How does COVID 19 Coronavirus (SARS-CoV-2) affect the immune-compromised individuals and organ transplant patients, who are on the immune suppressant drugs?
Malireddy S. Reddy, BVSc (DVM)., MS., Ph.D.
International Media and Cultures, Inc. (IMAC)
1280 S. Parker Road, Denver, CO 80231, USA
COVID-19 Coronavirus has shaken up the entire world by creating a pandemic involving over 205 countries with close to 1,130,000 infections and over 60,000 deaths as of April 7, 2020. In normal healthy human beings, with no underlying health ailments, the pathogenesis of COVID-19 disease is primarily due to lung infections, followed by the autoimmune syndrome due to patient’s own overactive immune system (Reddy, 2020). The lack of sufficient number of T-regulatory cells and the inflammation-reducing interleukins is one of the reasons for the uncontrollable overactive immune system resulting in dangerous life-threatening auto-immune syndrome, with respiratory system failure. In the case of elderly population, the pathophysiology of the onset of COVID-19 disease is different because of the immunesenescence i.e. lack of sufficient immune response, to start with, due to old age. Even in the older population, the immune system can be ramped up using the multiple mixed strains of probiotics with their diverse immunomodulins, and immune boosting antioxidants.
Now let us look into the naturally immune compromised individuals, immune compromised due to disease, and induced immune compromise condition to eliminate organ rejection as in the case of organ transplant subjects. Physicians naturally prescribe the immune suppressive medications to suppress the autoimmune reactions which will induce the transplant organ rejection. What exactly does immune suppressant drugs due? Mainly these drugs suppress the T-cells which operate as functional cell mediated cytotoxic adaptive immunity agents. In addition, they also significantly suppress the B-cells which are responsible for humoral antibody driven adaptive immunity. These immune suppressant drugs may also partly inhibit the natural killer cells which function in cell mediated cytotoxic innate immunity. All of the above outlined adaptive immune systems have to be simmered to eliminate the rejection of the transplanted organs, such as liver, kidney etc., etc.
Now let us analyze what happens to the innate immune system which constitutes Macrophages, Neutrophils, Basophils, Eosinophils etc. When the immune suppressant drugs are administered, apparently the innate immune system activity cannot be totally reduced, since they are nonspecific in nature and will act as first line of defense to ward off the infections, including both viral and bacterial, etc. Let us analyze what happens to the organ transplant recipients, who are on the immune suppressant drugs, if he or she is infected with the COVID-19 disease causing SARS-CoV-2 Coronavirus?
As I have outlined earlier, the COVID-19 disease causes more damage due to hosts overactive immune system, more than the primary damage due to virus on lung tissue. One of the lines of treatment for COVID-19 is through use of immunosuppressant drugs to simmer the autoimmunity due to overactive hosts immune system. If it is so, the organ transplant recipients who are on the immune suppressant drugs should not have severe secondary lung damage due to the hosts overactive immune system. It is good news. However, the COVID-19 virus can also do the primary damage to the lungs since the adaptive immune response is slow or none in these patients. Yet, if COVID-19 viral infection level is low, the transplant patient’s innate immune system, perhaps to some extent, should be able to suppress the infection to protect the patient, due to the activity of lung tissue associated Macrophages.
Since we do not know exactly the number of viral particles involved in each infection, the transplant patients must be extremely careful not to contact the disease. This can be accomplished through social distancing, regular washing of hands with soap, using the appropriate nose mask, and not shaking hands and giving hugs, and finally keeping away from crowded places and from people who have the COVID-19 disease symptoms.
In addition to the above listed prophylactic practices, I strongly recommend them consuming fresh yogurt (fully fermented) with multiple probiotics on a daily basis to strengthen their gastrointestinal microbiota. In addition, consumption of at least one ounce of aged cheese per day (one year old) made of pasteurized milk is the best way to strengthen their intestinal microbiota or microflora. Contrary to the peoples thinking, the aged cheeses are easy to digest, and they are loaded with the natural and highly beneficial probiotics. Even lactose intolerant people can consume aged cheeses without any discomfort due to significantly reduced or absence of lactose in them. One can question the efficiency of probiotics in terms of improving the immunity of organ transplant recipient to override the Coronavirus infection. Multiple Mixed Strain Probiotics and their growth end products (immunomodulins) induce the production of defensins (natural antimicrobial peptides with 29-35 amino acids), by the host epithelial cells, which can inactivate the infective viruses and bacteria. This is an indirect way of inactivating the viruses without having to involve the elaborate immune system. It is proven that probiotics significantly enhance the systemic activity of macrophages. Collectively the probiotic induced defensins and the fully operative innate immune system, including stimulated macrophages, will ward off both the viral and bacterial infections, without having to involve the adaptive immune systems i.e. specifically the effector T-cells and B-cells. My feeling is that multiple mixed strain probiotics induce selectively the production and activation of T-Regulatory cells without having to stimulate the effector T-cells, which have been suppressed deliberately by the immune suppressant drugs, in the case of organ transplant recipients, to reduce the overall inflammation. This is a plus for the organ transplant individuals. As I have discussed earlier, the adaptive immune systems have to be suppressed with the aid of immune suppressants in the case of organ transplant recipients, to prevent organ rejection.
The organ transplant patient should not abuse the use of alcohol, since alcohol has a significant effect on slowing the lung tissue associated Macrophages, which are essential for fighting COVID-19 infections. It is also extremely important to keep up the good oral hygiene, and the hygiene of the nasopharyngeal orifices to protect from yeast (candida albicins), Herpes (Herpes simplex virus), and respiratory viruses including the COVID-19, SARS-CoV-2 Coronavirus. In addition to the regular intake of active fresh yogurt and the aged cheese, (to derive maximum amounts of implantable natural probiotics), it is good to take the nutritional supplements such as Vit-C (perhaps 1000mg/day), Vit-E, Vit-D, and Zinc etc. to significantly reduce the oxidation of the tissues. As you all know, oxidation is the core cause of any disease. I strongly recommend you consult with your physician before taking any of these supplements. More than all, the stress, anxiety, and fear should be curtailed since they significantly diminish even the innate immune system and also induce dysbiosis (Reddy, 2017). A good restful sleep will replenish the organs and also significantly improve the physiological functions of the specialized tissues, such as bone marrow (which produces white blood corpuscles) etc. in a synchronized fashion to protect and maintain good health.
The latest medical journal article published from Italy, (where the highest death rate was encountered due to COVID-19), distinctly proved that the COVID-19 infection did not hamper the health of the organ transplanted persons receiving immunotherapy, confirming my hypothesis that the COVID-19 mortality may be solely due to the secondary auto immunity, due to patient’s overactive immune system (D’antiga, 2020).
Since the Immunesenescence in older population will have similar immune deficiency patterns, as in the case of organ transplant patients who are on the immunosuppressant drugs, the proactive precautions and nutritional modalities, outlined in this article, should be followed to override or reduce the chances of picking up COVID-19 infections.
- D’antiga L. 2020. Coronavirus and Immunosuppressed Patients. The Facts During the Third Epidemic. Doi: 10.1002/LT. 25756.
- Reddy MS. 2017. Chronic Stress – An Etiological Agent for the Genesis of Multitude of Diseases, and the Effect of Meditation on Modulating the Stress. Open ACC J of Toxicol. 1 (5): 555-561. Doi: 10. 19080/OAJT. 2017.01.555571.
- Reddy MS. 2020. Latest Coronavirus Episode of China – It’s Ramifications and Applicable Preventative and Clinical Treatment Measures. AAPI (American Association of Physicians of Indian Origin) Spring Journal 2020.