October 14, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Epidemiology: Outcomes of COVID-19 in living donor liver transplant (LDLT) recipients are studied by hepatologists and leading liver transplant surgeons from the Institute of Liver Transplantation & Regenerative Medicine in Gurugram, India through a case series of 12 living donor liver transplant patients who tested positive for SARS-CoV-2 via RT-PCR. Most were symptomatic (n=11, 91.7%) with evidence of pneumonia on radiologic imaging (n=9, 75%) and with median duration of detectable virus of 12 days. While the majority (n=10, 83.3%) were on tacrolimus-based immunosuppression, all but one patient (n=11, 91.7%) survived with only supportive care. Because the patient who died had multiple other risk factors for severe COVID-19 (quadruple immunosuppression, hypertension, metabolic syndrome, diabetes), these authors suggest that liver transplant patients as a whole are not at particularly increased risk for mortality from COVID-19.

· Hematological manifestations of SARS-CoV-2 in children  are explored in a review of 15 articles meeting study criteria and found children with SARS-CoV-2 were less likely to be lymphopenic compared to adults, with the most common abnormalities being leukopenia in older children and lymphocytosis in infants/neonates. Thrombotic complications and platelets and erythrocytes abnormalities were relatively uncommon and more likely in children with multisystem inflammatory syndrome. Authors suggest these findings, which contrast hematologic changes observed in adults, may be a result of pediatric patients' immature ACE-2 expression and immune systems.

—Understanding the Pathology: Mechanisms by Which SARS-CoV-2 May Impact Male Fertility are discussed in a letter to the editor based on Dutta and Sengupta’s article "SARS-CoV-2 and male infertility: possible multifaceted pathology." They propose viral binding to angiotensin-converting enzyme 2 receptors on spermatogonia, Leydig cells, and Sertoli cells may cause overactivation and negatively impact spermatogenesis. Additionally, they urge further studies on SARS-CoV-2's ability to disrupt sperm formation and function because SARS-CoV-2 seems to disproportionately impact males in some studies.    

—R&D: Diagnosis & Treatments: REGN-COV2 antibodies prevent and treat SARS-CoV-2 infection in certain species based on virologists from Regeneron Pharmaceuticals results from an in vivo study of their proprietary therapeutic cocktail REGN-COV2's (human antibodies REGN10933, REGN10987) ability to reduce viral load via SARS-CoV-2 spike protein binding in resus macaques and golden hamsters. They found a 50 mg/kg dose significantly reduced SARS-CoV-2 gRNA (p<0.0001) and sgRNA (P=0.0012) in rhesus macaques on oral swab and that 0.5-50 mg/kg prophylactic doses prevented weight loss and reduced lung findings associated with pneumonia in Golden hamsters (p<0.0001). Authors suggest this REGN-COV2 regimen shows potential for prevention and treatment of SARS-CoV-2 in humans and express optimism regarding ongoing clinical trials.

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