Rapid, at-home blood test could confirm COVID-19 vaccination in minutes

Rapid, at-home blood test could confirm COVID-19 vaccination in minutes

One challenge as society reopens is identifying who has been vaccinated for SARS-CoV-2, the virus that causes COVID-19. A team of Johns Hopkins researchers has developed a rapid blood test that could confirm a person has been vaccinated while they wait to board a plane or enter a sporting event.

Their COVID-19 antibody test is similar to one used at home to determine blood type, where the user pricks a finger and places a drop of blood on a card. A fusion protein developed by the research team is housed on the card and detects COVID-19 antibodies, tiny proteins in the blood the immune system produces to “remember” viral encounters and provide immunity to future infections. Results come back in less than five minutes, faster than current lateral flow tests to detect antibodies at point of care, while also potentially providing a clearer result.

Robert Kruse, M.D., Ph.D., who created the blood test, says it could be used to confirm a person’s vaccination instead of having to show a vaccine card.

“If a business is using the honor system for vaccinations, now they could test people on-site,” he says.

Kruse is lead author of a paper posted online earlier this month that reported results of the test on 400 blood samples, half of which were from prior COVID-19 patients. The test correctly identified antibodies in previously infected patients 87.5% of the time, a slightly higher rate than ELISA tests performed in hospitals that require hours to perform. The paper is being peer-reviewed.


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The test uses hemagglutination, in which the degree of clumping together of red blood cells reveals the concentration of antibodies. Kruse, a pathology resident at the Johns Hopkins University School of Medicine, said the hemagglutination results could let people know if they still have protection months after they received the vaccine or if they need a booster shot. The degree of hemagglutination also correlated with levels of neutralizing antibodies in patients, which protect against viral infection.

Immunocompromised patients, who studies have shown don’t always respond to the COVID-19 vaccine, could test their antibody level and see if the vaccine is working for them, says Yuting Huang, M.D., Ph.D., Kruse’s co-author and a research fellow at Johns Hopkins as well as chief resident of internal medicine at the University of Maryland Medical Center Midtown Campus.

Kruse and Huang developed the test in the lab of Zack Z. Wang, Ph.D., an associate professor at Johns Hopkins in the Division of Hematology. Kruse says the research is an example of the “Hopkins network coming through”: Colleagues in pathology connected Kruse and Huang with researchers from the Johns Hopkins Bloomberg School of Public Health who already had patient samples and test results they were using for their own COVID-19 studies, allowing for collaboration and data-sharing.

“If those collaborating labs didn’t have those samples, we wouldn’t really have known how well it worked,” says Kruse.

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Ultrasensitive blood test detects viral protein, confirms vaccine activates robust immune response

vaccine

The carefully orchestrated dance between the immune system and the viral proteins that induce immunity against COVID-19 may be more complex than previously thought. A new study by investigators at Brigham and Women’s Hospital used an ultrasensitive, single-molecule array (Simoa) assay to detect extremely low levels of molecules in the blood and measured how these levels change over the days and weeks following vaccination. The team found evidence of circulating protein subunits of SARS-CoV-2, followed by evidence of the body mounting its immune response and then clearing the viral protein to below the level of single-molecule detection. Results are published in Clinical Infectious Diseases.

“Because of our ultra-sensitive method, we’re able to corroborate that the mRNA vaccine is operating as intended, stoking the body’s immune response,” said co-corresponding author David Walt, Ph.D., a member of the faculty in the Department of Pathology at the Brigham. Walt is also a member of the Wyss Institute and is a Howard Hughes Medical Institute Professor. “We were able to detect extremely low levels of viral protein and see that as soon as the body begins generating antibodies, those levels declined to undetectable.” Walt has a financial interest in Quanterix Corporation, the company that developed the ultra-sensitive digital immunoassay platform used in this work.

To conduct their study, Walt and colleagues measured levels of SARS-CoV-2 protein subunits in plasma samples collected from 13 participants who received two doses of the Moderna (mRNA-1273) vaccine. Specifically, the team measured levels of SARS-CoV-2 antigens Spike, S1, and Nucleocapsid. The team examined plasma collected at 10-13 timepoints between 1 and 29 days after the first injection and 1-28 days after the second injection. The average age of participants was 24 and the percentage of female participants was 46.

The team found that 11 of 13 participants had low levels of SARS-CoV-2 protein (S1 subunit) as early as one day post-vaccination. S1 subunit protein level peaked on average five days after the first injection. In all participants, the level of S1 protein declined and became undetectable by day 14. Spike protein was detected in 3 of 13 participants an average of 15 days after the first injection. After the second vaccine dose, no S1 or Spike was detectable.

The team collected corresponding antibody data and showed that the immune response began to mount after the viral proteins were produced. Increased antibody levels correlated with viral protein clearance from plasma.

The researchers note that the level of translated protein detected was extremely low and disappeared once antibodies were detected. All participants in the study were healthy volunteers who were vaccinated but not infected with SARS-CoV-2.

“The vaccine is designed to introduce mRNA into the body, which is then translated into the Spike protein. It is the Spike protein that can activate the immune system, which in turn creates antibodies to prevent future infections,” said co-first author Alana Ogata, Ph.D., a postdoctoral fellow in the Walt lab. “We observed that antibodies that target Spike and S1 proteins are generated as early as 1-2 days after circulating S1 is detected, followed by the clearance of proteins. Additionally, we see that the second dose does not result in circulating protein but does provide an additional boost in antibody levels, as expected.”

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Prediabetes can boost a person's chance of major cardiovascular events

People with prediabetes were significantly more likely to suffer a heart attack, stroke or other major cardiovascular event when compared with those who had normal blood sugar levels, according to research being presented at the American College of Cardiology's 70th Annual Scientific Session. Researchers said the findings should serve as a wake-up call for clinicians and patients alike to try to prevent prediabetes in the first place.

"In general, we tend to treat prediabetes as no big deal. But we found that prediabetes itself can significantly boost someone's chance of having a major cardiovascular event, even if they never progress to having diabetes," said Adrian Michel, MD, internal medicine resident at Beaumont Hospital-Royal Oak, MI, and lead author of the study, which he said is one of the largest to date. "Instead of preventing diabetes, we need to shift focus and prevent prediabetes."

Prediabetes is a condition in which the average amount of sugar in the blood is high but not high enough to be diagnosed as Type 2 diabetes. While Type 2 diabetes is a well-known, leading risk factor for heart attack, stroke and blockages in the heart's arteries, the role of prediabetes has been less clear. Yet prediabetes is fairly common. The U.S. Centers for Disease Control and Prevention estimates that 34 million Americans–just over 1 in 10–have diabetes, and another 88 million–approximately 1 in 3–have prediabetes.

This study revealed that serious cardiovascular events occurred in 18% of people with prediabetes compared with 11% of people with normal blood sugar levels over a median of five years follow-up. The relationship between higher blood sugar levels and cardiovascular events remained significant even after taking into account other factors that could play a role, such as age, gender, body mass index, blood pressure, cholesterol, sleep apnea, smoking and peripheral artery disease.

Based on our data, having prediabetes nearly doubled the chance of a major adverse cardiovascular event, which accounts for 1 out of 4 deaths in the U.S. As clinicians, we need to spend more time educating our patients about the risk of elevated blood sugar levels and what it means for their heart health and consider starting medication much earlier or more aggressively, and advising on risk factor modification, including advice on exercise and adopting a healthy diet."

Adrian Michel, MD, Internal Medicine Resident, Beaumont Hospital-Royal Oak, MI

Of particular concern was the finding that even when patients in the prediabetes group were able to bring their blood sugar level back to normal, the risk of having a cardiovascular event was still fairly high. Events occurred in just over 10.5% of these patients compared with 6% of those with no diabetes or prediabetes.

"Even if blood sugar levels went back to normal range, it didn't really change their higher risk of having an event, so preventing prediabetes from the start may be the best approach," Michel said.

This single-center, retrospective study included data from 25,829 patients treated within the Beaumont Health System in Michigan between 2006 and 2020. Patients were then split into either the prediabetes or control group based on at least two A1C levels five years apart; the control group included patients who maintained a normal hemoglobin A1C during the study. A total of 12,691 patients and 13,138 were included in the prediabetes and control groups, respectively. Participants ranged in age from 18 to 104 years. All patients were followed for the 14-year study period and researchers used international classification of disease codes or diagnostic codes to determine whether a major adverse cardiovascular event occurred.

The relationship between prediabetes and events were strongest among males, Blacks and people with a family history of cardiovascular disease or personal risk factors for heart disease. People who were overweight had the highest rates of cardiovascular events among all patients, even more than those who were obese, which is something Michel said needs to be studied further.

Prediabetes is thought to play a role in heart health because elevated glucose levels in the blood can damage and cause inflammation within the vessels. This causes injury to the vessels in the body and can lead to narrowing of the vessels and ultimately cardiovascular injury, Michel said.

The study findings are an important reminder for adults to know their blood sugar numbers, especially as prediabetes usually has no symptoms. As with diabetes, prediabetes is diagnosed based on results from blood sugar tests, including an A1C, which reflects someone's average blood sugar for the past two to three months; a fasting plasma glucose test, which measures your blood sugar after not eating or drinking for at least eight hours beforehand; and/or an oral glucose tolerance test, which checks how well the body processes sugar after drinking a sweet drink given by the clinician. Prediabetes is suspected with an A1C between 5.7-6.4%, fasting blood sugar of 100-125 mg/dl, or an oral glucose tolerance test of 140-199 mg/dl, according to the American Diabetes Association.

More research is needed to validate these findings.

Source:

American College of Cardiology

Posted in: Medical Research News | Medical Condition News

Tags: Blood, Blood Pressure, Blood Sugar, Body Mass Index, Cardiology, Cardiovascular Disease, Cholesterol, Diabetes, Diagnostic, Diet, Education, Exercise, Fasting, Glucose, Glucose Test, Heart, Heart Attack, Heart Disease, Hemoglobin, Hospital, Inflammation, Medicine, Peripheral Artery Disease, Prediabetes, Research, Sleep, Sleep Apnea, Smoking, Stroke, Type 2 Diabetes

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Blood pressure-lowering medication can prevent serious cardiovascular conditions

Blood pressure-lowering medication can prevent serious cardiovascular conditions such as strokes, heart failure and heart attacks even in adults with normal blood pressure, according to new research published in The Lancet.

Importantly, the study found the beneficial effects of treatment were similar regardless of the starting blood pressure level, in both people who had previously had a heart attack or stroke and in those who had never had heart disease.

The authors say that the findings have immediate and important implications for global clinical guidelines that typically limit blood pressure-lowering treatment to individuals with high blood pressure (usually above 140/90 mmHg).

Our findings are of great importance to the debate concerning blood pressure treatment. This new and best available evidence tells us that decisions to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual's blood pressure level. Instead, medication should be viewed as an effective tool for preventing cardiovascular disease in people at increased risk of developing heart disease or stroke. Clinical guidelines should be changed to reflect these findings."

Kazem Rahimi, Study Lead Author and Professor, University of Oxford, UK

He cautions, "We're not saying that everyone must begin treatment. The decision will depend on an individual's risk factors for developing cardiovascular disease, the potential for side effects and patient choice."

Heart disease and stroke, linked to high blood pressure, are the leading cause of death across most of the western world. It is widely accepted that blood pressure medication protects people who have had a prior heart attack or stroke from having a second, but the use of these drugs in people with normal or mildly elevated blood pressure has been debated.

So far, studies examining whether blood pressure-lowering medication is equally beneficial in people with and without a history of cardiovascular disease, and at lower blood pressure levels than currently considered for treatment (typically 140/90 mmHg or higher) have reported conflicting findings. This has led to contradictory treatment recommendations around the world.

For the current analysis, the Blood Pressure Lowering Treatment Triallists' Collaborators pooled data from 344,716 adults (average age 65 years) in 48 randomized trials (the gold standard for evaluating the effectiveness of treatments) to explore the effects of blood pressure-lowering medications.

Participants were separated into two groups: those with a prior diagnosis of cardiovascular disease (157,728 participants – secondary prevention group) and those without (186,988 – primary prevention group, without cardiovascular disease).

Each group was then divided into seven subgroups based on levels of systolic blood pressure at study entry (less than 120, 120-129, 130-139, 140-149, 150-159, 160-169, 170 and above mmHg). Around 20% (31,239) of participants with prior cardiovascular disease and 8% (14,928) of those who had never had cardiovascular disease had normal or high-normal systolic blood pressure at the start of the trials (systolic blood pressure less than 130 mmHg).

Over an average of four years follow-up, 42,324 participants had at least one major cardiovascular event (heart attack, stroke, heart failure, or death from cardiovascular disease).

For every 5 mmHg reduction in systolic blood pressure, the risk of developing major cardiovascular disease fell by around 10% (18,287 vs 24,037 major cardiovascular disease in the intervention and comparator groups, respectively), stroke by 13% (6,005 vs 7,767), heart failure by 13% (3,249 vs 4,584), ischemic heart disease by 8% (8,307 vs 11,145), and death from cardiovascular disease by 5% (4,825 vs 6,110).

The beneficial effects of the treatment did not differ based on a history of having had cardiovascular disease or the level of blood pressure at study entry.

"It is important that people are considered for blood pressure-lowering treatment based on their cardiovascular risk, rather than focusing on blood pressure itself as a qualifying factor for or target of treatment," says co-author Zeinab Bidel from the University of Oxford, UK. "We must provide well-rounded guidelines to lower risks for cardiovascular disease that include exercise, nutrition, smoking cessation, and – where appropriate – medication."

The study has some limitations including that it only investigated the impact of starting blood pressure and prior cardiovascular disease on treatment effects, so the findings cannot be generalized to other patient characteristics that we have not included in our analysis.

Additionally, the effects on diseases other than major cardiovascular disease, including potential side effects of treatment, were not specifically examined.

Source:

The Lancet

Journal reference:

The Blood Pressure Lowering Treatment Trialists' Collaboration., (2021) Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. The Lancet. doi.org/10.1016/S0140-6736(21)00590-0.

Posted in: Medical Research News | Medical Condition News | Pharmaceutical News

Tags: Blood, Blood Pressure, Cardiovascular Disease, Drugs, Exercise, Heart, Heart Attack, Heart Disease, Heart Failure, High Blood Pressure, Nutrition, Research, Smoking, Smoking Cessation, Stroke

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Horizontal transmission route is responsible for HTLV-1 uveitis

Human T-cell lymphotropic virus type-1 (HTLV-1) is a retrovirus similar to human immunodeficiency virus (HIV) and has mostly been thought to be transmitted vertically (mother-to-child), or horizontally (sexually or parenterally (e.g. via blood transfusion)).

The spread of this infection in metropolitan areas such as Tokyo is presumed to be due to horizontal transmission, especially sexual transmission. HTLV-1-associated diseases are thought to be caused mainly through vertical transmission.

In a new study, clinicians from Tokyo Medical and Dental University (TMDU) describe that horizontal transmission route is responsible for HTLV-1 associated disease, i.e. HTLV-1 uveitis.

The clinicians saw a 57-year-old woman who presented with sudden blurred vision. An eye examination revealed profound pathologies in different anatomical locations of her eyes. Most prominent were cellular infiltrates and opacity in the vitreous body, a large gel-like substance between the lens and the back of the eye.

Because the pathologies were consistent with uveitis and an inflammation of the eyes, and given the patient's age, the clinicians tested her for the presence of several autoimmune diseases, such as rheumatoid arthritis and sarcoidosis, because uveitis can be a result of those.

The tests didn't reveal anything, so the clinicians tested the patient for a number of infectious diseases, such as HTLV-1 and HIV, that can also cause uveitis. When the HTLV-1 test came back positive, the clinicians made their diagnosis of HTLV-1 uveitis.

HTLV-1 can cause adult T-cell lymphoma, myelopathy and uveitis, among other disorders. Although we started the patient on the proper treatment, an unanswered question was how did the patient get infected with the virus in the first place."

Kyoko Ohno-Matsui, Study Senior Author, Tokyo Medical and Dental University

Because there's no targeted therapy for HTLV-1 infections, the clinicians had to weaken the patient's immune system with corticosteroids, because an over-reacting immune system is thought to cause harm to the patient. The clinicians started the patient on corticosteroid therapy systemically as well as with topical eye drops over 6 weeks.

Over the course of the next several months, the patient suffered from several recurrences, so the clinicians started her on a maintenance corticosteroid therapy, i.e. treatment over the course of 8 months. While no recurrences happened in this time period, 18 months after the start of the maintenance therapy, the patient presented with another recurrence, including a retinal detachment, which could lead to permanent blindness.

This detachment was managed by ophthalmic surgery and the patient was again started on corticosteroids, this time for 4 years. No recurrences have happened since then and the patients has remained symptom-free.

Interestingly, during follow-up the patient's mother underwent cataract surgery at the same clinic site. Testing for HTLV-1 revealed no infection of the mother, ruling out vertical transmission to the patient. Of note, HTLV-1 can become symptomatic even decades after initial infection.

"In the current environment of increasing HTLV-1 incidence, the existence of horizontal transmission causing HTLV-1 uveitis should be acknowledged as it can result in more severe inflammation than vertical transmission. Thus, physicians should take the route of infection into consideration when providing medical care to patients with HTLV-1-associated diseases." says first / corresponding author of the study Koju Kamoi.

Source:

Tokyo Medical and Dental University

Journal reference:

Kamoi, K., et al. (2021) Horizontal transmission of HTLV-1 causing uveitis. The Lancet Infectious Diseases. doi.org/10.1016/S1473-3099(21)00063-3.

Posted in: Medical Research News | Disease/Infection News

Tags: Arthritis, Blindness, Blood, Blood Transfusion, Cataract, Cell, Corticosteroid, Eye, HIV, Imaging, Immune System, Immunodeficiency, Infectious Diseases, Inflammation, Lymphoma, Myelopathy, Ophthalmology, Retinal Detachment, Retrovirus, Rheumatoid Arthritis, Sarcoidosis, Surgery, T-Cell, Uveitis, Virus

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Macrophages play a vital role in re-establishing and controlling blood flow after tissue damage

Cardiovascular disease, the most common cause of death, is the result of oxygen deprivation as blood perfusion to affected tissue is prevented. To halt the development of the disease and to promote healing, re-establishment of blood flow is crucial.

Researchers at Uppsala University have now discovered that one of the most common immune cells in the human body, macrophages, play an important role in re-establishing and controlling blood flow, something that can be used to develop new drugs.

The classic function of immune cells is to defend the body against attacks from microorganisms and tumour cells. Macrophages are immune cells specialised in killing and consuming microorganisms but they have also been shown to be involved in wound healing and building blood vessels.

A new study published by researchers at Uppsala University demonstrates that macrophages accumulate around blood vessels in damaged tissue in mice, but also in humans after a myocardial infarction or peripheral ischemia. In mice, these macrophages could be seen to regulate blood flow, performing a necessary damage-control function. In healthy tissue, this task is carried out by blood vessel cells.

This discovery led the research group to investigate whether their findings could be developed into a new treatment to increase blood flow to damaged leg muscles, thus stimulating healing and improving function. By increasing the local concentration of certain signal substances that bind to macrophages in the damaged muscle, the research group was able to demonstrate that more macrophages accumulated around the blood vessels, improving their ability to regulate blood flow. This in turn resulted in improved healing and that the mice were able use the injured leg to a far greater extent.

This is an entirely new function for the cells in our immune system and might mean that in future we can use immunotherapies to treat not only cancer but also cardiovascular diseases."

Mia Phillipson, Leader of Research Group, Uppsala University

Source:

Uppsala University

Journal reference:

Vågesjö, E., et al. (2021) Perivascular Macrophages Regulate Blood Flow Following Tissue Damage. Circulation Research. doi.org/10.1161/CIRCRESAHA.120.318380.

Posted in: Medical Science News | Medical Research News | Medical Condition News

Tags: Blood, Blood Vessel, Blood Vessels, Cancer, Cardiovascular Disease, Drugs, Immune System, Muscle, Myocardial Infarction, Oxygen, Research, Wound, Wound Healing

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Inhibition of Meprin Β enzyme can trigger the development of Alzheimer's disease, cancer

Researchers at Johannes Gutenberg University Mainz (JGU) in Germany and the Institute of Molecular Biology of Barcelona in Spain have discovered how the blood plasma protein fetuin-B binds to the enzyme meprin β and used a computer model to visualize their findings.

These results could lead to the development of new drugs to treat serious diseases such as Alzheimer's and cancer. Meprin β releases proteins from cell membranes, thus controlling important physiological functions in the human body.

However, a dysregulation of this process can trigger the development of Alzheimer's and cancer. Meprin β is regulated by fetuin-B binding to the enzyme when required, thereby preventing the release of other proteins. Presenting their findings in the journal Proceedings of the National Academy of Sciences, the researchers are now the first to describe this binding in detail.

The team at Mainz University produced both meprin β and fetuin-B in insect cells and then allowed them to react with one other in a test tube. By means of measurement of enzyme kinetics and biophysical analyses, the researchers determined that this reaction resulted in an exceptionally stable, high-molecular-mass complex.

Their colleagues in Barcelona subsequently managed to crystallize the complex and determine its three-dimensional structure using X-ray crystallography. This involved X-rays being fired at the protein crystals, which allowed the atomic structure of the crystals to be calculated from the diffraction of the X-rays. A computer model of the structure was then generated.

"Thanks to the model, we can now see exactly how meprin β and fetuin-B bind together," said Professor Walter Stöcker, who conducted the research at JGU together with Dr. Hagen Körschgen and Nele von Wiegen. "This research represents an excellent starting point for gaining a better understanding of diseases such as Alzheimer's and for developing the drugs to combat them."

Meprin β is already known to be involved in the formation of so-called beta-amyloid plaques, which are a characteristic feature of the condition. Moreover, people with Alzheimer's disease have relatively little fetuin-B in their blood, which in turn may lead to a lack of regulation of meprin β.

If it is possible to develop a drug that binds to the enzyme and inhibits it in a similar way to fetuin-B, this could be a new way of treating Alzheimer's."

Walter Stöcker, Professor, Johannes Gutenberg University Mainz (JGU), Germany

Source:

Johannes Gutenberg University Mainz

Journal reference:

Eckhard, U., et al. (2021) The crystal structure of a 250-kDa heterotetrameric particle explains inhibition of sheddase meprin β by endogenous fetuin-B. Proceedings of the National Academy of Sciences. doi.org/10.1073/pnas.2023839118.

Posted in: Medical Research News | Medical Condition News

Tags: Alzheimer's Disease, Blood, Cancer, Cell, Crystallography, Diffraction, Drugs, Enzyme, Molecular Biology, Protein, Research, X-Ray

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Canada records second case of rare blood clot after AstraZeneca shot

blood clot

Canadian health authorities said Saturday the country has recorded a second case of rare but serious blood clotting linked to AstraZeneca’s COVID-19 vaccine, but still recommend the shot for use.

The patient, who lives in the western province of Alberta and received a version of the AstraZeneca vaccine supplied by the Serum Institute of India, “has received treatment and is recovering,” Canadian health authorities wrote on Twitter.

Canada reported its first case of blood clotting associated with low platelets on Tuesday in a Quebec woman who received the same shot.

Blood clot formations linked to the AstraZeneca vaccine “remain very rare” and Canada still believes that the vaccine’s benefits “outweigh the potential risks,” Health Canada and the Public Health Agency of Canada said.

Canada’s health authorities added that they would “continue to monitor the use of all #COVID19 vaccines closely and examine and assess any new safety concerns.”

At the end of March Canada’s National Advisory Committee on Immunization (NACI) recommended suspending the use of the AstraZeneca vaccine in people under the age of 55 while it evaluated the risks.

However Health Canada said Wednesday that according to its analysis, limiting the use of the vaccine to certain populations was not necessary for the moment.

After a slow start, Canada’s vaccine campaign is gaining momentum. To date, 23.3 percent of the Canadian population has received at least one vaccine dose according to the COVID-19 Tracker Canada website.

The country is facing a third coronavirus wave, however, that has recently forced provinces to tighten restrictions.

Ontario, which has the highest number of cases, announced Friday it would strengthen and extend lockdown measures until May 19, and also close its borders with the provinces of Quebec and Manitoba beginning Monday.

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Novel PET tracer is safe and can clearly identify early stages of rheumatoid arthritis

New research shows that a novel positron emission tomography (PET) tracer that targets inflammation is safe and can clearly identify early stages of rheumatoid arthritis. The promising PET tracer, 68Ga-DOTA-Siglec-9, rapidly clears from blood circulation, has a low radiation dose, and can be easily produced. This first-in-human study was published in the April issue of the Journal of Nuclear Medicine.

Inflammation is a significant part of several chronic diseases, including rheumatoid arthritis and its related issues. While PET imaging with 18F-FDG is a valuable tool for the diagnosis and monitoring of the effects of treatments, it is not specific enough to assess inflammation.

It's important to detect inflammation early so that patients can receive the best treatment. Our institution has worked for several years to develop an imaging agent that targets areas of inflammation, and in this study, tested its effectiveness in humans for the first time."

Anne Roivainen, PhD, Professor of Preclinical Imaging and Drug Research, Turku PET Centre, University of Turku and Turku University Hospital in Finland

To evaluate the radiotracer's safety and biodistribution characteristics, six healthy study participants underwent whole body 68Ga-DOTA-Siglec-9 PET/computed tomography scans. 68Ga-DOTA-Siglec-9 was well-tolerated and cleared quickly from the blood, and its radiation dose was similar to other 68Ga tracers. In one additional study participant with rheumatoid arthritis, the tracer was able to clearly detect joints with arthritis.

"We have proven that the characteristics of 68Ga-DOTA-Siglec-9 are favorable for use in patient imaging studies," remarked Roivainen. "Future studies will clarify whether 68Ga-DOTA-Siglec-9 PET imaging has the potential to detect other inflammatory diseases early. It could also help to evaluate the effectiveness of treatments and promptly identify patients who are unlikely respond to therapy."

Source:

Society of Nuclear Medicine and Molecular Imaging

Journal reference:

Viitanen, R., et al. (2021) First-in-Humans Study of 68Ga-DOTA-Siglec-9, a PET Ligand Targeting Vascular Adhesion Protein 1. Journal of Nuclear Medicine. doi.org/10.2967/jnumed.120.250696.

Posted in: Medical Science News | Medical Research News | Medical Condition News

Tags: Arthritis, Blood, Chronic, Computed Tomography, CT, Heart, Hospital, Imaging, Immunology, Inflammation, Laboratory, Ligand, Medicine, Molecular Imaging, Nuclear Medicine, Oncology, Positron Emission Tomography, Preclinical, Preclinical Imaging, Protein, Radiology, Radiotherapy, Research, Rheumatoid Arthritis, Rheumatology, Theranostics, Tomography, Vascular

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Cerebral venous sinus thrombosis: What to know about rare blood clot condition

blood

Cerebral venous sinus thrombosis was reported in six American women after they were injected with the Johnson & Johnson COVID-19 vaccine, prompting federal officials to recommend a pause Tuesday in giving doses of the one-shot vaccine until an investigation can be completed.

But what is cerebral venous sinus thrombosis, and why are the U.S. Food & Drug Administration and the Centers for Disease Control and Prevention so concerned about it?

Dr. Geoffrey Barnes, a cardiologist and vascular medicine specialist at the Michigan Medicine Frankel Cardiovascular Center, told the Free Press Tuesday that the condition is an extremely rare form of stroke.

“This is a blood clot that forms in one of the veins that helps to drain blood from your head back down to your heart,” Barnes said. “It’s an uncommon place for blood clots to form, and when it forms up there, patients tend to have sort of a collection of symptoms.”

Those symptoms, he said, can include:

  • Severe headache
  • Vision changes
  • Severe nausea
  • Vomiting
  • Rarely, some people will have seizures

With these strokes, the blood clot forms in the cerebral spinal vein, he said.

“It is a pretty uncommon location,” Barnes said. “The two most common places in the body where people develop blood clots are either in the veins of the legs, or in the lungs; those are overwhelmingly where most blood clots form.”

Peter Marks, director of the Center for Biologics Evaluation and Research at the FDA, said in the general population, this occurs in between 2 and 14 people per million population.

What’s different about the six U.S. women who developed this condition within 6 and 13 days of getting a COVID-19 vaccine is that they also had a low platelet count, also known as thrombocytopenia.

“The combination here—the real thing that is so notable here—is not just the cerebral venous sinus thrombosis or the thrombocytopenia,” Marks said. “Those two things can occur. It’s their occurrence together that makes a pattern, and that pattern is very, very similar to what was seen in Europe with another vaccine.”

The vaccine Marks was referencing is AstraZeneca’s, which is similar to Johnson & Johnson’s in that it’s a recombinant vector vaccine using the adenovirus, which causes the common cold, that’s modified with the genetic spike protein found in SARS-CoV-2.

While Johnson & Johnson’s vaccine was developed using human adenovirus, there have been reports of blood clots in people in other countries who received AstraZeneca’s vaccine. It uses chimpanzee adenovirus.

“We don’t have a definitive cause,” Marks said. “But the probable cause that we believe may be involved here … is a similar mechanism that may be going on with other the other adeno-viral vector vaccine. That is that this is an immune response that occurs very, very rarely after some people receive the vaccine, and that immune response leads to activation of the platelets and these extremely rare blood clots.”

For most people who are having a stroke or are treated for blood clots, the standard therapy in hospitals is to give them heparin, a blood thinner, Barnes said.

But for people who have a CVST following a COVID-19 vaccine, that’s not the recommendation.

“What we are learning about these blood clots and how they might be associated with the use of the AstraZeneca vaccine in Canada and Europe and now it sounds like potentially with the Johnson & Johnson Johnson vaccine here,” Barnes said, “is we actually need … to use a different form of a blood thinner. That’s sort of the critical piece for doctors to know about.

“Doctors need to be aware that if this very rare blood clot occurs within three weeks of somebody getting the J&J vaccine, then there’s some routine lab tests that they need to do, and they would want to start them on a non-heparin blood thinner.”

Two important studies were published Monday in the New England Journal of Medicine, Barnes said, that suggest that after getting one of these COVID-19 vaccines, the body can form an immune response that binds heparin with platelets, which is one of the things in the blood that helps people form blood clots.

“We see patients who get this sort of allergic reaction, you might call it, to heparin all the time,” Barnes said. “But what’s interesting here is it seems to have developed in people who never got heparin before. And so because we’re aware of this, now we know how to immediately jump in and use some non-heparin blood thinners.”

Barnes said people who’ve recently gotten a Johnson & Johnson vaccine shouldn’t be all that concerned.

“I want to reassure people that this is an exceedingly rare event,” he said. “We’re talking about six cases that have been reported from the CDC and the FDA despite millions and millions of doses of the J&J vaccine.

“We’re talking a fairly tiny percentage of people who have developed the rare blood clot. The second thing I would say is what we’ve learned from Europe and Canada, is that there does not seem to be any role for taking aspirin or a blood thinner, you know, shortly after getting your vaccine. Again, the risk of this blood clot is so exceedingly low. that we don’t want people to have other harms from taking medicines, things like that.

“The third thing I would say is that it’s really important to understand the time course. If you just got your vaccine yesterday or the day before, it’s pretty common that you might feel for muscle aches, maybe chills, fever, headache, flu-like symptoms. That’s a sign that your body’s reacting to the vaccine as we would expect—that’s not something to be concerned about.”

For anyone who got a Johnson & Johnson vaccine a month or two ago, “you’re also out of the window where we’re not concerned about any blood-clotting risk,” Barnes said.

“But if you fall in this window of about four to five days up to three weeks (post-vaccination), that’s where we’ve heard about these very rare blood clot events and so those are the people for whom we just want to keep our antenna up.

“We want to be aware of it in case they develop these new severe symptoms.”

Those people, he explained, should go to the hospital for an evaluation if they develop symptoms of CVST, such as severe headache, vision changes, severe nausea and vomiting or seizures.

“You can be reassured that every hospital in the region has the tools needed to do this evaluation,” Barnes said. “In the rare case where this is found, we have the tools necessary to treat it, but it’s pretty unlikely this is not going to be a common event that people will experience.”

He said it’s also not a reason to avoid getting a COVID-19 vaccine.

“We know that the COVID pandemic is the most important health risk out there right now, and especially here in Michigan,” Barnes said. “We are on the front lines of that, and anything we can do to get the COVID pandemic under control is going to be really important.

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