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CMAAO Coronavirus Facts and Myth Buster: IBD

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Dr KK Aggarwal    29 November 2020

With input from Dr Monica Vasudev

1173: Anti-cytokine therapy controls inflammatory bowel disease (IBD) symptoms by normalizing decreased or raised ACE2 levels, and could play a protective role in COVID-19. ACE2 is known to be highly expressed in the bowel.

As per Dr. Dermot P. B. McGovern of Cedars-Sinai Medical Center in Los Angeles, ACE2 expression is altered in IBD and is linked with response to the anti-cytokine drug, infliximab. A paper published in Cell suggests that individuals with COVID-19 have high TNF levels and that mouse models were relatively protected from some of the COVID-19-like manifestations following treatment with neutralizing antibodies to TNF. (https://bit.ly/375VBEa).

A study, published in Gastroenterology, showed reduced small bowel, but raised colonic ACE2 levels in IBD are linked with inflammation and severe disease but normalized following anti-cytokine therapy suggesting compartmentalization of ACE2-related biology in small bowel and colonic inflammation. (https://bit.ly/3kXQPxI) 

1174: USA Vaccine picture

  1. December: Wont be enough doses for the entire country. People who get offered a vaccine should feel happy about that.
  2. Healthcare workers will likely receive one of the mRNA vaccines from Moderna and Pfizer/BioNTech.
  3. Government has contracts for 100 million doses each of the Pfizer/BioNTech and Moderna vaccines expected to be reached by spring of 2021. That would be sufficient for the highest-risk groups, including healthcare personnel, nursing home residents, essential workers, and the medically vulnerable.
  4. End of March: 200 million Americans will still be left to be immunized.
  5. Viral vector candidates: Oxford/AstraZeneca, Janssen/Johnson & Johnson, and Merck + protein subunit vaccines from Sanofi/GlaxoSmithKline and Novavax.
  6. Eventually: Mass vaccination sites run by public health agencies; vaccines will be available in community pharmacies. (Medpage Today)

1175: No clinical benefit of using convalescent plasma in patients with COVID-19 severe pneumonia

DG Alerts Excerpts: 1.     The use of convalescent plasma therapy besides standard treatment in patients with severe pneumonia due to COVID-19 did not decrease mortality or improve other clinical outcomes at day 30, in comparison with placebo, noted a study published in The New England Journal of Medicine.

  1. The answer may lie in IV immunoglobulin or anti-severe acute respiratory syndrome coronavirus 2 monoclonal antibodies.
  2. At day 30, investigators noted no significant difference between the convalescent plasma group and the placebo group in the distribution of clinical outcomes. Overall mortality was 10.96% in the convalescent plasma group, while it was 11.43% in the placebo group.
  3. The data were consistent with the recently published results of a randomized, controlled trial in patients with moderate COVID-19 showing no difference in severe disease or death at day 30.
  4. No definite conclusion can be drawn regarding the potential efficacy of passive immune therapy earlier than the median time of entry to this trial of 8 days or among patients with milder forms of the disease.

 [https://www.nejm.org/doi/full/10.1056/NEJMoa2031304?query-featured_coronavirus=]

1176: The FDA has authorized the use of a COVID-19 semi-quantitative antibody testing kit that can detect the exact level of IgG antibodies to SARS-CoV-2, stated the test manufacturer. COVID-SeroKlir received emergency use authorization (EUA) for the assay, which identifies SARS-CoV-2-specific IgG antibodies against the full length spike protein and its receptor binding domain with a sensitivity of 98.8% and specificity of 99.6%, Kantaro said. This is a two-step enzyme-linked immunoassay that can be used by any CLIA-certified laboratory with no proprietary equipment needed. (Medpage Today)

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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