My personal update on
#COVID19
research: no scientific breakthroughs yet... but a revolution in
#sciencecommunication
as journalists finally accept "We don't know yet" as a valid answer
#LongCovid
is complex to diagnose and treat, so we need
#biomarkers
! 1. to confirm viral persistence, and 2. to map the failing/overactive immune response. So we tried to hit two birds with one stone using digital transcriptomics 👇👇 (1/n)
@laurenancona
Actually, the Bomsel lab in Paris found direct evidence of infectious SARSCoV2 in
#LongCovid
patients' blood, inside their platelets (poster at Madrid conference) =the real smoking gun
What did we find?
1. viral RNAs were higher in
#LongCovid
: Nucleocapsid, ORF7a, ORF3a, Mpro (=Paxlovid target), and antisense ORF1ab RNA. Of note, presence of antisense RNA suggests ongoing viral replication
2.
#SARSCoV2
-related host RNAs ACE2/TMPRSS2, DPP4/FURIN also higher!
@laurenancona
Hi Lauren, we found small genetic fragments of the virus, which could be dead virus or "leftovers" BUT antisense RNA is only found inside a cell when the virus makes copies (thousands) of itself =circumstantial evidence if this would go to court
We believe clinically useful
#biomarkers
should be non-invasive: while it is interesting to know what happens with
#SARSCoV2
in muscle or colon/gut, these biopsies are too painful and laborious to integrate in daily care for
#LongCOVID
patients. Hence a blood test!
@laurenancona
Platelets are responsible for coagulation, also incriminated in the Science paper from
@carlo_cervia
and the
#microclots
from the Pretorius lab. So all evidence worldwide seems to point at a central role for platelets and blood clotting
Looking at viral RNAs above cutoff (red line below) comparing patients and controls: antisense (65% vs 25%), ORF7a (60% vs 25%), Nucleocapsid (50% vs 8%), total blood viral load (60% vs 8%). Remarkably, Spike RNA was low in all cases =infection not vaccine-derived
4. Yes we can! Viral antisense RNA is a "decent" diagnostic biomarker for
#LongCovid
but together with immune marker FYN it's even better:
4.1. multivariate logistic regression (corrected for age and sex, table below)
4.2. identify Long COVID with >90% sensitivity and specificity
3. Looking at the immune response in
#LongCovid
:
memory B-cell genes up (in green below) include IgE (resonates with new onset allergies in patients) and platelets genes up (salmon colored) -> hypercoagulative state
@resiapretorius
or viral reservoir =Bomsel lab
@UParisDescarte
@resiapretorius
Immune status in
#LongCovid
is neither hyperinflammation nor immunodepression BUT we find lower lymphocyte activation (yellow dots above) and lower
#immunometabolism
(blue dots) =similar to findings
@RobWust
team (but we find lower IDO1 not higher IDO2)
It's a short paper so details are in the Appendix 🤓
Look below at the very homogeneous controls (green) and the wild variation among
#LongCovid
patients: some are similar to controls but half are "deficient" in lymphocyte activation and immunometabolism -> higher viral load!
This is a real-world
#LongCovid
cohort, based on general practice of Marc
@jamoulle
who has become a beacon of hope for patients in Belgium & beyond. From his practice 48 patients and 12 controls were carefully matched for age, sex, time since COVID, vaccination and comorbidities
First in-human study to image
#HIV
replication using a new scanning technique that combines
#MRI
and antibodies. Viral reservoirs were identified not only in the gut and lymph nodes, but also the nose and bone marrow!
5. High or low blood viral load in LongCovid does not depend on age or sex. BUT every comorbidity increases the odds of high viral load with 61% AND every
#vaccine
dose lowers it with 64%, confirming protective effect of vaccination on LongCOVID found in large studies worldwide
@EricTopol
@NatureAging
@ElsKeyaerts
Thanks Eric for highlighting our study! I was planning a thread on new mucosal immune signatures to predict fatal COVID19 outcome, and its relevance for new nasal vaccines... but the aerosol detection seems to steal the Twitter spotlight! 🤓
@jamoulle
In short, significant associations between persistent viral RNA, immunometabolism, and patient-reported outcomes provide mechanistic insights for addressing the challenges posed by
#LongCOVID
=>speed up diagnosis and treatment (target virus & restore
#metabolism
)
What we don't know (yet): viral RNA in blood originates from reservoir in platelets/megakaryocytes, bone marrow, gut...? are these transcriptomic biomarkers related (upstream/downstream?) to other
#LongCOVID
biomarkers cortisol, serotonin, complement activation, coagulation...?
Interessante data ivm
#Wintermanifest
: grootschalige studie uit Engeland toont met
#COVID
maatregelen (maskers, lockdown etc) hospitaalopname van kinderen voor griep/longonsteking met 80-94% daalde! Kunnen we dat ook meerekenen?
What I do know: this study would not have been possible without Marc
@Jamoulle
taking such excellent care of all patients (and controls), raising the bar for all general practitioners dealing with
#LongCovid
So now some statistics to answer the following:
4. can we use persistent RNA in blood (+/- 2 years after acute COVID in this cohort) as a diagnostic biomarker for
#LongCovid
?
5. what predicts high vs. low blood viral load in
#LongCovid
?
And of course patients have the last word:
6. Higher antisense viral RNA and lower immunometabolism score in patients reporting worse anxiety and depression (group 4-5 👇)
#MentalHealth
Patient-Reported Outcome Measures
#PROMs
are crucial and
@Jamoulle
used COOP charts for this
Following a deadly
#COVID19
footprint in frail elderly: does the secret to new vaccines lie in the nose?
A 🧵on our nation-wide study, with 3 exceptionally deadly outbreaks in which >20% of infected nursing home residents died, now out
@NatureAging
:
Really proud of this amazing team effort, finally online as
#preprint
on
@researchsquare
: "Comprehensive immunovirological and environmental screening reveals risk factors for fatal
#COVID19
during post-vaccination nursing home outbreaks."
#aging
#vaccine
SARS-CoV-2 INFECTION and MENTAL HEALTH
We observed an association of a past SARS-CoV-2 infection on deteriorated mental health related symptoms, whereas no association or interaction with burden of the pandemic occurred.
@DaniBeckman
Thanks Dani for highlighting this!
I do hope the link between viral persistence and anxiety/depression will help diminish the
#stigma
that Long Covid patients frequently report
#MentalHealthAwareness
@HudsonLabRIT
Without even the slightest exaggeration: a life-changing book, not just for me but for the whole molecular biology field! This democratized
#DNA
,
#RNA
research for tens of thousands students young researchers.
#Maniatisforever
Happy to be a tiny part of a nice story on how
#IFN
swings both ways in
#SARSCoV2
infection: STAT2 signaling restricts viral dissemination but drives severe pneumonia in SARS-CoV-2 infected hamsters
@NeytsVirology
@NatureComms
Investing in Long Covid research is cost-effective: "The
#LongCOVID
group costs approximately 2,500 pounds per person per year, and the comparator group costs 1,500 pounds."
#healthcare
#EconTwitter
Good cop AND bad cop? Interferons work in
#COVID19
clinical trials, but how, when and for who exactly? IFN-beta but not -alpha or -lambda in nasal mucosa predict clinical outcome in critical COVID-19 patients independent of viral load.
#IFN
What if, on top of ending up in the ICU with
#COVID19
or
#flu
, you also get
#aspergillosis
? Bad news: it doubles your risk of dying! Good news: we found how your immune system fails, revealing clues for faster and probably more effective treatment. 🧵👇
Diagnostic
#biomarkers
and effective therapies are urgently needed for the millions of people currently living with
#LongCovid
. But the administrative burden for designing and conducting clinical trials is too high: currently only large, well-funded academic centers can do this
This Correspondence
@Nature
is <200 words but it tells a bigger story, mainly based on the experience of our team of clinicians, researchers and patients over the last years... but also inspired by the pioneers among patients and researchers
@elisaperego78
@amyproal
2/n
After a long wait, our longitudinal long COVID study is finally published in
@NatureComms
: . We find a skeletal muscle alterations in patients with
#longcovid
, which worsen with exercise. 1/n
So what do we mean by 'grassroots' clinical trials? Actually building on existing pragmatic,
#realword
trials and emulated trials based on
#bigdata
... but taking it a bit further, and by moving faster!
Does
#ME
/CFS look like
#LongCOVID
?
"Immune profiling suggested chronic antigenic stimulation with increase in naïve and decrease in switched memory B-cells. "
@financejonE
@EricTopol
@NatureAging
@ElsKeyaerts
Important question indeed! It is important to emphasize that each nursing home followed strict pandemic procedures, including isolation and ventilation measures. Still, SARSCoV2 was detected in aerosol of common spaces (used by either residents or staff) >50 d after 1st case
Despite a UN General Assembly resolution declaring 2021 as the International Year for the Elimination of Child Labour, child labour is increasing globally for the first time in two decades.
Our latest Editorial:
SARS-CoV-2 was classified at a biological safety level 3, due to the absence of a vaccine, treatment and its causing of a pandemic.
We have good working vaccines and the pandemic risk has passed. Hence, the WHO has classified SARS-CoV-2 at BSL-2.
Using
#crowdsourcing
and online interactive reviewing (similar to TRiP peer review or Wikipedia), we believe both clinical trial size and scientific rigor will increase. How? A two-way interaction between the clinician-patient pair and researchers through online matchmaking
Utterly shocked by
@jclinicalinvest
to allow a visual abstract wrongfully depicting a human body and a human protocol including
#leukapheresis
which was nowhere in the paper, as all experiments were done in murine models.
#justsayinmice
In
@jclinicalinvest
vaccination with antigen (Ag)-loaded monocytes is more efficient than vaccination with Ag-loaded DCs in inducing anti-tumor immunity. However, Ag loaded monocyte vaccination efficacy is dependent on the Ag transfert to endogenous cDC1.
Why is the clinician-patient pair crucial? In our experience, it is a matter of basic
#trust
. Who do you trust with your body and your
#data
? =also why we anticipate a crucial role for general practitioners in this process...
@jamoulle
takes 2-3 hours for a
#LongCOVID
consult!
"...substantial unmet clinical need, in keeping with reports from individuals with
#LongCOVID
of difficulties accessing
#healthcare
and suboptimal recognition... when they do. Our data also suggest that unmet needs could be higher among individuals of non-White ethnicity"👇👇👇
"Striking discrepancy" between occurrence of
#longCOVID
as perceived & reported by participants in longitudinal population-based studies vs evidence of long COVID recorded in their electronic health records, suggests new research letter 🔽
@LongCovidComms
@laurenancona
Using a combo of 2 biomarkers, viral and immune RNA, we show the combo is high in 92% of the patients and in only 8% of the carefully matched controls (same age, sex, and time since Covid)
Our preprint on a recent SARS-CoV-2 prolonged infection.
We infer it lasted over a year and see divergent lineages in the upper and lower respiratory tract, that acquired over 20 intrahost SNVs unique to each.
@laurenancona
@RecoveringRacc
Very important question (=we don't know yet) My guess: 1. Could be a risk for vulnerable (immunodepressed, cancer) patients or those receiving high quantities of platelets. 2. However, Long Covid patients are in bad shape so probably not donating blood
🤩exited to share our new publication in
@Cell_Metabolism
Incredible collaboration between researcher & clinician, RT
GAPDH Expression Predicts the Response to R-CHOP, the Tumor Metabolic Status, and the Response of DLBCL Patients to Metabolic Inhibitors
One of the very few positive side effects of the pandemic: "COVID’s
#preprint
bump set to have lasting effect on research publishing"
Let's keep sharing
#LongCovid
research findings as fast as possible 👇👇
@jamoulle
@eLife
@EricTopol
Finally, an idea that did not end up in the paper: with the considerable unemployment among LC patients, hiring of patient experts as (remote) clinical data coaches in this new model would be an economical win-win situation!
@patientled
Recovery from
#LongCovid
: "Significant risk factors for cognitive non-recovery were male sex, older age and <12 years of school education. Importantly,
#SARSCoV2
reinfection had no significant impact on recovery from
#fatigue
or cognitive deficits."
#brain
Patients with
#COVID19
may have an increased risk of developing respiratory diseases, increasing with severity of infection and reinfection. At 24-months follow-up, the risk of
#asthma
and bronchiectasis continued to increase.
#LongCOVID
A Review in
@NatRevCardiol
defines the major forms of cardiovascular autonomic dysfunction (CVAD) that are encountered in long COVID and discusses how CVAD, as a component of long COVID, can be diagnosed and managed.
Most spectacular finding of this trial IMHO: 0% myalgia and 0% cognitive symptoms at 3 months vs. >90% in standard care. Also, these are cheap and safe (repurposed) drugs... but can we trial them after acute Covid to treat
#LongCovid
?
Lastly, in terms of PASC (
#LongCovid
):
The percentage of participants reporting any PASC symptoms was significantly higher in the standard care arm relative to those in the treatment arms.
@PatientPersists
@laurenancona
The paper clearly demonstrates the virus in platelets is infectious: "plasma containing SARSCoV2 -positive platelets added to macrophages resulted in the production of infectious viral particles, using Vero reporter cells" Vero cells are gold standard to detect infectious virus
Have you ever heard of
#KalaAzar
?
This neglected disease cannot be eliminated without addressing its co-infection with
#HIV
.
What you need to know today:
Maybe there is mathematical evidence for group immunity, but as as an immunologist I must say: all available data point to the contrary: more antibodies means more severe disease, including ICU and fatal cases.
Zoomed in version (as PDF: ). The effect of group immunity is hopelessly entangled with measures taken in October, and it is not (yet) possible to estimate the relative contribution of either.
@jamoulle
@eLife
@EricTopol
4. After treatment, we advocate for an open data policy accessible to all ethically compliant researchers, through the same online peer review system.
We are hopeful 'grassroots' trials will resolve the current bottlenecks of all clinical trials, not just Long COVID trials 👇
@jamoulle
@eLife
@EricTopol
General practitioners should be playing a crucial role in this new paradigm. Access to electronic health records and established patient rapport provides an untapped source of accurate data (pre-existing comorbidities, over-the-counter treatments,...)
Intriguing findings: the major
#IFN
producing cells make mice more susceptible to
#SARSCOV2
... not sure how to rhyme this with extremely susceptible TLR7-deficienct humans? As
@Lo_Zanzi
would say
#FriendOrFoe
is hard to say in the IFN world!
@casanova_lab
Using digital transcriptome technology
#nCounter
@nanostringtech
, we mapped the local immune response in nasal mucosa (swabs in stead of blood samples) and found a new 'fatal' immune and viral footprint in residents who later died