Total escape of SARS-CoV-2 from dual monoclonal antibody therapy in an immunocompromised patient

Monoclonal antibodies (mAbs) directed against the spike of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are effective therapeutic options to combat infections in high-risk patients. Here, we report the adaptation of SARS-CoV-2 to the mAb cocktail REGN-COV in a kidney transplant patient with hypogammaglobulinemia. Following mAb treatment, the patient did not clear the infection. During viral persistence, SARS-CoV-2 acquired three novel spike mutations. Neutralization and mouse protection analyses demonstrate a complete viral escape from REGN-COV at the expense of ACE-2 binding. Final clearance of the virus occurred upon reduction of the immunosuppressive regimen and total IgG substitution. Serology suggests that the development of highly neutralizing IgM rather than IgG substitution aids clearance. Our findings emphasise that selection pressure by mAbs on SARS-CoV-2 can lead to development of escape variants in immunocompromised patients. Thus, modification of immunosuppressive therapy, if possible, might be preferable to control and clearance of the viral infection.

Impaired immune response drives age-dependent severity of COVID-19

Severity of COVID-19 shows an extraordinary correlation with increasing age. We generated a mouse model for severe COVID-19 and show that the age-dependent disease severity is caused by the disruption of a timely and well-coordinated innate and adaptive immune response due to impaired interferon (IFN) immunity. Aggravated disease in aged mice was characterized by a diminished IFN-γ response and excessive virus replication. Accordingly, adult IFN-γ receptor-deficient mice phenocopied the age-related disease severity, and supplementation of IFN-γ reversed the increased disease susceptibility of aged mice. Further, we show that therapeutic treatment with IFN-λ in adults and a combinatorial treatment with IFN-γ and IFN-λ in aged Ifnar1-/- mice was highly efficient in protecting against severe disease. Our findings provide an explanation for the age-dependent disease severity and clarify the nonredundant antiviral functions of type I, II, and III IFNs during SARS-CoV-2 infection in an age-dependent manner. Our data suggest that highly vulnerable individuals could benefit from immunotherapy combining IFN-γ and IFN-λ.

Probing a southern hemisphere VLBI Intensive baseline configuration for UT1 determination

The deviation of Universal Time from atomic time, expressed as UT1-UTC, reflects the irregularities of the Earth rotation speed and is key to precise geodetic applications which depend on the transformation between celestial and terrestrial reference frames. A rapidly varying quantity such as UT1-UTC demands observation scenarios enabling fast delivery of good results. These criteria are currently met only by the Very Long Baseline Interferometry (VLBI) Intensive sessions. Due to stringent requirements of a fast UT1-UTC turnaround, the observations are limited to a few baselines and a duration of one hour. Hence, the estimation of UT1-UTC from Intensives is liable to constraints and prone to errors introduced by inaccurate a priori information. One aspect in this context is that the regularly operated Intensive VLBI sessions organised by the International VLBI Service for Geodesy and Astrometry solely use stations in the northern hemisphere. Any potential systematic errors due to this northern hemisphere dominated geometry are so far unknown. Besides the general need for stimulating global geodetic measurements with southern observatories, this served as a powerful motivation to launch the SI (Southern Intensive) program in 2020. The SI sessions are observed using three VLBI antennas in the southern hemisphere: Ht (South Africa), Hb (Tasmania) and Yg (Western Australia). On the basis of UT1-UTC results from 53 sessions observed throughout 2020 and 2021, we demonstrate the competitiveness of the SI with routinely operated Intensive sessions in terms of operations and UT1-UTC accuracy. The UT1-UTC values of the SI reach an average agreement of 32 µs in terms of weighted standard deviation when compared with the conventional Intensives results of five independent analysis centers and of 27 µs compared with the 14C04 series. The mean scatter of all solutions of the considered northern hemisphere Intensives with respect to C04 is at a comparable level of 29 µs. The quality of the results is only slightly degraded if just the baseline HtHb is evaluated. In combination with the e-transfer capabilities from Ht to Hb, this facilitates continuation of the SI by ensuring rapid service UT1-UTC provision.

Case Series: Convalescent Plasma Therapy for Patients with COVID-19 and Primary Antibody Deficiency

Patients with primary antibody deficiency are at risk for severe and in many cases for prolonged COVID-19. Convalescent plasma treatment of immunocompromised individuals could be an option especially in countries with limited access to monoclonal antibody therapies. While studies in immunocompetent COVID19 patients have demonstrated only a limited benefit, evidence for the safety, timing, and effectiveness of this treatment in antibody-deficient patients is lacking. Here, we describe 16 cases with primary antibody deficiency treated with convalescent plasma in four medical centers. In our cohort, treatment was associated with a reduction in viral load and improvement of clinical symptoms, even when applied over a week after onset of infection. There were no relevant side effects besides a short-term fever reaction in one patient. Longitudinal full-genome sequencing revealed the emergence of mutations in the viral genome, potentially conferring an antibody escape in one patient with persistent viral RNA shedding upon plasma treatment. However, he resolved the infection after a second course of plasma treatment. Thus, our data suggest a therapeutic benefit of convalescent plasma treatment in patients with primary antibody deficiency even months after infection. While it appears to be safe, PCR follow-up for SARS-CoV-2 is advisable and early re-treatment might be considered in patients with persistent viral shedding.

Within-host evolution of SARS-CoV-2 in an immunosuppressed COVID-19 patient as a source of immune escape variants

The origin of SARS-CoV-2 variants of concern remains unclear. Here, we test whether intra-host virus evolution during persistent infections could be a contributing factor by characterizing the long-term SARS-CoV-2 infection dynamics in an immunosuppressed kidney transplant recipient. Applying RT-qPCR and next-generation sequencing (NGS) of sequential respiratory specimens, we identify several mutations in the viral genome late in infection. We demonstrate that a late viral isolate exhibiting genome mutations similar to those found in variants of concern first identified in UK, South Africa, and Brazil, can escape neutralization by COVID-19 antisera. Moreover, infection of susceptible mice with this patient’s escape variant elicits protective immunity against re-infection with either the parental virus and the escape variant, as well as high neutralization titers against the alpha and beta SARS-CoV-2 variants, B.1.1.7 and B.1.351, demonstrating a considerable immune control against such variants of concern. Upon lowering immunosuppressive treatment, the patient generated spike-specific neutralizing antibodies and resolved the infection. Our results suggest that immunocompromised patients could be a source for the emergence of potentially harmful SARS-CoV-2 variants.

Here, in a longitudinal case study, Weigang et al. demonstrate that evolution of SARS-CoV-2 within a persistently infected immunosuppressed patient can result in the emergence of novel variants with reduced sensitivity to antibody neutralization.

Optimal VLBI baseline geometry for UT1-UTC Intensive observations

One of the main tasks of Very Long Baseline Interferometry (VLBI) is the rapid determination of the highly variable Earth's rotation expressed through the difference between Universal Time UT1 and Coordinated Universal Time UTC (dUT1). For this reason, dedicated one hour, single baseline sessions, called "Intensives", are observed on a daily basis. Thus far, the optimal geometry of Intensive sessions was understood to include a long east-west extension of the baseline to ensure a dUT1 estimation with highest accuracy. In this publication, we prove that long east-west baselines are the best choice only for certain lengths and orientations. In this respect, optimal orientations may even require significant inclination of the baseline with respect to the equatorial plane. The basis of these findings is a simulation study with subsequent investigations in the partial derivatives of the observed group delays τ with respect to dUT1 ∂ τ / ∂ d U T 1 . Almost 3000 baselines between artificial stations located on a regular 10 × 10 degree grid are investigated to derive a global and generally valid picture about the best length and orientation of Intensive baselines. Our results reveal that especially equatorial baselines or baselines with a center close to the equatorial plane are not suited for Intensives although they provide a good east-west extension. This is explained by the narrow right ascension band of visible sources and the resulting lack of variety in the partial derivatives. Moreover, it is shown that north-south baselines are also capable of determining dUT1 with reasonable accuracy, given that the baseline orientation is significantly different from the Earth rotation axis. However, great care must be taken to provide accurate polar motion a priori information for these baselines. Finally, we provide a better metric to assess the suitability of Intensive baselines based on the effective spread of ∂ τ / ∂ d U T 1 .

Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

Objective

Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery.

Methods

A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger.

Results

In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself.

Conclusion

The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain.

Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

Evolution of depression during rehabilitation program in patients with cardiovascular diseases

Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.

Effect of l-theanine tablets in reducing stress-related emotional signs in cats: an open-label field study

Background

L-theanine is an aminoacid found in tea leaves which has relaxing effects in humans and animals. It is a structural analogue of glutamate which can bind glutamate receptors. Although the relaxing action of L-theanine has been shown in humans, laboratory animals and dogs, it has never been published in cats. The goal of this open-label, multicentre and prospective trial was to determine whether an L-theanine based oral supplement (Anxitane®, Virbac, France) could attenuate manifestations of stress in cats under field conditions.

Case presentation

Thirty-three privately owned cats presenting signs associated with stress or fear (inappropriate urination/defecation, fear-induced aggressiveness, hypervigilance/tenseness or physical/functional manifestations of stress) for at least 1 month, were included in the study. They were given L-theanine (Anxitane®, 25 mg twice a day) for 30 days and 20 stress-related parameters were scored at Days 0, 15 and 30. The evolution of some parameters was also rated relative to Day 0. All median scores of the 20 parameters were significantly reduced at D30, and 30/33 cats (91%) had a reduced global score at the end of the study, including 21/33 with ≥50% score reduction. The median (IQR) global scores went from 18 (13-23) at D0 to 11 (8-13) at D15 and 5 (3-12) at D30 (p < 0.0001; Friedman test; significant reduction starting from D15). All the stress-related signs were significantly improved compared to D0, according to the owners, especially inappropriate elimination. Tablet palatability was judged good or very good in 94% of cases with spontaneous intake by cats when given by hand or in food. Tolerance was satisfactory as well, and no side effects were reported, so that most owners (27/33; 82%) were satisfied with the product.

Conclusions

Despite the lack of a placebo group, it can be concluded that L-theanine (Anxitane®) helped to improve the undesirable manifestations of stress in cats in as soon as 15 days, though better results could be seen after 30 days of administration. These encouraging results show that L-theanine can help manage stress-related behaviour, but additional trials with a placebo group should be run to confirm this effect.

[Relationship between exercise dependence and big five personality]

INTRODUCTION

Despite the increased interest in exercise dependence, there is limited research examining the personality characteristics of exercise dependent individuals. Furthermore, researchers examining the relationship between exercise dependence and personality have found inconsistent results. This maybe the result of the varying methods used by researchers to assess exercise dependence and personality.

AIM OF THE STUDY

The purpose of this study was to examine the relationship between exercise dependence and personality, and that determine whether there is an addictive personality type. Participants were 484 university students (M=21.24, SD=3.03), and 322 sport leisure participants (M=30.08, Sd=13.58) who completed multidimensional assessments of exercise dependence and personality.

INSTRUMENTS

to assess exercise dependence, the EDS-R (French version, Kern, L, 2007, Validation de l'adaptation française de l'échelle de dépendance à l'exercice physique : l'EDS-R Pratiques Psychologiques, 13, 4, 425-441) was undertaken. This scale is based on the DSM_IV criteria for substance dependence which are: withdrawal effects, intention effects, lack of control, time, reductions in other activities, continuance. The D5D was chosen to assess the big five personality dimensions (Rolland, J.-P., & Mogenet, J.-L. (1994). Manuel du système d5d. Paris: ECPA.). These dimensions are: Extraversion, Emotional Stability, Agreeableness, Conscientiousness, and Openness to Experience. To examine the predictive relationship of personality for exercise dependence symptoms, a series of multiple regressions was carried out.

RESULTS

Results show that, according to the status of the people under scrutiny, it is either openness to experience and emotional stability or openness to experience and agreeableness which explain the greatest variance of exercise dependence. Then, the description of a personality type seemed very difficult to obtain. We feel it's important to know the personality type, but not sufficient; it is more pertinent to know the type of personality. Then, further research could examine the relationship between personality disorder and exercise dependence. In contrast with the literature, we did not find a relationship between exercise dependence and extraversion.

Applications of integrated data mining methods to exploring natural product space for acetylcholinesterase inhibitors

Nature, especially the plant kingdom, is a rich source for novel bioactive compounds that can be used as lead compounds for drug development. In order to exploit this resource, the two neural network-based virtual screening techniques novelty detection with self-organizing maps (SOMs) and counterpropagation neural network were evaluated as tools for efficient lead structure discovery. As application scenario, significant descriptors for acetylcholinesterase (AChE) inhibitors were determined and used for model building, theoretical model validation, and virtual screening. Top-ranked virtual hits from both approaches were docked into the AChE binding site to approve the initial hits. Finally, in vitro testing of selected compounds led to the identification of forsythoside A and (+)-sesamolin as novel AChE inhibitors.

Effect of S-adenosylmethionine tablets on the reduction of age-related mental decline in dogs: a double-blinded, placebo-controlled trial

Oral S-adenosylmethionine (SAMe) tosylate supplementation (Novifit tablets, Virbac) was evaluated as a dietary aid for the management of age-related mental impairment in dogs. Thirty-six dogs older than 8 years that had displayed signs of cognitive dysfunction for at least 1 month were selected for the study. The dogs were administered 18 mg/kg SAMe tosylate (n=17) or identical placebo tablets (n=19) for 2 months. Concurrent behavioral treatment was forbidden. A 14-item standardized questionnaire evaluated behavior and locomotion difficulties. Compared with the placebo group, SAMe-treated dogs showed greater improvement in activity (41.7% versus 2.6% after 4 weeks, P<.0003; 57.1% versus 9.0% after 8 weeks, P<.003) and awareness (33.3% versus 17.9% after 4 weeks, P<.05; 59.5% versus 21.4% after 8 weeks, P<.01). The aggregate mental impairment score was reduced by more than 50% in 41.2% and 15.8% of dogs treated with SAMe and placebo, respectively, at week 8. SAMe tosylate tablets proved safe and effective in improving signs of age-related mental decline in dogs.

Analysis of the estrogen regulation of the zebrafish estrogen receptor (ER) reveals distinct effects of ERalpha, ERbeta1 and ERbeta2

We have previously cloned and characterized three estrogen receptors (ER) in the zebrafish (zfERalpha, zfERbeta1 and zfERbeta2). We have also shown that they are functional in vitro and exhibit a distinct expression pattern, although partially overlapping, in the brain of zebrafish. In this paper, we have shown that the hepatic expression of these zfER genes responds differently to estradiol (E2). In fact, a 48-h direct exposure of zebrafish to E2 resulted in a strong stimulation of zfERalpha gene expression while zfERbeta1 gene expression was markedly reduced and zfERbeta2 remained virtually unchanged. To establish the potential implication of each zfER in the E2 upregulation of the zfERalpha gene, the promoter region of this gene was isolated and characterized. Transfection experiments with promoter-luciferase reporter constructs together with different zfER expression vectors were carried out in different cell contexts. The data showed that in vivo E2 upregulation of the zfERalpha gene requires ERalpha itself and a conserved transcription unit sequence including at least an imperfect estrogen-responsive element (ERE) and an AP-1/ERE half site at the proximal transcription initiation site. Interestingly, although in the presence of E2 zfERalpha was the most potent at inducing the expression of its own gene, the effect of E2 mediated by zfERbeta2 represented 50% of the zfERalpha activity. In contrast, zfERbeta1 was unable to upregulate the zfERalpha gene whereas this receptor form was able to tightly bind E2 and activate a reporter plasmid containing a consensus ERE. Altogether, these results indicated that the two ERbeta forms recently characterized in teleost fish could have partially distinct and not redundant functions.

Peptide insertion in the DNA-binding domain of fish glucocorticoid receptor is encoded by an additional exon and confers particular functional properties

The trout glucocorticoid receptor (rtGR) contains an additional sequence of nine amino acids located between the two zinc fingers of the DNA-binding domain (DBD) (Endocrinology 136 (1995) 3774). Polymerase chain reaction on trout genomic DNA and sequencing were performed in the DBD region, demonstrating that this peptide is encoded by an additional exon of 27 nucleotides between the two exons encoding the two zinc fingers of other nuclear receptors. This additional sequence in the rtGR confers a better binding affinity of the receptor to a single GRE, as shown by gel shift experiments with GST-DBDrtGR fusion proteins, deleted or not of the nine amino acids (Delta9). This higher affinity is correlated with a higher constitutive transcriptional activity of the receptor on a reporter gene driven by a single GRE, but not with the ligand-induced transcriptional activity. Nevertheless, on a double GRE, the wild type and rtGR-Delta9 are equally active on both constitutive or dexamethasone-induced transcriptional activity. This original DBD structure could have emerged during evolution such as to allow better regulation of glucocorticoid dependent genes in relation to the large spectrum of cortisol physiological functions in fish.

"Pseudo" twin-to-twin transfusion syndrome and fetal outcome

OBJECTIVE

To assess the fetal outcome, in a tertiary center, in pregnancies with suspected twin-to-twin transfusion syndrome (TTTS) not confirmed using ultrasonographic examination, diagnosis of pathology, or both.

STUDY DESIGN

Forty-four pregnancies with suspected TTTS were followed longitudinally using ultrasonographic examination until delivery. The minimal criteria for the diagnosis of TTTS were: (1) suspicion of monochorionicity gleaned from ultrasound examination (to be confirmed at birth); (2) presence of polyhydramnios in one gestational sac (either assessed subjectively--or, finding that the largest vertical pocket of amniotic fluid was >8 cm in diameter before 20 weeks' gestation and >10 cm in diameter thereafter); and (3) presence of oligohydramnios in the other gestational sac (finding either that there was a "stuck" twin complication or that the largest vertical pocket of amniotic fluid was <1 cm in diameter). When one of the above criteria was not present, the pregnancy was defined as "pseudo" TTTS. Fetal outcome in "pseudo" TTTS was analyzed according to the relative size of the neonate (large or small) and whether the cord insertion was normal or velamentous.

RESULTS

There were 18 cases of "pseudo" TTTS. No treatment in utero was necessary in any of the 18 pregnancies. The mean gestational age was 21.9 +/- 3.7 (1 SD) weeks at diagnosis and 33.0 +/- 3.0 weeks at delivery. The average weight discrepancy between the twins at birth was 34.3 +/- 14.8%. There were three fetal demises of the small twin and one neonatal demise of the large twin (p > 0.05). Large twins developed respiratory distress syndrome (RDS) more often than small twins (p < 0.05). Five percent of the large twins and 50% of the small twins had a velamentous insertion of the cord (p < 0.05).

CONCLUSION

In pregnancies complicated by "pseudo" TTTS our data indicate that: (1) small twins have abnormal cord insertion more frequently than large twins, (2) large twins develop RDS more frequently than small twins. Our data suggest that the perinatal mortality in these pregnancies appears to be lower than that reported for the classical TTTS.

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.