Severe acute respiratory syndrome-coronavirus (SARS-CoV) and SARS-like coronavirus are a potential threat to global health. However, reviews of the long-term effects of clinical treatments in SARS patients are lacking. Here a total of 25 recovered SARS patients were recruited 12 years after infection. Clinical questionnaire responses and examination findings indicated that the patients had experienced various diseases, including lung susceptibility to infections, tumors, cardiovascular disorders, and abnormal glucose metabolism. As compared to healthy controls, metabolomic analyses identified significant differences in the serum metabolomes of SARS survivors. The most significant metabolic disruptions were the comprehensive increase of phosphatidylinositol and lysophospha tidylinositol levels in recovered SARS patients, which coincided with the effect of methylprednisolone administration investigated further in the steroid treated non-SARS patients with severe pneumonia. These results suggested that high-dose pulses of methylprednisolone might cause long-term systemic damage associated with serum metabolic alterations. The present study provided information for an improved understanding of coronavirus-associated pathologies, which might permit further optimization of clinical treatments. Between 2002 and 2003, severe acute respiratory syndrome (SARS) caused by coronavirus (SARS-CoV) affected over 30 countries on five continents. Soon after, HCoV-NL63 was identified in a seven-month-old infant with bronchiolitis and conjunctivitis in 2004 1 , and followed by HCoV-HKU1 in 2005 2 . Later, the Middle East Respiratory Syndrome coronavirus (MERS-CoV) rapidly spread worldwide with fatality rates up to 30% 3 . Several reports have recently demonstrated the existence of a SARS-like coronavirus, which indicates that coronavirus-associated respiratory tract infections continue to have a significant epidemic potential 4-6 . Therefore, there remains an urgent requirement for standardization of treatments in order to develop more effective interventional strategies for coronavirus-associated diseases. Clinical treatments implemented following the sudden outbreak of SARS-CoV included empirical and experimental types, although their effectiveness and side effects remain controversial. Antiviral drugs, including ribavirin, lopinavir, and ritonavir, were prescribed soon after SARS-CoV was identified as the causative agent 7, 8 . Type I interferon was also used owing to its inhibitory effect on SARS-CoV replication 9 . Furthermore, the use of convalescent plasma or immunoglobulin was reported for the treatment of SARS 10 . More frequently, corticosteroids, including methylprednisolone alone or in combination with antiviral drugs, were administered to SARS patients to prevent immunopathological lung damage 11 , although the timing and dosage regimens for steroid administration were controversial 12, 13 . The administration of high-dose pulses of methylprednisolone has been associated with psychic derangements, acute myopathy, and osteonecrosis [14] [15] [16] . Considering the fact that these disorders usually progress to a chronic state, we propose that the SARS survivors may suffer from metabolic disturbances, Published: xx xx xxxx OPEN www.nature.com/scientificreports/ 2 SCIeNTIfIC REPORTS | 7: 9110 |
Output: Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection OPEN