Acute chest syndrome and coronavirus disease may actually be genetically determined exaggerated immune response syndromes particularly in pulmonary capillaries

Abstract

Background: Sickle cell diseases (SCD) are severe inflammatory processes on vascular endothelium, particularly at the capillaries since the capillary system is the main distributor of hardened red blood cells into the tissues. Similarly, coronavirus disease (COVID-19) may also be a genetically determined inflammatory process particularly in pulmonary capillaries with much higher mortality rates in some families. Methods: All patients with the SCD were studied. Results: The study included 222 males and 212 females with similar mean ages (30.8 versus 30.3 years, p>0.05, respectively). Smoking (23.8% versus 6.1%, p<0.001), alcohol (4.9% versus 0.4%, p<0.001), disseminated teeth losses (5.4% versus 1.4%, p<0.001), ileus (7.2% versus 1.4%, p<0.001), cirrhosis (8.1% versus 1.8%, p<0.001), leg ulcers (19.8% versus 7.0%, p<0.001), digital clubbing (14.8% versus 6.6%, p<0.001), coronary heart disease (CHD) (18.0% versus 13.2%, p<0.05), chronic renal disease (CRD) (9.9% versus 6.1%, p<0.05), chronic obstructive pulmonary disease (COPD) (25.2% versus 7.0%, p<0.001), and stroke (12.1% versus 7.5%, p<0.05) were all higher but not acute chest syndrome (ACS), in males (2.7% versus 3.7%, p>0.05). Conclusion: Although smoking, alcohol, disseminated teeth losses, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, COPD, and stroke-like atherosclerotic end-points were all higher in males, prevalence of ACS was similar in both genders. In another definition, ACS and severe COVID-19 may be genetically determined exaggerated immune response syndromes particularly in pulmonary capillaries, and immunomodulatory drugs including dexamethasone probably should take the major role in the treatment. Key words: Acute chest syndrome, coronavirus disease, exaggerated immune response syndromes, sickle cell diseases, capillary endothelial inflammation, capillary endothelial edema, tissue hypoxia