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Yoga asanas and breathing exercises to boost immunity during monsoon, keep infections at bay  |  Photo Credit: iStock Images

New Delhi: The monsoon season invariably brings with it water-borne infections, respiratory illnesses, allergies, and stomach disorders. But nature has provided us with an immune system, a highly advanced piece of technology in-built in the human body. The immune system protects us against harmful substances from the environment, diseases and harmful cells. There are two types of immune systems the active and the passive immune system. The main parts of the immune system are white blood cells, antibodies, the complement system, the lymphatic system, the spleen, the thymus, and the bone marrow.

By keeping both the mind and body strong, you can raise your immunity levels. This has to be combined with a proper diet that includes immunity building foods. The following yoga practices will help you to improve your immune system and develop your defences. Yoga stimulates the lymphatic system removing toxins from the body, conditions the lungs and respiratory tract, and ensures the optimal functioning of your organs. Research shows that even 20 minutes of yoga on a regular basis can boost your overall health.

Formation of the posture

Begin with Dandasana Ensure that your knees are slightly bent while your legs are stretched out forward Extend your arms upward and keep your spine erect Exhale and empty your stomach of air With the exhale, bend forward at the hip and place your upper body on your lower body Lower your arms and grip your big toes with your fingers Try to touch your knees with your nose

Breathing Methodology - Exhale while bending forward

In Sanskrit, Kapal means skull and Bhati means shining/illuminating. Therefore, this Kapalbhati Pranayam is also known as Skull Shining Breathing Technique.

Method

Add these asanas and flow to your regular exercise routine to protect your health during the monsoons. Equip yourself with the necessary protective gear like jackets, raincoats and rain boots to keep yourself dry. Choose only trusted sources when it comes to eating outside to prevent falling prey to any infections. With a little care, the monsoon can easily become the best season of the year.

Grand Master Akshar is a guest contributor. Views expressed are personal.

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Yoga asanas and breathing exercises to boost immunity during monsoon, keep infections at bay - Times Now

A national clinical trial this summer will focus on protecting cancer patients against severe COVID-19 infection by attempting to boost their compromised immune system.

Researchers from The Ottawa Hospital say they want to explore the potential of IMM-101, a preparation featuring a dead pathogen containing properties that can stimulate the first-response arm of the immune system.

Study lead Dr. Rebecca Auer, surgical oncologist and director of cancer research at the Ottawa Hospital, says it could help experts understand why some COVID-19 patients are relatively asymptomatic while others end up in intensive care or die.

The difference it seems between these two different presentations has to do with how strong your innate, or your sort of non-specific, first-line defence immune system response is to the virus, Auer said Wednesday.

And so were hoping that by boosting and stimulating this innate immune response, particularly in those vulnerable patients that have a reduced immune response to begin with, wed be able to prevent symptomatic infections and prevent serious infections.

Cancer patients are at much higher risk of severe complications from COVID-19 because chemotherapy, cancer surgery and radiation treatments suppress innate immunity even further.

Auer points to an urgent need to protect them while the world waits for an effective COVID-19 vaccine, which could take another year or more to develop, test, and implement.

A successful trial could also protect cancer patients against other respiratory infections as well as the coming flu season, says Auer, noting the threat of illness is a fairly big problem for those undergoing treatment.

A study demonstrated that about 13 to 15 per cent of cancer patients will have to delay or stop their treatment because of influenza during the average flu season, she says.

And also cancer patients dont respond as well to the influenza vaccine every year because their immune system isnt as strong. So we think that the IMM-101 may in itself be able to help prevent symptomatic influenza infections.

Auer says IMM-101 has also been tested elsewhere for its anti-cancer properties and that, too, will be examined in this trial, although its not the primary objective.

The researchers say the bacteria, Mycobacterium obuense, is safe to use in cancer patients because it has been killed by heat.

The Canadian study will recruit 1,500 patients currently receiving cancer treatment, and participants will be randomly assigned to receive either regular care, or regular care plus IMM-101.

Auer says the treatment would be administered as an injection in the arm, to be followed by two more booster shots.

Researchers will follow patients for a year, watching for any respiratory infections and monitoring whether the treatment works and how long it lasts.

The trials will take place in eight centres located in Ontario, British Columbia and Quebec.

Researchers say people interested in participating should speak with their cancer specialist.

Researchers from the Ottawa Hospital came up with the idea and worked with the Canadian Cancer Trials Group at Queens University to design the trial.

Dr. Chris OCallaghan of the Queens University group notes cancer patients are also at greater risk of COVID-19 infection because they require regular medical care, making it difficult to adhere fully to public health guidelines.

These patients are unable to practice social isolation due to the need to regularly attend hospital to receive critically important cancer treatment, says OCallaghan, who will oversee the trial.

Auer says a successful trial of IMM-101 could also suggest usefulness in treating any patient with a reduced innate immune system, such as older patients with chronic illness.

She notes that the tuberculosis vaccine known as BCG which uses a similar formulation to IMM-101 but uses live bacteria instead of dead bacteria is being tested around the world to see if it can boost the immunity of health-care workers exposed to COVID-19.

Funding and in-kind support, valued at $2.8 million, comes from the Canadian Cancer Society, BioCanRx, the Ontario Institute for Cancer Research, The Ottawa Hospital Foundation, The Ottawa Hospital Academic Medical Organization, ATGen Canada/NKMax, and Immodulon Therapeutics, the manufacturer of IMM-101.

The Canadian Press

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Coronavirus

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Cancer trial to focus on protecting patients from COVID-19 infection - 100 Mile House Free Press

Related video above: Doctors noticing stroke-like symptoms in COVID-19 patientsCoronavirus damages not only the lungs, but the kidneys, liver, heart, brain and nervous system, skin and gastrointestinal tract, doctors said Friday in a review of reports about COVID-19 patients.The team at the Columbia University Irving Medical Center in New York City one of the hospitals flooded with patients in the spring went through their own experiences and collected reports from other medical teams around the world.Their comprehensive picture shows the coronavirus attacks virtually every major system in the human body, directly damaging organs and causing the blood to clot, the heart to lose its healthy rhythm, the kidneys to shed blood and protein and the skin to erupt in rashes. It causes headaches, dizziness, muscle aches, stomach pain and other symptoms along with classic respiratory symptoms like coughing and fever."Physicians need to think of COVID-19 as a multisystem disease," said Dr. Aakriti Gupta, a cardiology fellow at Columbia who worked on the review, in a statement. "There's a lot of news about clotting but it's also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease."Much of the damage wrought by the virus appears to come because of its affinity for a receptor a kind of molecular doorway into cells called ACE2. Cells lining the blood vessels, in the kidneys, the liver ducts, the pancreas, in the intestinal tract and lining the respiratory tract all are covered with ACE2 receptors, which the virus can use to grapple and infect cells, the Columbia team wrote in their review, published in the journal Nature Medicine."These findings suggest that multiple-organ injury may occur at least in part due to direct viral tissue damage," the team wrote.Coronavirus infection also activates the immune system. Part of that response includes the production of inflammatory proteins called cytokines. This inflammation can damage cells and organs and the so-called cytokine storm is one of the causes of severe symptoms."This virus is unusual and it's hard not to take a step back and not be impressed by how many manifestations it has on the human body," Dr. Mahesh Madhavan, another cardiology fellow who worked on the review, said in a statement.Blood clotting effects appear to be caused by several different mechanisms: direct damage of the cells lining the blood vessels and interference with the various clotting mechanisms in the blood itself. Low blood oxygen caused by pneumonia can make the blood more likely to clot, the researchers said.These clots can cause strokes and heart attacks or can lodge in the lungs or legs. They clog the kidneys and interfere with dialysis treatments needed for the sickest patients.Damage to the pancreas can worsen diabetes, and patients with diabetes have been shown to be at the highest risk of severe illness and death from coronavirus.The virus can directly damage the brain, but some of the neurological effects likely come from the treatment. "COVID-19 patients can be intubated for two to three weeks; a quarter require ventilators for 30 or more days," Gupta said."These are very prolonged intubations, and patients need a lot of sedation. 'ICU delirium' was a well-known condition before COVID, and the hallucinations may be less an effect of the virus and more an effect of the prolonged sedation."The virus affects the immune system, depleting the T-cells the body usually deploys to fight off viral infections. "Lymphopenia, a marker of impaired cellular immunity, is a cardinal laboratory finding reported in 67-90% of patients with COVID-19," the researchers wrote.Doctors need to treat all of these effects when coronavirus patients show up in the hospital, the Columbia team said.There is some good news."Gastrointestinal symptoms may be associated with a longer duration of illness but have not been associated with increased mortality," the researchers wrote. Many of the skin effects, such as rashes and purplish, swollen "Covid toes," also clear up on their own.

Related video above: Doctors noticing stroke-like symptoms in COVID-19 patients

Coronavirus damages not only the lungs, but the kidneys, liver, heart, brain and nervous system, skin and gastrointestinal tract, doctors said Friday in a review of reports about COVID-19 patients.

The team at the Columbia University Irving Medical Center in New York City one of the hospitals flooded with patients in the spring went through their own experiences and collected reports from other medical teams around the world.

Their comprehensive picture shows the coronavirus attacks virtually every major system in the human body, directly damaging organs and causing the blood to clot, the heart to lose its healthy rhythm, the kidneys to shed blood and protein and the skin to erupt in rashes. It causes headaches, dizziness, muscle aches, stomach pain and other symptoms along with classic respiratory symptoms like coughing and fever.

"Physicians need to think of COVID-19 as a multisystem disease," said Dr. Aakriti Gupta, a cardiology fellow at Columbia who worked on the review, in a statement. "There's a lot of news about clotting but it's also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease."

Much of the damage wrought by the virus appears to come because of its affinity for a receptor a kind of molecular doorway into cells called ACE2. Cells lining the blood vessels, in the kidneys, the liver ducts, the pancreas, in the intestinal tract and lining the respiratory tract all are covered with ACE2 receptors, which the virus can use to grapple and infect cells, the Columbia team wrote in their review, published in the journal Nature Medicine.

"These findings suggest that multiple-organ injury may occur at least in part due to direct viral tissue damage," the team wrote.

Coronavirus infection also activates the immune system. Part of that response includes the production of inflammatory proteins called cytokines. This inflammation can damage cells and organs and the so-called cytokine storm is one of the causes of severe symptoms.

"This virus is unusual and it's hard not to take a step back and not be impressed by how many manifestations it has on the human body," Dr. Mahesh Madhavan, another cardiology fellow who worked on the review, said in a statement.

Blood clotting effects appear to be caused by several different mechanisms: direct damage of the cells lining the blood vessels and interference with the various clotting mechanisms in the blood itself. Low blood oxygen caused by pneumonia can make the blood more likely to clot, the researchers said.

These clots can cause strokes and heart attacks or can lodge in the lungs or legs. They clog the kidneys and interfere with dialysis treatments needed for the sickest patients.

Damage to the pancreas can worsen diabetes, and patients with diabetes have been shown to be at the highest risk of severe illness and death from coronavirus.

The virus can directly damage the brain, but some of the neurological effects likely come from the treatment. "COVID-19 patients can be intubated for two to three weeks; a quarter require ventilators for 30 or more days," Gupta said.

"These are very prolonged intubations, and patients need a lot of sedation. 'ICU delirium' was a well-known condition before COVID, and the hallucinations may be less an effect of the virus and more an effect of the prolonged sedation."

The virus affects the immune system, depleting the T-cells the body usually deploys to fight off viral infections. "Lymphopenia, a marker of impaired cellular immunity, is a cardinal laboratory finding reported in 67-90% of patients with COVID-19," the researchers wrote.

Doctors need to treat all of these effects when coronavirus patients show up in the hospital, the Columbia team said.

There is some good news.

"Gastrointestinal symptoms may be associated with a longer duration of illness but have not been associated with increased mortality," the researchers wrote. Many of the skin effects, such as rashes and purplish, swollen "Covid toes," also clear up on their own.

Read the original here:
How coronavirus affects the entire body - WXII The Triad

Police in Ontario shot 62-year-old Ejaz Choudry in his home. In New Brunswick, they shot Chantel Moore in her home and Rodney Levi at a friends barbecue. Prior to that, Regis Korchinski-Paquet fell from her balcony in Toronto while police were in her apartment. All four have died in the last six weeks; police called not because they committed crimes, but to check on their well-being.

Amid national and international reckonings over racism and police brutality, there have been widespread calls to use mental health practitioners not cops in moments of crisis. But while mental health is just one aspect of overall health (albeit a very important one), Canadian health care is not immune to the systemic racism impacting the countrys police forces.

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Experts say thats evident in a myriad of ways, from the coronavirus pandemics disproportionate impact on Indigenous people and Black people to other, non-COVID-19 headlines.

In Alberta, the minister of health recently ordered an independent investigation into the health authoritys handling of a noose taped to an operating room at the Grande Prairie Hospital in 2016. In B.C., the province is looking into allegations that some staff have been engaging in a racist game of whats-the-blood-alcohol-level of the (primarily) Indigenous patients who come to them seeking care.

But where defunding the police is an option, defunding health care is decidedly not. Nor, says Dr. Suzanne Shoush, does adding more Black, Indigenous and other racialized health-care providers solve the problem on its own you have to change the system.

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Like policing, health cares racism problem is systemic, says Shoush, who is a Black Indigenous doctor of Sudanese and Coast Salish heritage and the Indigenous health faculty lead for the University of Torontos family and community medicine department. Much like policing, she says, tackling it will require facing up to some uncomfortable truths.

It really all has to do with the blindness of privilege. People who have privilege are really, really blind to the fact privilege plays a role in where they are today.

Start with thesocial determinants of health: key factors that contribute to how healthy you, as an individual, are, as well as the group of people living around you.

Some you can control (to a degree), others you cannot: income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, access to health services, biology and genetic endowment, gender, culture, race and racism, and historical trauma.

These factors merge together, making Indigenous people amongthe highest-risk groups for diabetes and complications from diabetes, over-represented in HIV infection cases, tuberculosis cases and sexually transmitted infections, with a stroke rate nearly twice as high as non-Indigenous Canadians and a suicide rate among First Nations youth five to seven times higher than their non-Indigenous peers.

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For Black people in Canada, the data is harder to come by (a factor experts sayserves to worsen Black health). Buta research review from the Wellesley Institute, a non-profit that seeks to improve health equity in the Greater Toronto Area, indicates Black peoples health is harmed in part because they live in a racist environment. Much like Indigenous people, any racism experienced during their interactions with the system impacts their access to future care.

Furthermore, statistics compiled by the Black Health Alliance reveal that Black people make up 18 per cent of Canadians living in poverty even though they only represent less than three per cent of the total population. In Ontario, the risk of psychosis for people of Caribbean, East African and West African origin is 60 per cent higher than for others. And the likelihood that breast cancer kills Black women is 43 per cent higher than for white women.

Epidemiologist Nancy Kriegerboils it down to six pathways through which racism harms a persons health, including economic and social deprivation, socially inflicted trauma, inadequate or degrading medical care, and ecosystem degradation and alienation from the land the latter a recurring theme in reports like theRoyal Commission on Aboriginal Peoples, the Truth and Reconciliation Commission and theNational Inquiry into Missing and Murdered Indigenous Women and Girls.

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When you are displaced, you are not healthy, says Shoush, who recently wrote about how Canada was founded without the consent of Indigenous and Black people.

When we have a society that reflects and was founded in a non-consensual relationship, its very displacing, and this is why we see huge disparities in wellness, in health, chronic disease, life expectancy, child poverty.

Where some Indigenous people in Toronto will not consider going to the doctor, they might consider chatting with Cheryllee Bourgeois. They see her, after all, with her three children out in the community, at a powwow, at Thursday night socials at the Native Centre.

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Bourgeois is an exemption Mtis midwife working with Seventh Generation Midwives Toronto, as well as a professor in Ryerson Universitys midwifery education program. She became the citys first exemption midwife in 2018, following in the well-trodden footsteps of exemption midwives in Six Nations in southern Ontario.

Working under the exemption allows registered midwives (Bourgeois was one for more than a decade) to provide a broader scope of care to their clients to do Pap tests, address sexual and reproductive health and provide other health care not confined to pregnancy and the first six weeks of a babys life.

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The job itself is a tacit reminder of systemic racism in health care and recognition that increasing Indigenous access to health care involves community accountability and acknowledging Canadian history.

The health-care system was a very critical, key piece of the whole colonial history of the subjugation of Indigenous people, Bourgeois says.

There were such things as Indian hospitals where you were provided substandard care and where you were not allowed to go to the mainstream hospital.

Even now, it doesnt matter if Indigenous people give birth in rural, remote or urban settings in Canada, she says, their outcomes remain the same.

So that leads to something deeper, which is this very pervasive and strong systemic racism that exists within the system, affecting health outcomes, she says. In other words, its good to look at improving access, but if thats the sole focus of change then it doesnt actually solve the problem.

But Bourgeois patients grow by word of mouth, so-and-so telling their aunt or brother or cousin or friend youll be treated well there.

When the first wave of the coronavirus pandemic struck Canada this spring, Bourgeois and Shoush started Call Auntie, an information hotline for Indigenous people to ask their COVID-19 questions. In only a few short months, its morphed into something more.

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Its a form of accountability, Bourgeois says health-care workers can call ahead to certain testing centres to let them know an Indigenous person is incoming, a warm referral. Some people also ask about how to apply for the Canada Emergency Response Benefitor how they can get food delivered to their house because they have a compromised immune system.

Sometimes, Bourgeois says, people just want to talk through their concerns with a supportive listener. It isnt always about COVID-19. People call to say theyre living on the street Black people and Indigenous people are over-represented in Torontos homeless population and theyre scared of going to a shelter, so what can they do?

Its low stakes, Bourgeois says, because nothing they ask will get them put on a list of trouble clients.

They want to keep the line going after the pandemic.

For the Indigenous community, there is literally I dont want to say zero but really, theres zero trust in the health-care system that theyre actually going to be able to give them what they need, Bourgeois says.

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In pain? Labelled as drug seeking. Having a trauma response to something? Youre non-compliant. Treated badly so you dont go to your next appointment? Youre kicked out of care.

Its about so much more than extra funding, she says, because the current funding models dont take into account that need for community accountability the need for health-care providers like Bourgeois, who deliver babies, give people birth control shots, answer the questions people are scared to ask and then bring their children to Thursday night socials.

When health care your whole life has basically worked against you, youre going to do everything in your power to avoid it, she says.

Youre really not going to do anything if you dont change the system If you actually want to see a change in outcomes or a change in people engaging, you need to build trust.

Its important to remember that equitable access is not the same as equitable outcomes, says Kwame McKenzie, CEO of the Wellesley Institute, but he thinks people spend a lot of time thinking about the former rather than the latter.

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Whatd he like people to think about is: if everybody gets the same service, is the outcome the same? And is giving everybody the same service a reasonable thing to do?

Take something simple like treating high blood pressure, McKenzie says. One size does not fit all because the commonly used drugs do not work well for people of Caribbean and African origin. In other words, he says, equal access might be the same drug for everyone but it wont translate into equal outcomes.

Outcomes can be not as good because the intervention is the wrong intervention and you need a completely different intervention for different groups, he says.

You need a system that interacts with the social determinants of health because both your risk of illness and chance of getting better are very linked to who you are, how you live, what your income is.

More than a decade before health-care workers in British Columbia allegedly made a game out of guessing the blood alcohol levels of (predominantly) Indigenous people seeking care, Brian Sinclair wasignored to death in a Winnipeg ER in September 2008 presumed to be another drunken Indian rather than a 45-year-old with a severe bladder infection.

Sinclair was not ill but simply sleeping or intoxicated. This assumption, made and remade over and over in the 34 hours while Sinclair sickened and died in a hospital ER, is a striking and painful example of one of the structures of indifference that cost Brian Sinclair his life, as it has cost the lives of other Indigenous people in Canadian cities, wrote Mary Jane Logan McCallum and Adele Perry in their book Structures of Indifference: An Indigenous life and death in a Canadian City.

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It isnt that people dont recognize when things are problematic, Shoush says they do, and that realization isnt new. She thinks here of the Jane Elliott clip thats been circulating on social media.

In it, Elliott, a diversity educator, asks a room full of white people in the 1960s to please stand if theyd like to be treated the way Black people are treated. Nobody stands. She asks again. Nobody stands.

Then, she tells the room, That says very plainly that you know whats happening, you know you dont want it for you. I want to know why youre so willing to accept it or to allow it to happen for others.

Decades later, Shoush says more people are starting to understand how the structure of systems be it child apprehension, policing, incarceration or health care impacts individual outcomes, but more is needed.

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We understand that there are deep, deep injustices in our culture, in our society, but we always say that they should somehow pull themselves up, we should pull ourselves up by the bootstraps, not realizing that some people have been resourced from birth, she says.

That myth of individualism has to be shattered across every aspect of our society.

with files from The Canadian Press

The Call Auntie information hotline for Indigenous people is open daily from 4 to 9 p.m. at 437-703-8703. All messages left after hours will be responded to.

2020 Global News, a division of Corus Entertainment Inc.

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Canadian health care isnt immune to racism, experts say. Heres why - Global News

While more countries around the world continue to acknowledge the potential of CBD, the full biological effects of the cannabinoid are yet to be fully understood. However, some research demonstrates that CBD has anti-inflammatory and immunosuppressive properties.

But what does this mean for those that use CBD products, and who could potentially benefit from it?

CBD is one of the most common chemical compounds found in the cannabis plant. It is classed as a cannabinoid, along with Tetrahydrocannabinol (THC) and Cannabinol (CBN), and over a hundred other compounds in the plant. Cannabinoids are naturally occurring chemicals that have become known for their medicinal and wellness potential.

It is also clear that, in some cases, CBD might be used to treat particular diseases for which other available treatments have failed to be effective. Although we know that it produces effects in the central nervous system, in contrast to THC, which is psychoactive, CBD doesnt create the so-called high feeling.

In a nutshell, the immune system is the main defense our bodies have against diseases and other potentially damaging threats. When functioning properly, the immune system identifies and attacks intruders, such as bacteria, viruses, and parasites distinguishing them from our bodys healthy tissue.

Lymphocytes, or B cells and T cells, fight against antigens and they help the body to remember the once-beaten substances so that the next time the immune system can act quickly and effectively.

Despite the existence of the Endocannabinoid System only being confirmed by researchers in the 1990s, we already know that this system can play an important role in many bodily functions, including brain functions. Endocannabinoid receptors are expressed throughout the central nervous system, as well as in the human immune system.

Interactions between endocannabinoids and receptors are thought to influence mood, emotions, appetite, pain-sensation and memory, among other important physiological and cognitive processes. Phytocannabinoids (the most well-known are CBD and THC) interact with this system in similar ways to endocannabinoids.

According to research by James M. Nichols and Barbara L.F. Kaplan, it would appear that considering all the studies conducted on immune responses and inflammation, the data overwhelmingly demonstrate that CBD is immune suppressive and anti-inflammatory.While the definition of something being anti-inflammatory should be clear, CBD functioning as an immunosuppressant might require clarification.

As a potential immunosuppressant, CBD may reduce the immune systems inflammatory responses, promote apoptosis (cellular death), and prevent rapid cellular growth. In certain cases, these features may have a negative effect on a healthy humans immune system.

In addition, CBD exposure may also suppress the functions of cytokines, chemokines, and T cells all of which play an important role in immunodefense.

It has been suggested that CBD may have potential as an adjunct treatment for some autoimmune diseases.

An autoimmune disease is when the immune system begins to attack healthy cells, tissues, and organs. This can occur basically anywhere in the body, and it can result in particular body functions weakening and, in some cases, life-threatening conditions. The most common autoimmune diseases include Multiple Sclerosis (MS), Rheumatoid Arthritis, and Psoriasis.

Inflammation plays an important role in autoimmune diseases. As an anti-inflammatory,CBD might help the body to tackle the disease. In addition, CBDs immunosuppressive nature might be able to help it to deal with hyperactive immune systems that attack themselves.

Link:
How Does CBD Affect the Immune System and Autoimmune Disease? - The Cannabis Exchange

People living with HIV spent a similar amount of time in hospital as HIV-negative COVID-19 patients and had a comparable death rate during the height of the outbreak in New York City, but they were more likely to be put on ventilators, according to a study presented at the23rd International AIDS Conference (AIDS 2020: Virtual) today.

A related study showed that people with HIV had higher levels of inflammation, indicating that they are capable of mounting a strong inflammatory response to the new coronavirus and remain at risk for severe COVID-19 despite taking antiretroviral therapy (ART).

A type of white blood cell that is important in the immune system. Includes B cells (B lymphocytes, which produce circulating antibodies) and T cells (T lymphocytes, which are responsible for cell-mediated immunity).

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

Chemical "messengers" exchanged between immune cells that affect the function of the immune system. Interleukins such as IL-2 are a particular type of cytokine.

When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events.

Studies have generally found that people with HIV are no more likely to contract the coronavirus (known as SARS-CoV-2) than their HIV-negative counterparts, and they generally do not develop more severe illness or have a higher risk of death. An exception is a study from South Africa that did see increased COVID-19 mortality among HIV-positive people.

Given that people with HIV appear to have a similar risk of contracting SARS-CoV-2 and developing severe illness despite having some degree of immune suppression, some experts and advocates have suggested that antiretrovirals may have a protective effect. However, studies of the effects of HIV medications on COVID-19 outcomes have so far yielded mixed results.

Dr Viraj Patel of Albert Einstein College of Medicine and Montefiore Health System in the Bronx, New York conducted a retrospective cohort study of people with and without HIV who tested PCR positive for SARS-CoV-2 when they were hospitalised between 10 March and 11 May 2020. Montefiore is the largest provider of HIV care in the Bronx, serving more than 4000 people with HIV at four hospitals and 21 primary care clinics.

Located north of Brooklyn and across the river from Manhattan, the Bronx has a largely African-American and Latino population. Over a third of residents were born outside the US and 30% live in poverty among the highest rates in the US. The Bronx was one of the epicentres of the New York City COVID-19 outbreak, which was the worst in the US and among the worst in the world, with more than 300 hospitalisations a day at the peak in early April.

"The likelihood of intubation and death in hospital was higher for people with viral suppression compared to those with uncontrolled HIV."

The researchers looked at length of hospital stays, intubation and mechanical ventilation for respiratory support, development of acute kidney injury and mortality. The analysis did not account for the use of COVID-19 treatments such as remdesivir or steroids.

The analysis included 100 HIV-positive and 4513 HIV-negative people. Just over half were men and the median ages were 62 and 65 years, respectively. Approximately 40% were black, a similar proportion were Latino and 6% were white. Most were on Medicaid (coverage for people with low income) or Medicare (coverage for older people), with only about 15% having private health insurance.

Among the people living with HIV, 94% had been prescribed ART and 81% had a suppressed viral load (below 40 copies/ml). However, about one in five had a CD4 count below 200 cells/mm3, reflecting advanced immune suppression.

The researchers found that most outcomes did not differ between the HIV-positive and HIV-negative patients, including length of stay in hospital (five days in both groups), rates of acute kidney injury or likelihood of death while hospitalised (22% vs 24%, respectively).

However, people with HIV did have a higher rate of intubation and mechanical ventilation21% vs 14%, which worked out to about a 50% greater risk but the difference fell just short of the threshold for statistical significance.

Interestingly, the study found that the likelihood of intubation and death in hospital was higher for people with viral suppression compared to those with uncontrolled HIV. In fact, no one with unsuppressed HIV required intubation or died. People with detectable HIV viral load spent slightly longer in hospital (seven vs five days). But this group only included 15 people, so it is difficult to draw firm conclusions.

In another unexpected finding, having a higher CD4 count before hospitalisation was associated with a higher likelihood of intubation, but no differences in length of stay or risk of death were seen.

"The observation of no intubations or deaths among people living with HIV without viral suppression warrants further examination," Patel and colleagues concluded.

In a separate study, Dr John Hsi-en Ho of the Icahn School of Medicine at Mount Sinai in New York City looked at clinical and immunological characteristics among HIV-positive people with COVID-19.

HIV is characterised by chronic inflammation and varying degrees of immune dysfunction even in people on effective ART, Ho noted as background. COVID-19, too, is associated with abnormal immune function, including low lymphocyte levels.

This retrospective analysis included medical chart data from 93 people with HIV seen at five emergency departments in New York between 2 March and 15 April 2020 who tested PCR positive for SARS-CoV-2.

"People with HIV are capable of mounting a strong inflammatory response to the new coronavirus and remain at risk for severe COVID-19."

Here, 72% of the cohort members were men, 41% were black, 31% were Latino, 23% were white and the median age was 58 years. This study had no HIV-negative control group for comparison.

Participants had a CD4 count of 554 cells/mm3 prior to COVID-19 diagnosis and a nadir or lowest-ever level of 320 cells/mm3. Almost all were on ART, including 70% who used tenofovir disoproxil fumarate or tenofovir alafenamide and 14% who used the protease inhibitors atazanavir (Reyataz), darunavir (Prezista) or lopinavir/ritonavir (Kaletra) drugs that in some studies have shown activity against SARS-CoV-2. More than 80% had an undetectable viral load (below 50 copies/ml).

Upon presentation at the hospital, HIV-positive people with COVID-19 had low total lymphocyte levels and decreased CD4 T cell counts. In contrast, levels of various inflammatory markers were elevated. C-reactive protein (CRP), fibrinogen and D-dimer (a blood clotting marker) were all above the upper limit of normal.

The participants also had much higher than normal levels of the cytokines interleukin 6 (IL-6), IL-8 and tumour necrosis factor alfa, but not IL 1b. Excessive cytokine levels known as a cytokine storm is one of the hallmarks of severe COVID-19 illness that leads to lung and other organ damage.

Looking at differences between 19 HIV-positive people who died of COVID-19 and 53 HIV-positive people who recovered, those who died had hadsignificantly lower total lymphocyte levels compared with survivors. They also had significantly higher peak levels of CRP, IL-6 and IL-8.

However, there was no difference according to pre-diagnosis, current or nadir CD4 counts, whether or not they had undetectable HIV, age, sex or body mass index. Other studies of HIV-negative populations have found that older age, male sex,obesity and other co-morbidities are associated with more severe COVID-19 and higher mortality.

"A subset of people living with HIV are capable of mounting profound inflammatory responses that have been noted to correlate with poor outcomes in people without HIV," the researchers concluded. "These findings raise concerns that people living with HIV remain at risk for severe manifestations of COVID-19 despite ART, and that immune dysregulation in a subset of people living with HIV during infection is associated with worse outcomes."

Ho noted that coronavirus testing was limited during this period and tended to be reserved for sicker patients, so this group is not representative of all HIV-positive people with COVID-19. Further, the proportion of people with HIV suppression was high, so it was not possible to do an informative comparison between those with and without detectable viral load.

Continue reading here:
New York studies look at COVID-19 outcomes and immune function among people with HIV - aidsmap

A national clinical trial this summer will focus on protecting cancer patients against severe COVID-19 infection by attempting to boost their compromised immune system.

Researchers from The Ottawa Hospital say they want to explore the potential of IMM-101, a preparation featuring a dead pathogen containing properties that can stimulate the first-response arm of the immune system.

Study lead Dr. Rebecca Auer, surgical oncologist and director of cancer research at the Ottawa Hospital, says it could help experts understand why some COVID-19 patients are relatively asymptomatic while others end up in intensive care or die.

The difference it seems between these two different presentations has to do with how strong your innate, or your sort of non-specific, first-line defence immune system response is to the virus, Auer said Wednesday.

And so were hoping that by boosting and stimulating this innate immune response, particularly in those vulnerable patients that have a reduced immune response to begin with, wed be able to prevent symptomatic infections and prevent serious infections.

Cancer patients are at much higher risk of severe complications from COVID-19 because chemotherapy, cancer surgery and radiation treatments suppress innate immunity even further.

Auer points to an urgent need to protect them while the world waits for an effective COVID-19 vaccine, which could take another year or more to develop, test, and implement.

A successful trial could also protect cancer patients against other respiratory infections as well as the coming flu season, says Auer, noting the threat of illness is a fairly big problem for those undergoing treatment.

A study demonstrated that about 13 to 15 per cent of cancer patients will have to delay or stop their treatment because of influenza during the average flu season, she says.

And also cancer patients dont respond as well to the influenza vaccine every year because their immune system isnt as strong. So we think that the IMM-101 may in itself be able to help prevent symptomatic influenza infections.

Auer says IMM-101 has also been tested elsewhere for its anti-cancer properties and that, too, will be examined in this trial, although its not the primary objective.

The researchers say the bacteria, Mycobacterium obuense, is safe to use in cancer patients because it has been killed by heat.

The Canadian study will recruit 1,500 patients currently receiving cancer treatment, and participants will be randomly assigned to receive either regular care, or regular care plus IMM-101.

Auer says the treatment would be administered as an injection in the arm, to be followed by two more booster shots.

Researchers will follow patients for a year, watching for any respiratory infections and monitoring whether the treatment works and how long it lasts.

The trials will take place in eight centres located in Ontario, British Columbia and Quebec.

Researchers say people interested in participating should speak with their cancer specialist.

Researchers from the Ottawa Hospital came up with the idea and worked with the Canadian Cancer Trials Group at Queens University to design the trial.

Dr. Chris OCallaghan of the Queens University group notes cancer patients are also at greater risk of COVID-19 infection because they require regular medical care, making it difficult to adhere fully to public health guidelines.

These patients are unable to practice social isolation due to the need to regularly attend hospital to receive critically important cancer treatment, says OCallaghan, who will oversee the trial.

Auer says a successful trial of IMM-101 could also suggest usefulness in treating any patient with a reduced innate immune system, such as older patients with chronic illness.

She notes that the tuberculosis vaccine known as BCG which uses a similar formulation to IMM-101 but uses live bacteria instead of dead bacteria is being tested around the world to see if it can boost the immunity of health-care workers exposed to COVID-19.

Funding and in-kind support, valued at $2.8 million, comes from the Canadian Cancer Society, BioCanRx, the Ontario Institute for Cancer Research, The Ottawa Hospital Foundation, The Ottawa Hospital Academic Medical Organization, ATGen Canada/NKMax, and Immodulon Therapeutics, the manufacturer of IMM-101.

The Canadian Press

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Cancer trial to focus on protecting patients from COVID-19 infection - Victoria News

The Sao Paulo patient is a 36-year-old man who finished an antiretroviral therapy treatment to specifically address HIV/AIDS in March 2019. The news raises myriad questions in the scientific community. Additionally, the data are preliminary and the case is particularly compelling because, of the five people who received the treatment, only one has been cured.

Jrgen Rockstroh, professor and doctor of medicine and the head of the outpatient Clinic for Infectious Diseases and Immunology at the Center for Integrated Oncology at the University Clinic in Bonn, said: "These are exciting findings, but they're very preliminary. This has happened to one person, and one person only, but it did not succeed in four others given the same treatment. Clearly, reproducibility of the findings or confirmation in an additional individual would be important."

If the case were proven, it would be a monumental discovery. However, Brazilian scientists say the results are yet to be confirmed, and testing is ongoing.

Why is it so difficult to cure HIV?

HIV inserts its genetic material into the DNA of its target immune cell obliging the cell to form copies of the virus. In this way, the HIV integrates itself directly into the DNA and literally becomes part of its host's body. This makes the virus incredibly difficult to treat.

HIV hides in those cells residing dormant in them for years before it wakes up and causes acquired immunodeficiency syndrome (AIDS). Some scientists believe that the dormant stage is an evolutionary advantage to the virus. In the sites where HIV first enters the body, there are few immune cells to infect.

If the virus destroys all these few existing cells immediately after invasion, there will be no immune cells left to carry the infection to further cells. Rather, the HIV delays its activation until it is carried by those cells initially infected to tissues where it can infect even more cells.

This process ensures a better chance for the virus to spread. This dormant or latent stage can last up to 12 years. After the virus wakes up, the immune system weakens, and AIDS develops. A weakened immune system leaves the patient prone to mild infections that an otherwise healthy individual would likely not develop.

Only two people have been completely cured from HIV

Two patients in London and Berlin underwent a risky bone marrow transplant from a very particular donor, who was discovered to have a natural immunity to HIV. The bone marrow from this individual is immune to the virus due to a mutation in one of the receptors of the immune cells that HIV must be able to enter to successfully cause AIDs.

Before the stem-cell transplantation, doctors destroyed the immune cells carrying the HIV virus in their DNA from the Berlin patient's bone marrow. Later, the naturally mutated stem-cells from the donor were transplanted. The procedure is precarious and can result in life threating conditions, such as graft-versus-host disease, where the body rejects the transplant.

While long-term remission was achieved in these two patients, a bone marrow transplant is not a viable cure for all cases. These patients underwent this experimental treatment to address cancer diagnoses.

How is HIV treated?

Antiretrovirals hinder viral replication, as well as attachment to target cells. The purpose is to stop any viral activity and viral production. Currently, antiretroviral therapy can decrease the viral load in the body to an extent that the person is no longer infectious.

Read more:Stem cell transplants and HIV: What you need to know

If the viral load remains undetectable, one could have unprotected sex without infecting their partner. Moreover, HIV would not be transmitted from a mother to a child in this case. However, if the antiretroviral therapy is stopped, the control of virus replication ends.

The So Paulo patient received antiretrovirals. When asked whether it is possible to expect a complete elimination of a virus which integrates itself in the DNA by antiretroviral drugs, Dr. Rockstroh said, "numerous studies including intensified 3-drug therapy (including maraviroc and dolutegravir given to the Brazilian patient) even very early in HIV-infection were not able to achieve viral elimination or even decrease reservoir over time in multiple clinical trials."

Dr. Rockstroh explained that patients taking post-treatment controllers showed no signs of restarted viral replication for over one year after interrupting anti-retroviral therapy. However, the complete elimination of the virus has not been found in these patients.

How does the immune system react?

The physician added, "As each individual immune system reacts very differently and the spectrum of immune response ranges from rapid disease progression to elite controllers who have no signs of ongoing replication in plasma over years without treatment makes single cases very difficult to generalize from."

The So Paulo patient received a cocktail of antiretroviral drugs, including nicotinamide, a form of vitamin B3, which is thought to wake up the hidden virus and lure it out of its reservoirs. This is done to highlight infected cells for other drugs, so the immune system can kill the virus.

Dr. Rockstroh suggested the approach of virus activation could be significant in finding a functional cure for HIV. Whether this approach works or contributes to this specific case is still unknown.

Scientists are questioning the case and raising the concerns that the patient may have continued to take antiretroviral drugs without the knowledge of the study team. The team commented that they plan to check his blood for antiviral drugs to rule out this possibility.

What is also intriguing about the case is the loss of HIV antibodies. Dr. Rockstroh suggested that the weakening of the antibody test overtime is due to a diminishing immune response. However, the reasons for this remain unclear and require further testing.

Former South African president Thabo Mbeki (1999 - 2008) went down in history as the foremost African denier of AIDS. Against all scientific evidence he maintained that HIV did not cause AIDS. He instructed his health officials to combat the disease with herbal remedies. Experts believe his denialism cost up to 300,000 lives. Some have called for Mbeki to be tried for crimes against humanity.

In 2007 former Gambian president Yahya Jammeh (1996 - 2017) forced AIDS patients to undergo a cure that he had personally developed. It turned out to be a concoction based on herbs; an unknown number of people died. Jammeh, who claimed that he had mystic powers, is the first African head of state to be tried for violating the rights of HIV-positive people.

Another former South African head of state to make headlines for an unconventional take on AIDS was Jacob Zuma (2009 - 2018). After being charged with raping an HIV-positive woman in 2006, Zuma said he was not at risk of infection, despite not using a condom, because he had "taken a shower afterwards." In 2010 he disclosed the negative results of his AIDS test, to fight the stigma, he said.

Ugandas President Yoweri Museveni took his time before joining the fight against the epidemic. As late as 2004, during an international AIDS conference in Thailand, he downplayed the effectiveness of condoms, alleging, among other things, that they ran counter to some African sexual practices. "We dont think we can become universally condomised," he said. His remarks were met with laughter.

Some action taken by African heads of state to fight the scourge did not go down well at home. A tax introduced in 1999 by Zimbabwe's President Robert Mugabe (1987-2017) to help orphans and sufferers met with resistance. It is still in place today. In 2004 Mugabe admitted that his own family had been affected by AIDS. He said the disease was "one of the greatest challenges facing our nation."

Fear of economic repercussions affecting, for example, tourism, is one reason why African leaders have been reluctant to acknowledge the threat. But President Kenneth Kaunda of Zambia (1964-1991) announced as early as 1987 that one of his sons had died of AIDS. In 2002 he was the first African leader to take an AIDS test. He still fights against AIDS today.

The fight against AIDS by Kaundas successor Edgar Lungu met with some hitches when he tried to make AIDS-testing compulsory in Zambia. Lungu said in 2016 that the policy was non-negotiable. But a huge outcry in Zambia and abroad forced him to backpedal especially as the World Health Organization made clear that compulsion encourages the stigmatization of HIV-positive people.

After leaving office, Festus Mogae, former president of Botswana (1998-2008), launched Champions for an AIDS-Free Generation, which brings together a number of former African presidents and other influential personalities eager to help fight the scourge. They hope that their experience and influence will enable them to exert pressure on governments and partners to invest in AIDS prevention.

Author: Cristina Krippahl

Read more here:
Brazilian HIV patient cured: Can this be true? - DW (English)

Young or old, hospitalized or asymptomatic, anyone who had COVID-19 is at risk, doctors say

***EDITORS NOTE: This article is Part 2 of 2. Please read Part 1, "Two weeks then gone? Not even close, say doctors about the lingering effects of COVID-19" by clicking here.

Following is a breakdown of some of the lingering effects of COVID-19 infections, according doctors and public health officials treating and examining cases.

Lungs

Since coronavirus is, at its most simplified, a respiratory virus, the lungs are typically where doctors say they see the most damage.

"I think lung fibrosis is the most worrying," said Dr. Michael Hamblin, associate professor and chemist specializing in Dermatology at Harvard Medical School. "The virus damages the lungs and you get this fibrosis which dramatically decreases your breathing capacity."

Lingering lung problems can affect people of all ages, said Dr. Aileen Marty, infectious disease specialist at Florida International University. She cites international research that shows some young people who report being asymptomatic actually have scar tissue in their lungs of which they are unaware.

"When studies have been done on people who feel great, about 67% of those people have changes on chest x-rays," she said. "CT scans will then refine those images, but changes on the CT scans are worse than the changes on the film."

Young people, in particular, may not realize they have diminished lung capacity until they are older, Marty said. And because the "majority" of COVID-19 hospitalizations in Florida right now are patients in their 30s and below, she said, a significant number of younger patients might be surprised to find themselves with breathing problems down the road.

"A young person may have 150% lung capacity, so if they lose 10-15%, they don't notice it; they feel great," she said. "The problem is, we dont know how much of that tissue gets scarred up. The virus is causing the damage, it's just their youth is not letting them perceive the damage."

Neurological disease

"Patients with COVID-19 are experiencing an array of effects on the brain, ranging in severity from confusion to loss of smell and taste to life-threatening strokes," said Dr. Robert Stevens, associate director of the Johns Hopkins Precision Medicine Center of Excellence for Neurocritical Care at Johns Hopkins Medicine in a June 4 report. "Younger patients in their 30s and 40s are suffering possibly life-changing neurological issues due to strokes."

Researchers at University of Bonn in Germany in a separate June 4 publication found some of these effects might be long lasting.

"Evidence strongly suggests that patients surviving COVID-19 are at high risk for subsequent development of neurological disease and in particular Alzheimers disease," they wrote.

Even those with no prior neurological problems could find themselves with issues, as detrimental effects from the virus put COVID-19 survivors "at risk for developing long-term neurological consequences either by aggravating a pre-existing neurological disorder or by initiating a new disorder," researchers said.

Neurological disease can be evidenced by cognitive decline, in which brain cells lose function or die, resulting in reduced intellectual or motor skills.

This condition affected one-third of hospitalized patients at the time of discharge, the researchers said. They also noted a growing number of "Kawasaki-like multisystem inflammatory syndromes now being recognized in children and teenagers" something they called "clinically striking."

Symptoms of Kawasaki disease include fever, rash, inflammation of the mouth, lips and throat and swelling of the hands and feet.

Blood clots, inflammation, heart

COVID-19-induced blood clots can result in strokes, heart attacks, pulmonary embolisms and kidney failure, as well as prevent oxygen flow to the hands and feet, Hamblin said.

"A lot of people ended up with necrosis of the extremities, so they have fingers and toes amputated because they turn black from COVID," he said. "Your blood inappropriately clots and you get no blood supply to the extremities and they die."

COVID-19-induced hyper-inflammation, which can result in respiratory failure or other severe problems, is also something he said doctors are working to understand.

One cause may be a "cytokine storm," which is when the body releases too many infection-fighting substances into the bloodstream.

"[The body] is trying to limit the infection and overcome the virus; however, it leads to an excessive inflammatory response rather than harming the virus," researchers said in a June 2 paper published in the U.S. National Library of Medicine.

University of Bonn researchers warn that inflammation can result in long-lasting, detrimental effects on the brain.

"The fact that systemic inflammation has been shown to promote cognitive decline and neurodegenerative disease makes it likely that COVID-19 survivors will experience neurodegeneration in the following years," they wrote.

While inflammation is observable, the underlying causes are less so, Hamblin said. And that is something doctors must determine if they hope to treat it effectively.

"The question is, is it the virus affecting the cells of the blood vessels or is it more like a serious infection where the immune cells go into overdrive and create systemic inflammation?" he said. "Local inflammation is not too bad, but systemic inflammation is very bad."

Kidneys

Kidneys act as a filter to eliminate toxins, waste and excess water from the body. Blood clots caused by COVID-19 can impair the kidneys ability function, leading to a host of problems throughout the the body.

"If the kidney function isn't normal, that's going to be a very significant issue over time," said Dr. C. John Sperati, kidney specialist and associate professor of medicine at Johns Hopkins Medicine.

Chronic kidney disease can lead to heart disease, as well as the need for dialysis. High potassium, acid, and protein levels; swelling of the arms and legs; and fluid in the lungs are indicators one might have kidney trouble, he said.

Those with pre-existing conditions are most likely to suffer kidney damage from COVID-19, but people with no previous kidney problems are also at risk, he said.

"In some cases 90% of ventilated patients in the ICU have gone on to develop kidney issues," he said. "If you were in the ICU, there is a 50-70 percent chance of kidney damage. Many of those will get better, but we dont have enough data to see how much recovery they will have."

Sperati said people tend to seek care for lung or heart problems before kidney trouble because the symptoms of the former tend to be more apparent. Unless kidney damage is severe, he said, many people might not know they have a problem until a blood test is performed.

"Its going to be one of those sort of silent killers thats under the surface," he warned. "If it resolves, good, but if it doesnt, that becomes a major health issue that needs to be addressed over time."

Psychological issues

Suffering through a COVID-19 infection, particularly for those who have been hospitalized or intubated, can be emotionally and mentally devastating, said Dr. Jessi Gold, assistant professor of psychiatry at Washington University in St. Louis, Missouri.

"When you leave the ICU, you can end up having dreams and not know if the things happened to you or not," she said. "You might have these really dark visions."

Like physical symptoms, psychological symptoms can persist even after the virus is gone.

"Just because you were in the ICU and lived, doesnt mean you are better," Gold said. "It can take months and months, if not years, and you can end up very different than your previous self."

Anxiety and depression, including Post Traumatic Stress Disorder, or PTSD, can accompany flashbacks, nightmares or a crushing sense of being unable to breathe, she said.

Even the most common stressors reported by ICU patients are exacerbated during COVID-19, she said. Feelings of isolation and worry are heightened because family and friends are typically not allowed to visit and nurses must avoid unnecessary contact with sick patients.

Those who convalesce at home can also be traumatized, she said, because fear of contracting the virus may cause those who would otherwise help out to steer clear, leaving the patient miserable and alone.

One area in need of additional research involves the idea that some psychological implications related to COVID-19 may be caused by factors beyond a persons individual experience while ill, Gold said.

"I wouldn't be surprised if there are things that we will find out over time where well see that the disease itself causes biological problems that affect the brain and your mood and how you are feeling," Gold said. "That it is not the circumstance the experience, stress, anxiety or trauma of it but that it is actually coming from the disease itself."

Click here to read Part 1, "Two weeks then gone? Not even close, say doctors about the lingering effects of COVID-19."

@WendyRhodesFL

wrhodes@pbpost.com

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Lingering effects of COVID-19 on the lungs, heart, brain, kidneys and immune system - Palm Beach Post

A lot of scientific brain power and research dollars are being going to tests and treatments for the novel coronavirus. And much recent attention has been focused on antibody testing. Theres a lot of excitement, because the presence of antibodies in your blood can reveal if youve been infected previously with the virus and produced an immune response to fight it off. But beyond that basic finding, theres not much scientific evidence to translate what this means to your own health, as well as others.

Before I bust the biggest myths about the testing, its important to know exactly what antibodies are. Theyre proteins produced by the body that recognize and bind to a virus. Once this happens, a process is triggered, which inactivates the virus and eliminates it from the body. This is the bodys natural immune response to a viral infection.

And while the field of immunology and antibody response has been studied for decades and is well-defined for many viruses (like polio), when it comes to COVID-19, the whole process is not well understood because its a never-seen-before virus.

So before you consider going for a COVID-19 antibody test, its time to do a little myth-busting to first understand what your results actually can tell you. Remember to always talk with your doctor for personal guidance.

MYTH #1: All antibody tests provide reliable information

Fact: Only a fraction of the tests advertised meet FDA specifications. At first, the FDA didnt require manufacturers to get authorization from the agency, making test quality very inconsistent. But this changed on May 4, when the FDA announced that all companies had to submit validation data and apply for emergency utilization authority (EUA) to sell a test. Fewer than 20 of the dozens of tests available have achieved that so far. Always look for a test that documents accuracy of at least 99 percent, and ideally 99.5 percent. The FDA lists this information on their website.

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MYTH #2: All antibody tests measure the same thing

Fact: Different tests measure different types of antibodies, with some more specific than others. A positive test only indicates that you were infected at some point in the past.

The typical first responder antibody of the immune system is called IgM (immunoglobulin M). Another type, IgA, found in the lining of the respiratory and digestive tracts contributes to the early response. The body next produces IgG (immunoglobulin G), an antibody better able to recognize and target a specific virus. The IgM component typically disappear after a few months, while the IgG lasts longer, and is likely the most useful measure for longer term immunity.

Only the small number of antibody tests receiving EUA authorization from the FDA are reliable, as they are at least 99 percent accurate and specific for particular antibodies directed against COVID-19. Some tests are measuring other kinds of viral antibodies.

Otherwise, you are open to a greater likelihood of a result that is a false positive (you really DONT have antibodies) or a false negative (you really DO have them). Either false result doesnt help make informed health decisions.

MYTH #3: If you have antibodies, you are protected from getting the virus again

Fact: There is no evidence that a positive antibody test protects you from another infection.With the presence of antibodies, there is some protection, but theres still no information on how long that protection lasts and what level of antibodies you need to get that protection. A reliable antibody test only indicates if your body has produced antibodies to a previous infection. It also does NOT tell you if you have an active infection.

MYTH #4: You can go to your doctors office for a test

Fact: An antibody test cannot be done at a doctors office. You need to go to a large laboratory chain like Quest Diagnostics or LabCorps. And you can request the test via your primary care doctor, or schedule it directly. Its important to check with your insurance carrier for coverage.

And remember that this is a blood test, with a scheduled blood draw at the lab. While there is a home test available, using a pin-prick blood test, the accuracy is uncertain and not recommended at this time.

Madelyn Fernstrom, PhD is NBC News health editor. Follow her on Twitter @drfernstrom.

See the article here:
Busted! The 4 biggest myths about COVID-19 antibody testing - NBC News

Lack of sleep can increase risk of high blood pressure

Lack of sleep or sleep deprivation can play havoc with your health. For starters, it can negatively affect your immunity and may interrupt with your weight loss goals. Not sleeping well for nights in a row can affect your mental abilities as well. Getting less than seven hours of sleep on a regular basis can lead to health consequences that affect your entire body. Digestive system, respiratory system, immune system and central nervous system can all be affected by lack of sleep or sleep deprivation.

Insufficient sleep has been linked to a number of health problems. Here are some of them.

1. Weight gain: Not sleeping well for even one night can put your body in sleep debt. What's worse is that it may increase cravings and appetite. Sleep deprivation disturbs the balance of chemicals which signal the brain that you are full. As a result, you are likely to overeat even if you are full. This may lead to weight gain, obesity and other health risks linked to being overweight.

2. Low libido: Not sleeping well can lower your sex drive. The decrease in libido in men maybe because of a drop in testosterone levels.

Also read:Disrupted Sleep And Your Relationship With Food: Know The Surprising Link

3. Diabetes risk: Body's release of insulin can be affected by lack of sleep. Insulin is the hormone which is required to regulate blood sugar levels. People who don't sleep sufficiently are likely to have higher blood sugar levels and are at higher risk of developing type 2 diabetes.

4. Weak immunity: Sleeping too less can affect immune system's ability to fight virus that cause cold, flu and other infections. It makes you more susceptible to getting sick on being exposed to germs.

5. Mood swings: Being sleep deprived for too long can make you short-tempered, moody and emotional. Being chronically sleep deprived can lead to anxiety and increase risk of depression.

6. Poor concentration and focus: Your thinking, problem-solving skills, concentration and creativity can be negatively affected if you are sleep deprived and haven't rested well.

Lack of sleep can affect your thinking, concentration and focusPhoto Credit: iStock

Also read:Losing Out On Sleep Amidst Lockdown? Milk, Eggs And Bajra Can Help

7. Poor balance: Balance and coordination can be negatively affected if you have not been sleeping well off late. It increases your risk of falls and accidents.

8. High blood pressure: Sleep deprivation needs to be taken seriously by hypertension patients. Sleeping for less than five hours at night increases your risk of getting high blood pressure.

9. Heart disease risk: High blood pressure is one of the top causes of heart disease. Sleep deprivation can also increase inflammation in the body, which can also increase risk of heart disease.

10. Poor memory: When you are asleep, the brain forms connections that can help you process and remember information. Not sleeping well can affect both short and long-term memory.

Also read:Do You Have Sleep Apnoea? Know The Symptoms; It May Cause Memory Loss, Depression

Working on your sleep and making time for it no matter how busy your life is, can help in preventing sleep deprivation.

Also read:Increased Stress, Disturbed Sleep And Other Risks Associated With Drinking Too Much Alcohol

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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Weak Immunity And 9 Other Risks Associated With Sleep Deprivation - NDTV

Dr. Rebecca Auer says the study could help experts understand why some COVID-19 patients are relatively asymptomatic while others end up in intensive care or die

OTTAWA A national clinical trial this summer will focus on protecting cancer patients against severe COVID-19 infectionby attempting to boost their compromised immune system.

Researchers from The Ottawa Hospital say they want to explore the potential of IMM-101, a preparation featuring a dead pathogen containing properties that can stimulate the "first-response arm" of the immune system.

Study lead Dr. Rebecca Auer, surgical oncologist and director of cancer research at the Ottawa Hospital, says it could help experts understand why some COVID-19 patients are relatively asymptomatic while others end up in intensive care or die.

"The difference it seems between these two different presentations has to do with how strong your innate, or your sort of non-specific, first-line defence immune system response is to the virus," Auer said Wednesday.

"And so we're hoping that by boosting and stimulating this innate immune response, particularly in those vulnerable patients that have a reduced immune response to begin with, we'd be able to prevent symptomatic infections and prevent serious infections."

Cancer patients are at much higher risk of severe complications from COVID-19 because chemotherapy, cancer surgeryand radiation treatments suppress innate immunity even further.

Auer points to an "urgent need" to protect them while the world waits for an effective COVID-19 vaccine, which could take another year or more to develop, test, and implement.

A successful trial could also protectcancer patientsagainst other respiratory infections as well as the coming flu season, says Auer, noting the threat of illness is a fairly big problem for those undergoing treatment.

"A study demonstrated that about 13 to 15 per centof cancer patients will have to delay or stop their treatment because of influenza during the average flu season," she says.

"And also cancer patients don't respond as well to the influenza vaccine every year because their immune system isn't as strong. So we think that the IMM-101 may in itself be able to help prevent symptomatic influenza infections."

Auer says IMM-101 has also been tested elsewhere for its anti-cancer properties and that, too, will be examined in this trial, although it's not the primary objective.

The researchers say the bacteria, Mycobacterium obuense, is safe to use in cancer patients because it has been killed by heat.

The Canadian study will recruit 1,500 patients currently receiving cancer treatment,and participants will be randomly assigned to receive either regular care, or regular care plus IMM-101.

Auer says the treatment would be administered as an injection in the arm, to be followed by two more booster shots.

Researchers will follow patients for a year, watching for any respiratory infections and monitoring whether the treatment works and how long it lasts.

The trials will take place in eight centres located in Ontario, British Columbia and Quebec.

Researchers saypeople interested in participating should speak with their cancer specialist.

Researchers from the Ottawa Hospital came up with the idea and worked with the Canadian Cancer Trials Group at Queen's University to design the trial.

Dr. Chris O'Callaghan of the Queen's University group notes cancer patients are also at greater risk of COVID-19 infection because they require regular medical care, making it difficult to adhere fully to public health guidelines.

"These patients are unable to practice social isolation due to the need to regularly attend hospital to receive critically important cancer treatment, says O'Callaghan, who will oversee the trial.

Auer says asuccessful trial of IMM-101 could also suggest usefulness in treating any patient with a reduced innate immune system, such as older patients with chronic illness.

She notes that the tuberculosis vaccine known as BCG which uses a similar formulation to IMM-101 but uses live bacteria instead of dead bacteria is being tested around the world to see if it can boost the immunity of health-care workers exposed to COVID-19.

Funding and in-kind support, valued at $2.8 million, comes from the Canadian Cancer Society, BioCanRx, the Ontario Institute for Cancer Research, The Ottawa Hospital Foundation, The Ottawa Hospital Academic Medical Organization, ATGen Canada/NKMax, and Immodulon Therapeutics, the manufacturer of IMM-101.

By Cassandra Szklarski in Toronto

This report by The Canadian Press was first published July 8, 2020.

The Canadian Press

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CANADA: Cancer trial to focus on protecting patients from COVID-19 infection - KitchenerToday.com

When Dr. Carl June first heard about symptoms in seriously ill COVID-19 patients, his thoughts jumped to Emily Whitehead. Seven-year-old Emily had endured the same kind of immune over-reaction when June treated her in 2012 with an experimental therapy against her leukemia.

Her immune system went into life-threatening overdrive, just like many of those with COVID-19.

In a last-ditch effort to save Emily's life, he had given her a drug, tocilizumab, that kept his own daughter's rheumatoid arthritis under control. To everyone's surprise, the drug worked. Emily is now a normal teenager.

Tocilizumab is now one of hundreds of therapies being tested against COVID-19.

Four months ago when COVID-19 first arrived in the United States, there were no therapies shown to treat it. Doctors relied solely on what's called supportive care including intravenous fluids, fever reducers, and ventilators, those bulky machines that allow people to breathe when they can't do it anymore on their own.

Today, there are two approved therapies shown to make a difference in COVID-19, and 150 treatments and more than 50 antivirals are being tested in people.

A treatment that kept people from falling seriously ill or even needing hospitalization at all could strip the fear from the coronavirus and allow people to resume their pre-COVID-19 lives.

Once somebody develops a treatment for the virus, everything will go away, said Daniel Batlle, a kidney expert from Northwestern Medicine and professor of medicine at Northwestern University in Chicago.

Even after a vaccine is developed, treatments that save lives and prevent hospitalization will be crucial. Vaccines might not work for everyone and doses may initially be limited.

Treatments under development

The vast majority of people diagnosed with COVID-19 more than 80% will recover without the need for hospitalization or significant treatment.

For those who do require care, treatments have been evolving as researchers learn more about the coronavirus and the infection it causes, as well as the havoc it can wreak on various parts of the body.

Potential therapies being tested, experts said, fall into four major categories that are best used at different times:

Antivirals that slow or block the virus expansion in the body will be most effective early in infection, before the virus is fully established;

Convalescent plasma and antibodies that provide immune weapons to attack the virus once its established could help control infections and avoid the need for hospitalization;

Immune system modulators, most that tamp down an over-reacting immune system, will be particularly useful later in the course of disease, when the immune response rather than the virus is driving the patients condition;

Anti-coagulants that stop or slow the blood clots that can cause organ damage or stroke are also likely to be most useful in patients having a serious reaction to the virus.

But even as these different approaches are being tested, many unanswered questions and challenges remain. One is how to treat patients who might have different responses to the virus, said Dr. John Wherry, director of the institute for immunology at the Perlman School of Medicine at the University of Pennsylvania.

At Penn, he and his colleagues have seen three types of patients: a large group whose immune system is over-reacting, a small group whose immune system is under-reacting, and others where the immune system is more balanced in the response.

Right now, drugs are tested on all patients without making any distinction, Wherry said. That means ones that tamp down the immune system might help patients with an over-active immune system but hurt those whose immune systems arent working hard enough, and do nothing for those with a balanced immune response.

And drugs that might be useful for patients with too little immune response might be seen as ineffective because they don't help the larger number of people with immune overreactions, he said.

Wherry said researchers are getting closer to being able to identify which patients are likely to do better with which kind of therapy. We still need to be pushing very hard and thinking very creatively about how to match treatments to the right patient, he said.

Doctors are learning other approaches simply by treating patients.

Batlle, the kidney expert, said although COVID-19 has been considered a lung disease, as many as half of patients hospitalized with severe cases also suffer acute kidney injury. Its not yet clear how many patients will be left with long-term kidney problems after recovering from severe cases of COVID-19.

We dont want to scare anybody, but kidney damage was initially under-reported, and now several studies have shown that it is extremely frequent in hospitalized patients," he said.

Treatment for acute kidney injury usually involves dialysis, which removes toxins from the blood that the kidneys can no longer address. But Batlle is hopeful treatments that address COVID-19-related inflammation and formation of blood clots will eventually reduce such injuries.

We should be better prepared to help these patients and not rely (only) on supportive care, he said.

Just two drugs recommended so far

Since mid-May, dexamethasone and remdesivir have been shown useful for certain COVID-19 patients. Both are recommended by the National Institutes of Health and the Infectious Disease Society of America.

For hospitalized patients, these drugs are beginning to show an effect, said Dr. Rajesh Gandhi, an infectious disease specialist at Massachusetts General Hospital who sits on both panels.

Placing patients on their stomachs rather than their back when they have breathing problems may also help, according to some experts.

And Gandhi and other doctors said they are now much more comfortable treating COVID-19s many symptoms, which can include blood clots, immune problems and organ failure, in addition to lung issues.

Some now even say that COVID-19 is a multi-system disease, targeting at times the lining of blood vessels. This would explain how it manages to damage so many of the body's organs, all of which are fed by blood vessels.

One recent study, still not fully vetted, showed that dexamethasone, at a dose of 6 mg per day for up to 10 days, can be lifesaving for patients with COVID-19 who are on ventilators. The evidence was weaker for patients who are hospitalized and receiving oxygen. The study found no support for giving the steroid to less seriously ill COVID-19 patients, but more research is underway.

In a May study in the New England Journal of Medicine, the drug remdesivir, first developed to treat Ebola, was shown to shorten the recovery time of patients hospitalized with COVID-19 and lower respiratory tract infections.

Scientists think remdesivir might be even more effective in people who are not yet sick enough to require hospitalization, but because it can only be delivered intravenously at the moment, it has not been tested on outpatients. Its manufacturer, Gilead, is rushing to ramp up production and to develop an inhaled version of the drug.

But while remdesivir is helpful, it doesnt cure COVID-19 and is far from a home run, said Dr. Mark Rupp, an infectious disease expert at the University of Nebraska.

Its kind of like getting on base with a single, he said. Weve got a long way to go.

As hydroxychloroquine shows, research is key

Although its tempting to just throw everything in the medicine cabinet at COVID-19, Rupp said he learned while fighting Ebola in 2014-2015 that its much more important to conduct high-quality clinical research during an outbreak.

Without such research, you throw the kitchen sink at everybody and you dont know what helps and what hurts and thats a dangerous place to be, he said.

He cited the example of hydroxychloroquine, which was used early on to treat COVID-19, but which research has shown to be ineffective in very sick patients.

Everybody wants to do good, we want to help our patients, Rupp said. But sometimes well-meaning efforts really dont result in beneficial effects.

Its only by testing drugs and other therapies through clinical trials that doctors can learn what works and what doesnt, he added. The more data and information we can gather, the better off were going to be.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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The mysterious coronavirus can wreak havoc on your health. Medical care for very ill COVID-19 patients is getting better. - Taunton Daily Gazette

Immunotherapy is a wonderfultestament to the benefits that arise from our growing understanding of the incredibly intricate human immune system.

BY Debu Tripathy, M.D.

Scientists have known for decades that the presence of these immune cells in cancerous tumors is associated with better health outcomes, but not until more recently did they understand why. Compounding the challenge to learn more was the fact that, for a long time, tumor immunology was considered a soft science, with these approaches dismissed as alternative medicine.As we learned that cancer can affect the bodys immune responses and realized rare victories with early immune stimulators such as interferon and interleukin-2, the field of immunotherapy was revived. Newer tools emerged, including drugs known as monoclonal antibodies that target specific proteins to stimulate the immune system. In addition, genetic analysis enabled scientists to identify separate classes of T cells and learn about their unique cancer-fighting abilities.

The location of certain T cells also attracted attention: Why would lymphocytes swarm specifically around tumor cells? This observation, along with new knowledge about the different types of immune cells and the cancer-driving proteins they fight, shed light on why TIL-infiltrated tumors were linked with a better prognosis. Armed with that understanding, scientists created an immunotherapy technique that harnessed the power of TILs to treat numerous cancer types, an experimental strategy discussed in an article in this special issue of CURE.

With this strategy, scientists remove TILs from a patients tumor and select the ones best able to fight the disease those that naturally bind to antigens created by cancer-driving genes. Then the scientists multiply the TILs in a lab through exposure to interleukin-2, which stimulates the cells growth, finally reinfusing them into the patient.

There is still a hit-or-miss element to TIL-based therapy not everyone has a good response, and many techniques are being tried and refined. The work is laborious and requires time to isolate and grow the TILs, which can be too long a wait for some patients with rapidly growing cancers. To address that problem, companies are trying to move this effort from small-bandwidth academic laboratories to scaled-up commercial facilities. As these processes become standardized, it is our hope that the time needed to create ready-to-use cells, along with the cost of the technology, will drop as the success rate rises.

With many of the nations top academic and communithy centers conducting clinical trials in this area, TIL therapy seems poised to make strides in the next couple of years. It will be exciting to watch this strategy move toward wider availability.

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Exciting Treatment Harnesses the Immune System - Curetoday.com

What happened: Autoimmune conditions affect millions of Americans. A new study from the University of California, Los Angeles published in JAMA Psychiatry analyzed 56 studies about autoimmune disease and concluded that psychosocial intervention (essentially therapy) was associated with enhanced immune system functioning.

In particular, the study found that cognitive behavioral therapy (CBT) created the same amount of immune system improvement as drugs that are typically used to treat inflammatory diseases of the immune system. The study also noted that 10 weeks of CBT costs about $1,500, while one years worth of a drug for autoimmune inflammation can cost $25,000 per year.

Psychosocial interventions are reliably associated with enhanced immune system function and may therefore represent a viable strategy for improving immune-related health.

The Frontlines: The immune system usually works to attack germs and viruses that endanger our health. People with autoimmune diseases have an immune system that mistakenly attacks their own body, destroying organs, joints or skin. Autoimmune diseases are on the rise and are connected with genetic factors, stress, environmental factors and diet.

Get more on mental health: Sign up for our weekly mental health newsletter.

A Mighty Voice: Our community member, Samantha Reid, who has Crohns disease, already knows how interconnected her body and mind are. She shared, If youre physically sick, its exceedingly normal to develop mental illness symptoms as well. You are not alone, and you are not to blame. But just because its normal doesnt mean you cant treat it and try to create a life with more peaks and fewer valleys. You can submit your first person story, too.

Also keep in mind: Often patients with invisible symptoms are told its all in their head and referred for mental health treatment instead of further work to diagnosis a chronic illness. Its important to note that while therapy traditionally associated with mental health can help you manage chronic illness symptoms, its likely only one strategy in a larger treatment plan.

From Our Community:

What takes up the most time in your day-to-day life?

Add your voice:

Other things to know: Autoimmune disease is a physical condition but it also has a psychological impact. Read more about this connection:

Where to learn more: Get information about autoimmune conditions from the American Autoimmune Related Diseases Association.

Header image via microgen/Getty Images

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New Study Shows Therapy May Improve Your Immune System - The Mighty

The immune response against the AlloPrime vaccine can influence the response to a virus (like the coronavirus that causes COVID-19).

What if you could get one vaccine that protects you against a wide spectrum of viruses, even viruses we havent discovered yet? That might sound impossible and futuristic, but this is just what Immunovative Therapies and its sister company Mirror Biologics, Inc. are aiming to achieve. Their new pan-viral vaccine called AlloPrime is slated to begin a Phase I/II trial next month.

Our pan-viral vaccine harnesses the same protection mechanism that naturally protects us from viral diseases a healthy immune system, Michael Har-Noy, MD, Ph.D., Founder and CEO of Immunovative Therapies, told BioSpace. By remodeling the elderly immune system with a vaccine, we can arm the system to rapidly respond to a viral encounter in the same manner that a young immune system responds to a novel viral encounter.

Just as our body slows down with age, so does our immune system. AlloPrime focuses on remodeling the weakened older immune system by a mechanism known as heterologous immunity. Heterologous immunity occurs when the immune response to one pathogen causes an enhanced response to a later unrelated pathogen. This means that the immune response against the AlloPrime vaccine can influence the response to a virus (like the coronavirus that causes COVID-19).

Im sure the timeliness of strengthening the elderly immune system isnt lost on you COVID-19 heavily impacts older adults. In fact, 80 percent of COVID-19 deaths in the United States have been in people 65 years and older.

As the majority of younger individuals exposed to the virus that causes COVID-19 are either asymptomatic or have mild symptoms, protecting the vulnerable elderly population would enable opening of the economy and building of herd immunity without an increase in hospitalizations and deaths, commented Dr. Har-Noy.

Older adults usually have a weaker response to vaccines, so even if an effective COVID-19 vaccine is created, it could be less protective in older adults, the population that needs protection the most. Thats what is unique about this pan-viral vaccine it focuses specifically on modulating the elderly immune system. AlloPrime could be given as an immune modulator to the elderly on its own or it could be administered as an adjuvant with other vaccines to boost their effectiveness.

In respiratory viral infections that can be transmitted person-to-person, it is especially important to protect the vulnerable elderly population, Dr. Har-Noy said. There is no guarantee that current vaccine technologies, which focus on eliciting neutralizing antibodies, will work to develop a COVID-19 vaccine that is why having a plan B that focuses on a cellular anti-viral immune response is so important, specifically one that targets the most vulnerable.

Immune system basics

Before we get into the nitty gritty details, lets go over the basics of the immune system. Your immune system is the collection of specialized cells and molecules that fight invading pathogens, like viruses and bacteria.

There are two main branches: innate immunity is the quick, non-specific first line of defense, and adaptive immunity is the slower, pathogen-specific response. There are also two types of adaptive immunity: responses that involve cells that destroy pathogens or infected cells (cell-mediated immunity), and responses that involve making antibodies to tag the pathogen for destruction (humoral immunity).

If the pathogen hides inside cells, like viruses do, then creating antibodies against the virus may not provide the most comprehensive protection as they tend to recognize things outside the cell. Generating a cell-based immune response against a virus could provide more robust, longer-lasting protection.

Knowing the optimal immune response to a virus is especially important now. Understanding how COVID-19 affects cell-mediated and antibody-based immunity will be crucial to determining immunity and developing an effective COVID-19 vaccine.

How is this pan-viral vaccine different than other vaccines?

Current vaccine development usually focuses on stimulating the production of antibodies against the virus of interest. This relies not only on knowing what virus you are targeting, but also on having a deep understanding of the virus molecular structure. Most vaccines directly use viral information (such as viral genetic material, viral pieces, or even whole, weakened virus) to attempt to train the persons immune system to recognize and destroy the virus.

Although this method has generated the multitude of efficient vaccines currently available, it has come up short for creating vaccines against certain viruses, such as HIV, Zika, and other pandemic coronavirus strains (such as those that caused SARS and MERS).

Even if a vaccine can successfully generate antibodies against a virus, the vaccine may be rendered less effective or useless if the virus mutates; the antibodies wouldnt recognize the viral mutant as well (if at all). This happens with the various strains and mutations of the flu virus, which is why you need to get an annual flu shot to stay protected.

Immunovatives vaccine, however, isnt reliant on the virus it focuses on the cell-mediated immune response rather than virus-specific antibodies. The vaccine supplements a persons immune system by providing living bioengineered foreign immune cells, called AlloStim, that arent virus-specific. Instead, these foreign cells elicit a powerful immune response that creates a swarm of immune cells ready to sound the alarm and fight future viral invaders.

Rather than trying to figure out which viral peptides are immunogenic or could display on MHC molecules, our approach focuses on the natural immune response, which starts with the cellular innate immune response, Dr. Har-Noy said. Our vaccine would provide pan-viral protection to the most vulnerable population without needing to know the viral structure, including protection against COVID-19 viral mutants and the next viral pandemic that might emerge.

What are AlloStim cells and how are they made?

Immunovatives pan-viral AlloPrime vaccine consists of specialized, engineered living immune cells called AlloStim. To create AlloStim cells, blood from healthy donors is collected and a subset of the white blood cells, called CD4+ T-cells, are isolated from the blood. In the laboratory, the donor T-cells are converted into a patented immune cell that is activated with antibody-coated microbeads to create AlloStim cells.

AlloStim cells possess properties from multiple types of immune cells. They have cytolytic T-cell/natural killer (NK) cell-like properties because they contain sacs (called granules) of certain digestive enzymes (perforin and granzyme B) that can destroy virally-infected cells. AlloStim cells also have the ability to promote anti-viral effects by steering the immune response to elicit Th1 helper T-cells by producing critical signaling molecules, such as CD40L, interferon-gamma (IFN-gamma), and TNF-alpha. These molecules activate macrophages, which educate the immune system to develop memory immune cells that can elicit a response upon encountering any virus.

AlloStim cells are also currently being tested in separate studies as a cancer vaccine for various chemotherapy-refractory metastatic cancers.

Weve seen that AlloStim cells provided protective effects in cancer patients with viral infections, such as lower viral counts in cancer patients with hepatitis B and lowered viral burden in HIV patients, Dr. Har-Noy said. We also have animal data demonstrating that this approach could protect mice from lethal challenge with cancer cells and malaria. These observations, in light of the current pandemic, made us think about using this technology as a preventative vaccine against viral infections.

(image above depicts AlloStim cells. Credit: Immunovative Therapeutics)

How can AlloStim cells be used as a pan-viral vaccine?

The rationale for creating this AlloStim cell-based vaccine was recently published in the Journal of Translational Medicine. Dr. Har-Noy suggests that giving older adults AlloStim cells can repopulate their exhausted immune cells, creating an army of new, refreshed memory immune cells that are ready and waiting for an invader.

Because AlloStim cells are intentionally mismatched to the person, their immune system will be alerted and create an immune response against the cells. After injecting the angry living AlloStim cells under the skin, the cells produce high levels of inflammatory molecules (such as IFN-gamma and TNF-alpha) and express CD40L on their surface. These inflammatory molecules, in addition to danger signals released by the persons own cells, cause an immune response known to be effective against most viral infections.

The elderly have missing or senescent interferon-producing cells, and many modern viruses, such as the virus that causes COVID-19, actively suppresses interferon production as an immune evasion strategy, Dr. Har-Noy said. The goal of this pan-viral vaccine is to provide this missing part of the elderly immune system to overcome the viral evasion mechanism and provide an immediate source of interferon.

Having a stronger, quicker anti-viral immune response the next time they encounter an invading virus provides heterologous immunity, tamping down the early viral infection before it can get out of hand.

Allopriming with AlloStim cells is a more refined and modern method to elicit heterologous immunity, explained Dr. Har-Noy. Heterologous immunity can broaden the protective outcomes of vaccinations, so it could potentially be used to enhance a future COVID-19 vaccine to be more effective in the elderly.

The AlloPrime vaccine wouldnt just be for healthy people either. At the onset of a viral illness, such as COVID-19, a person who previously got this vaccine could get another dose of AlloStim cells. This would prompt a stronger and faster anti-viral immune response that could help the body fight off the virus quicker.

AlloStim cells have already been shown to prompt an immune response in heavily immunocompromised cancer patients, whose immune systems are not too far off from the weakened older immune system. Although it is not known how long the AlloStim-induced immunity lasts, Dr. Har-Noy said it lasted for years in many of the cancer patients they assessed.

AlloStim cells have the benefits of having lots of human safety data and these cells are already being manufactured under good manufacturing processes (GMP), so we are able to quickly pivot into COVID-19 clinical trials, commented Dr. Har-Noy. In addition, since the AlloStim cells are off-the-shelf, where one donor can produce enough doses for potentially thousands of patients, the vaccine has the benefit of economy of scale to make it more affordable.

FDA clearance of Phase I/II study

The FDA recently cleared Immunovative and Mirror Biologics to begin a Phase I/II trial of their pan-viral AlloPrime vaccine in healthy older adults. For the study, the company aims to recruit a total of 40 healthy adults divided between two age cohorts: ages 65-74 and ages 75+.

Participants will receive five doses of the vaccine intradermally (under the skin) within a 14-day period, each dose being a few days apart. They will be monitored for adverse events for 30 days after receiving their initial dose. Blood samples will be taken before, 30 days after, 6 months after, and 1 year after initial dosing to monitor immune response durability.

The blood samples will be used to monitor participants immune response to the vaccine, including if they make memory T-cells against the AlloStim cells, if those memory T-cells can be activated after exposure to virus components, and if the activated memory T-cells can trigger an anti-viral state (if they produce IFN-gamma) and suppress viral growth in virally-infected human respiratory tract cells. The vaccine-induced cytotoxic T-cells ability to kill virally-infected cells will also be assessed.

This is a good way to show efficacy because it produces a definitive response, Dr. Har-Noy said. The production of neutralizing antibodies against the virus of interest doesnt necessarily determine a vaccines efficacy. Especially for new viral infections like COVID-19, we dont know if the antibodies recovered from patients are protective or, if they are protective, for how long they provide protection.

The Phase I/II study is expected to begin next month.

More:
A 'Pan-Viral' Vaccine Designed to Protect the Elderly from Known, and Unknown, Viruses - BioSpace

Dr Manoj Kutteri, Wellness Director Atmantan Wellness Centre, has shared some Ayurvedic and Naturotherapy based tips for the better immune system. Read on to know more.

Every human body has an ingrained doctor that we call the immune system. The science today has conveniently forgotten this inherent capacity of the human body to heal by itself. Ayurveda, Naturopathy and Yoga systems are built to fit into this wholesome health model proposed by evolutionary biologists globally these days. The understanding is that human physiology is a self-correcting system that does not tolerate outside interventions in minor illness syndromes.

Ayurvedic treatments are a natural cure for viral infections. The traditional Ayurvedic Panchakarma retreat with its deeply nourishing, enriching, and purifying practice is one of the best Ayurvedic treatments to treat viral infections like the coronavirus. Through Yogic Kriyas like Neti, Dhouti, etc the Ayurvedic Panchakarma is performed in various forms like Shirodara, Januvasti, Kativasti, etc. and water therapies to cleanse, and cure the body from within. The cleansing therapy helps detoxify the body, and boost immunity to fight through viral infections.

Ayurveda is full of medicines and herbs potent to improve immunity and cure cough and cold. Tulsi is the herb of all reasons with Vitamin C, antioxidants, antiseptic and antiviral properties. For Viral infections like cold, flu, etc or something as severe as the coronavirus, Tulsi leaves can be a perfect solution to fight through the viral infections, increase immunity and recover from infections. Chewing on one fresh Tulsi leaf daily is recommended to fight through viral infections. Alternatively, Tulsi tea or adding the leaves in soup, food, etc. can help boost your immunity and provide some relief.

Ayurvedic practices can help you stay healthy through seasonal viral infections. Be it cough, cold or flu, the Ayurvedic lifestyle can help you improve your body functioning, boost immunity and fight through infections.

Some tips include:

Turmeric Paste Turmeric is a healing Ayurvedic herb known for healing properties. Making a paste of turmeric or adding raw turmeric with honey can bring in relief from coughing and sneezing.

Neem Neem has antiseptic and antiviral properties. Neem concoctions, when taken daily, can fight through viral infections.

Fruits and Vegetables Adding a lot of fruits, green leafy vegetables, nuts, and seeds, etc can enrich your diet and bring in nutrients for optimum body functioning.

Oil Pulling and other therapies Traditional Ayurvedic Therapies are a great cleanse, entailing improved stamina, immunity and energy to fight through diseases.

In addition to Naturopathic practices, here are small steps that you can take which reap astoundingly positive results:

Eat clean: The clich is true; your body is a temple and you have to be careful of what youre feeding it. While a once in a blue moon cheat day wont hurt, unmindful eating habits are the core reason for stunting the growth of your immune system. Nourish your body with vitamin-rich foods and give it a sufficient amount of fibre, remember your immune system has nothing to do with the way your body looks. For a healthy liver, cruciferous vegetables like Kale, Broccoli and Cabbage should be included in daily diet. A healthy liver ensures the bodys natural detoxification process.

Sleep well: Getting your sleep cycle in sync is one of the biggest gifts you can give your body. The body requires bout 8 hours of sound sleep to rejuvenate and reboot its systems. It has to be kept in mind that its not only 8 hours of sleep, but the timely hours of sleep that matter too. Often, we stress ourselves by staying up till 3 am and sleeping only at sun up thereby disrupting the normal functioning of our body that leads to obesity, stress, emotional imbalance and other illnesses.

Work-out: Working out on a regular basis has been scientifically proven to boost the immune system. Regular exercise mobilizes the T cells, a type of white blood cell which guards the body against infection. However, continuous rigorous workout weakens the immune system, leaving you prone to flu and viral infections. The low level of Vitamin D in the body has been termed as one of the major reasons for respiratory problems. A brisk walk in the sunlight for 1015 minutes will ensure that enough Vitamin D is produced in the body. These are simple but highly effective tweaks in your daily routine. The key is listening carefully to your body and conscious living, consistently.

Dr Manoj Kutteri, Wellness Director Atmantan Wellness Centre.

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How Ayurveda and Naturotherapy can help to boost your immune system? - PINKVILLA

A safe, effective vaccine is the ultimate tool needed to end the coronavirus disease 2019 (COVID-19) pandemic. Biomedical researchers are making progress every day towards such a vaccine, whether its devising innovative technologies or figuring out ways to speed human testing. In fact, just this week, NIHs National Institute of Allergy and Infectious Diseases (NIAID) established anew clinical trials networkthat will enroll tens of thousands of volunteers in large-scale clinical trials testing a variety of investigational COVID-19 vaccines.

Among the vaccines moving rapidly through the development pipeline is one developed by NIAIDs Dale and Betty Bumpers Vaccine Research Center (VRC), in partnership with Moderna, Inc., Cambridge, MA. So, I couldnt think of a better person to give us a quick overview of the COVID-19 vaccine research landscape than NIHs Dr. John Mascola, who is Director of the VRC. Our recent conversation took place via videoconference, with John linking in from his home in Rockville, MD, and me from my place in nearby Chevy Chase. Heres a condensed transcript of our chat:

Collins: Vaccines have been around since Edward Jenner and smallpox in the late 1700s. But how does a vaccine actually work to protect someone from infection?

Mascola: The immune system works by seeing something thats foreign and then responding to it. Vaccines depend on the fact that if the immune system has seen a foreign protein or entity once, the second time the immune response will be much brisker. So, with these principles in mind, we vaccinate using part of a viral protein that the immune system will recognize as foreign. The response to this viral protein, or antigen, calls in specialized T and B cells, the so-called memory cells, and they remember the encounter. When you get exposed to the real thing, the immune system is already prepared. Its response is so rapid that you clear the virus before you get sick.

Collins: What are the steps involved in developing a vaccine?

Mascola: One cant make a vaccine, generally speaking, without knowing something about the virus. We need to understand its surface proteins. We need to understand how the immune system sees the virus. Once that knowledge exists, we can make a candidate vaccine in the laboratory pretty quickly. We then transfer the vaccine to a manufacturing facility, called a pilot plant, that makes clinical grade material for testing. When enough testable material is available, we do a first-in-human study, often at our vaccine clinic at the NIH Clinical Center.

If those tests look promising, the next big step is finding a pharmaceutical partner to make the vaccine at large scale, seek regulatory approval, and distribute it commercially. That usually takes a while. So, from start to finish, the process often takes five or more years.

Collins: With this global crisis, we obviously dont have five years to wait. Tell us about what the VRC started to do as soon as you learned about the outbreak in Wuhan, China.

Mascola: Sure. Its a fascinating story. We had been talking with NIAID Director Dr. Anthony Fauci and our colleagues about how to prepare for the next pandemic. Pretty high on our list were coronaviruses, having already worked on past outbreaks of SARS and MERS [other respiratory diseases caused by coronaviruses]. So, we studied coronaviruses and focused on the unique spike protein crowning their surfaces. We designed a vaccine that presented thespike proteinto the immune system.

Collins: Knowing that the spike protein was likely your antigen, what was your approach to designing the vaccine?

Mascola: Our approach was a nucleic acid-based vaccine. Im referring to vaccines that are based on genetic material, either DNA or RNA. Its this type of vaccine that can be moved most rapidly into the clinic for initial testing.

When we learned of the outbreak in Wuhan, we simply accessed the nucleic acid sequence of SARS-CoV-2, the novel coronavirus that causes COVID-19. Most of the sequence was on a server from Chinese investigators. We looked at the spike sequence and built that into an RNA vaccine. This is calledin silicovaccine design. Because of our experience with the original SARS back in the 2000s, we knew its sequence and we knew this approach worked. We simply modified the vaccine design to the sequence of the spike protein of SARS-CoV-2. Literally within days, we started making the vaccine in the lab.

At the same time, we worked with a biotechnology company called Moderna that creates personalized cancer vaccines. From the time the sequence was made available in early January to the start of the first in-human study, it was about 65 days.

Collins: Wow! Has there ever been a vaccine developed in 65 days?

Mascola: I dont think so. There are a lot of firsts with COVID, and vaccine development is one of them.

Collins: For the volunteers who enrolled in the phase 1 study, what was actually in the syringe?

Mascola: The syringe included messenger RNA (mRNA), the encoded instructions for making a specific protein, in this case the spike protein. The mRNA is formulated in a lipid nanoparticle shell. The reason is mRNA is less stable than DNA, and it doesnt like to hang around in a test tube where enzymes can break it down. But if one formulates it just right into a nanoparticle, the mRNA is protected. Furthermore, that protective particle allows one to inject it into muscle and facilitates the uptake of the mRNA into the muscle cells. The cells translate the mRNA into spike proteins, and the immune system sees them and mounts a response.

Collins: Do muscle cells know how to take that protein and put it on their cell surfaces, where the immune system can see it?

Mascola: They do if the mRNA is engineered just the right way. Weve been doing this with DNA for a long time. With mRNA, the advantage is that it just has to get into the cell [not into the nucleus of the cell as it does for DNA]. But it took about a decade of work to figure out how to do nucleotide silencing, which allows the cell to see the mRNA, not destroy it, and actually treat it as a normal piece of mRNA to translate into protein. Once that was figured out, it becomes pretty easy to make any specific vaccine.

Collins: Thats really an amazing part of the science. While it seems like this all happened in a blink of an eye, 65 days, it was built on years of basic science work to understand how cells treat mRNA. Whats the status of the vaccine right now?

Mascola: Early data from the phase 1 study are very encouraging. Theres a manuscript in preparation that should be out shortly showing that the vaccine was safe. It induced a very robust immune response to that spike protein. In particular, we looked for neutralizing antibodies, which are the ones that attach to the spike, blocking the virus from binding to a cell. Theres a general principle in vaccine development: if the immune system generates neutralizing antibodies, thats a very good sign.

Collins: Youd be the first to say that youre not done yet. Even though those are good signs, that doesnt prove that this vaccine will work. What else do you need to know?

Mascola: The only real way to learn if a vaccine works is to test it in people. We break clinical studies into phases 1, 2, and 3. Phase 1 has already been done to evaluate safety. Phase 2 is a larger evaluation of safety and immune response. Thats ongoing and has enrolled 500 or 600 people, which is good. The plan for the phase 3 study will be to start in July. Again, thats incredibly fast, considering that we didnt even know this virus existed until January.

Collins: How many people do you need to study in a phase 3 trial?

Mascola: Were thinking 20,000 or 30,000.

Collins: And half get the vaccine and half get a placebo?

Mascola: Sometimes it can be done differently, but the classic approach is half placebo, half vaccine.

Collins: Weve been talking about the VRC-Moderna nucleic acid vaccine. But there are others that are coming along pretty quickly. What other strategies are being employed, and what are their timetables?

Mascola: There are many dozens of vaccines under development. The response has been extraordinary by academic groups, biotech companies, pharmaceutical companies, and NIHsAccelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership. I dont think Ive ever seen so much activity in a vaccine space moving ahead at such a rapid clip.

As far as being ready for advanced clinical trials, there are a just handful and they involve different types of vaccines. At least three nucleic acid vaccines are in clinical trials. There are also two vaccines that use proteins, which is a more classic approach.

In addition, there are several vaccines based on a viral vector. To make these, one puts the genes for the spike protein inside an adenovirus, which is an innocuous cold virus, and injects it into muscle. In regard to phase 3 trials, there are maybe three or four vaccines that could be formally in such tests by the fall.

Collins: How is it possible to do this so much more rapidly than in the past, without imposing risks?

Mascola: Its a really important question, Francis. A number of things are being done in parallel, and that wouldnt usually be the case. We can get a vaccine into a first-in-human study much more quickly because of time-saving technologies.

But the real important point is that for the phase 3 trial, there are no timesavers. One must enroll 30,000 people and watch them over months in a very rigorous, placebo-controlled environment. The NIH has stood up whats called a Data Safety Monitoring Board for all the trials. Thats an independent group of investigators that will review all vaccine trial data periodically. They can see what the data are showing: Should the trial be stopped early because the vaccine is working? Is there a safety signal that raises concern?

While the phase 3 trial is going on, the U.S. government also will be funding large-scale manufacture of the vaccine. Traditionally, you would do the vaccine trial, wait until its all done, and analyze the data. If it worked, youd build a vaccine plant to make enough material, which takes two or three years, and then go to the Food and Drug Administration (FDA) for regulatory approval.

Everything here is being done in parallel. So, if the vaccine works, its already in supply. And we have been engaging the FDA to get real-time feedback. That does save a lot of time.

Collins: Is it possible that well manufacture a whole lot of doses that may have to be thrown out if the vaccine doesnt work?

Mascola: It certainly is possible. One would like to think that for coronaviruses, vaccines are likely to work, in part because the natural immune response clears them. People get quite sick, but eventually the immune system clears the virus. So, if we can prime it with a vaccine, there is reason to believe vaccines should work.

Collins: If the vaccine does work, will this be for lifelong prevention of COVID-19? Or will this be like the flu, where the virus keeps changing and new versions of the vaccine are needed every year?

Mascola: From what we know about coronaviruses, we think its likely COVID-19 is not like the flu. Coronaviruses do have some mutation rate, but the data suggest its not as rapid as influenza. If were fortunate, the vaccine wont need to be changed. Still, theres the matter of whether the immunity lasts for a year, five years, or 10 years. That we dont know without more data.

Collins: Do we know for sure that somebody who has had COVID-19 cant get it again a few months later?

Mascola: We dont know yet. To get the answer, we must do natural history studies, where we follow people whove been infected and see if their risk of getting the infection is much lower. Although classically in virology, if your immune system shows neutralizing antibodies to a virus, its very likely you have some level of immunity.

Whats a bit tricky is there are people who get very mild symptoms of COVID-19. Does that mean their immune system only saw a little bit of the viral antigen and didnt respond very robustly? Were not sure that everyone who gets an infection is equally protected. Thats going to require a natural history study, which will take about a year of follow-up to get the answers.

Collins: Lets go back to trials that need to happen this summer. You talked about 20,000 to 30,000 people needing to volunteer just for one vaccine. Whom do you want to volunteer?

Mascola: The idea with a phase 3 trial is to have a broad spectrum of participation. To conduct a trial of 30,000 people is an enormous logistical operation, but it has been done for the rotavirus and HPV vaccines. When you get to phase 3, you dont want to enroll just healthy adults. You want to enroll people who are representative of the diverse population that you want to protect.

Collins: Do you want to enrich for high-risk populations? Theyre the ones for whom we hope the vaccine will provide greatest benefit: for example, older people with chronic illnesses, African Americans, and Hispanics.

Mascola: Absolutely. We want to make sure that we can feel comfortable to recommend the vaccine to at-risk populations.

Collins: Some people have floated another possibility. They ask why do we need expensive, long-term clinical trials with tens of thousands of people? Couldnt we do a human challenge trial in which we give the vaccine to some healthy, young volunteers, wait a couple of weeks, and then intentionally expose them to SARS-CoV-2. If they dont get sick, were done. Are challenge studies a good idea for COVID-19?

Mascola: Not right now. First, one has to make a challenge stock of the SARS-CoV-2 thats not too pathogenic. We dont want to make something in the lab that causes people to get severe pneumonia. Also, for challenge studies, it would be preferable to have a very effective small drug or antibody treatment on hand. If someone were to get sick, you could take care of the infection pretty readily with the treatments. We dont have curative treatments, so the current thinking is were not there yet for COVID-19 challenge studies [1]. If you look at our accelerated timeline, formal vaccine trials still may be the fastest and safest way to get the answers.

Collins: Im glad youre doing it the other way, John. Its going to take a lot of effort. Youre going to have to go somewhere where there is still ongoing spread, otherwise you wont know if the vaccine works or not. Thats going to be tricky.

Mascola: Yes. How do we know where to test the vaccine? We are using predictive analytics, which is just a fancy way of saying that we are trying to predict where in the country there will be ongoing transmission. If we can get really good at it, well have real-time data to say transmission is ongoing in a certain area. We can vaccinate in that community, while also possibly protecting people most at risk.

Collins: John, this conversation has been really informative. Whats your most optimistic view about when we might have a COVID-19 vaccine thats safe and effective enough to distribute to the public?

Mascola: An optimistic scenario would be that we get an answer in the phase 3 trial towards the end of this year. We have scaled up the production in parallel, so the vaccine should be available in great supply. We still must allow for the FDA to review the data and be comfortable with licensing the vaccine. Then we must factor in a little time for distributing and recommending that people get the vaccine.

Collins: Well, its wonderful to have someone with your skills, experience, and vision taking such a leading role, along with your many colleagues at the Vaccine Research Center. People like Kizzmekia Corbett, Barney Graham, and all the others who are a part of this amazing team that youve put together, overseen by Dr. Fauci.

While there is still a ways to go, we can take pride in how far we have come since this virus emerged just about six months ago. In my 27 years at NIH, Ive never seen anything quite like this. Theres been a willingness among people to set aside all kinds of other concerns. Theyve gathered around the same table, worked on vaccine design and implementation, and gotten out there in the real world to launch clinical trials.

John, thank you for what you are doing 24/7 to make this kind of progress possible. Were all watching, hoping, and praying that this will turn out to be the answer that people desperately need after such a terribly difficult time so far in 2020. I believe 2021 will be a very different kind of experience, largely because of the vaccine science that weve been talking about today.

Mascola: Thank you so much, Francis. And thanks for recognizing all the people behind the scenes who are making this happen. Theyre working really hard!

The rest is here:
Meet the Researcher Leading NIH's COVID-19 Vaccine Development Efforts - GovExec.com

The U.S. is currently facing a shortage of ventilators. Here's how they work and why they are so important in fighting COVID-19. USA TODAY

When Dr. Carl June first heard about symptoms in seriously ill COVID-19 patients, his thoughts jumped to Emily Whitehead.Emily, 7, had endured the same kind of immune systemoverreaction when June treated her in 2012 with an experimental therapy against her leukemia.

Her immune system went into life-threatening overdrive, just like many of those with COVID-19.

In a last-ditch effort to save Emily's life, he had given her a drug,tocilizumab, that kept his own daughter's rheumatoid arthritis under control. To everyone's surprise, the drug worked. Emily is now a normal teenager.

Tocilizumab is one of hundreds of therapies being tested against COVID-19.

Four months ago when COVID-19 arrived in the USA, there were no therapies shown to treat it. Doctors relied solely on what's called supportive care, including intravenous fluids, fever reducersand ventilators, the bulky machines that allow people to breathe when they can't do it on their own.

There are two approved therapies shown to make a difference in COVID-19, and 150 treatments and more than 50 antivirals are being tested in people.

A treatment that kept people from falling seriously ill or even needing hospitalization could strip the fear from the coronavirus andallow people to resume their pre-COVID-19 lives.

Once somebody develops a treatment for the virus, everything will go away, said Daniel Batlle, a kidney expert from Northwestern Medicine and professor of medicine at Northwestern University in Chicago.

Even after a vaccine is developed, treatments that save lives and prevent hospitalization will be crucial.Vaccines might not work for everyone, and doses may initially be limited.

The majority of people diagnosed with COVID-19 more than 80% will recover without the need for hospitalization or significant treatment.

For those who do require care, treatments haveevolved as researchers learn more about the coronavirus and the infection it causes, as well as the damage it can do tovarious parts of the body.

Potential therapies being tested, experts said, fall into four major categories that are best used at different times:

Even as these different approaches are tested, many unanswered questions and challenges remain. One is how to treat patients who might have different responses to the virus, said Dr. John Wherry, director of the institute for immunology at the Perlman School of Medicine at the University of Pennsylvania.

At Penn, he and his colleagues have seen three types of patients: a large group whose immune system is overreacting, a small group whose immune system is underreacting, and others whose immune system is more balanced in the response.

Drugs are tested on all patients without making any distinction, Wherry said. That means ones that tamp down the immune system might help patients with an overactive immune systembut hurt those whose immune systems arent working hard enough, and do nothing for those with a balanced immune response.

Drugs that might be useful for patients with too little immune response might be seen as ineffectivebecause they don't help the larger number of people with immune overreactions, he said.

Wherry said researchers are getting closer to identifying which patients are likely to do better with which kind of therapy. We still need to be pushing very hard and thinking very creatively about how to match treatments to the right patient, he said.

Doctors learn other approaches simply by treating patients.

Batlle, the kidney expert, said that although COVID-19 has been considered a lung disease, as many as half of patients hospitalized with severe cases also suffer acute kidney injury. Its notclear how many patients will be left with long-term kidney problems after recovering from severe cases of COVID-19.

We dont want to scare anybody, but kidney damage was initially underreported, and now several studies have shown that it is extremely frequent in hospitalized patients," he said.

Treatment for acute kidney injury usually involves dialysis, which removes toxins from the blood that the kidneys can no longer address. Batlle hopes treatments that address COVID-19-related inflammation and formation of blood clots will eventually reduce such injuries.

We should be better prepared to help these patients and not rely (only)on supportive care, he said.

As coronavirus cases in some states start to rise again, make sure to remember these safety tips. USA TODAY

Since mid-May, dexamethasone and remdesivir have been shown useful for certain COVID-19 patients. Both are recommended by the National Institutes of Health and the Infectious Disease Society of America.

For hospitalized patients, these drugs are beginning to show an effect, said Dr. Rajesh Gandhi, an infectious disease specialist at Massachusetts General Hospital who sits on both panels.

Placing patients on their stomachs rather than their back when they have breathing problems may help, according to some experts.

Gandhi and other doctors said they are much more comfortable treating COVID-19s many symptoms, which can include blood clots, immune problems and organ failure, in addition to lung issues.

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Some said COVID-19 is a multi-system disease, targeting at times the lining of blood vessels. This would explain how it damages so many of the body's organs, all of which are fed by blood vessels.

A study by theRecovery Collaborative Group, still not fully vetted, showed that dexamethasone, at a dose of 6 mg per day for up to 10 days, can be lifesaving for patients with COVID-19 who are on ventilators. The evidence was weaker for patients who are hospitalized and receiving oxygen. The study found no support for giving the steroid to less seriously ill COVID-19 patients, but more research is underway.

According to a study in May in the New England Journal of Medicine,the drug remdesivir, developed to treat Ebola, shortened the recovery time of patients hospitalized with COVID-19 and lower respiratory tract infections.

Scientists said remdesivir might be even more effective in people who are notsick enough to require hospitalization, but because it can be delivered only intravenously, it has not been tested on outpatients. Its manufacturer, Gilead, is rushing to ramp up production and to develop an inhaled version of the drug.

Although remdesivir is helpful, it doesnt cure COVID-19 and is far from a home run, said Dr. Mark Rupp, an infectious disease expert at the University of Nebraska.

Its kind of like getting on base with a single, he said. Weve got a long way to go.

Although its tempting tothrow everything in the medicine cabinet at COVID-19, Rupp said he learned while fighting Ebola in 2014-2015 that its much more important to conduct high-quality clinical research during an outbreak.

Without such research, you throw the kitchen sink at everybody, and you dont know what helps and what hurts and thats a dangerous place to be, he said.

He cited the example of hydroxychloroquine,which was used early on to treat COVID-19 before research showed it was ineffective in very sick patients.

Everybody wants to do good, we want to help our patients, Rupp said. But sometimes well-meaning efforts really dont result in beneficial effects.

Its only by testing drugs and other therapies through clinical trials that doctors learn what works and what doesnt, he said. The more data and information we can gather, the better off were going to be.

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Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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Medical care for very ill COVID-19 patients is getting better - USA TODAY

The Research Brief is a short take about interesting academic work.

Researchers around the world are working frantically to develop COVID-19 vaccines meant to target and attack the SARS-CoV-2 virus. Researchers in my nanoengineering lab are taking a different approach toward stopping SARS-CoV-2. Instead of playing offense and stimulating the immune system to attack the SARS-CoV-2 virus, were playing defense. Were working to shield the healthy human cells the virus invades.

Conceptually, the strategy is simple. We create decoys that look like the human cells the SARS-CoV-2 virus invades. So far, weve made lung-cell decoys and immune-cell decoys. These cell decoys attract and neutralize the SARS-CoV-2 virus, leaving the real lung or immune cells healthy.

To make the decoys, we collect the outer membranes of the lung or immune cells and wrap them around a core made of biodegradable nanoparticles. From the outside the decoys look the same as the human cells they are impersonating. Our decoys are hundreds of times smaller in diameter than an actual lung or immune cell, but they have all the same cellular hardware sticking out of them.

We call them nanosponges because they soak up harmful pathogens and toxins that attack the cells they impersonate. My team and I first developed the concept 10 years ago, and since then weve shown the nanosponges offer a new approach to fighting viral infections like HIV; bacterial infections like methicillin-resistant Staphylococcus aureus, or MRSA, E. coli and sepsis; and inflammatory diseases like rheumatoid arthritis.

We recently published results showing that the SARS-CoV-2 coronavirus binds to these decoy nanosponges, which were more than 90% effective in causing the virus to lose its ability to infect cells in petri dishes. Once the virus is locked into the decoy, it cant invade any real cells, and is cleared by the bodys immune system.

Vaccines are critical for protecting against viral infections, but as viruses mutate they can render vaccines and treatments ineffective. This is why new flu vaccines are developed each year. Fortunately, SARS-CoV-2 doesnt appear to mutate as quickly as influenza viruses, but this highlights the need for alternatives that are unaffected by mutations.

Im hopeful that other teams of researchers come up with safe and effective treatments for COVID-19 as soon as possible. But for now, my team is working and planning as if the world is counting on us.

The different types of nanosponges weve developed are in various stages of pre-clinical development. So far, the results look promising, but there is more work to do to ensure theyre safe and effective.

Cellular nanosponges are a new kind of drug. We made the first nanosponges using human red blood cell membranes, and these are the furthest along in the regulatory process, having undergone all stages of pre-clinical testing.

Cellics Therapeutics, a startup company I co-founded, is in the process of submitting an investigational new drug application to the FDA for the red blood cell nanosponges to treat bacterial pneumonia. If these red blood cell nanosponges get FDA approval and if the pre-clinical data for the COVID-19 nanosponges keep looking good, the COVID-19 nanosponges could have a clearer path to clinical trials in the years ahead.

We are currently testing the nanosponges for SARS-CoV-2 in animals. If the nanosponges do reach the clinical trial stage, there are several ways of delivering the therapy, including direct delivery into the lung for intubated patients via an inhaler like those used by asthmatic patients or through an intravenous injection.

There is also the possibility that our immune-cell nanosponges could soak up the inflammatory cytokine proteins that are triggering the dangerous immune system overreactions in some people suffering from COVID-19.

[You need to understand the coronavirus pandemic, and we can help. Read The Conversations newsletter.]

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Cell-like decoys could mop up viruses in humans including the one that causes COVID-19 - The Conversation US