 45 mg/day
<xref rid="b0250" ref-type="bibr">[50]</xref>
. Interestingly, pioglitazone and rosiglitazone treatment attenuated the elevation of inflammatory markers and the decrease in the glutamate transporter (GLT-1) expression, in a primary mixed culture of astrocytes and microglia caused by exposition to viral proteins (i.e.HIV
<sub>ADA</sub>
gp120); similarly these results were replicated by in vivo treatment
<xref rid="b0255" ref-type="bibr">[51]</xref>
.</p>
<p id="p0055">With regard to the use of TZD in the COVId-19 emergency, concerns will inevitably be raised about the drug’s efficacy and patient reaction time after short term administration. Patel et al.
<xref rid="b0260" ref-type="bibr">[52]</xref>
showed that pioglitazone is able to suppress neuro-inflammation and maintains mitochondrial respiration when administered acutely in a model of spinal cord injury in mice. In addition, a sub-chronic treatment with pioglitazone exerted anti-convulsive effects in pentylentetrazole-induced seizures in mice, probably through the induction of constitutive nitric oxide synthase
<xref rid="b0265" ref-type="bibr">[53]</xref>
. Pioglitazone showed to have short-term (16 week trial) anti-inflammatory effects by lowering C-reactive protein by 41 % and IL-6 by 38 % in men with advanced nephropathy
<xref rid="b0270" ref-type="bibr">[54]</xref>
. Pioglitazone, administered acutely, is effective in abrogating the dysfunction by attenuating neutrophilia, TNFα, and oxidative stress in an LPS-induced model of acute lung inflammation in guinea pigs
<xref rid="b0275" ref-type="bibr">[55]</xref>
. Based on these and other reports, we are confident that pioglitazone could be efficacious after acute or sub-chronic treatment (9-38-44). On these premises, we are suggesting that the treatment with pioglitazone or other PPARγ agonists does have a rationale in COVID-19 treatment.</p>
</sec>
<sec id="s0035">
<title>Conclusions</title>
<p id="p0060">Looking at the clinical profile of COVID 19 patients, from one study it emerges that all the progression group had elevated C-reactive protein and decreased albumin levels
<xref rid="b0060" ref-type="bibr">[12]</xref>
. A second study shows that in patients hospitalized with COVID-19, among the laboratory markers, D-dimer, IL-6, Serum ferritin, Lactate dehydrogenase, D-dimer, high-sensitivity cardiac troponin were significantly elevated while patient’s lymphocyte count was significantly decreased at various time points from illness onset (4 to 19 days) during hospitalization
<xref rid="b0050" ref-type="bibr">[10]</xref>
. A third study shows that on admission, 83 % of patients had lymphocytopenia while most of the patients had elevated levels of C-reactive protein, and those with severe disease had more prominent laboratory abnormalities
<xref rid="b0280" ref-type="bibr">[56]</xref>
.Given that pioglitazone is able to reduce many of these inflammatory parameters and considering that the comorbidity of diabetes, hypertension and cardiovascular disorders are indicative of a general inflammation associated with metabolic syndrome and lipid profile alteration, all conditions that can be improved by pioglitazone, we are therefore suggesting that a clinical trial with this drug or with other TZD should be considered as a support therapy in COVID-19. Finally we would like to stress that pioglitazone can be administered in patients that are on statins as it has been reported that the addition of pioglitazone to atorvastatin, further reduces C-reactive protein and other laboratory markers of inflammation
<xref rid="b0285" ref-type="bibr">[57]</xref>
. 2008).</p>
</sec>
<sec id="s0040">
<title>Conflict of interest:</title>
<p id="p0065">All authors declare no conflict of interest.</p>
</sec>
</body>
<back>
<ref-list id="bi005">
<title>References</title>
<ref id="b0005">
<label>1</label>
<mixed-citation publication-type="other" id="h0005">Li H, Zhou Y, Zhang M, Wang H, Zhao Q, Liu J. Updated approaches against SARS-CoV-2. Antimicrob Agents Chemother. 2020 Mar 23. pii: AAC.00483-20. doi:10.1128/AAC.00483-20.</mixed-citation>
</ref>
<ref id="b0010">
<label>2</label>
<mixed-citation publication-type="other" id="h0010">Meng L, Qiu H, Wan L, et al. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan's Experience [published online ahead of print, 2020 Mar 26]. Anesthesiology. 2020;10.1097/ALN.0000000000003296. doi:10.1097/ALN.0000000000003296</mixed-citation>
</ref>
<ref id="b0015">
<label>3</label>
<element-citation publication-type="journal" id="h0015">
<person-group person-group-type="author">
<name>
<surname>Guo</surname>
<given-names>Y.R.</given-names>
</name>
<name>
<surname>Cao</surname>
<given-names>Q.D.</given-names>
</name>
<name>
<surname>Hong</surname>
<given-names>Z.S.</given-names>
</name>
</person-group>
<article-title>The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status</article-title>
<source>Mil Med Res.</source>
<volume>7</volume>
<issue>1</issue>
<year>2020 Mar 13</year>
<fpage>11</fpage>
<pub-id pub-id-type="doi">10.1186/s40779-020-00240-0</pub-id>
<pub-id pub-id-type="pmid">32169119</pub-id>
</element-citation>
</ref>
<ref id="b0020">
<label>4</label>
<element-citation publication-type="journal" id="h0020">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Yang</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Zhao</surname>
<given-names>F.</given-names>
</name>
</person-group>
<article-title>Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China</article-title>
<source>Clin Res Cardiol.</source>
<year>2020 Mar 11</year>
<pub-id pub-id-type="doi">10.1007/s00392-020-01626-9</pub-id>
</element-citation>
</ref>
<ref id="b0025">
<label>5</label>
<element-citation publication-type="journal" id="h0025">
<person-group person-group-type="author">
<name>
<surname>Zhang</surname>
<given-names>J.J.</given-names>
</name>
<name>
<surname>Dong</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Cao</surname>
<given-names>Y.Y.</given-names>
</name>
</person-group>
<article-title>Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan</article-title>
<source>China. Allergy.</source>
<year>2020 Feb 19</year>
<pub-id pub-id-type="doi">10.1111/all.14238</pub-id>
</element-citation>
</ref>
<ref id="b0030">
<label>6</label>
<mixed-citation publication-type="other" id="h0030">Yang J, Zheng Y, Gou X et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020 Mar 12. pii: S1201-9712(20)30136-3. doi: 10.1016/j.ijid.2020.03.017.</mixed-citation>
</ref>
<ref id="b0035">
<label>7</label>
<element-citation publication-type="journal" id="h0035">
<person-group person-group-type="author">
<name>
<surname>Peng</surname>
<given-names>Y.D.</given-names>
</name>
<name>
<surname>Meng</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Guan</surname>
<given-names>H.Q.</given-names>
</name>
</person-group>
<article-title>Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV</article-title>
<source>Zhonghua Xin Xue Guan Bing Za Zhi.</source>
<volume>48</volume>
<year>2020 Mar 2</year>
<fpage>E004</fpage>
<pub-id pub-id-type="doi">10.3760/cma.j.cn112148-20200220-00105</pub-id>
<pub-id pub-id-type="pmid">32120458</pub-id>
</element-citation>
</ref>
<ref id="b0040">
<label>8</label>
<element-citation publication-type="journal" id="h0040">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>L.Q.</given-names>
</name>
<name>
<surname>Huang</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Y.Q.</given-names>
</name>
</person-group>
<article-title>2019 novel coronavirus patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis</article-title>
<source>J Med Virol.</source>
<year>2020 Mar 12</year>
<pub-id pub-id-type="doi">10.1002/jmv.25757</pub-id>
</element-citation>
</ref>
<ref id="b0045">
<label>9</label>
<element-citation publication-type="journal" id="h0045">
<person-group person-group-type="author">
<name>
<surname>Kanda</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Shimoda</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Hamamoto</surname>
<given-names>S.</given-names>
</name>
</person-group>
<article-title>Molecular mechanism by which pioglitazone preserves pancreatic beta-cells in obese diabetic mice: evidence for acute and chronic actions as a PPARgamma agonist</article-title>
<source>Am J Physiol Endocrinol Metab.</source>
<volume>298</volume>
<issue>2</issue>
<year>2010 Feb</year>
<fpage>E278</fpage>
<lpage>E286</lpage>
<pub-id pub-id-type="doi">10.1152/ajpendo.00388.2009</pub-id>
<pub-id pub-id-type="pmid">19920213</pub-id>
</element-citation>
</ref>
<ref id="b0050">
<label>10</label>
<mixed-citation publication-type="other" id="h0050">Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054–1062. doi:10.1016/S0140-6736(20)30566-3</mixed-citation>
</ref>
<ref id="b0055">
<label>11</label>
<element-citation publication-type="journal" id="h0055">
<source>The Lancet</source>
<volume>395</volume>
<issue>10223</issue>
<year>2020</year>
<fpage>514</fpage>
<lpage>523</lpage>
<pub-id pub-id-type="doi">10.1016/S0140-6736(20)30154-9</pub-id>
</element-citation>
</ref>
<ref id="b0060">
<label>12</label>
<element-citation publication-type="journal" id="h0060">
<person-group person-group-type="author">
<name>
<surname>Liu</surname>
<given-names>W.</given-names>
</name>
<name>
<surname>Tao</surname>
<given-names>Z.W.</given-names>
</name>
<name>
<surname>Lei</surname>
<given-names>W.</given-names>
</name>
</person-group>
<article-title>Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease</article-title>
<source>Chin Med J (Engl).</source>
<year>2020 Feb 28</year>
<pub-id pub-id-type="doi">10.1097/CM9.0000000000000775</pub-id>
</element-citation>
</ref>
<ref id="b0065">
<label>13</label>
<element-citation publication-type="journal" id="h0065">
<person-group person-group-type="author">
<name>
<surname>Liu</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Yang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>C.</given-names>
</name>
</person-group>
<article-title>Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury</article-title>
<source>Sci China Life Sci.</source>
<volume>63</volume>
<issue>3</issue>
<year>2020 Mar</year>
<fpage>364</fpage>
<lpage>374</lpage>
<pub-id pub-id-type="doi">10.1007/s11427-020-1643-8</pub-id>
<pub-id pub-id-type="pmid">32048163</pub-id>
</element-citation>
</ref>
<ref id="b0070">
<label>14</label>
<element-citation publication-type="journal" id="h0070">
<person-group person-group-type="author">
<name>
<surname>Huang</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>X.</given-names>
</name>
</person-group>
<article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan</article-title>
<source>China. Lancet.</source>
<volume>395</volume>
<issue>10223</issue>
<year>2020 Feb 15</year>
<fpage>497</fpage>
<lpage>506</lpage>
<pub-id pub-id-type="doi">10.1016/S0140-6736(20)30183-5</pub-id>
<pub-id pub-id-type="pmid">31986264</pub-id>
</element-citation>
</ref>
<ref id="b0075">
<label>15</label>
<element-citation publication-type="journal" id="h0075">
<source>The Lancet</source>
<volume>395</volume>
<issue>10229</issue>
<year>2020</year>
<fpage>1033</fpage>
<lpage>1034</lpage>
<pub-id pub-id-type="doi">10.1016/S0140-6736(20)30628-0</pub-id>
</element-citation>
</ref>
<ref id="b0080">
<label>16</label>
<mixed-citation publication-type="other" id="h0080">Chinese Clinical Trial Registry. A multicenter, randomized controlled trial for the efficacy and safety of tocilizumab in the treatment of new coronavirus pneumonia (COVID-19). Feb 13, 2020. http://www.chictr.org.cn/ showprojen.aspx?proj=49409 (accessed March 6, 2020).</mixed-citation>
</ref>
<ref id="b0085">
<label>17</label>
<element-citation publication-type="journal" id="h0085">
<person-group person-group-type="author">
<name>
<surname>Gao</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Han</surname>
<given-names>M.</given-names>
</name>
</person-group>
<article-title>Diagnostic Utility of Clinical Laboratory Data Determinations for Patients with the Severe COVID-19</article-title>
<source>J Med Virol.</source>
<year>2020 Mar 17</year>
<pub-id pub-id-type="doi">10.1002/jmv.25770</pub-id>
</element-citation>
</ref>
<ref id="b0090">
<label>18</label>
<element-citation publication-type="journal" id="h0090">
<person-group person-group-type="author">
<name>
<surname>Fu</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Cheng</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Wu</surname>
<given-names>Y.</given-names>
</name>
</person-group>
<article-title>Understanding SARS-CoV-2-Mediated Inflammatory Responses: From Mechanisms to Potential Therapeutic Tools</article-title>
<source>Virol Sin.</source>
<year>2020 Mar 3</year>
<pub-id pub-id-type="doi">10.1007/s12250-020-00207-4</pub-id>
</element-citation>
</ref>
<ref id="b0095">
<label>19</label>
<element-citation publication-type="journal" id="h0095">
<person-group person-group-type="author">
<name>
<surname>Chen</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>H.G.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>W.</given-names>
</name>
</person-group>
<article-title>Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia</article-title>
<source>Zhonghua Jie He He Hu Xi Za Zhi.</source>
<volume>43</volume>
<issue>3</issue>
<year>2020 Mar 12</year>
<fpage>203</fpage>
<lpage>208</lpage>
<pub-id pub-id-type="doi">10.3760/cma.j.issn.1001-0939.2020.03.013</pub-id>
<pub-id pub-id-type="pmid">32164089</pub-id>
</element-citation>
</ref>
<ref id="b0100">
<label>20</label>
<element-citation publication-type="journal" id="h0100">
<source>Travel Medicine and Infectious Disease</source>
<year>2020</year>
<fpage>101642</fpage>
<pub-id pub-id-type="doi">10.1016/j.tmaid.2020.101642</pub-id>
<pub-id pub-id-type="pmid">32220634</pub-id>
</element-citation>
</ref>
<ref id="b0105">
<label>21</label>
<element-citation publication-type="journal" id="h0105">
<source>Clinical Infectious Diseases</source>
<volume>41</volume>
<issue>8</issue>
<year>2005</year>
<fpage>1089</fpage>
<lpage>1096</lpage>
<pub-id pub-id-type="doi">10.1086/444461</pub-id>
<pub-id pub-id-type="pmid">16163626</pub-id>
</element-citation>
</ref>
<ref id="b0110">
<label>22</label>
<element-citation publication-type="journal" id="h0110">
<person-group person-group-type="author">
<name>
<surname>Yu</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Du</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Ojcius</surname>
<given-names>D.M.</given-names>
</name>
<name>
<surname>Pan</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Jiang</surname>
<given-names>S.</given-names>
</name>
</person-group>
<article-title>Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan</article-title>
<source>China.
<italic>Microbes Infect</italic>
.</source>
<volume>22</volume>
<issue>2</issue>
<year>2020</year>
<fpage>74</fpage>
<lpage>79</lpage>
<pub-id pub-id-type="doi">10.1016/j.micinf.2020.01.003</pub-id>
<pub-id pub-id-type="pmid">32017984</pub-id>
</element-citation>
</ref>
<ref id="b0115">
<label>23</label>
<element-citation publication-type="journal" id="h0115">
<person-group person-group-type="author">
<name>
<surname>Gu</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Gong</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>B.</given-names>
</name>
</person-group>
<article-title>Multiple organ infection and the pathogenesis of SARS</article-title>
<source>J Exp Med.</source>
<volume>202</volume>
<issue>3</issue>
<year>2005</year>
<fpage>415</fpage>
<lpage>424</lpage>
<pub-id pub-id-type="pmid">16043521</pub-id>
</element-citation>
</ref>
<ref id="b0120">
<label>24</label>
<element-citation publication-type="journal" id="h0120">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>Y.C.</given-names>
</name>
<name>
<surname>Bai</surname>
<given-names>W.Z.</given-names>
</name>
<name>
<surname>Hashikawa</surname>
<given-names>T.</given-names>
</name>
</person-group>
<article-title>The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients</article-title>
<source>J Med Virol.</source>
<year>2020 Feb 27</year>
<pub-id pub-id-type="doi">10.1002/jmv.25728</pub-id>
</element-citation>
</ref>
<ref id="b0125">
<label>25</label>
<element-citation publication-type="journal" id="h0125">
<person-group person-group-type="author">
<name>
<surname>Chen</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Wu</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>H.</given-names>
</name>
</person-group>
<article-title>Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study</article-title>
<source>BMJ.</source>
<volume>368</volume>
<year>2020</year>
<object-id pub-id-type="publisher-id">m1091</object-id>
<pub-id pub-id-type="doi">10.1136/bmj.m1091</pub-id>
</element-citation>
</ref>
<ref id="b0130">
<label>26</label>
<mixed-citation publication-type="other" id="h0130">Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study [published online ahead of print, 2020 Mar 26]. Clin Infect Dis. 2020;ciaa330. doi:10.1093/cid/ciaa330</mixed-citation>
</ref>
<ref id="b0135">
<label>27</label>
<element-citation publication-type="journal" id="h0135">
<person-group person-group-type="author">
<name>
<surname>Mori</surname>
<given-names>I.</given-names>
</name>
</person-group>
<article-title>Highlighting the 'blood-nerve barrier' in virology research</article-title>
<source>Acta Virol.</source>
<volume>62</volume>
<issue>1</issue>
<year>2018</year>
<fpage>28</fpage>
<lpage>32</lpage>
<pub-id pub-id-type="doi">10.4149/av_2018_103</pub-id>
<pub-id pub-id-type="pmid">29521100</pub-id>
</element-citation>
</ref>
<ref id="b0140">
<label>28</label>
<element-citation publication-type="journal" id="h0140">
<person-group person-group-type="author">
<name>
<surname>Netland</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Meyerholz</surname>
<given-names>D.K.</given-names>
</name>
<name>
<surname>Moore</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Cassell</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Perlman</surname>
<given-names>S.</given-names>
</name>
</person-group>
<article-title>Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2</article-title>
<source>J Virol.</source>
<volume>82</volume>
<issue>15</issue>
<year>2008</year>
<fpage>7264</fpage>
<lpage>7275</lpage>
<pub-id pub-id-type="doi">10.1128/JVI.00737-08</pub-id>
<pub-id pub-id-type="pmid">18495771</pub-id>
</element-citation>
</ref>
<ref id="b0145">
<label>29</label>
<mixed-citation publication-type="other" id="h0145">Zhang W, Zhao Y, Zhang F, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The experience of clinical immunologists from China [published online ahead of print, 2020 Mar 25]. Clin Immunol. 2020;108393. doi:10.1016/j.clim.2020.108393</mixed-citation>
</ref>
<ref id="b0150">
<label>30</label>
<element-citation publication-type="journal" id="h0150">
<person-group person-group-type="author">
<name>
<surname>Bloomgarden</surname>
<given-names>Z.T.</given-names>
</name>
</person-group>
<article-title>Diabetes and COVID-19</article-title>
<source>J Diabetes.</source>
<volume>12</volume>
<issue>4</issue>
<year>2020</year>
<fpage>347</fpage>
<lpage>348</lpage>
<pub-id pub-id-type="doi">10.1111/1753-0407.13027</pub-id>
<pub-id pub-id-type="pmid">32162476</pub-id>
</element-citation>
</ref>
<ref id="b0155">
<label>31</label>
<mixed-citation publication-type="other" id="h0155">Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic [published online ahead of print, 2020 Mar 10]. Diabetes Metab Syndr. 2020;14(3):211–212. doi:10.1016/j.dsx.2020.03.002</mixed-citation>
</ref>
<ref id="b0160">
<label>32</label>
<mixed-citation publication-type="other" id="h0160">Bersanelli M. Controversies about COVID-19 and anticancer treatment with immune checkpoint inhibitors [published online ahead of print, 2020 Mar 26]. Immunotherapy. 2020;10.2217/imt-2020-0067. doi:10.2217/imt-2020-0067</mixed-citation>
</ref>
<ref id="b0165">
<label>33</label>
<element-citation publication-type="journal" id="h0165">
<person-group person-group-type="author">
<name>
<surname>Lebovitz</surname>
<given-names>H.E.</given-names>
</name>
</person-group>
<article-title>Thiazolidinediones: the Forgotten Diabetes Medications</article-title>
<source>Curr Diab Rep.</source>
<volume>19</volume>
<issue>12</issue>
<year>2019</year>
<fpage>151</fpage>
<pub-id pub-id-type="doi">10.1007/s11892-019-1270-y</pub-id>
<pub-id pub-id-type="pmid">31776781</pub-id>
</element-citation>
</ref>
<ref id="b0170">
<label>34</label>
<element-citation publication-type="journal" id="h0170">
<person-group person-group-type="author">
<name>
<surname>Esser</surname>
<given-names>N.</given-names>
</name>
<name>
<surname>Legrand-Poels</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Piette</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Scheen</surname>
<given-names>A.J.</given-names>
</name>
<name>
<surname>Paquot</surname>
<given-names>N.</given-names>
</name>
</person-group>
<article-title>Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes</article-title>
<source>Diabetes Res Clin Pract.</source>
<volume>105</volume>
<issue>2</issue>
<year>2014</year>
<fpage>141</fpage>
<lpage>150</lpage>
<pub-id pub-id-type="doi">10.1016/j.diabres.2014.04.006</pub-id>
<pub-id pub-id-type="pmid">24798950</pub-id>
</element-citation>
</ref>
<ref id="b0175">
<label>35</label>
<element-citation publication-type="journal" id="h0175">
<person-group person-group-type="author">
<name>
<surname>Laakso</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Kuusisto</surname>
<given-names>J.</given-names>
</name>
</person-group>
<article-title>Insulin resistance and hyperglycaemia in cardiovascular disease development</article-title>
<source>Nat Rev Endocrinol.</source>
<volume>10</volume>
<issue>5</issue>
<year>2014</year>
<fpage>293</fpage>
<lpage>302</lpage>
<pub-id pub-id-type="doi">10.1038/nrendo.2014.29</pub-id>
<pub-id pub-id-type="pmid">24663222</pub-id>
</element-citation>
</ref>
<ref id="b0180">
<label>36</label>
<element-citation publication-type="journal" id="h0180">
<person-group person-group-type="author">
<name>
<surname>Liu</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Feng</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>Q.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>Q.</given-names>
</name>
<name>
<surname>Hua</surname>
<given-names>M.</given-names>
</name>
</person-group>
<article-title>Adiponectin, TNF-α and inflammatory cytokines and risk of type 2 diabetes: A systematic review and meta-analysis</article-title>
<source>Cytokine.</source>
<volume>86</volume>
<year>2016</year>
<fpage>100</fpage>
<lpage>109</lpage>
<pub-id pub-id-type="doi">10.1016/j.cyto.2016.06.028</pub-id>
<pub-id pub-id-type="pmid">27498215</pub-id>
</element-citation>
</ref>
<ref id="b0185">
<label>37</label>
<element-citation publication-type="journal" id="h0185">
<person-group person-group-type="author">
<name>
<surname>King</surname>
<given-names>G.L.</given-names>
</name>
<name>
<surname>Park</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>Q.</given-names>
</name>
</person-group>
<article-title>Selective Insulin Resistance and the Development of Cardiovascular Diseases in Diabetes: The 2015 Edwin Bierman Award Lecture</article-title>
<source>Diabetes.</source>
<volume>65</volume>
<issue>6</issue>
<year>2016</year>
<fpage>1462</fpage>
<lpage>1471</lpage>
<pub-id pub-id-type="doi">10.2337/db16-0152</pub-id>
<pub-id pub-id-type="pmid">27222390</pub-id>
</element-citation>
</ref>
<ref id="b0190">
<label>38</label>
<element-citation publication-type="journal" id="h0190">
<person-group person-group-type="author">
<name>
<surname>Pfützner</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Schöndorf</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Hanefeld</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Forst</surname>
<given-names>T.</given-names>
</name>
</person-group>
<article-title>High-sensitivity C-reactive protein predicts cardiovascular risk in diabetic and nondiabetic patients: effects of insulin-sensitizing treatment with pioglitazone</article-title>
<source>J Diabetes Sci Technol.</source>
<volume>4</volume>
<issue>3</issue>
<year>2010 May 1</year>
<fpage>706</fpage>
<lpage>716</lpage>
<pub-id pub-id-type="pmid">20513338</pub-id>
</element-citation>
</ref>
<ref id="b0195">
<label>39</label>
<element-citation publication-type="journal" id="h0195">
<person-group person-group-type="author">
<name>
<surname>Xie</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Sinha</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Yi</surname>
<given-names>Z.</given-names>
</name>
</person-group>
<article-title>Role of adipocyte mitochondria in inflammation, lipemia and insulin sensitivity in humans: effects of pioglitazone treatment</article-title>
<source>Int J Obes (Lond).</source>
<year>2017 Aug 14</year>
<pub-id pub-id-type="doi">10.1038/ijo.2017.192</pub-id>
</element-citation>
</ref>
<ref id="b0200">
<label>40</label>
<element-citation publication-type="journal" id="h0200">
<person-group person-group-type="author">
<name>
<surname>Zhang</surname>
<given-names>W.Y.</given-names>
</name>
<name>
<surname>Schwartz</surname>
<given-names>E.A.</given-names>
</name>
<name>
<surname>Permana</surname>
<given-names>P.A.</given-names>
</name>
<name>
<surname>Reaven</surname>
<given-names>P.D.</given-names>
</name>
</person-group>
<article-title>Pioglitazone inhibits the expression of inflammatory cytokines from both monocytes and lymphocytes in patients with impaired glucose tolerance</article-title>
<source>Arterioscler Thromb Vasc Biol.</source>
<volume>28</volume>
<issue>12</issue>
<year>2008 Dec</year>
<fpage>2312</fpage>
<lpage>2318</lpage>
<pub-id pub-id-type="doi">10.1161/ATVBAHA.108.175687</pub-id>
<pub-id pub-id-type="pmid">18818415</pub-id>
</element-citation>
</ref>
<ref id="b0205">
<label>41</label>
<element-citation publication-type="journal" id="h0205">
<person-group person-group-type="author">
<name>
<surname>Qiu</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>X.N.</given-names>
</name>
</person-group>
<article-title>Pioglitazone inhibits the secretion of proinflammatory cytokines and chemokines in astrocytes stimulated with lipopolysaccharide</article-title>
<source>Int J Clin Pharmacol Ther.</source>
<volume>53</volume>
<issue>9</issue>
<year>2015 Sep</year>
<fpage>746</fpage>
<lpage>752</lpage>
<pub-id pub-id-type="doi">10.5414/CP202339</pub-id>
<pub-id pub-id-type="pmid">26227097</pub-id>
</element-citation>
</ref>
<ref id="b0210">
<label>42</label>
<element-citation publication-type="journal" id="h0210">
<person-group person-group-type="author">
<name>
<surname>Sakamoto</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Hongo</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Saito</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Nagai</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Ishizaka</surname>
<given-names>N.</given-names>
</name>
</person-group>
<article-title>Reduction of renal lipid content and proteinuria by a PPAR-γ agonist in a rat model of angiotensin II-induced hypertension</article-title>
<source>Eur J Pharmacol.</source>
<volume>682</volume>
<issue>1–3</issue>
<year>2012 May 5</year>
<fpage>131</fpage>
<lpage>136</lpage>
<pub-id pub-id-type="doi">10.1016/j.ejphar.2012.02.027</pub-id>
<pub-id pub-id-type="pmid">22387860</pub-id>
</element-citation>
</ref>
<ref id="b0215">
<label>43</label>
<element-citation publication-type="journal" id="h0215">
<person-group person-group-type="author">
<name>
<surname>Kutsukake</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Matsutani</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Tamura</surname>
<given-names>K.</given-names>
</name>
</person-group>
<article-title>Pioglitazone attenuates lung injury by modulating adipose inflammation</article-title>
<source>J Surg Res.</source>
<volume>189</volume>
<issue>2</issue>
<year>2014</year>
<fpage>295</fpage>
<lpage>303</lpage>
<pub-id pub-id-type="doi">10.1016/j.jss.2014.03.007</pub-id>
<pub-id pub-id-type="pmid">24713471</pub-id>
</element-citation>
</ref>
<ref id="b0220">
<label>44</label>
<element-citation publication-type="journal" id="h0220">
<person-group person-group-type="author">
<name>
<surname>Aoki</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Maeno</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Aoyagi</surname>
<given-names>K.</given-names>
</name>
</person-group>
<article-title>Pioglitazone, a peroxisome proliferator-activated receptor gamma ligand, suppresses bleomycin-induced acute lung injury and fibrosis</article-title>
<source>Respiration.</source>
<volume>77</volume>
<issue>3</issue>
<year>2009</year>
<fpage>311</fpage>
<lpage>319</lpage>
<pub-id pub-id-type="doi">10.1159/000168676</pub-id>
<pub-id pub-id-type="pmid">18974632</pub-id>
</element-citation>
</ref>
<ref id="b0225">
<label>45</label>
<element-citation publication-type="journal" id="h0225">
<person-group person-group-type="author">
<name>
<surname>Barbarin</surname>
<given-names>V.</given-names>
</name>
<name>
<surname>Nihoul</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Misson</surname>
<given-names>P.</given-names>
</name>
</person-group>
<article-title>The role of pro- and anti-inflammatory responses in silica-induced lung fibrosis</article-title>
<source>Respir Res.</source>
<volume>6</volume>
<year>2005</year>
<fpage>112</fpage>
<pub-id pub-id-type="pmid">16212659</pub-id>
</element-citation>
</ref>
<ref id="b0230">
<label>46</label>
<element-citation publication-type="journal" id="h0230">
<person-group person-group-type="author">
<name>
<surname>Colle</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>de Larminat</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Rotenberg</surname>
<given-names>S.</given-names>
</name>
</person-group>
<article-title>PPAR-γ Agonists for the Treatment of Major Depression: A Review</article-title>
<source>Pharmacopsychiatry.</source>
<volume>50</volume>
<issue>2</issue>
<year>2017 Mar</year>
<fpage>49</fpage>
<lpage>55</lpage>
<pub-id pub-id-type="doi">10.1055/s-0042-120120</pub-id>
<pub-id pub-id-type="pmid">27978584</pub-id>
</element-citation>
</ref>
<ref id="b0235">
<label>47</label>
<element-citation publication-type="journal" id="h0235">
<person-group person-group-type="author">
<name>
<surname>Galimberti</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Scarpini</surname>
<given-names>E.</given-names>
</name>
</person-group>
<article-title>Pioglitazone for the treatment of Alzheimer's disease</article-title>
<source>Expert Opin Investig Drugs.</source>
<volume>26</volume>
<issue>1</issue>
<year>2017</year>
<fpage>97</fpage>
<lpage>101</lpage>
<pub-id pub-id-type="doi">10.1080/13543784.2017.1265504</pub-id>
</element-citation>
</ref>
<ref id="b0240">
<label>48</label>
<element-citation publication-type="journal" id="h0240">
<person-group person-group-type="author">
<name>
<surname>Carta</surname>
<given-names>A.R.</given-names>
</name>
<name>
<surname>Pisanu</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Carboni</surname>
<given-names>E.</given-names>
</name>
</person-group>
<article-title>Do PPAR-Gamma Agonists Have a Future in Parkinson's Disease Therapy?</article-title>
<source>Parkinsons Dis.</source>
<volume>2011</volume>
<year>2011</year>
<object-id pub-id-type="publisher-id">689181</object-id>
<pub-id pub-id-type="doi">10.4061/2011/689181</pub-id>
</element-citation>
</ref>
<ref id="b0245">
<label>49</label>
<element-citation publication-type="journal" id="h0245">
<person-group person-group-type="author">
<name>
<surname>Carta</surname>
<given-names>A.R.</given-names>
</name>
</person-group>
<article-title>PPAR-γ: therapeutic prospects in Parkinson's disease</article-title>
<source>Curr Drug Targets.</source>
<volume>14</volume>
<issue>7</issue>
<year>2013</year>
<fpage>743</fpage>
<lpage>751</lpage>
<pub-id pub-id-type="doi">10.2174/1389450111314070004</pub-id>
<pub-id pub-id-type="pmid">23469878</pub-id>
</element-citation>
</ref>
<ref id="b0250">
<label>50</label>
<element-citation publication-type="journal" id="h0250">
<person-group person-group-type="author">
<name>
<surname>Simon</surname>
<given-names>D.K.</given-names>
</name>
<name>
<surname>Simuni</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Elm</surname>
<given-names>J.N.I.N.D.S.N.E.T.-P.D.</given-names>
</name>
</person-group>
<article-title>Investigators. Peripheral Biomarkers of Parkinson's Disease Progression and Pioglitazone Effects</article-title>
<source>J Parkinsons Dis.</source>
<volume>5</volume>
<issue>4</issue>
<year>2015</year>
<fpage>731</fpage>
<lpage>736</lpage>
<pub-id pub-id-type="doi">10.3233/JPD-150666</pub-id>
<pub-id pub-id-type="pmid">26444095</pub-id>
</element-citation>
</ref>
<ref id="b0255">
<label>51</label>
<element-citation publication-type="journal" id="h0255">
<person-group person-group-type="author">
<name>
<surname>Omeragic</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Hoque</surname>
<given-names>M.T.</given-names>
</name>
<name>
<surname>Choi</surname>
<given-names>U.Y.</given-names>
</name>
<name>
<surname>Bendayan</surname>
<given-names>R.</given-names>
</name>
</person-group>
<article-title>Peroxisome proliferator-activated receptor-gamma: potential molecular therapeutic target for HIV-1-associated brain inflammation</article-title>
<source>J Neuroinflammation.</source>
<volume>14</volume>
<issue>1</issue>
<year>2017</year>
<fpage>183</fpage>
<pub-id pub-id-type="doi">10.1186/s12974-017-0957-8</pub-id>
<pub-id pub-id-type="pmid">28886715</pub-id>
</element-citation>
</ref>
<ref id="b0260">
<label>52</label>
<element-citation publication-type="journal" id="h0260">
<person-group person-group-type="author">
<name>
<surname>Patel</surname>
<given-names>S.P.</given-names>
</name>
<name>
<surname>Cox</surname>
<given-names>D.H.</given-names>
</name>
<name>
<surname>Gollihue</surname>
<given-names>J.L.</given-names>
</name>
</person-group>
<article-title>Pioglitazone treatment following spinal cord injury maintains acute mitochondrial integrity and increases chronic tissue sparing and functional recovery</article-title>
<source>Exp Neurol.</source>
<volume>293</volume>
<year>2017 Jul</year>
<fpage>74</fpage>
<lpage>82</lpage>
<pub-id pub-id-type="doi">10.1016/j.expneurol.2017.03.021</pub-id>
<pub-id pub-id-type="pmid">28365473</pub-id>
</element-citation>
</ref>
<ref id="b0265">
<label>53</label>
<element-citation publication-type="journal" id="h0265">
<person-group person-group-type="author">
<name>
<surname>Shafaroodi</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Moezi</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Ghorbani</surname>
<given-names>H.</given-names>
</name>
</person-group>
<article-title>Sub-chronic treatment with pioglitazone exerts anti-convulsant effects in pentylenetetrazole-induced seizures of mice: The role of nitric oxide</article-title>
<source>Brain Res Bull.</source>
<volume>87</volume>
<issue>6</issue>
<year>2012 Apr 10</year>
<fpage>544</fpage>
<lpage>550</lpage>
<pub-id pub-id-type="doi">10.1016/j.brainresbull.2012.02.001</pub-id>
<pub-id pub-id-type="pmid">22366335</pub-id>
</element-citation>
</ref>
<ref id="b0270">
<label>54</label>
<element-citation publication-type="journal" id="h0270">
<person-group person-group-type="author">
<name>
<surname>Agarwal</surname>
<given-names>R.</given-names>
</name>
</person-group>
<article-title>Anti-inflammatory effects of short-term pioglitazone therapy in men with advanced diabetic nephropathy</article-title>
<source>Am J Physiol Renal Physiol.</source>
<volume>290</volume>
<issue>3</issue>
<year>2006</year>
<fpage>F600</fpage>
<lpage>F605</lpage>
<pub-id pub-id-type="pmid">16159895</pub-id>
</element-citation>
</ref>
<ref id="b0275">
<label>55</label>
<element-citation publication-type="journal" id="h0275">
<person-group person-group-type="author">
<name>
<surname>Sharma</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Kaundal</surname>
<given-names>R.K.</given-names>
</name>
<name>
<surname>Sharma</surname>
<given-names>S.S.</given-names>
</name>
</person-group>
<article-title>Amelioration of pulmonary dysfunction and neutrophilic inflammation by PPAR gamma agonist in LPS-exposed guinea pigs</article-title>
<source>Pulm Pharmacol Ther.</source>
<volume>22</volume>
<issue>3</issue>
<year>2009 Jun</year>
<fpage>183</fpage>
<lpage>189</lpage>
<pub-id pub-id-type="doi">10.1016/j.pupt.2008.11.011</pub-id>
<pub-id pub-id-type="pmid">19073273</pub-id>
</element-citation>
</ref>
<ref id="b0280">
<label>56</label>
<mixed-citation publication-type="other" id="h0280">Guan WJ, Ni ZY, Hu Y et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032.</mixed-citation>
</ref>
<ref id="b0285">
<label>57</label>
<element-citation publication-type="journal" id="h0285">
<person-group person-group-type="author">
<name>
<surname>Forst</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Wilhelm</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Pfützner</surname>
<given-names>A.</given-names>
</name>
</person-group>
<article-title>Investigation of the vascular and pleiotropic effects of atorvastatin and pioglitazone in a population at high cardiovascular risk</article-title>
<source>Diab Vasc Dis Res.</source>
<volume>5</volume>
<issue>4</issue>
<year>2008</year>
<fpage>298</fpage>
<lpage>303</lpage>
<pub-id pub-id-type="doi">10.3132/dvdr.2008.043</pub-id>
<pub-id pub-id-type="pmid">18958840</pub-id>
</element-citation>
</ref>
</ref-list>
</back>
</pmc>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Sante/explor/StressCovidV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000773 | SxmlIndent | more

Ou

HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000773 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Sante
   |area=    StressCovidV1
   |flux=    Pmc
   |étape=   Corpus
   |type=    RBID
   |clé=     PMC:7175844
   |texte=   Can pioglitazone be potentially useful therapeutically in treating patients with covid-19?
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i   -Sk "pubmed:32344313" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd   \
       | NlmPubMed2Wicri -a StressCovidV1 

Wicri

This area was generated with Dilib version V0.6.33.
Data generation: Wed May 6 16:44:09 2020. Site generation: Sun Mar 28 08:26:57 2021