Publisher Health

One of the enduring mysteries of the COVID-19 pandemic is why most children tend to experience fewer symptoms than adults after infection with the coronavirus. The immune system response that occurs in the rare cases in which children experience life-threatening reactions after infection may offer an important insight, a Yale-led study published in the journal Immunity suggests.
While many children infected with the virus are asymptomatic or go undiagnosed, about one in 1,000 children experience multi-system inflammatory response (MIS-C) four to six weeks after confirmed infection with SARS-CoV-2, the virus that causes COVID-19. The condition is marked by a variety of symptoms, including fever, abdominal pain with vomiting and/or diarrhea, rash, and cardiovascular and neurological problems. If diagnosed early, the condition is readily treatable with immune suppressants such as steroids. If left untreated, however, it can be fatal.
“Why does this happen when there is no virus or anti-viral response still present and in kids? And why is it only occurring in youth?” asked Carrie Lucas, an assistant professor of immunobiology at Yale and corresponding author of the new study.
In an exhaustive analysis, Lucas and her lab tested blood from children with MIS-C, adults with severe COVID symptoms, as well as healthy children and adults. They found that children with MIS-C had immune system signatures distinct from other groups.
Specifically, the children with MIS-C had high levels of alarmins, molecules that make up part of the innate immune system which is mobilized quickly to respond to all infections. Other research findings have suggested that a child’s innate immune system response may be stronger than those of adults, one possible explanation for why they generally experience milder symptoms than adults after infection.
“Innate immunity may be more active in children who are infected with virus,” Lucas said. “But on the flip side, in rare cases it may get too revved up and contribute to this inflammatory disease.”
Children diagnosed with MIS-C were also found to have a marked elevation of certain adaptive immune responses, which are defenses to combat specific pathogens — such as the virus causing COVID-19 — and that typically confer immunological memory. But instead of being protective, the responses produced in these affected children appear to attack a variety of host tissues, a hallmark of autoimmune diseases.
Lucas speculates that the initial immune response in these rare cases triggers a cascade that damages healthy tissue, which in turns makes the tissue more susceptible to attack by autoantibodies.
In the meantime, the peculiar immune system signatures of MIS-C could help in the diagnosis and early treatment options of children at high risk of the disorder, Lucas said.
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Materials provided by Yale University. Original written by Bill Hathaway. Note: Content may be edited for style and length.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesThe government’s review of social distancing rules in England might have to be delayed because of the spread of the Indian Covid variant.Boris Johnson had hoped to give an update by the end of May ahead of the planned lifting of all remaining restrictions on 21 June.But No 10 said the government now “cannot be definitive at this point”.It comes as millions of people can now enjoy new freedoms as lockdown is eased in England, Wales and most of Scotland.People have been visiting pubs and restaurants indoors for the first time in months, hugging loved ones again and going on holiday as the ban on foreign travel is lifted.It is hoped all remaining legal limits on social contact can be removed on 21 June, meaning unlimited numbers of guests at events such as weddings, and nightclubs allowed to reopen.Ahead of this, a review of the measures – as well as the possible use of coronavirus status certification or passports – had been expected by the end of May.The prime minister’s official spokesman said: “The Indian variant could pose a threat to this process – our decision will be based on latest data. We will set out plans as soon as the data allows.”Live updates: Lockdown easing not luring people to High StreetsIn pictures: Lockdown eases in parts of the UKWhy is the India variant causing concern in the UK?What are Monday’s big changes to lockdown?The government has set four tests which must be met before lockdown can ease further, which include vaccines continuing to be effective and the risks not being fundamentally changed by new variants.The rule changes on Monday – which are different in England, Wales and Scotland – have seen thousands of people heading off on foreign holidays, flocking to bingo halls and drinking inside pubs again.Hospital ward manager Viv Hudson, 58, wept with joy as she finally hugged her daughter Theresa Fox for the first time in more than a year.”It’s a bit weird – but a good kind of weird. I’ve missed this so much,” said Theresa, 38, who also works for the NHS.image copyrightPA MediaHowever, the variant first identified in India continues to spread in the UK, with mass testing rolled out to hotspots including Bolton in Greater Manchester, Sefton, in Merseyside and parts of London. Speaking ahead of the relaxation, Mr Johnson said the government was keeping the variant under close observation and taking swift action where infection rates were rising.Asked whether ministers would consider a return to a tiered system of rules, the prime minister’s spokesman said: “I don’t want to get ahead of where we are at the moment and start getting into hypothetical situations.”But he said there was a “very targeted increase in surge vaccinations and testing in these areas where we’re seeing rises and that’s what we want to proceed with if at all possible – but we don’t want to rule anything out”.Scientists believe the Indian variant does spread more easily, but early data suggests vaccines still work. The exact impact on vaccine efficacy – if any – is yet to be confirmed.image copyrightPA MediaDowning Street said its concern was about a worst-case scenario where people who had had the jab were still vulnerable.”That would then lead to increased hospitalisations and put unsustainable pressure on our NHS. That’s the situation we are attempting to avoid here.” Meanwhile, Downing Street has urged health officials not to extend the vaccine rollout to younger people yet.Bolton Council and the London mayor are among those to have urged officials to allow people in areas where there are higher rates of the Indian variant to have the jab regardless of their age.But No 10 said the Joint Committee on Vaccination and Immunisation had advised that the best way to protect against the new variant was to stick to its priority list.Health Secretary Matt Hancock is due to make a statement to MPs in the House of Commons on Covid at 16:30 BST.How are the rules changing on Monday?England:People can now meet indoors in groups of up to six or two households, or in groups of up to 30 outdoors. Overnight stays are allowedPubs, bars and restaurants can serve customers indoorsMuseums, cinemas, children’s play areas, theatres, concert halls and sports stadiums can all reopen, as can hotelsSocial distancing guidance is changing and contact with other households like hugs is a matter of personal choiceScotland (except Glasgow and Moray): People can meet indoors in groups of six from up to three households. Outdoors, up to eight people from eight households can mixPubs and restaurants can serve alcohol indoors until 22:30Entertainment venues such as cinemas, theatres and bingo halls can reopen and up to 100 people are allowed at indoor eventsWales: Pubs and restaurants can reopen indoors and customers can meet in groups of up to six from six householdsAll holiday accommodation can reopenCinemas, bowling alleys, museums, galleries and theatres can reopenNo change to indoor socialising – this is still restricted to extended households where two households can mix with each other and have physical contactAnd in all three nations, foreign holidays are allowed.Northern Ireland will review lockdown rules on 20 May, with the hope that some could be lifted on 24 May.Read more about the changes here.Earlier, Business Secretary Kwasi Kwarteng told BBC Radio 4’s Today programme he was “very confident” the government would be able to lift England’s remaining restrictions on 21 June but could not guarantee it.He said: “There is flexibility here because we have another five weeks till the reopening and we will be revisiting the data.”Sir Jeremy Farrar, a member of the government’s independent scientific advisory group Sage, said Monday’s lifting of the rules was a “very finely balanced” decision.He said the variant was “becoming dominant in parts of the UK, and yet vaccination across the country has been extraordinary successful”, adding: “A very careful lifting is reasonable, but we may have to reverse that if there is escape from the vaccines.”Latest figures show another 1,976 cases have been recorded across the UK and a further five people have died.The number of people who have received their first vaccine dose has topped 36.7 million, while more than 20.2 million second doses have been given.AnalysisBy Greg Dawson, BBC News political correspondentJust a week ago Boris Johnson stood at the podium in Downing Street and talked of his hopes that the government would be able to update businesses by the end of May on the future social distancing rules. That commitment is already looking shaky.It is an indication of just how seriously the government views the emergence of the Indian variant that Downing Street today admitted that deadline could slip.An expected update for when weddings will be able to resume as normal also looks to be on hold; the prime minister’s original intention was to give people 28 days notice ahead of the planned 21 June re-opening. The government has been adamant for months that it wants this lockdown to be the last.However, it has repeatedly said it wants to be guided by “data and not dates”, and at the moment there simply isn’t enough data on how serious the Indian variant could be, and how quickly it is spreading within the UK for the government to confidently stand by previously stated deadlines. LOOK-UP TOOL: How many cases in your area?YOUR QUESTIONS: We answer your queriesVACCINE: When will I get the jab?NEW VARIANTS: How worried should we be?MOTHERLAND: Comedy navigating the trials and traumas of parentingRACISM IN THE MUSIC INDUSTRY: Little Mix’s Leigh-Anne confronts her own experiences

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesThe US Supreme Court has agreed to hear a challenge to Mississippi’s 15-week ban on abortion in a major case that will be closely watched across the US.The verdict could upend the legal right to abortion laid out in the court’s 1973 landmark Roe v Wade ruling.It will be the first abortion case heard by Justice Amy Coney Barrett, a Catholic conservative who then-President Trump nominated in fall 2020.The court is ideologically split, with conservatives holding a 6-3 majority.The case, Dobbs v Jackson Women’s Health Organization, challenges the constitutionality of abortions performed after week 15 of pregnancy.If Mississippi’s ban is upheld by the Supreme Court, it could pave the way for further abortion restrictions that have been pushed for by conservatives.’It could be the case that kills Roe’Anti-abortion activists have been waiting, sometimes impatiently, for the increasingly conservative-dominated Supreme Court to take up a case that could allow it to drive a stake through the heart of Roe v Wade. On Monday morning, the court obliged.Mississippi’s 15-week abortion ban was written as direct challenge to existing Supreme Court guidelines governing the legality of abortion. If a majority of the nine-member court decides to uphold the law, it will pave the way for other states to impose their own stringent limitations on the procedure. That the court decided to hear the case after lower courts struck down the law suggests that at least four justices are open to doing just that.Abortion has been one of the most highly charged judicial topics in the last half-century. The 1973 Roe case legalising first-trimester abortion nationwide was sweeping in its scope and gave rise to the modern religious conservative movement. A slim majority of justices turned back a serious challenge to the precedent in 1992’s Planned Parenthood v Casey.This Mississippi challenge has the potential to rank alongside those landmark cases. It could be the case that kills Roe and hands the issue of abortion legality back to the states to decide.What is Roe v Wade? The 1973 Supreme Court ruling legalised abortion in the US.By a vote of seven to two, the court justices ruled that governments lacked the power to prohibit abortions.The court’s judgement was based on the decision that a woman’s right to terminate her pregnancy came under the freedom of personal choice in family matters as protected by the 14th Amendment of the US Constitution.The case created the “trimester” system that:gives American women an absolute right to an abortion in the first three months of pregnancyallows some government regulation in the second trimester of pregnancydeclares that states may restrict or ban abortions in the last trimester as the foetus nears the point where it could live outside the wombRoe v Wade also established that in the final trimester a woman can obtain an abortion despite any legal ban only if doctors certify it is necessary to save her life or health.Overturning Roe v Wade would not make abortion illegal, it would just allow each state to determine its own rules.What power do states have?Since Roe v Wade, conservative states have pushed to bypass the ruling and make their own rules governing abortion.Though the Roe v Wade judgement was upheld, states won the right to restrict abortion even in the first trimester for non-medical reasons after the 1992 Planned Parenthood v Casey Supreme Court case.State laws must not place an “undue burden” on women seeking abortion services, the court said. However, it is the woman and not the authorities who have to prove that the regulations are damaging.What’s going on with US abortion rights? WATCH: The abortion battle explainedAmy Coney Barrett on abortion, healthcare and her faithAs a result many states now have restrictions in place such as requirements that young pregnant women involve their parents or a judge in their abortion decision. Others have introduced waiting periods between the time a woman first visits an abortion clinic and the actual procedure.The result of these restrictions is that many women have to travel further to get an abortion, often across state borders, and pay more for them. Last year, the Supreme Court struck down a Louisiana law that required doctors who perform abortions to have admitting privileges at nearby hospitals.Critics said the controversial law would limit the number of providers in the state, violating a woman’s right to an abortion.Last week, Texas joined at least a dozen states that have passed bills that ban abortion after a foetal heartbeat can be detected – which often happens before a woman even knows she is pregnant.According to the Guttmacher Institute, a research group that supports abortion rights, state lawmakers have introduced more than 500 restrictions on abortion this year.”The year 2021 is well on its way to being a defining one in abortion rights history,” said the authors of the report.Many of the cases have been challenged in the courts, setting up possible future legal showdowns in the Supreme Court such as the current one prompted by the Mississippi law.You may also be interested in:

The early immune response in a person who has been vaccinated for COVID-19 can predict the level of protection they will have to the virus over time, according to analysis from Australian mathematicians, clinicians, and scientists, and published today in Nature Medicine.
The researchers from UNSW’s Kirby Institute, the Peter Doherty Institute for Infection and Immunity, and the University of Sydney have identified an ‘immune correlate’ of vaccine protection. This has the potential to dramatically cut development times for new vaccines, by measuring neutralising antibody levels as a ‘proxy’ for immune protection from COVID-19.
“Neutralising antibodies are tiny Y-shaped proteins produced by our body in response to infection or vaccination. They bind to the virus, reducing its ability to infect,” says Dr Deborah Cromer from the Kirby Institute.
“While we have known for some time that neutralising antibodies are likely to be a critical part of our immune response to COVID-19, we haven’t known how much antibody you need for immunity. Our work is the strongest evidence to date to show that specific antibody levels translate to high levels of protection from disease.”
The researchers analysed data from seven COVID-19 vaccines to examine the how the response measured soon after vaccination correlated with protection. They then used statistical analysis to define the specific relationship between immune response and protection. Their analysis was remarkably accurate and was able to predict the efficacy of a new vaccine.
Dr Cromer said that this finding has the potential to change the way we conduct COVID-19 vaccine trials in the future.

Sperm are generally viewed as having just one action in reproduction — to fertilise the female’s egg — but studies at the University of Adelaide are overturning that view.
Published in Nature Research journal Communications Biology, new research shows that sperm also deliver signals directly to the female reproductive tissues to increase the chances of conception.
Robinson Research Institute’s Professor Sarah Robertson, who led the project, said: “This research is the first to show that the female immune response is persuaded by signals in sperm to allow the male partner to fertilise her eggs and conceive a pregnancy.
“This overturns our current understanding of what sperm are capable of — they are not just carriers of genetic material, but also agents for convincing the female to invest reproductive resources with that male.”
It has been known that proteins in seminal fluid modulate the female immune response at conception to encourage her body to accept the foreign embryo. Whether sperm affect this response has not been clear until now.
The team evaluated effects on global gene expression in the mouse uterus after mating with males with intact sperm, or vasectomized males. Intact males induced greater changes in female genes, particularly affecting immune response pathways.
The females that had contact with sperm produced stronger immune tolerance than those females mated with vasectomised males. By examining effects of sperm interactions with female cells in cell culture experiments, the researchers confirmed the sperm were directly responsible.
These new findings suggest that sperm health isn’t only important for conceiving, but also has ongoing effects on the chances of a healthy baby. Factors like age, diet, weight, alcohol and smoking, and exposures to environmental chemicals can affect sperm quality in men and so might have greater consequences for pregnancy health than previously considered.
“Recognition that sperm influence reproductive events beyond simply fertilizing oocytes shows that sperm quality can have consequences for pregnancy health, beyond just conception,” Professor Robertson said.
“Conditions like recurrent miscarriage, preeclampsia, preterm birth and stillbirth are affected by the female’s immune response in ways that the partner’s sperm contribute to.”
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Materials provided by University of Adelaide. Note: Content may be edited for style and length.

Researchers at the University of Tsukuba found that, despite only covering about one-third of the distance in HIIT compared with that covered in endurance training, similar improvements in exercise capacity and brain function were observed for both forms of exercise.
“We investigated how rats’ muscles and brains — specifically, the region of the brain involved in spatial learning called the hippocampus — adapted to these types of exercise, and how the rats consequently learned and remembered navigating mazes,” explains Professor Hideaki Soya, the principal investigator.
In the experiment, rats were assigned to 1 of 3 groups — resting, endurance running, or alternating intervals (short sprints and rest) — during training sessions on treadmills 5 days/week for 4 weeks.
Both endurance running and HIIT resulted in weight loss, greater muscle mass, and the ability to exercise longer compared with controls; however, increased cellular aerobic capacity was found in the soleus (a muscle with predominantly slow-twitch fibers that makes it functionally well suited to endurance) and in the plantaris (a muscle with predominantly fast-twitch fibers for meeting high-energy functional demands) in the endurance-running and HIIT groups, respectively.
Rats in both groups demonstrated having better memory of spatial learning trials in searching for an escape platform in a water maze. In the hippocampus, increased cell development — neurogenesis — was also observed for both forms of exercise; however, levels of a signaling protein that promotes neurogenesis (BDNF) were increased by HIIT but not by endurance running, whereas the levels of its receptor (TrkB) were increased by both.
Given that BDNF expression is known to be affected by exercise, why didn’t endurance running increase BDNF expression? The answer may lie in the mediating role of stress on BDNF expression; exercise is a type of stress. While stress indicators in both exercise groups were found to be similar, this line of enquiry may lead to future studies:
“In this study, we showed that an HIIT exercise regimen with a low exercise volume nevertheless improves spatial memory, and we demonstrated that these improvements are supported by changes in neuronal plasticity in the hippocampus. In a previous study, we found that continuous light-intensity training had a similar beneficial effect, whereas continuous high-intensity training did not,” Professor Soya summarizes. “Thus, it seems that the benefits yielded by exercise may actually depend on optimization, that is, a trade-off between exercise time and intensity.”
A future where exercise regimens can be tailored to improve both physical and cognitive features may be on the horizon.
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Materials provided by University of Tsukuba. Note: Content may be edited for style and length.

In an important step toward the clinical application of synthetic biology, Rice University researchers have engineered a bacterium with the necessary capabilities for diagnosing a human disease.
The engineered strain of the gut bacteria E. coli senses pH and glows when it encounters acidosis, an acidic condition that often occurs during flareups of inflammatory bowel diseases like colitis, ileitis and Crohn’s disease.
Researchers at the University of Colorado (CU) School of Medicine used the Rice-created organism in a mouse model of Crohn’s disease to show acidosis activates a signature set of genes. The corresponding genetic signature in humans has previously been observed during active inflammation in Crohn’s disease patients. The results are available online in the Proceedings of the National Academy of Sciences.
Study co-author Jeffrey Tabor, whose lab engineered the pH-sensing bacterium, said it could be reprogrammed to make colors that show up in the toilet instead of the fluorescent tags used in the CU School of Medicine experiments.
“We think it could be added to food and programmed to turn toilet water blue to warn patients when a flareup is just beginning,” said Tabor, an associate professor of bioengineering in Rice’s Brown School of Engineering.
Over their 3.5 billion-year history, bacteria have evolved countless specific and sensitive genetic circuits to sense their surroundings. Tabor and colleagues developed a biohacking toolkit that allows them to mix and match the inputs and outputs of these bacterial sensors. The pH-sensing circuit was discovered by Rice Ph.D. student Kathryn Brink in a 2019 demonstration of the plug-and-play toolkit.

A team of McMaster University researchers who studied heart patients found that stair-climbing routines, whether vigorous or moderate, provide significant cardiovascular and muscular benefits.
The findings, published in closely related studies in the journals Medicine & Science in Sports & Exercise and Frontiers, address the most frequently cited barriers to exercise: time, equipment and access to gym facilities.
“Brief, vigorous stair-climbing and traditional moderate intensity exercise both changed fitness, which is a key predictor of mortality after a cardiac event,” says Maureen MacDonald, one of the lead researchers on both studies and a professor in McMaster’s Department of Kinesiology.
“We’ve shown stair-climbing is a safe, efficient and feasible option for cardiac rehabilitation, which is particularly relevant during the pandemic when many people don’t have the option to exercise in a gym,” she says.
While it is widely known that exercise and lifestyle changes reduce the risk of secondary cardiovascular disease, statistics suggest less than a quarter of all cardiac patients adhere to fitness programs.
Researchers worked closely with the Cardiac Health and Rehabilitation Centre at the Hamilton General Hospital to develop an exercise protocol that did not require specialized equipment or monitoring and could be easily performed outside a laboratory.
Participants with coronary artery disease who had undergone a cardiac procedure were randomly assigned either to traditional moderate-intensity exercise or vigorous stair climbing: three rounds of six flights of 12 stairs, separated by recovery periods of walking, with participants selecting their own stepping pace.
Researchers compared the results and found that individuals who had done traditional exercise and those who had done stair-climbing both increased their cardiorespiratory fitness after four weeks of supervised training and maintained those levels for an additional eight weeks of unsupervised training.
They also reported substantial muscular improvement.
“These patients who had undergone a coronary bypass or stent procedure had muscle that was compromised, compared to age-matched healthy controls,” explained Stuart Phillips, a co-author of the studies and a professor in the Department of Kinesiology at McMaster who oversaw the analysis of muscle tissue taken during the study.
Previously, there had been very few studies of the impact of exercise on cardiac patients’ muscle specifically. This analysis shows heart patients can still repair and build lost muscle.
“Even in just a short period, whether it was moderate intensity, continuous training or high-intensity stair climbing, there were beneficial adaptations in muscles after a cardiac procedure,” Phillips says. “The improvements were clear.”
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Materials provided by McMaster University. Note: Content may be edited for style and length.

An international team of researchers from Japan, the US and the UK has analyzed the function of the histone demethylase KDM5A in multiple myeloma, one of the three major hematological cancers, and clarified the mechanism by which it promotes myeloma cell proliferation. They also developed a novel KDM5 inhibitor and showed that it inhibits cancer cell growth in a myeloma mouse model. The researchers expect that new therapies targeting KDM5A will be developed in the future.
The prognosis for multiple myeloma is improving every year with the introduction of new therapeutic agents, but there is still no cure. Further elucidation of the pathogenesis of this cancer and the development of therapeutic agents are required. The molecular pathogenesis of cancers, including multiple myeloma, is deeply related not only to genetic alterations but also to epigenetic changes. The epigenetic regulator KDM5 family proteins are highly expressed in myeloma cells, but their function is not clear.
To clarify the role of KDM5 family proteins in myeloma cells, researchers from Kumamoto University and the Dana-Farber Cancer Institute used genetic manipulation to suppress the expression of KDM5 in human myeloma cell lines. They found that among KDM5 family members, KDM5A in particular had a strong effect on cell proliferation which prompted them to analyze its molecular mechanisms. They also developed a novel KDM5 inhibitor and validated its efficacy using both myeloma patient cells and myeloma mouse models.
Genetic suppression of KDM5A expression or pharmacological inhibition of KDM5 inhibited the growth of myeloma cells. Furthermore, by using myeloma mouse models in which a human myeloma cell line was transplanted into immunodeficient mice, the researchers demonstrated that their KDM5 inhibitor suppresses myeloma cell growth even in vivo. Functional analysis revealed that KDM5A cooperates with MYC, an important transcription factor in myeloma development and growth, to promote the expression of MYC target genes. Although a high level of histone methylation (H3K4me3) was originally observed near the transcription start site of MYC target genes, this modification level was further increased by repressing KDM5A. This indicates that excess H3K4me3 acts as a barrier to transcription thereby inhibiting transcription contrary to previous theories that H3K4me3 promoted transcription. Further analysis suggested that KDM5A helps switch transcription-associated complexes as they proceed from transcription initiation to transcription elongation by transiently releasing H3K4me3.
This study proposed a new model of epigenetic regulation in which KDM5A regulates histone methylation at the transcription start site to optimal levels during the required phase, thereby promoting the transcription of MYC target genes and leading myeloma cells to proliferation. It also showed that KDM5 inhibitor inhibits the growth of myeloma cells.
“Our research has elucidated part of the mechanism of myeloma cell proliferation mediated by histone modification regulation, and has shown the potential for therapies targeting KDM5A,” said Associate Professor Hiroto Ohguchi, who led this study. “It is also becoming clear that the KDM5 family is involved in the growth of other carcinomas. The problem with the KDM5 inhibitors so far is that they have weak cell membrane permeability and are not effective in cells or in vivo. However, if a therapeutic drug is developed based on the KDM5 inhibitor developed in this study, it is expected to develop into a new therapeutic strategy for not only multiple myeloma but also various other types of cancer by combining it with conventional treatment methods.”
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Materials provided by Kumamoto University. Note: Content may be edited for style and length.

A rare syndrome has been observed in people following vaccination against Covid-19. This involves thrombosis at unusual sites in the body, associated with a low thrombocyte (blood platelet) count and a clotting disorder. In medical jargon, this syndrome is referred to as VITT (vaccine-induced thrombotic thrombocytopenia). Doctors at the Department of Medicine I of MedUni Vienna and Vienna General Hospital (Division of Hematology and Hemastaseology) have now successfully treated an acute instance of this syndrome.
VITT is most probably caused by a defective immune response, whereby thrombocyte-activating antibodies are produced resulting in thrombocytopenia (low platelet count) and thrombosis. The mortality rate in VITT is high (40-50 %) and the syndrome requires immediate and appropriate treatment. However, the current recommendations are only empirical and are based on in-vitro data.
A team of doctors at the Department of Medicine I of MedUni Vienna and Vienna General Hospital, led by coagulation specialist Paul Knöbl, has now successfully treated a patient suffering from vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). The female patient was admitted to the Department with a low platelet count and low fibrinogen levels. Fibrinogen is a protein that plays a major role in blood clotting. Knöbl reports: “Apart from that, her D-dimer values, which indicate thrombosis, were very high and an ELISA assay produced a clear positive result for heparin-PF4 antibodies — all signs of incipient thrombosis.”
The doctors acted quickly, and the patient responded immediately to treatment with a high dose of intravenous immunoglobulin concentrates, cortisone and specific anticoagulants, so that thrombosis was prevented. Immunoglobulin concentrates contain antibodies that can block the misdirected immune response. The usual heparin preparations must not be used to prevent clotting, since they can trigger thrombosis, or aggravate it.
“In this case we were able to describe, for the first time, the efficacy of a potentially life-saving treatment strategy for vaccine-induced thrombosis,” says Knöbl. These new findings have been published in the Journal of Thrombosis and Haemostasis. On the one hand, the findings support the current treatment recommendations, but they also show that prompt diagnosis and immediate initiation of treatment are necessary in order to prevent a life-threatening thrombosis. “This experience could be of great help in treating other patients with similar conditions.”
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Materials provided by Medical University of Vienna. Note: Content may be edited for style and length.