A Newly Discovered Coronavirus Variant

Introduction

A new variant of the SARS-CoV-2, known as B.1.1.7, has been discovered in the rising cases in the United Kingdom and has been spreading very rapidly. The U.K. government estimates that the new coronavirus strain is more than 70% transmissible than other variants currently in circulation. 

This new variant of the coronavirus has come to the attention of researchers in mid-December when there was a surge in coronavirus cases as well as it began to show up more frequently in patient samples from various parts of Southern England. However, it seems that this variant has been collected from patients from early September. The new variant of the disease was first detected in September, by November a quarter of new cases in London were attributed to it. However, by mid-December, it had reached three-quarters of all new cases. The mutated coronavirus strain that’s been spreading in the U.K. appears to be more contagious which will likely lead to higher levels of hospitalizations, placing further strain on health care systems around the world

The new variant of COVID-19 involves mutations in the structure of the virus. Jeffrey Barrett, director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute in the UK, noted that 23 nucleobases of the virus’s genetic code had changed, including 17 that could potentially impact the way the virus behaves and spreads.

Actions Taken Against the New SARS-CoV-2 Strain

Currently, over 40 countries have suspended travel with the United Kingdom in response to this new strain. Various European countries along with other countries are restricting travel from Britain since the new variant of the SARS-CoV-2 virus is spreading very rapidly in the United Kingdom. For example, according to the Ministry of External Affairs (MEA), India has temporarily suspended its Vande Bharat flights from the United Kingdom due to the emergence of a new strain of coronavirus. 

Countries throughout Europe and the world announced that they would no longer admit any travelers from Britain, which includes Austria, Belgium, Italy, Ireland, Germany, France, and the Netherlands. Additionally, Boris Johnson, the prime minister of the United Kingdom, had introduced a new “Tier 4” level of restrictions, affecting 16.4 million people, including around 9 million people in all 32 London boroughs and much of southeast England.

Is the New Coronavirus Variant in the United States?

Currently, the new coronavirus variant has been identified the state of Colorado. No other US State has identified the variant yet. However, ongoing travel between the United States and the United Kingdom coupled with the increasing prevalence of the new variant in the UK makes the likelihood of it arriving in the US extremely high   Furthermore, only about 51,000 viruses of the 17 million US cases have been sequenced.   Given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected.

Dr. Fauci, the United States leading infectious diseases expert, said on “Good Morning America” Tuesday morning that it’s “certainly possible” that the strain has hit the U.S. already. “When you have this amount of spread within a place like the U.K., you really need to assume that it’s here already … it certainly is not the dominant strain but I would certainly not be surprised at all if it is already here,” Fauci warns. 

Implications of the New COVID-19 Variant

There are many potential consequences of the new COVID-19 variant. For example, the new COVID-19 variant is able to spread more quickly in humans. There is already evidence that one mutation, D614G, has this property to spread more quickly. In the lab, G614 variants propagate more quickly in human respiratory epithelial cells, out-competing D614 viruses. There also is evidence that the G614 variant spreads more quickly than viruses without the mutation.

Although there is currently no evidence whether or not the new COVID-19 variant is able to produce more severe illness than the other coronavirus variants, this new strain has the ability to cause either milder or more severe disease in humans. Furthermore, the new COVID strain has the ability to evade vaccine-induced immunity. This is because FDA-authorized vaccines are “polyclonal” which means that it has the capability to produce antibodies that target several parts of the spike protein. The virus would likely need to accumulate multiple mutations in the spike protein to evade immunity induced by vaccines or by natural infection.

Lastly, the new variant has the ability to evade vaccine-induced immunity. This brings up a concern that once a large proportion of the world’s population is vaccinated, there will be an immense amount of pressure that could favor and accelerate the emergence of such variants by selecting for “escape mutants.” Though there is no evidence that this is currently occurring, many experts believe that escape mutants are unlikely to emerge because of the nature of the virus.

Will the recent vaccines that are in the process of distribution protect us against the new COVID strain?

Pfizer and Moderna have recently started to administer COVID-19 vaccinations on health workers and at-risk people. With the discovery of the new COVID strain, Pfizer and Moderna are in the process of testing their FDA-authorized vaccines against the new strain of the virus. Both of these companies anticipate that it will take about a couple of weeks before they can confirm whether or not their vaccine will protect us against the new coronavirus strain. As of now, there is no evidence that the vaccines will not be effective against the new strain. 

However, Moderna expects its mRNA-based vaccine, mRNA-1273, will provide immunity against the new strain. On the other hand, Pfizer is generating data on neutralizing the new strain from blood samples of people immunized with their vaccine.

Some experts believe that mRNA-based vaccines will likely be effective against the new coronavirus strain found in the United Kingdom. This is due to the fact that the genetic material in mRNA-based vaccines can be quickly re-engineered to match that of the mutated protein. However, many experts believe that the new strain may reduce the efficacy rates of the vaccines. 

Conclusion

As countries around the world are beginning to roll out coronavirus vaccines, the U.K. reported yet another strain of the virus which is reported to be even more transmissible than the recently discovered B117 strain. At present, scientists and researchers have not found the said variant of the virus more deadly but have found it 70% more transmissible than its previous versions. Scientists are vigilantly researching this new COVID strain and are trying to determine the current vaccine efficacy against the new variant. The question of when COVID-19 will come to an end still remains unclear. The only way to find out is by testing patients and analyzing case studies to find answers to the questions and concerns on the rise regarding the new mutation of COVID-19. 

Samiksha Komatireddy, Youth Medical Journal 2020

References

[1] “The Guardian View on a New Covid Strain: a More Stringent Lockdown Beckons | Editorial.” The Guardian, Guardian News and Media, 20 Dec. 2020, www.theguardian.com/commentisfree/2020/dec/20/the-guardian-view-on-a-new-covid-strain-a-more-stringent-lockdown-beckons.

[2] Bloomberg.com, Bloomberg, www.bloomberg.com/news/articles/2020-12-24/new-virus-strain-s-transmissibility-to-cause-more-deaths-study.

[3] Times, Los Angeles, and Jennifer Gould. “New, More Infectious Strain of Coronavirus Worries California.” KTLA, KTLA, 22 Dec. 2020, ktla.com/news/california/new-more-infectious-strain-of-coronavirus-worries-california/.

[4] (WFAA), Author: William Joy. “Disease Experts Urge Caution, Not Panic over New Strain of COVID-19.” Wfaa.com, 24 Dec. 2020, www.wfaa.com/article/news/health/coronavirus/disease-experts-urge-caution-not-panic-over-new-strain-of-covid-19/287-e6439ea4-1b25-4287-add2-725a8755190b.

[5] McKie, Robin. “What Is the New Covid Strain – and Will Vaccines Work against It?” The Guardian, Guardian News and Media, 19 Dec. 2020, www.theguardian.com/world/2020/dec/19/what-is-the-new-covid-strain-and-will-vaccines-work-against-it.

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Newly Discovered Gene Mutant Reveals New Mechanisms for Heart Failure

Introduction

Dilated cardiomyopathy is a disease of the heart muscle where the ventricle of the heart stretches and dilates and can’t pump blood as well, usually starting in the left ventricle of the heart. While the cause of dilated cardiomyopathy often can’t be determined, numerous factors can cause the left ventricle to dilate and weaken, including diabetes, obesity, hypertension, alcohol abuse, certain cancer medications, cocaine use and abuse, infections, including those caused by bacteria, viruses, fungi, and parasites, exposure to toxins, such as lead, mercury, and cobalt, arrhythmias and complications of late-stage pregnancy. Ultimately, poor blood flow from the left ventricle can lead to heart failure. Additionally, enlargement of the left ventricle may make it harder for your heart valves to close, causing a backward flow of blood and making your heart pump less effectively. Dilated cardiomyopathy can also cause your heart to suddenly stop beating. 

Figure 1: This figure shows an illustration of a normal heart versus a heart affected by dilated cardiomyopathy. The differences are clear that a heart affected with dilated cardiomyopathy has thickened walls due to the enlargement of the left ventricle. 

About ten years ago, a pediatric cardiologist at Mayo Clinic, had traced this disease to a genetic mutation in a gene known as RBM20. This gene causes cardiomyopathy to affect patients ages as early as young adulthood. 

Analysis of Research and Study

Although in the past ten years, heart failure in the RBM20 form of cardiomyopathy was connected to the abnormal splicing of genes for proteins that help the heart’s muscles contract, the new research suggests that the mutant RBM20 actually damages the heart muscle cells. The damage is done through the buildup of pathological ribonucleoprotein granules which end up harming everything inside the healthy cells. This causes the formation of the new version of dilated cardiomyopathy. Dr. Tim Nelson MD, Ph.D., who is the research study lead author and director, and his team had created the first-ever large animal model. Their model was of a pig that was born with the human gene RBM20 for dilated cardiomyopathy. Their model includes a display of all the signs and symptoms of heart failure. Within months, the large animal model had allowed them to further look into the gene and study the development of dilated cardiomyopathy where on the contrary it takes more than 20 years for results to show for dilated cardiomyopathy in humans. 

Dr. Nelson and his team had conducted a simple staining test using pig heart tissue samples that contained RNA-binding protein. Their discovery was verified using a similar study conducted one decade ago using tissue samples from Dr. Olson, a pediatric cardiologist at Mayo Clinic, RBM20 dilated cardiomyopathy human patient tissue. 

Dr. Nelson and his team say that it is important to comprehend that there could be young children to adults who may be suffering from dilated cardiomyopathy due to the RBM20 gene mutant. Dr. Nelson says, “We have taken these findings back into the lab and developed cell cultures to test new therapeutics. The future of this research is focused on moving discoveries out of the lab and into clinical trials to make new therapies available to our patients. This research is a very important catalytic step to do that.” (Tim Nelson, MD, Ph.D., Study Lead Author, and Director, Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome, Mayo Clinic). 

Usually, the overload of protein granules in cells happens in the brain or the spinal cord. However, due to this recent discovery, it has now been found that overgrowth of protein granules in cells can also occur in the heart. However, the benefit of this is that the heart is a much larger and more accessible organ compared to the brain tissue or the spinal cord. Dr.Jay Schneider, MD, Ph.D., who is a Mayo Clinic cardiologist and first author of the study conducted says, “[…] we can study and develop therapies to prevent the buildup of these toxic granules at the beginning of life instead of waiting 50 years or more for a degenerative disease to appear clinically. This is a huge advantage that should accelerate drug discovery in ribonucleoprotein granule degenerative diseases of the heart and nervous system.” 

Conclusion

Dilated cardiomyopathy is the most common type of genetic heart disease, occurring mostly in adults 20 to 60. It affects the heart’s ventricles and atria, in the lower and upper chambers of the heart. However, new research shows that the new form of RBM20 dilated cardiomyopathy can also affect young adults and can lead to heart valve problems, arrhythmias, and blood clots in the heart. There is still much to be discovered on this new gene mutant and its effects causing heart failure. 

Samiksha Komatireddy, Youth Medical Journal 2020

References

[1] Henderson, Reviewed by Emily. “Research on Genetic Heart Disease Uncovers New Mechanism for Heart Failure.” News, 19 Nov. 2020, 

www.news-medical.net/news/20201119/Research-on-genetic-heart-disease-uncovers-new-mechanism-for-heart-failure.aspx.

[2] Ani. “Cellular Pathway of Genetic Heart Disease Similar to Neurodegenerative Disease: Health.” Devdiscourse, Devdiscourse, 19 Nov. 2020,

www.devdiscourse.com/article/health/1313544-cellular-pathway-of-genetic-heart-disease-similar-to-neurodegenerative-disease.

[3] “RWJBarnabas Health, Inc.” RWJBarnabas Health, 

www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/cardiomyopathy/.

Neurological Complications of COVID-19

COVID-19 Background

COVID-19, also known as Severe Acute Respiratory Syndrome Coronavirus Two (SARS-CoV-2 for short), is an infectious respiratory illness that is the cause of the “COVID-19 Pandemic”. The first case of this respiratory illness was reported in late December 2019 in Wuhan, China. From December 2019 to present day, there has been a rapid increase in cases with the United States being a contender for the most cases at a total of more than seven million cases and approximately 210,000 deaths. Worldwide, there are a total of almost thirty-eight million cases with about one million deaths. 

Neurological Complications

COVID-19 impacts the neurological functioning of many people diagnosed with this illness and causes detrimental effects to the nervous system. This is leading to a rise in mortality in the ceaseless COVID-19 pandemic. Currently, there are many efforts being made in research to uncover many of the neurological complications in patients affected by COVID-19. These complications include headache, dizziness, myalgia, loss of smell and taste, with more serious complications including the worsening of strokes and seizures. It remains uncertain where the development of these complications occur, although it seems that these complications are typically prevalent in older patients with pre-existing risk factors which include Type two diabetes, cancer, chronic kidney disease, sickle cell disease, coronary artery disease, etc. Neurological functioning is being impacted by COVID-19 mainly due to hypoxic-ischemic injury to the brain. In other words, COVID-19 is causing a lack of oxygen in the brain because of low oxygen levels in the blood.

Figure 1: SARS-CoV-2 invasion of the CNS and symptoms of the direct invasion. 

CNS = central nervous system; BBB = blood-brain barrier

There have also been reports of brain inflammation as one of the neurological complications of COVID-19. Many of the people who went through the symptoms of having brain inflammation also experienced a rare disorder which is called acute demyelinating encephalomyelitis (ADEM). ADEM is triggered by the viral infections of the SARS-CoV-2 which leads to damage of the myelin sheaths that surround the nerves in the brain. This disturbs the homeostasis of the brain and causes death of the neurons. 

In order for the brain to remain at the optimal level of homeostasis, the autonomic nervous system and its related limbs have to function properly.  Another neurological disorder that is the result of COVID-19 is Guillain-Barré syndrome. Guillain-Barré syndrome is a rare neurological disorder in which the immune system attacks healthy nerves in the body. This disorder is also involved in the damage of the myelin sheath. Overall, the main neurological complications of COVID-19 include seizures, brain inflammation (ADEM), anosmia, hypoxia, Guillain-Barré syndrome (very rare), and stroke being a primary concern for many doctors and researchers. 

Case Studies

According to the medical article, “Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients”, the authors included a clinical study of seven hundred sixty-five COVID-19 patients. In a clinical study of seven hundred sixty-five COVID-19 patients, about 18% of the patients had neurological complications such as acute myelitis and Guillain-Barré syndrome. Clinical studies have also shown that the loss of the sense of smell is turning out to be one of the most common symptoms in patients diagnosed with COVID-19, indicating that olfactory dysfunction is a prognostic factor. Another article, “Neurological manifestations of COVID-19 and other coronaviruses: A systematic review” discusses seven case studies that were done in patients diagnosed with a positive coronavirus test result. The investigation had concluded that encephalitis was a prevalent disorder in the pediatric age range. The case study investigation had four hundred nine patients, who were diagnosed with COVID-19, had an onset of neurological complications such as headaches, dizziness, epileptic seizures, neuralgia, and only about 1.4 percent of the patients had the Guillain-Barré syndrome. 

Conclusion

The coronavirus pandemic has caused a lot of tension throughout the world with a death toll of more than one million people and a drastic total of more than thirty-eight million cases. Doctors and scientists have found that some patients diagnosed with a positive coronavirus results also have an onset of neurological complications. Although many of the neurological complications aren’t life-threatening, about ten to 20 percent of the complications are requiring hospitalizations and are fatal. Such complications include brain inflammation, acute cerebrovascular diseases, meningitis, hypoxic encephalopathy and the most rare of all the complications which is Guillain-Barré syndrome. There have been many case studies done to highlight that some of the more crucial disorders are very rare with having only about one percent of the patients in a case study be diagnosed with a rare complication. These neurological complications raise concerns and questions regarding how much worse the complications could get if and when the virus strain gets more stronger, crushing the world with a possible second wave. The only way to find out is testing patients and analyzing case studies to find answers to the questions and concerns on the rise about COVID-19. 

Samiksha Komatireddy, Youth Medical Journal 2020

References

[1] Iadecola, C., Anrather, J., & Kamel, H. (2020). Effects of COVID-19 on the nervous system. Cell, 183(1), 16-27.e1. https://pubmed.ncbi.nlm.nih.gov/32882182/

[2] Stafstrom, C. E., & Jantzie, L. L. (2020). COVID-19: Neurological considerations in neonates and children. Children (Basel, Switzerland), 7(9). doi:10.3390/children7090133

https://pubmed.ncbi.nlm.nih.gov/32927628/

[3] Orsini, A., Corsi, M., Santangelo, A., Riva, A., Peroni, D., Foiadelli, T., … Striano, P. (2020). Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(9), 2353–2366.

https://pubmed.ncbi.nlm.nih.gov/32767055/

[4] Bostanciklioglu, M. (2020). Severe acute respiratory syndrome coronavirus 2 is penetrating to dementia research. Current Neurovascular Research, 17. doi: 10.2174/1567202617666200522220509 

https://pubmed.ncbi.nlm.nih.gov/32442082/

[5] Özdağ Acarli, A. N., Samanci, B., Ekizoğlu, E., Çakar, A., Şirin, N. G., Gündüz, T., … Baykan, B. (2020). Coronavirus disease 2019 (COVID-19) from the Point of View of neurologists: Observation of neurological findings and symptoms during the combat against a pandemic. Noro Psikiyatri Arsivi, 57(2), 154–159. 

https://pubmed.ncbi.nlm.nih.gov/32550783/

[6] Correia, A. O., Feitosa, P. W. G., Moreira, J. L. de S., Nogueira, S. Á. R., Fonseca, R. B., & Nobre, M. E. P. (2020). Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. Neurology, Psychiatry, and Brain Research, 37, 27–32.

https://pubmed.ncbi.nlm.nih.gov/32834527/

[7] Yachou, Y., El Idrissi, A., Belapasov, V., & Ait Benali, S. (2020). Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(10), 2657–2669.

https://pubmed.ncbi.nlm.nih.gov/32725449/

[8] Baig, A. M., & Sanders, E. C. (2020). Potential neuroinvasive pathways of SARS-CoV-2: Deciphering the spectrum of neurological deficit seen in coronavirus disease-2019 (COVID-19). Journal of Medical Virology, (jmv.26105). doi:10.1002/jmv.26105

https://pubmed.ncbi.nlm.nih.gov/32492193/