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Caohuy H, Eidelman O, Chen T, Mungunsukh O, Yang Q, Walton NI, Pollard BS, Khanal S, Hentschel S, Florez C, Herbert AS, Pollard HB. Inflammation in the COVID-19 airway is due to inhibition of CFTR signaling by the SARS-CoV-2 spike protein. Sci Rep 2024; 14:16895. [PMID: 39043712 PMCID: PMC11266487 DOI: 10.1038/s41598-024-66473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/01/2024] [Indexed: 07/25/2024] Open
Abstract
SARS-CoV-2-contributes to sickness and death in COVID-19 patients partly by inducing a hyper-proinflammatory immune response in the host airway. This hyper-proinflammatory state involves activation of signaling by NFκB, and unexpectedly, ENaC, the epithelial sodium channel. Post-infection inflammation may also contribute to "Long COVID"/PASC. Enhanced signaling by NFκB and ENaC also marks the airway of patients suffering from cystic fibrosis, a life-limiting proinflammatory genetic disease due to inactivating mutations in the CFTR gene. We therefore hypothesized that inflammation in the COVID-19 airway might similarly be due to inhibition of CFTR signaling by SARS-CoV-2 spike protein, and therefore activation of both NFκB and ENaC signaling. We used western blot and electrophysiological techniques, and an organoid model of normal airway epithelia, differentiated on an air-liquid-interface (ALI). We found that CFTR protein expression and CFTR cAMP-activated chloride channel activity were lost when the model epithelium was exposed to SARS-CoV-2 spike proteins. As hypothesized, the absence of CFTR led to activation of both TNFα/NFκB signaling and α and γ ENaC. We had previously shown that the cardiac glycoside drugs digoxin, digitoxin and ouabain blocked interaction of spike protein and ACE2. Consistently, addition of 30 nM concentrations of the cardiac glycoside drugs, prevented loss of both CFTR protein and CFTR channel activity. ACE2 and CFTR were found to co-immunoprecipitate in both basal cells and differentiated epithelia. Thus spike-dependent CFTR loss might involve ACE2 as a bridge between Spike and CFTR. In addition, spike exposure to the epithelia resulted in failure of endosomal recycling to return CFTR to the plasma membrane. Thus, failure of CFTR recovery from endosomal recycling might be a mechanism for spike-dependent loss of CFTR. Finally, we found that authentic SARS-CoV-2 virus infection induced loss of CFTR protein, which was rescued by the cardiac glycoside drugs digitoxin and ouabain. Based on experiments with this organoid model of small airway epithelia, and comparisons with 16HBE14o- and other cell types expressing normal CFTR, we predict that inflammation in the COVID-19 airway may be mediated by inhibition of CFTR signaling by the SARS-CoV-2 spike protein, thus inducing a cystic fibrosis-like clinical phenotype. To our knowledge this is the first time COVID-19 airway inflammation has been experimentally traced in normal subjects to a contribution from SARS-CoV-2 spike-dependent inhibition of CFTR signaling.
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Affiliation(s)
- Hung Caohuy
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Consortium for Health and Military Performance (CHAMP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Ofer Eidelman
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Tinghua Chen
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Consortium for Health and Military Performance (CHAMP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Ognoon Mungunsukh
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Consortium for Health and Military Performance (CHAMP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Center for Military Precision Health, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Qingfeng Yang
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Center for the Study of Traumatic Stress (CSTS), and Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Nathan I Walton
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Consortium for Health and Military Performance (CHAMP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | | | - Sara Khanal
- Virology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD, 21702, USA
- The Geneva Foundation, Tacoma, WA, 98402, USA
| | - Shannon Hentschel
- Virology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD, 21702, USA
- Cherokee Nation Assurance, Catoosa, OK, 74015, USA
| | - Catalina Florez
- Virology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD, 21702, USA
- The Geneva Foundation, Tacoma, WA, 98402, USA
| | - Andrew S Herbert
- Virology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD, 21702, USA
| | - Harvey B Pollard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
- Consortium for Health and Military Performance (CHAMP), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
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Wang X, Zhang M, Wei K, Li C, Yang J, Jiang S, Zhao C, Zhao X, Qiao R, Cui Y, Chen Y, Li J, Cai G, Liu C, Yu J, Zhang W, Xie F, Wang P, Zhang Y. Longitudinal Analysis of Humoral and Cellular Immune Response up to 6 Months after SARS-CoV-2 BA.5/BF.7/XBB Breakthrough Infection and BA.5/BF.7-XBB Reinfection. Vaccines (Basel) 2024; 12:464. [PMID: 38793715 PMCID: PMC11125724 DOI: 10.3390/vaccines12050464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
The rapid mutation of SARS-CoV-2 has led to multiple rounds of large-scale breakthrough infection and reinfection worldwide. However, the dynamic changes of humoral and cellular immunity responses to several subvariants after infection remain unclear. In our study, a 6-month longitudinal immune response evaluation was conducted on 118 sera and 50 PBMC samples from 49 healthy individuals who experienced BA.5/BF.7/XBB breakthrough infection or BA.5/BF.7-XBB reinfection. By studying antibody response, memory B cell, and IFN-γ secreting CD4+/CD8+ T cell response to several SARS-CoV-2 variants, we observed that each component of immune response exhibited distinct kinetics. Either BA.5/BF.7/XBB breakthrough infection or BA.5/BF.7-XBB reinfection induces relatively high level of binding and neutralizing antibody titers against Omicron subvariants at an early time point, which rapidly decreases over time. Most of the individuals at 6 months post-breakthrough infection completely lost their neutralizing activities against BQ.1.1, CH.1.1, BA.2.86, JN.1 and XBB subvariants. Individuals with BA.5/BF.7-XBB reinfection exhibit immune imprinting shifting and recall pre-existing BA.5/BF.7 neutralization antibodies. In the BA.5 breakthrough infection group, the frequency of BA.5 and XBB.1.16-RBD specific memory B cells, resting memory B cells, and intermediate memory B cells gradually increased over time. On the other hand, the frequency of IFN-γ secreting CD4+/CD8+ T cells induced by WT/BA.5/XBB.1.16 spike trimer remains stable over time. Overall, our research indicates that individuals with breakthrough infection have rapidly declining antibody levels but have a relatively stable cellular immunity that can provide some degree of protection from future exposure to new antigens.
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Affiliation(s)
- Xun Wang
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Meng Zhang
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, China; (M.Z.); (J.Y.); (S.J.)
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing 210001, China
| | - Kaifeng Wei
- College of Traditional Chinese Medicine·College of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China;
| | - Chen Li
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Jinghui Yang
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, China; (M.Z.); (J.Y.); (S.J.)
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing 210001, China
| | - Shujun Jiang
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, China; (M.Z.); (J.Y.); (S.J.)
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing 210001, China
| | - Chaoyue Zhao
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Xiaoyu Zhao
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Rui Qiao
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Yuchen Cui
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Yanjia Chen
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Jiayan Li
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Guonan Cai
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Changyi Liu
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Jizhen Yu
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Wenhong Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai 200437, China;
| | - Faren Xie
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, China; (M.Z.); (J.Y.); (S.J.)
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing 210001, China
| | - Pengfei Wang
- Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Genetic Engineering, MOE Engineering Research Center of Gene Technology, School of Life Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200437, China; (X.W.); (C.L.); (C.Z.); (X.Z.); (R.Q.); (Y.C.); (Y.C.); (J.L.); (G.C.); (C.L.); (J.Y.)
| | - Yanliang Zhang
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, China; (M.Z.); (J.Y.); (S.J.)
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing 210001, China
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7
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Hampshire A, Azor A, Atchison C, Trender W, Hellyer PJ, Giunchiglia V, Husain M, Cooke GS, Cooper E, Lound A, Donnelly CA, Chadeau-Hyam M, Ward H, Elliott P. Cognition and Memory after Covid-19 in a Large Community Sample. N Engl J Med 2024; 390:806-818. [PMID: 38416429 PMCID: PMC7615803 DOI: 10.1056/nejmoa2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear. METHODS We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating ("brain fog"). RESULTS Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no-Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (-0.23 SD [95% confidence interval {CI}, -0.33 to -0.13] and -0.24 SD [95% CI, -0.36 to -0.12], respectively); larger deficits as compared with the no-Covid-19 group were seen in participants with unresolved persistent symptoms (-0.42 SD; 95% CI, -0.53 to -0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., -0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, -0.20 to -0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, -0.35 SD; 95% CI, -0.49 to -0.20). Results of the analyses were similar to those of propensity-score-matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no-Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (-0.33 to -0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported. CONCLUSIONS Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.).
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Affiliation(s)
- Adam Hampshire
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adriana Azor
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christina Atchison
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - William Trender
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Peter J Hellyer
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Valentina Giunchiglia
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Masud Husain
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Graham S Cooke
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Emily Cooper
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adam Lound
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christl A Donnelly
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Marc Chadeau-Hyam
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Helen Ward
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Paul Elliott
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
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