Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Enhanced chemical weathering as a geoengineering strategy to reduce atmospheric carbon dioxide, supply nutrients, and mitigate ocean acidification

Chemical weathering is an integral part of both the rock and carbon cycles and is being affected by changes in land use, particularly as a result of agricultural practices such as tilling, mineral fertilization, or liming to adjust soil pH. These human activities have already altered the chemical terrestrial cycles and land-ocean flux of major elements, although the extent remains difficult to quantify. When deployed on a grand scale, Enhanced Weathering (a form of mineral fertilization), the application of finely ground minerals over the land surface, could be used to remove CO2 from the atmosphere. The release of cations during the dissolution of such silicate minerals would convert dissolved CO2 to bicarbonate, increasing the alkalinity and pH of natural waters. Some products of mineral dissolution would precipitate in soils or taken up by ecosystems, but a significant portion would be transported to the coastal zone and the open ocean, where the increase in alkalinity would partially counteract “ocean acidification” associated with the current marked increase in atmospheric CO2. Other elements released during this mineral dissolution, like Si, P or K, could stimulate biological productivity, further helping to remove CO2 from the atmosphere. On land, the terrestrial carbon-pool would likely increase in response to Enhanced Weathering in areas where ecosystem growth rates are currently limited by one of the nutrients that would be released during mineral dissolution. In the ocean, the biological carbon pumps (which export organic matter and CaCO3 to the deep ocean) may be altered by the resulting influx of nutrients and alkalinity to the ocean. This review merges current interdisciplinary knowledge about Enhanced Weathering, the processes involved, and the applicability as well as some of the consequences and risks of applying the method