Human respiratory beta coronavirus are emerging causes for Public Health Emergencies of International Concern (PHEIC). SARS-CoV2 is circulating worldwide since November 2019. We review here the cardiovascular morbidity and mortality in COVID-19, and data supporting the role for dysregulation of the RAS counterregulatory axis due to binding of SARS-CoV2 S protein to ACE2 receptor. Since this counterregulatory axis provides benefits not only on the cardiovascular front but also in acute lung injury, we speculate on potential use of ACE inhibitors and AT₁R blockers in critically ill COVID-19 patients, and report current evidences.

Previous research via cell experiments has shown that ultrafine particles (UFPs, particles less than 100 nm) emitted from Three-Dimensional desktop printers (3D printers) had cytotoxicity. However, a few particles from different filaments and their cytotoxicity combinations have been tested. Here we quantify emissions of UFPs and use Air-Liquid Interface (ALI) from one commercially available filament extrusion desktop 3D printer utilizing three different filaments by controlled experiments. A549 cells were exposed at the ALI to UFPs generated by a working 3D printer for an average of 45 minutes and 90 minutes. Twenty-four hours after exposure, cells were analyzed for percent cytotoxicity grown on the 24-well ALI insert (LDH assay). UFP exposure resulted in decreased cell viability (significantly increased LDH levels). The result shows that Acrylonitrile butadiene styrene (ABS) has the most significant particle emission. ALI exposures enable in vitro testing of mixtures of particles such as UFP from a 3D printer. ABS is the only filament with a significant difference compared with the HEPA control in 90 minutes of exposure (p-value <0.05). ABS and PETG we used during the experiment presented a significant difference compared with the HEPA control in 45 minutes of exposure.A screening analysis of potential exposure to these products in a typical environment suggests caution should be used when operating many printer and filament combinations in poorly ventilated spaces or without the aid of combined gas and particle filtration systems.

COVID-19 is a highly infectious respiratory illness caused by SARS-CoV-2, and acute lung injury (ALI) is the major cause of COVID-19. The challenge in studying SARS-CoV-2 pathogenicity is the limited availability of animal models. Therefore, it is necessary to establish animal models that can reproduce multiple characteristics of ALI to study therapeutic applications. The present study established a mouse model that has features of ALI that are similar to COVID-19 syndrome to investigate the role of ACE2 and the administration of the Chinese herbal prescription NRICM101 in ALI. Mice with genetic modifications, including overexpression of human ACE2 (K18-hACE2 TG) and absence of ACE2 (mACE2 KO), were intratracheally instillated with hydrochloric acid. The acid intratracheal instillation induced severe immune cell infiltration, cytokine storms, and pulmonary disease in mice. Compared with K18-hACE2 TG mice, mACE2 KO mice exhibited dramatically increased levels of multiple inflammatory cytokines (IL-6, TNF-α, and TGF-β1) in bronchoalveolar lavage fluid, histological evidence of lung injury, and dysregulation of MAPK and MMP activation. In mACE2 KO mice, NRICM101 could ameliorate the disease progression of acid-induced ALI. In conclusion, the established mouse model provided an effective platform for researchers to investigate pathological mechanisms and develop therapeutic strategies for ALI, including COVID-19-related ALI.

Set theory faces two difficulties: formal definitions of sets/subsets are incapable of assessing biophysical issues; formal axiomatic systems are complete/inconsistent or incomplete/consistent. To overtake these problems reminiscent of the old-fashioned principle of individuation, we provide formal treatment/validation/operationalization of a methodological weapon termed “outer approach” (OA). The observer’s attention shifts from the system under evaluation to its surroundings, so that objects are investigated from outside. Subsets become just “holes” devoid of information inside larger sets. Sets are no longer passive containers, rather active structures enabling their content’s examination. Consequences/applications of OA include: a) operationalization of paraconsistent logics, anticipated by unexpected forerunners, in terms of advanced truth theories of natural language, anthropic principle and quantum dynamics; b) assessment of embryonic craniocaudal migration in terms of Turing’s spots; c) evaluation of hominids’ social behaviors in terms of evolutionary modifications of facial expression’s musculature; d) treatment of cortical action potentials in terms of collective movements of extracellular currents, leaving apart what happens inside the neurons; e) a critique of Shannon’s information in terms of the Arabic thinkers’ active/potential intellects. Also, OA provides an outer view of a) humanistic issues such as the enigmatic Celestino of Verona’s letter, Dante Alighieri’s “Hell” and the puzzling Voynich manuscript; b) historical issues such as Aldo Moro’s death and the Liston/Clay boxing fight. Summarizing, the safest methodology to quantify phenomena is to remove them from our observation and tackle an outer view, since mathematical/logical issues such as selective information deletion and set complement rescue incompleteness/inconsistency of biophysical systems.

An application of CO2/HCO3--free solution (Zero-CO2) did not increase intracellular pH (pHi) in ciliated human nasal epithelial cells (c-hNECs), leading to no increase in the beating frequency (CBF) or bend distance (CBD, an index of amplitude). This study demonstrated that the pHi of the c-hNECs expressing carbonic anhydrase IV (CAIV) is high (7.64), while that of the ciliated human bronchial epithelial cells (c-hBECs) expressing no CAIV is low (7.10). Upon applying Zero-CO2, an extremely high level of pHi caused the pHi, CBF and CBD to decrease, while a low level of pHi caused them to increase. The high pHi was generated by a high rate of HCO3- influx via interac-tions between CAIV and Na+/HCO3- cotransport (NBC) in c-hNECs. An NBC inhibitor (S0859) decreased the pHi and CBF, and Zero-CO2 application increased the CBF in S0859-treated c-hNECs. In conclusion, the interactions of CAIV and NBC maximize the HCO3- influx to increase the pHi in c-hNECs. This novel mechanism causes the pHi to decrease, leading to no increase in CBF and CBD in c-hNECs upon Zero-CO2 application, and appears to play a crucial role in maintaining pHi, CBF and CBD in c-hNECs periodically exposed to air (0.04% CO2) with respiration.

RLF-100 (Aviptadil), a synthetic form of Vasoactive Intestinal Peptide (VIP) is shown to block replication of the SARS-CoV-2 virus and has been granted Fast Track Designation by the US FDA for the treatment of Critical COVID-19 with Respiratory Failure. We describe the clinical course of the first patient treated with this investigational medication in an open label manner -- a 54 year old patient suffering antibody-mediated rejection of his double lung transplant who contracted COVID-19 with respiratory failure refractory to all currently available therapies. He received three infusions of RLF-100 under an FDA-approved emergency use IND. Within 24 hours of the third infusion, substantial improvement in oxygen saturation and radiographic improvement in characteristic COVID-19 pneumonitis was noted. He was discharged from intensive care at that point and scheduled for discharge to home at 1 week on room air. Despite an intervening hospitalization for trauma, he remains alive and free of respiratory failure at 28 days post treatment.