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(Thread IKs: PoundSand)
 
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nexous
Jan 14, 2003

I just want to be pure

RandomBlue posted:

Had the same thing about a year and a half ago, took about 3 weeks to get into surgery but we're not in a major metro area. Big enough to have decent hospital services but not so big they're completely overwhelmed thankfully.

Good luck, hope it goes well for you, it did for me (so far).

In my case they took out the whole right kidney along with the softball sized tumor.

thanks! mines golf ball sized so hoping they can salvage the kidney. also on the right side. will find out on the 29th when I can get an mri

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VideoKid
Jul 28, 2006

Avatar War
I tested positive this morning and was able to get a rx for paxlovid via sesame care. I’m really grateful for all of the information in the op. stay safe goons :coronatoot:

VomitOnLino
Jun 13, 2005

Sometimes I get lost.

nexous posted:

it’s been back and forth between just ignoring it and freaking out. Another goon in the goon doctor thread really helped, he had the same thing (renal cell carcinoma) and it’s like the easiest cancer to treat so I’m not gonna die or anything it’s just very tedious waiting to do anything about it. I am quite concerned about getting Covid during the surgery tho. it’s gonna be close to see if I can get the updated booster before.

Yeah, it absolutely sucks that during this trying time you have to worry about Covid, too. gently caress this hellworld.
Best wishes to you and hoping that all goes well!

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry

RandomBlue posted:

softball sized tumor.

nexous posted:

mines golf ball sized

:stonk: :stonk:

Pingui
Jun 4, 2006

WTF?

Largest tumor ever recorded was 306 lb.

RandomBlue
Dec 30, 2012

hay guys!


Biscuit Hider

Yeah I only remotely know one person (through my wife, I haven't met them) who died of covid but we had a pet and 3 or 4 other people die of cancer during the pandemic so far. Not downplaying covid at all but cancer has been real bad in my circle.

Zugzwang
Jan 2, 2005

You have a kind of sick desperation in your laugh.


Ramrod XTreme

nexous posted:

it’s been back and forth between just ignoring it and freaking out. Another goon in the goon doctor thread really helped, he had the same thing (renal cell carcinoma) and it’s like the easiest cancer to treat so I’m not gonna die or anything it’s just very tedious waiting to do anything about it. I am quite concerned about getting Covid during the surgery tho. it’s gonna be close to see if I can get the updated booster before.
My mom made it through a ton of time in the hospital and multiple surgeries this year without getting got, so it's certainly possible. Hoping for the best for you; cancer is always scary, even if it's the Most Treatable Kind.

RandomBlue
Dec 30, 2012

hay guys!


Biscuit Hider

Pingui posted:

Largest tumor ever recorded was 306 lb.

yeah he was the president

Zugzwang
Jan 2, 2005

You have a kind of sick desperation in your laugh.


Ramrod XTreme

RandomBlue posted:

yeah he was the president
6'3", 239 lbs

nexous
Jan 14, 2003

I just want to be pure

RandomBlue posted:

yeah he was the president

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry

RandomBlue posted:

Yeah I only remotely know one person (through my wife, I haven't met them) who died of covid but we had a pet and 3 or 4 other people die of cancer during the pandemic so far. Not downplaying covid at all but cancer has been real bad in my circle.

yeah i bitched about it earlier but my best friends mom started acting erratically while visiting family abroad. he and his father are doctors and were like "oh poo poo we know what's happening" and even given an immediate correct diagnosis and their combined insanely accomplished team of professional interventions three weeks later (Tuesday) she was dead of a glioma

loving sucks I'm sorry goon, everything is just death nowadays

nexous
Jan 14, 2003

I just want to be pure
I haven’t had Covid (afaik) but aren’t there studies showing some correlation with cancer?

my cancer usually affects older men who are overweight and have high blood pressure so lol I owned myself. but then again I was in the best shape of my life 10 years ago before I had to have a cervical fusion and I stopped exercising cause everything hurts

Pingui
Jun 4, 2006

WTF?

nexous posted:

I haven’t had Covid (afaik) but aren’t there studies showing some correlation with cancer?

my cancer usually affects older men who are overweight and have high blood pressure so lol I owned myself. but then again I was in the best shape of my life 10 years ago before I had to have a cervical fusion and I stopped exercising cause everything hurts

It is possible it can cause cancer and some mechanisms have been proposed, but likely we won't know until subtypes increase. There has also been research which correlates cancer and COVID, but imho that doesn't mean much beyond cancer patients often being immunocompromised and tend to have many points of contact with hospitals.

Example of the former:
Possible cancer-causing capacity of COVID-19: Is SARS-CoV-2 an oncogenic agent?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202899/ posted:

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown diverse life-threatening effects, most of which are considered short-term. In addition to its short-term effects, which has claimed many millions of lives since 2019, the long-term complications of this virus are still under investigation. Similar to many oncogenic viruses, it has been hypothesized that SARS-CoV-2 employs various strategies to cause cancer in different organs. These include leveraging the renin angiotensin system, altering tumor suppressing pathways by means of its nonstructural proteins, and triggering inflammatory cascades by enhancing cytokine production in the form of a “cytokine storm” paving the way for the emergence of cancer stem cells in target organs. Since infection with SARS-CoV-2 occurs in several organs either directly or indirectly, it is expected that cancer stem cells may develop in multiple organs. Thus, we have reviewed the impact of coronavirus disease 2019 (COVID-19) on the vulnerability and susceptibility of specific organs to cancer development. It is important to note that the cancer-related effects of SARS-CoV-2 proposed in this article are based on the ability of the virus and its proteins to cause cancer but that the long-term consequences of this infection will only be illustrated in the long run.

Pingui has issued a correction as of 03:05 on Aug 21, 2023

Geight
Aug 7, 2010

Oh, All-Knowing One, behold me!
This year I've finally secured insurance for my partner as well as myself, and I'd like to start actually using it in the near future because I'm not sure how long that will be the case. I'm comfortable cold calling random offices and asking what sort of precautions they're still taking against covid, but I don't really know what sort of answer I should be looking for. What would be good precautions, and what should I consider the bare minimum? Are there any specifics for dentists/optometrists since they'll be getting all up in there?

Pingui
Jun 4, 2006

WTF?
Good sign on the eligibility:
Biden administration to urge Americans get new COVID-19 boosters

https://www.reuters.com/world/us/biden-administration-urge-americans-get-new-covid-19-boosters-2023-08-20/ posted:

The Biden administration plans to urge all Americans to get a booster shot for the coronavirus this autumn to counter a new wave of infections, a White House official said on Sunday.
(..)
"We will be encouraging all Americans to get those boosters in addition to flu shots and RSV shots," the official said, referring to the Respiratory Syncytial Virus.

pillsburysoldier
Feb 11, 2008

Yo, peep that shit

Pingui posted:

It is possible it can cause cancer and some mechanisms have been proposed, but likely we won't know until subtypes increase. There has also been research which correlates cancer and COVID, but imho that doesn't mean much beyond cancer patients often being immunocompromised and tend to have many points of contact with hospitals.

Example of the former:
Possible cancer-causing capacity of COVID-19: Is SARS-CoV-2 an oncogenic agent?

Couldve sworn i read a 30% increase in stomach cancers (but a small decrease in head and neck cancers) being associated with covid

Insanite
Aug 30, 2005

Harik posted:

florida, new york, california, there's no real difference in governance when it comes to reminding everybody that it's their sacred duty to go to work so their kids have to be sent to the plague pits and also Chilli's happy hour is self care.


Not enjoying the new thread vibe of "do not say anything bad about the people who've piled millions of rotting corpses in an offering to mammon" tbh.
love having a kid who will be in preschool next year and that if I could spend 30K in tuition on him, he could go somewhere with UV filters and hepa and poo poo everywhere. there is a private school that does all of that a mile from our home. instead, I guess my whole household will get covid every few months until tragedy strikes. this is in smart, progressive Massachusetts, btw.

same to that final line.

e: we didn’t get covid during the delivery of kid 2. this is in spite of half of the personnel around us having coughs. Ty, 10 ACH labor and delivery room air, I guess.

Zantie
Mar 30, 2003

Death. The capricious dance of Now You Stop Moving Forever.
https://twitter.com/LongDesertTrain/status/1693411723254927481

We have the tools :toot:

[edit] seriously though I hope you feel better soon, Glumwheels

Zantie has issued a correction as of 04:42 on Aug 21, 2023

ibid
Aug 18, 2022

by vyelkin

Gunshow Poophole posted:

... farid jalali has had to go protected since he posted the writeup which is a great indicator of how X The Everything App is going, gently caress me I can't even link to the tweet or find the paper now


"First, some introduction in order to better understand the premise and the findings of this work:

In the last 3 years, an exhaustive amount of research has been carried out to elucidate the precise events that directly cause progression of COVID from an early mild acute illness in the first few days, to a severe/fatal form in a subset.

Two specific early events key to such progression have been identified: The first key event identified is the early interaction between SARS-CoV-2 and megakaryocytes (MKs) in the bone marrow. PMID: 36920790, 35708858

If MKs are infected by SARS-CoV-2, the patient is anticipated to progress to severe COVID in the ensuing days. Vice versa, if MKs remain uninfected, the patient is expected to experience a mild course and recover. PMID: 35708858

The other key event that is thoroughly well-established to drive severe COVID is: The early production of a distinct form of antibody against the spike protein ("afucosylated") that delivers a double blow to the host ... PMID: 33361116

This distinct anti-spike IgG antibody: (1) Does not neutralize SARS-CoV-2 (2) And instead, triggers and directly drives the immune-mediated pathology of severe COVID

It goes without saying that upon infection with SARS-CoV-2, our immune system tries to produce antibodies against proteins of this virus, including the spike protein, with one goal: To neutralize and clear the infection. And this happens without deviation in a majority

However, not all antibodies targeting the spike protein are created equal in COVID. Anti-spike IgGs come in two forms in this disease, with dire consequences for the patient.

Multiple studies have shown this phenomenon. That the *quality* of antibodies produced early on in response to SARS-CoV-2 spike protein differs between individuals, and this variation determines the fate of the patient. PMID: 33361116, 33979301, 35040666

In fact, the detection of a distinct form of anti-spike IgG *early* in the illness accurately predicts who progresses to severe disease in the ensuing days, and who doesn’t progress and experiences only a mild illness.

So how is this variability in the anti-spike IgGs defined? Understanding this requires a brief background on antibody structure first:

IgG antibody structure comprises of: (1) antigen-binding region (“Fab”), where antigens such as spike protein are recognized and bound, and …

In the Fc regions of IgG, there are specific sites (at Asparagine 297) where modifications called “glycosylation” can change the inflammatory capability of each IgG.

For instance, the addition of a “fucose” moiety to this site on the Fc region would create a less inflammatory IgG. 90% of all IgGs in humans are formed this way, containing a fucose moiety, and referred to as “fucosylated” IgGs.

On the other hand (and of relevance to COVID), the lack of fucose in the Fc region of IgG, brings about an *intensely* inflammatory quality to the antibody. IgGs lacking fucose (“afucosylated” IgGs) have a 100-fold *higher* affinity for the FcyRIlla receptors on immune cells.

This translates into an extremely intense activation of monocytes, macrophages, NK and dendritic cells — all of which are then recruited to attack the antigen recognized and bound by the antibody

Less than 10% of human IgGs encountered are afucosylated, as these afucosylated IgGs are intensely inflammatory and can cause severe immune-mediated pathology.

Our immune system relies on fucosylated IgGs — with much lower inflammatory quality than the afucosylated ones — to respond to a vast majority of infectious pathogens

However, afucosylated responses are found in response to specific situations. Infections with enveloped viruses such as SARS-CoV-2, dengue virus, and HIV can be associated with afucosylated IgG production against viral antigens

Afucosylated IgG responses are also seen in reaction to foreign antigens on blood cells such as platelets. PMID: 24243971

In the case of COVID, multiple prominent studies have demonstrated the detection of afucosylated IgGs against the spike protein in severe COVID. PMID: 33361116, 33979301

These studies have also shown that not only afucosylated anti-spike IgGs are present in severe COVID, but also … their presence is an early predictor and a direct driver of progression to severe COVID.

In two prospective cohorts of outpatients with early COVID who underwent blood draws ... the detection of these afucosylated IgGs against the spike protein was shown to determine the fate of these individuals later on.

Those with an early production of afucosylated anti-spike IgG detected on, for instance day 5 of illness as outpatient, reliably progressed to severe COVID on subsequent days, whereas … On the other hand, the patients ...

... who only formed normally fucosylated IgGs against the spike protein experienced only a mild course and recovered

The timing of antibody formation mattered too. In those who progressed to severe disease, the afucosylated (and non-neutralizing) IgGs were formed prior to the normally fucosylated (and neutralizing) IgGs against the spike protein.

Something … somehow … pushed these unfortunate individuals to form a non-neutralizing and pathogenic afucosylated response against the spike protein … And these pathogenic antibodies were formed much earlier than the neutralizing ones that clear the virus.

Mechanistically, these studies also clearly show how the formation of these afucosylated anti-spike IgGs are key drivers of the immune-mediated pathology in severe COVID …

Recall that lack of fucose in the anti-spike IgGs triggers an intense activation of monocytes, macrophages, NK and dendritic cells — all targeted any and all tissue harboring the spike protein

In other words, these afucosylated IgGs order our own immune system to most ferociously attack and eliminate any trace of spike protein in the body.

The only problem becomes that … the spike protein is broadly expressed on the cell surface of many infected human tissues during COVID. And our own body becomes the collateral damage to our immune system’s reaction by way of these afucosylated IgGs

This is why in severe COVID, most successful therapeutics are immune-modulators such as steroids, JAK/STAT inhibitors, anti-TNFs, etc.

These afucosylated responses are *not* unique to severe COVID. We’ve seen them before. They also drive severe dengue. PMID: 31765380, 34083490

Dengue virus also happens to another enveloped RNA virus like SARS-CoV-2, that also infects bone marrow megakaryocytes like SARS-CoV-2.

In addition to these, afucosylated responses are also seen in HIV, but this time, they act in a beneficial fashion by conferring improved viral suppression. HIV is yet another enveloped virus that not only infects MKs, but also ...

... uses MK infection as a reservoir to cause persistence despite patients taking highly-active antiretroviral therapy. PMID: 32188724

We thought there may be a pattern here, perhaps. And naturally, this is where shaping of our hypothesis began. Is there a relationship between enveloped viruses infecting MKs, and this infection causing afucosylated responses toward antigens of these enveloped viruses?

What do we know about the contexts and antigens that are associated with afucosylated responses? Owing to a comprehensive study by Larsen et al. (PMID 33361116), we know that ...

Afucosylated responses can occur in response to a limited set of stimuli including … (1) Enveloped virus antigens (2) Alloantigens on surface of platelets (3) Alloantigens on surface of RBCs

In contrast (bottom row): (1) Soluble proteins (2) Bacterials antigens, and (3) Non-enveloped virus antigens are not known to cause afucosylated responses — and instead form the typical fucosylated IgGs only.

To dig deeper … In the case of enveloped viruses, not all viral proteins are known to trigger afucosylated responses. Larsen et al. have demonstrated that the location of the viral protein matters. Surface expression is the differentiator.

Surface proteins of enveloped viruses can cause afucosylated responses. An example of a surface protein would be the spike protein of SARS-CoV-2. In contrast, viral proteins without any surface expression do not induce afucosylated responses.

Larsen et al. showed in the case of severe COVID patients, afucosylated IgGs are only detectable against the spike protein (has surface expression) … Whereas very little to no afucosylated IgGs are formed against the nucleocapsid protein (no surface expression).

We also know that afucosylated responses are seen in response to foreign antigens expressed on the surface of platelets. This is best illustrated in the case of a fetal platelet disorder called FNAIT. PMID: 24243971

Further refining our hypothesis based on these lines of evidence … We began to wonder whether ... SARS-CoV-2 can infect platelets and pathogenically embed its spike protein on the surface of platelets ➡️leading to an afucosylated response and the associated immunopathology.

But we hit a roadblock there. Several prominent studies clearly show that platelets are infected by SARS-CoV-2 during COVID. None, however, were able to visualize evidence of spike protein expression on the surface of platelets.

I even pursued personal communication with the authors of these studies over the last 2 years, who confirmed that …

... although the spike protein was found in the cytoplasm of infected platelets, and such finding was highly predictive of severe disease progression, no evidence of spike protein expression was found on the surface of platelet membrane

So, our attention switched to platelet progenitors, megakaryocytes, to explore our suspicion about the spike protein expression on the surface of these cells.

Multiple human studies thus far have established that SARS-CoV-2 infects MKs in the bone marrow (all in postmortem samples of bone marrow)

wo studies in particular demonstrated that not only SARS-CoV-2 infects MKs, but also … The viral infection of bone marrow MKs — similar to the case of afucosylated anti-spike IgGs — was an early predictor of progression to severe COVID. PMID: 36920790, 35708858

Strikingly, virus-infected MKs were shown to transfer viral antigens including the spike protein (red) to emerging platelets during differentiation to proplatelets and platelets (Fortmann et al.)

What was not explored in this study was whether the spike protein is specifically expressed on the surface of resultant platelet progenitors emerging from the virus-infected MKs.

Such finding — similar to platelet alloantigens encountered in FNAIT — would provide a plausible pathway by which afucosylated IgGs form against the spike protein.

Moreover, thus far no group has explored the possibility of whether virus-infected bone marrow MKs may be the key trigger for the production of the pathogenic afucosylated IgGs against the spike protein.

These two questions formed the basis of our study. The schematic below summarizes the four parts of our hypothesis.

Based on the described hypotheses, experiment was designed as depicted in this diagram

After obtaining IRB and approval from ethics committee, human bone marrow megakaryocytes were isolated from hospitalized subjects who were in the early days of experiencing severe COVID.

Subsequently, human bone marrow MKs were isolated from the bone marrow aspirate. PCR confirmed the infection of bone marrow MKs by SARS-CoV-2 in these living donors in early stage of severe COVID

Next … Virus-infected MKs were grown and allowed to differentiate under favorable conditions and assessed for evidence of spike protein expression on the surface of resultant platelet progenitors.

Proplatelets emerging from the virus-infected MKs were labeled to identify their periphery (α-tubulin, green) and to identify any evidence of spike protein (red). Indeed, we found the spike protein expressed on the surface of virus-infected proplatelets!

We then pursued our second question. Virus-infected human bone marrow MKs were injected intravenously to transgenic mice harboring human ACE2 to see whether it triggers the formation of fucosylated IgGs against the spike protein.

First: We found that injection of virus-infected human MKs into transgenic mice significantly promoted the formation afucosylated IgG antibodies against the spike protein To our knowledge, this is the 1st instance of afucosylated IgGs detection against a viral antigen in vivo.

Second: The mortality rate in the infected mice was proportional to the level of afucosylated anti-spike IgG produced.

This finding suggests that the afucosylated anti-spike IgG antibodies were pathogenic and contributed significantly to the severity of COVID-19 in mice - as is the case in humans.

Third: The plasma levels of PF4 and serotonin, as soluble markers of platelet activation and/or granule release, were significantly higher in the infected mice compared with the uninfected mice.

Lastly, and perhaps most importantly: Injection of virus-infected MKs into the circulation of these mice (without inhalation of the virus) mimicked the lung pathology seen in human cases of severe COVID:

Inflammatory cell infiltrate in the lung, followed by clot formation in the pulmonary vascular lumen, and distortion of the lung tissue.

In summary, to the best of our knowledge, this is the first study that demonstrates direct evidence that bone marrow megakaryocytes are infected early on by SARS-CoV-2 in those experiencing severe COVID.

Additionally, to the best of our knowledge, this is the first study that demonstrates proplatelets express SARS-CoV-2 spike protein on the surface of their membranes during differentiation from virus-infected human MKs. This surface expression of spike protein matters …

... as it likely explains the context within which our immune system decides to switch gears and form highly inflammatory afucosylated antibodies against the spike protein.

In millions infected by this virus, the immune response follows a predictable pattern. Virus infects the respiratory tract. Immune system reacts in a typical fashion, and forms neutralizing fucosylated antibodies against the spike protein. Virus clears. Acute disease resolves

In a subset who progress to severe COVID, the antibody response is atypical — and actually causes disease progression. Our proposed mechanism is that in these instances, the virus likely breaches the respiratory tract, reaches the bloodstream, and infects the bone marrow MKs.

As the virus infects MKs, and expresses the spike protein on the surface of emerging proplatelets, the immune system senses a much more 🔥dangerous situation. Body’s own circulating blood cells are now infected — beyond the respiratory tract, beyond the oropharynx

The infection of circulating blood cells is likely a highly alarming 🚨context to the immune system. To combat viral spread now aided by far-reaching infected platelets, a most potent inflammatory reaction is called into action by creating afucosylated IgGs against spike protein

This leads to an intense FcyRIlla-mediated activation of monocytes, macrophages, NK and dendritic cells systemically, attacking every tissue harboring spike protein. That is, unfortunately, a large part of body's tissues, including the vasculature, lung, neural tissue, etc.

... causing widespread immuno-thrombosis, and immune-mediated injury to vasculature, lungs, blood-brain barrier, nervous system, and other tissues in the body.

In summary, we provide preliminary evidence that SARS-CoV-2 infects human bone marrow megakaryocytes, and this infection of megakaryocytes is directly responsible for triggering the immune-mediated pathology of severe COVID

We acknowledge that this is a preprint, and has not been peer-reviewed. We also acknowledge that we have a significant amount of future work left to be done to better characterize the preliminary findings described in this work.

If your group has expertise in glycobiology, please consider reaching out to us as we are open to collaboration to decipher the detailed mechanisms of the findings in this work.

We appreciate your patience in reading through this long thread. And we encourage you to read our preprint below for further details.

Lastly, we would like to thank the entire team of Dr. Younes Zaid @ZaidYounes9, and acknowledge the generous funding by Balvi and @VitalikButerin to allow us to continue our work."

https://nitter.net/farid__jalali/status/1683707701866692608

https://www.biorxiv.org/content/10.1101/2023.07.14.549113v2

ibid
Aug 18, 2022

by vyelkin

Insanite posted:

e: we didn’t get covid during the delivery of kid 2. this is in spite of half of the personnel around us having coughs. Ty, 10 ACH labor and delivery room air, I guess.

Great news!

Phigs
Jan 23, 2019

Sunny Side Up posted:

Yeah it’s weird as poo poo. Even if they’re empty suits like Biden and would be replaced if they didn’t toe the line, they’re still despicable. It is okay to wish ill on mass murderers.

Some people think we'll talk ourselves into an act that begins with rear end and is not fun for the person on the receiving end.

Some other people just don't like the bad vibes.

Phigs has issued a correction as of 06:31 on Aug 21, 2023

ibid
Aug 18, 2022

by vyelkin

quote:

If people infected with SARS-CoV-2 and in #LongCovid were to be given all the clinical exams needed, healthcare would collapse instantly. Hence, the "vague syndromes". The lucky and the wealthy will be looked after. The most will be told there's nothing to do.

thread

quote:

So you're told your pulse oximeter is "broken" and you can't be hypoxic in #LongCovid. You're not tested. You're not supported. And you're left with no oxygen with your oxygen saturation levels dropping to brain damage levels

https://nitter.net/elisaperego78/status/1693321452609511585

Delta-Wye
Sep 29, 2005
:eyepop:

ibid
Aug 18, 2022

by vyelkin

Phigs posted:

Some other people just don't like the bad vibes.

Basic as FAFO, and that's what people don't like to hear.

Precambrian Video Games
Aug 19, 2002



https://twitter.com/scottlincicome/status/1693271300460962195

Food for thought about the unintended consequences of the very real lockdowns that must still be happening somewhere (in my imagination).

Paradoxish
Dec 19, 2003

Will you stop going crazy in there?
Here's my very serious research about how Applebee's being shut down for a few weeks in a handful of places has permanently widened the class divide in America. Also, have you seen my paper explaining that children who aren't born yet will suffer a lifetime of immunity debt because one time a school closed in 2020?

corona familiar
Aug 13, 2021


ladies and gentlemen, we got em

Computer Serf
May 14, 2005
Buglord

ibid posted:

"First, some introduction in order to better understand the premise and the findings of this work:

In the last 3 years, an exhaustive amount of research has been carried out to elucidate the precise events that directly cause progression of COVID from an early mild acute illness in the first few days, to a severe/fatal form in a subset.

Two specific early events key to such progression have been identified: The first key event identified is the early interaction between SARS-CoV-2 and megakaryocytes (MKs) in the bone marrow. PMID: 36920790, 35708858

If MKs are infected by SARS-CoV-2, the patient is anticipated to progress to severe COVID in the ensuing days. Vice versa, if MKs remain uninfected, the patient is expected to experience a mild course and recover. PMID: 35708858

The other key event that is thoroughly well-established to drive severe COVID is: The early production of a distinct form of antibody against the spike protein ("afucosylated") that delivers a double blow to the host ... PMID: 33361116

This distinct anti-spike IgG antibody: (1) Does not neutralize SARS-CoV-2 (2) And instead, triggers and directly drives the immune-mediated pathology of severe COVID

It goes without saying that upon infection with SARS-CoV-2, our immune system tries to produce antibodies against proteins of this virus, including the spike protein, with one goal: To neutralize and clear the infection. And this happens without deviation in a majority

However, not all antibodies targeting the spike protein are created equal in COVID. Anti-spike IgGs come in two forms in this disease, with dire consequences for the patient.

Multiple studies have shown this phenomenon. That the *quality* of antibodies produced early on in response to SARS-CoV-2 spike protein differs between individuals, and this variation determines the fate of the patient. PMID: 33361116, 33979301, 35040666

In fact, the detection of a distinct form of anti-spike IgG *early* in the illness accurately predicts who progresses to severe disease in the ensuing days, and who doesn’t progress and experiences only a mild illness.

So how is this variability in the anti-spike IgGs defined? Understanding this requires a brief background on antibody structure first:

IgG antibody structure comprises of: (1) antigen-binding region (“Fab”), where antigens such as spike protein are recognized and bound, and …

In the Fc regions of IgG, there are specific sites (at Asparagine 297) where modifications called “glycosylation” can change the inflammatory capability of each IgG.

For instance, the addition of a “fucose” moiety to this site on the Fc region would create a less inflammatory IgG. 90% of all IgGs in humans are formed this way, containing a fucose moiety, and referred to as “fucosylated” IgGs.

On the other hand (and of relevance to COVID), the lack of fucose in the Fc region of IgG, brings about an *intensely* inflammatory quality to the antibody. IgGs lacking fucose (“afucosylated” IgGs) have a 100-fold *higher* affinity for the FcyRIlla receptors on immune cells.

This translates into an extremely intense activation of monocytes, macrophages, NK and dendritic cells — all of which are then recruited to attack the antigen recognized and bound by the antibody

Less than 10% of human IgGs encountered are afucosylated, as these afucosylated IgGs are intensely inflammatory and can cause severe immune-mediated pathology.

Our immune system relies on fucosylated IgGs — with much lower inflammatory quality than the afucosylated ones — to respond to a vast majority of infectious pathogens

However, afucosylated responses are found in response to specific situations. Infections with enveloped viruses such as SARS-CoV-2, dengue virus, and HIV can be associated with afucosylated IgG production against viral antigens

Afucosylated IgG responses are also seen in reaction to foreign antigens on blood cells such as platelets. PMID: 24243971

In the case of COVID, multiple prominent studies have demonstrated the detection of afucosylated IgGs against the spike protein in severe COVID. PMID: 33361116, 33979301

These studies have also shown that not only afucosylated anti-spike IgGs are present in severe COVID, but also … their presence is an early predictor and a direct driver of progression to severe COVID.

In two prospective cohorts of outpatients with early COVID who underwent blood draws ... the detection of these afucosylated IgGs against the spike protein was shown to determine the fate of these individuals later on.

Those with an early production of afucosylated anti-spike IgG detected on, for instance day 5 of illness as outpatient, reliably progressed to severe COVID on subsequent days, whereas … On the other hand, the patients ...

... who only formed normally fucosylated IgGs against the spike protein experienced only a mild course and recovered

The timing of antibody formation mattered too. In those who progressed to severe disease, the afucosylated (and non-neutralizing) IgGs were formed prior to the normally fucosylated (and neutralizing) IgGs against the spike protein.

Something … somehow … pushed these unfortunate individuals to form a non-neutralizing and pathogenic afucosylated response against the spike protein … And these pathogenic antibodies were formed much earlier than the neutralizing ones that clear the virus.

Mechanistically, these studies also clearly show how the formation of these afucosylated anti-spike IgGs are key drivers of the immune-mediated pathology in severe COVID …

Recall that lack of fucose in the anti-spike IgGs triggers an intense activation of monocytes, macrophages, NK and dendritic cells — all targeted any and all tissue harboring the spike protein

In other words, these afucosylated IgGs order our own immune system to most ferociously attack and eliminate any trace of spike protein in the body.

The only problem becomes that … the spike protein is broadly expressed on the cell surface of many infected human tissues during COVID. And our own body becomes the collateral damage to our immune system’s reaction by way of these afucosylated IgGs

This is why in severe COVID, most successful therapeutics are immune-modulators such as steroids, JAK/STAT inhibitors, anti-TNFs, etc.

These afucosylated responses are *not* unique to severe COVID. We’ve seen them before. They also drive severe dengue. PMID: 31765380, 34083490

Dengue virus also happens to another enveloped RNA virus like SARS-CoV-2, that also infects bone marrow megakaryocytes like SARS-CoV-2.

In addition to these, afucosylated responses are also seen in HIV, but this time, they act in a beneficial fashion by conferring improved viral suppression. HIV is yet another enveloped virus that not only infects MKs, but also ...

... uses MK infection as a reservoir to cause persistence despite patients taking highly-active antiretroviral therapy. PMID: 32188724

We thought there may be a pattern here, perhaps. And naturally, this is where shaping of our hypothesis began. Is there a relationship between enveloped viruses infecting MKs, and this infection causing afucosylated responses toward antigens of these enveloped viruses?

What do we know about the contexts and antigens that are associated with afucosylated responses? Owing to a comprehensive study by Larsen et al. (PMID 33361116), we know that ...

Afucosylated responses can occur in response to a limited set of stimuli including … (1) Enveloped virus antigens (2) Alloantigens on surface of platelets (3) Alloantigens on surface of RBCs

In contrast (bottom row): (1) Soluble proteins (2) Bacterials antigens, and (3) Non-enveloped virus antigens are not known to cause afucosylated responses — and instead form the typical fucosylated IgGs only.

To dig deeper … In the case of enveloped viruses, not all viral proteins are known to trigger afucosylated responses. Larsen et al. have demonstrated that the location of the viral protein matters. Surface expression is the differentiator.

Surface proteins of enveloped viruses can cause afucosylated responses. An example of a surface protein would be the spike protein of SARS-CoV-2. In contrast, viral proteins without any surface expression do not induce afucosylated responses.

Larsen et al. showed in the case of severe COVID patients, afucosylated IgGs are only detectable against the spike protein (has surface expression) … Whereas very little to no afucosylated IgGs are formed against the nucleocapsid protein (no surface expression).

We also know that afucosylated responses are seen in response to foreign antigens expressed on the surface of platelets. This is best illustrated in the case of a fetal platelet disorder called FNAIT. PMID: 24243971

Further refining our hypothesis based on these lines of evidence … We began to wonder whether ... SARS-CoV-2 can infect platelets and pathogenically embed its spike protein on the surface of platelets ➡️leading to an afucosylated response and the associated immunopathology.

But we hit a roadblock there. Several prominent studies clearly show that platelets are infected by SARS-CoV-2 during COVID. None, however, were able to visualize evidence of spike protein expression on the surface of platelets.

I even pursued personal communication with the authors of these studies over the last 2 years, who confirmed that …

... although the spike protein was found in the cytoplasm of infected platelets, and such finding was highly predictive of severe disease progression, no evidence of spike protein expression was found on the surface of platelet membrane

So, our attention switched to platelet progenitors, megakaryocytes, to explore our suspicion about the spike protein expression on the surface of these cells.

Multiple human studies thus far have established that SARS-CoV-2 infects MKs in the bone marrow (all in postmortem samples of bone marrow)

wo studies in particular demonstrated that not only SARS-CoV-2 infects MKs, but also … The viral infection of bone marrow MKs — similar to the case of afucosylated anti-spike IgGs — was an early predictor of progression to severe COVID. PMID: 36920790, 35708858

Strikingly, virus-infected MKs were shown to transfer viral antigens including the spike protein (red) to emerging platelets during differentiation to proplatelets and platelets (Fortmann et al.)

What was not explored in this study was whether the spike protein is specifically expressed on the surface of resultant platelet progenitors emerging from the virus-infected MKs.

Such finding — similar to platelet alloantigens encountered in FNAIT — would provide a plausible pathway by which afucosylated IgGs form against the spike protein.

Moreover, thus far no group has explored the possibility of whether virus-infected bone marrow MKs may be the key trigger for the production of the pathogenic afucosylated IgGs against the spike protein.

These two questions formed the basis of our study. The schematic below summarizes the four parts of our hypothesis.

Based on the described hypotheses, experiment was designed as depicted in this diagram

After obtaining IRB and approval from ethics committee, human bone marrow megakaryocytes were isolated from hospitalized subjects who were in the early days of experiencing severe COVID.

Subsequently, human bone marrow MKs were isolated from the bone marrow aspirate. PCR confirmed the infection of bone marrow MKs by SARS-CoV-2 in these living donors in early stage of severe COVID

Next … Virus-infected MKs were grown and allowed to differentiate under favorable conditions and assessed for evidence of spike protein expression on the surface of resultant platelet progenitors.

Proplatelets emerging from the virus-infected MKs were labeled to identify their periphery (α-tubulin, green) and to identify any evidence of spike protein (red). Indeed, we found the spike protein expressed on the surface of virus-infected proplatelets!

We then pursued our second question. Virus-infected human bone marrow MKs were injected intravenously to transgenic mice harboring human ACE2 to see whether it triggers the formation of fucosylated IgGs against the spike protein.

First: We found that injection of virus-infected human MKs into transgenic mice significantly promoted the formation afucosylated IgG antibodies against the spike protein To our knowledge, this is the 1st instance of afucosylated IgGs detection against a viral antigen in vivo.

Second: The mortality rate in the infected mice was proportional to the level of afucosylated anti-spike IgG produced.

This finding suggests that the afucosylated anti-spike IgG antibodies were pathogenic and contributed significantly to the severity of COVID-19 in mice - as is the case in humans.

Third: The plasma levels of PF4 and serotonin, as soluble markers of platelet activation and/or granule release, were significantly higher in the infected mice compared with the uninfected mice.

Lastly, and perhaps most importantly: Injection of virus-infected MKs into the circulation of these mice (without inhalation of the virus) mimicked the lung pathology seen in human cases of severe COVID:

Inflammatory cell infiltrate in the lung, followed by clot formation in the pulmonary vascular lumen, and distortion of the lung tissue.

In summary, to the best of our knowledge, this is the first study that demonstrates direct evidence that bone marrow megakaryocytes are infected early on by SARS-CoV-2 in those experiencing severe COVID.

Additionally, to the best of our knowledge, this is the first study that demonstrates proplatelets express SARS-CoV-2 spike protein on the surface of their membranes during differentiation from virus-infected human MKs. This surface expression of spike protein matters …

... as it likely explains the context within which our immune system decides to switch gears and form highly inflammatory afucosylated antibodies against the spike protein.

In millions infected by this virus, the immune response follows a predictable pattern. Virus infects the respiratory tract. Immune system reacts in a typical fashion, and forms neutralizing fucosylated antibodies against the spike protein. Virus clears. Acute disease resolves

In a subset who progress to severe COVID, the antibody response is atypical — and actually causes disease progression. Our proposed mechanism is that in these instances, the virus likely breaches the respiratory tract, reaches the bloodstream, and infects the bone marrow MKs.

As the virus infects MKs, and expresses the spike protein on the surface of emerging proplatelets, the immune system senses a much more 🔥dangerous situation. Body’s own circulating blood cells are now infected — beyond the respiratory tract, beyond the oropharynx

The infection of circulating blood cells is likely a highly alarming 🚨context to the immune system. To combat viral spread now aided by far-reaching infected platelets, a most potent inflammatory reaction is called into action by creating afucosylated IgGs against spike protein

This leads to an intense FcyRIlla-mediated activation of monocytes, macrophages, NK and dendritic cells systemically, attacking every tissue harboring spike protein. That is, unfortunately, a large part of body's tissues, including the vasculature, lung, neural tissue, etc.

... causing widespread immuno-thrombosis, and immune-mediated injury to vasculature, lungs, blood-brain barrier, nervous system, and other tissues in the body.

In summary, we provide preliminary evidence that SARS-CoV-2 infects human bone marrow megakaryocytes, and this infection of megakaryocytes is directly responsible for triggering the immune-mediated pathology of severe COVID

We acknowledge that this is a preprint, and has not been peer-reviewed. We also acknowledge that we have a significant amount of future work left to be done to better characterize the preliminary findings described in this work.

If your group has expertise in glycobiology, please consider reaching out to us as we are open to collaboration to decipher the detailed mechanisms of the findings in this work.

We appreciate your patience in reading through this long thread. And we encourage you to read our preprint below for further details.

Lastly, we would like to thank the entire team of Dr. Younes Zaid @ZaidYounes9, and acknowledge the generous funding by Balvi and @VitalikButerin to allow us to continue our work."

https://nitter.net/farid__jalali/status/1683707701866692608

https://www.biorxiv.org/content/10.1101/2023.07.14.549113v2

mkultra ii

SplitSoul
Dec 31, 2000

Anecdotal, but I've had a shitload of people in my family and social circle develop cancer since COVID showed up. For two out of the nine I'm fairly certain it wasn't related (asbestosis-induced lung cancer and long-undiagnosed prostate cancer), but it wouldn't surprise me in the least if it turned out COVID causes cancer.

Anyway, what's hot in the world of COVID? I hear we might all have to get boosters again. That can't be right, it's over.

blunt
Jul 7, 2005

Currently on day 3 of my second covid infection (first was April last year). It's at least going much better than last time, just have a headache and am a bit phlegmy/achy, normal BP + O2 sat, but i've been doing listerine gargles + carragelose nose sprays 3-4 times a day. Sadly Pax isn't available to me in my country.

I'm normally a daily runner but i've been making myself chill the gently caress out in bed. I recall there was advice about how long to wait before returning to activity but I don't see it in the OP. Can anyone recall how long it was supposed to be after testing negative before resuming exercise - 2 weeks, 4 weeks, 6 weeks etc? I'd like to start running again when appropriate but would rather not drop dead of a heart attack in a few weeks or give myself long covid.

Steve Yun
Aug 7, 2003
I'm a parasitic landlord that needs to get a job instead of stealing worker's money. Make sure to remind me when I post.
Soiled Meat
6 weeks. When you start exercising again, do the thing where you quit immediately when you get tired

blunt
Jul 7, 2005

Thanks!

Phigs
Jan 23, 2019

When you start running again start by running around the block or similar so you can more easily get home if you need to stop early.

Snowglobe of Doom
Mar 30, 2012

sucks to be right

Phigs posted:

When you start running again start by running around the block or similar so you can more easily get home if you need to stop early.

Yeah there were stories in the earlier threads about people with PASC fatigue getting into trouble when they got stuck somewhere due to their exhaustion. I think one goon had to go rescue their MIL who got stuck halfway up a staircase and didn't have the strength to climb all the way up.
One of my friends had a similar issue with fatigue thanks to their PASC, they had to plan out their day so they could avoid stairs as much as possible. If they overexerted themselves they'd pretty much be bedridden for days after.

Snowglobe of Doom has issued a correction as of 09:39 on Aug 21, 2023

CGI Stardust
Nov 7, 2010


Brexit is but a door,
election time is but a window.

I'll be back

blunt posted:

Currently on day 3 of my second covid infection (first was April last year). It's at least going much better than last time, just have a headache and am a bit phlegmy/achy, normal BP + O2 sat, but i've been doing listerine gargles + carragelose nose sprays 3-4 times a day. Sadly Pax isn't available to me in my country.

I'm normally a daily runner but i've been making myself chill the gently caress out in bed. I recall there was advice about how long to wait before returning to activity but I don't see it in the OP. Can anyone recall how long it was supposed to be after testing negative before resuming exercise - 2 weeks, 4 weeks, 6 weeks etc? I'd like to start running again when appropriate but would rather not drop dead of a heart attack in a few weeks or give myself long covid.
this BMJ practice pointer from 2021 might be helpful Returning to physical activity after covid-19. not sure if there's anything more up-to-date



RPE: Rating of Perceived Exertion; this article and graphic uses the Borg (lol) scale of 1-20 on the right:


ed: wait gently caress the scale is already in the original. oh well

CGI Stardust has issued a correction as of 09:45 on Aug 21, 2023

Tzen
Sep 11, 2001

Zugzwang posted:

War is peace
Freedom is slavery
We have the tools
Covid is mild

blunt
Jul 7, 2005

CGI Stardust posted:

this BMJ practice pointer from 2021 might be helpful Returning to physical activity after covid-19. not sure if there's anything more up-to-date



RPE: Rating of Perceived Exertion; this article and graphic uses the Borg (lol) scale of 1-20 on the right:


ed: wait gently caress the scale is already in the original. oh well

Thankyou for this. It's a little disheartening seeing that it's gonna be 5+ weeks to get back up to speed once I start again, but I wanna make sure I do everything right so this is super helpful.

Lmao Borg

Dancer
May 23, 2011

CGI Stardust posted:

this BMJ practice pointer from 2021 might be helpful Returning to physical activity after covid-19. not sure if there's anything more up-to-date



RPE: Rating of Perceived Exertion; this article and graphic uses the Borg (lol) scale of 1-20 on the right:


ed: wait gently caress the scale is already in the original. oh well

This could go in tge OP

Lucky Greedo
Feb 14, 2012

At last, he held the throat of his beater.
"could continue all day"

There are people who can perform an activity all day??? That sounds life-changing. I thought it was normal to need a five hour nap after five hours of moderate-intensity labor. Deffo don't have CFS tho, because it doesn't exist. Well, back to work *eats a fistful of liver-destroying otc pain meds because nothing else is available to me*

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Steve Yun
Aug 7, 2003
I'm a parasitic landlord that needs to get a job instead of stealing worker's money. Make sure to remind me when I post.
Soiled Meat


Hayley from Paramore likely has long term health damage from Covid now

(USER WAS PUT ON PROBATION FOR THIS POST)

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