In his weekly clinical update, Dr. Griffin discusses how vaccination and vaccine hesitancy affects public health and disease spread in terms of mpox, the first human death from H5N1 in US, why one should not feed their pets raw pet food and the metapneumonia outbreak in China before reviewing the recent statistics on RSV, influenza and SARS-CoV-2 infections, the WasterwaterScan dashboard, where to find PEMGARDA, how nirmatrelvir-ritonavir/Paxlovid reduces adverse outcomes of COVID in patients with kidney disease, provides information for Columbia University Irving Medical Center’s long COVID treatment center, SARS-CoV-2 infection affects skin conditions including shingles and if long antiviral treatment affects long COVID.
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Links for this episode
- Mpox vaccination hesitancy, previous immunisation coverage, and vaccination readiness in the African region (eClincial Medicine)
- Global prevalence and correlates of mpox vaccine acceptance and uptake (Communications Medicine)
- First case of new mpox variant in France (Reuters)
- First “Bird flu” death in US (NY Times)
- Emerging threat of H5N1 to human health (NEJM)
- Don’t feed your pets raw food (County of Los Angeles Public Health)
- Oregon, nationwide raw pet food recall (CIRAP)
- Raw cat food avian flu, is this like raw milk? (CIDRAP)
- Human metapneumovirus surging in China (The Guardian)
- Viral video of viral chaos: human metapneumovirus in Chinese hospital (The Economic Times)
- Human metapneumovirus in China (NY Times)
- Acute respiratory infections including human metapneumovirus in northern hemisphere (WHO)
- Waste water scan for 11 pathogens (WastewaterSCan)
- US respiratory virus activity (CDC Respiratory Illnesses)
- Weekly surveillance report: clift notes (CDC FluView)
- RSV: Waste water scan for 11 pathogens (WastewaterSCan)
- RSV-Network (CDC Respiratory Syncytial virus Infection)
- US respiratory virus activity (CDC Respiratory Illnesses)
- Waste water scan for 11 pathogens (WastewaterSCan)
- COVID-19 deaths (CDC)
- COVID-19 national and regional trends (CDC)
- COVID-19 variant tracker (CDC)
- SARS-CoV-2 genomes galore (Nextstrain)
- Where to get pemgarda (Pemgarda)
- EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD)
- Fusion center near you….if in NY (Prime Fusions)
- CDC Quarantine guidelines (CDC)
- NIH COVID-19 treatment guidelines (NIH)
- Infectious Disease Society guidelines for treatment and management (ID Society)
- Drug interaction checker (University of Liverpool)
- The effect of nirmatrelvir-ritonavir on short- and long-term adverse outcomes from COVID-19 among patients with kidney disease (OFID)
- Paxlovid tied to lower risk of hospital stay, heart problems, death in adults with kidney disease and COVID (CIDRAP)
- Molnupiravir safety and efficacy (JMV)
- Convalescent plasma recommendation for immunocompromised (ID Society)
- What to do when sick with a respiratory virus (CDC)
- When your healthcare provider is infected/exposed with SARS-CoV-2 (CDC)
- Managing healthcare staffing shortages (CDC)
- Steroids, dexamethasone at the right time (OFID)
- Anticoagulation guidelines (hematology.org)
- Daniel Griffin’s evidence based medical practices for long COVID (OFID)
- Long COVID hotline (Columbia : Columbia University Irving Medical Center)
- Chronic urticaria, vitiligo, alopecia areata, and herpes zoster following COVID-19 infection (Journal of Dermatology)
- Impact of extended-course oral nirmatrelvir/ritonavir in established Long COVID:
- (Communications Medicine)
- Letters read on TWiV 1182
- Dr. Griffin’s COVID treatment summary (pdf)
- Timestamps by Jolene. Thanks!
Intro music is by Ronald Jenkees
Send your questions for Dr. Griffin to [email protected]
The post TWiV 1182: Clinical update with Dr. Daniel Griffin first appeared on This Week in Virology.
The ‘letters read’ link points to page for twiv 349 rather than 351
Thanks, Steen, for always catching my errors. Fixed.
My pleasure! Every twiv link is worth clicking on!
Firstly, we would like to thank you for the segment on the current debate as to the mechanism of how viruses can become attenuated through wholescale genome modification. We really appreciated the comments made during the discussion – and enjoyed listening to the viewpoints of those on the panel.
At one point during the discussion it was suggested RNA structure could play a
role in the mechanism of attenuation. This had occurred to us, too, so we included a permuted control in our studies (Atkinson et al., 2014; http://www.ncbi.nlm.nih.gov/pubmed/24470146 and eLife paper). Here, the peptide sequence was maintained, but we randomised the order of codon usage – whilst preserving CpG/UpA dinucleotide frequencies. Permuting codon usage in this manner would destroy any undetected RNA structures within these regions of the viral sequence. The replication kinetics of this mutant virus were identical to wild-type, supporting the notion that in this case RNA secondary structure is not involved in virus attenuation.
A key point was made about the use of cell-free translation systems to analyse protein synthesis in the absence of any cellular innate immunity-based translational control mechanisms. We, and Burns et al.,(2006; http://www.ncbi.nlm.nih.gov/pubmed/16537593), carried out such experiments and did not observe any differences in protein synthesis between wild-type and the different mutant viruses.
Whilst the mechanism of attenuation remains unknown, data generated by Atkinson et al., (2014) demonstrated that high and low CpG/UpA mutated genomes were not sensitive to the cellular IFN response but were, however, sensitive to the addition of the kinase inhibitor C16 (thought to be PKR specific; Jammi et al., 2003): the replication phenotype reversed following inhibitor treatment. With regards to the Dengue paper under discussion, (i) the results in BHK cells and (ii) the effects of the Jak inhibitor 1 upon the attenuated phenotype of both the hmin and NS3hmin viruses (in accord with the C16 Atkinson data), suggest attenuation occurs through an unknown component of a cellular stress response pathway – and does not support the hypothesis of attenuation arising from a defect in translation.
Again, thank you for highlighting and discussing this topic.
We think you all agreed it is certainly very interesting and we hope your
listeners enjoy the podcast as much as we did.
Fiona Tulloch, Peter Simmonds, David Evans and Martin Ryan.
Thanks for your comments, Fiona. Do listen to TWiV #353, as there is a letter from a listener relevant to the mechanism of attenuation. I agree it’s not translation.
24:00 table 2 irrelevant to the argument. Even if it were true that some
group used
publication “tricks” (or bad newspaper headlines, Vincent’s favourite) to
get more attention,
that doesn’t tell us anything about the correct,reasonable judgement of the
issue.
24:50 Frankenstein does not apply. This is not a public (artificial fear)
debate,
but rather an experts discussion.
25:55 lots of laughter (I didn’t understand, somehow about the origin of
science-fear)
27:00 Pittsburg center = origin of (evil) GOF-critics
[ if they become right, TWiV will enter history as the center of
GOF-dangers ignorism ?! ]
[ attacking the arguers, not the argument ]
27:30
1977 is no longer an argument ?
Why would a vaccine trial that went wrong be _any_ better
than a lab escape wrt. that science-distrust – Frankenstein theme
or the other examples that gave you so much laughter ?
There was a danger that the scientists didn’t consider enough
in their research. It can’t happen again, because now we know
about that danger and such trials won’t be done ? (in humans)
What’s the logic ?
Besides that, I think the paper does bad science.
When you consider all the segments, not just HA, then it’s clear
that the common ancester is in summer or fall 1976.
And the 4-places virus became extinct while the Hongkong virus
did spread worldwide. They also don’t mention the earthquake
and the political trouble in 1976. Looks agenda-driven to me.
As for the codon-bias, I remember that Wimmer also used codon
de-optimization for
flu (PR8,1934), see TWiV236,10:00-26:20.
I first saw
it in a 2006-paper by Rabadan (Columbia,who was also in TWiV, afair) who
showed
that Avian and Human flu can be distinguished by their Nucleotide-bias
:
human ones have more A,T which was astonishing to me at that time.
Wimmer et.al. use this for de-optimization and vaccine, but it is clear
that the same could
be used for optimization. TWiV didn’t mention this …
It will probably be more difficult to optimize than to deoptimize, but
eventually they might
get the patterns and use computers to effectively
optimize viruses.
Similar to what was done with reassortment until it was
“stopped”.
23:00
I couldn’t find the letter on TWiV 353 which led to discussion of the
mechanism
BTW., I get this error here:
https://wordpress.org/support/topic/disqus-browser-legacy-error
searching google-scholar for citations of that Wimmer et.al.
paper on influenza codon-de-optimization :
—————————————————————————–
http://www.nature.com/nrm/journal/v15/n2/abs/nrm3738.html
[2014] Recent
progress in DNA manipulation and gene circuit engineering has greatly
improved our ability to programme and probe mammalian cell behaviour. These
advances
have led to a new generation of synthetic biology research tools and
potential therapeutic
applications. Programmable DNA-binding domains and RNA regulators are
leading to
unprecedented control of gene expression and elucidation of gene function.
Rebuilding
complex biological circuits such as T cell receptor signalling in isolation
from their
natural context has deepened our understanding of network motifs and
signalling
pathways. Synthetic biology is also leading to innovative therapeutic
interventions
based on cell-based therapies, protein drugs, vaccines and gene
therapies.
——————————————————————————-
http://www.sciencedirect.com/science/article/pii/S0167779911001636
Genetic design automation: engineering fantasy or scientific renewal?
————————————————————————————
Large-scale de novo DNA synthesis: technologies and
applications
————————————————————————————-
http://www.pnas.org/content/110/23/9481.short
A long-held dogma posits that strong presentation to the immune system of
the dominant
influenza virus glycoprotein antigens neuraminidase (NA) and hemagglutinin
(HA) is
paramount for inducing protective immunity against influenza virus
infection. We have
deliberately violated this dogma … We conclude that the suppression of
HA and NA
is a unique strategy in live vaccine development.
[cited by 21 at google scholar]
——————————————————————–
Efficient manipulations of synonymous mutations for controlling translation
rate:
an analytical approach
————————————————————————
Species-specific codon context rules unveil non-neutrality effects of
synonymous
mutations
————————————————————————–
Many ways to make an influenza virus–review of influenza virus reverse
genetics
methods
———————————————————————–
Slow fitness recovery in a codon-modified viral
genome
——————————————————————–
Pandemic influenza A virus codon usage revisited: biases, adaptation and
implications
for vaccine strain development
———————————————————————–
Synthetic genomics and synthetic biology applications between hopes and
concerns
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580775/
——————————————————————-
http://jvi.asm.org/content/88/18/10525.full.pdf
[they have an algorithm to de-optimize, they detect variants that are
likely less optimal.
You can use the same for optimizing. If you know which variants are likely
less
optimal, then you also know which variants are likely more optimal]
—————————————————————————-
Codon usage in vertebrates is associated with a low risk of acquiring
nonsense
mutations
—————————————————————
Synthetic genomics: from synthesis of prokaryotic genomes to synthesis of a
fully
functional eukaryotic chromosome
… It also raises concerns about the risks of its use in bioterrorism.
…
———————————————————–
Event report: SynBio Workshop (Paris 2012)–Risk assessment challenges of
Synthetic
Biology
————————————————————-
live attenuated influenza vaccine (LAIV)
mimics natural virus
infection, which consequently has risks and benefits [37]
——————————————————————————–
http://jvi.asm.org/content/early/2015/08/07/JVI.01443-15.short
[Aug.2015] converting its codon usage … to avian … gave a new H1N1
attenuated
in humans but not in eggs
[as well you could start with an avian flu virus and convert its codon
usuage to human.
[[There you have your possible Frankenvirus]
use reassortments and assaging to improve the process. Make a statistics,
figure out
which start-viruses lead to most virulent end-results. Find the
patterns]]
[[[ loss of function research can be abused for gain-of-function ]]]
——————————————————————————
Large-Scale Nucleotide Optimization of Simian Immunodeficiency Virus
Reduces Its
Capacity To Stimulate Type I Interferon In Vitro
——————————————————————————
If you read Wimmer’s papers, he shows that the WT viral nucleotide sequence is as good as it can be. Increasing the number of overrepresented codon pairs in a gene does not make the gene functionally better in most cases. Data that is yet to be published shows only a modest increase is possible in Eukaryotic genes, and no increase in virulence has ever been found with “optimization”.
Small viruses have so much evolutionary pressure selection that every nucleotide is optimized in the wildtype sequence for virulence. Remember that just producing more protein may not be helpful to a virus. The sequence of the gene is such that it fine tunes the level of each protein to what is needed. More protein may not always be better.
but you might adapt an avian flu to humans (mice first) this way ?!