Early COVID Has Signs For Severe and Long Haul Outcomes

all this is dr mobine saying from doctorbean.com welcome to one more show so the discussion today both discussions this one and the chit chat are going to be really fascinating in the chit chat i'm going to discuss the discussion we had this morning about the long haulers and this discussion now we would discuss about a paper from uk credit goes to dr teen appears she actually shared that paper during the discussion this morning which this paper the scientist discussed that the markers for severe case of a covet or long hauling can actually be identified early on with the symptoms or even before the symptoms so i wanted to give us a taste of that that paper i'm going to go over the markers later on in the next week and actually discuss the markers but there are some things that we cool beans have discussed already and are aware of them interestingly those are becoming the research as well so let's look at the research together and everybody welcome so fascinating studies today um i think you would you would enjoy it so this is dr bean.com this is the preprint of the study that i'm talking about that dr tina pierce sent in they they say delayed by standard cd8 t cell activation early immune pathology and persistent dysregulation characterizes severe covet 19. so i'll explain what they are talking about and here is the paper this is an article based on their paper and and then they have their pdf as well that i would discuss in detail next week i also wanted to share a different concept here as well and that is the leprosy so in leprosy we believe that the immune system incorrectly responds to the mycobacterium leproid and the result is that the person becomes lepromatic so here is a study in which the authors say we found that live mycobacterium lepray infected macrophages macrophages keep an eye on this one macrophages because we're going to discuss a little more of that polarized towards regulatory m2 type which i would discuss in a second prefer preferentially primed t regulatory responses and down regulated t helper 1 and cytotoxic t cell response so in summary the things that we have been discussing that covet we have seen is asymptomatic in two cases in two cases there may be much more but the ones the two cases are the ones that we have seen in studies can any cool bean tell me what are the two cases in which the the uh covert is asymptomatic or very mild symptoms to two immune mechanisms one of those is over here so if i can spill the beans we know that in children nk cells are more and in those adults that have more nk cells they also perform better with the covet secondly we also know we have done this study about eight to nine months ago that if the cytotoxicity d cytotoxic pathways taken or t helper one pathway is taken then the person recovers with better outcomes here you are seeing that in leprosy instead of sending the immune pathway towards t helper 1 pathway and cytotoxic immune system incorrectly goes towards the let's say antibody past pathway t helper 2 and that causes the disease so with this i'm gonna and all of these links are present here is the discord server that is continuing on so very good and i believe that france and bonkbonk are working on some parts of it so thank you very much for that and finally let's have our discussion so i'm just going to quickly start my turned out my drawing board is not started so one second [Music] so while we are waiting for the drawing board to load i want to show you something funny which my wife has not yet found out and then when she will find out she will be a little upset so let me show you i should have done this earlier and it looks like so give me one second i think i have the wrong file okay so while this is happening i'm going to show you this let me stop sharing for a second so this little jar do you see that the plant plant is in it so this jar was here with this much of water and it had plants sprouting out of it there are a couple of more plants over here as well and this is luffy he has thrown some some things out and the remaining his throne inside and now he's gonna get it from hina my wife so this is the kind of things he does to get in trouble so back here so gifts for humanity continuing sorry for the delay here is what the study is talking about let's have our um let's get our bearings so we know that there is an innate arm correct and the innate arm the cells that we are concerned with our natural killer cell dendritic cell macrophages neutrophils and other proteins in today we'll talk more about dendritic cell macrophages and nk cells the innate arms function is to non-specifically but immediately start responding to foreign antigens we know that as well and one outcome of that is that the naive t cells or the adaptive arm t cell is engaged with the dendritic cell or macrophages then there is co-stimulation hugs and kisses occur and the result is that the naive t cell either goes the helper 2 pathway or goes to helper one pathway as well i'm repeating i know that you know all of this and then p helper 2 will further cause b cell to become a plasma cell plasma cell will make antibodies and that is the antibody pathway if the naive t cell becomes a t helper one cells and that happens in the presence of interleukin-12 then the t helper one cell would activate cytotoxic t cells so the researchers are saying that someone who responds early on with cytotoxic t cells they usually have asymptomatic or mildly symptomatic disease they usually do not end up in a hospital they usually do not have severe covet and they usually do not have long covert and those who either spend too much time on the innate arm either they spend too much time fighting with the virus using the innate arm and their adaptive arm is not engaged quick enough or if the adaptive arm is engaged it goes to helper 2 pathway they have more more symptoms possibility of severe symptoms possibility of long covet that is the summary of this this is a whole paper so in one diagram if you see here in this study of to 207 of two infected individuals with a range of severities followed over 12 weeks from symptoms onset we demonstrate that an early robust bystander cd8 positive t-cell immune response without systemic inflammation is characteristic of asymptomatic or mild disease they have a pdf and i believe that in that pdf there is a lot of markers as well that we want to discuss but i wanted to share this one now i want to then connect this if you allow me let's just look at their findings for one more second here so this is the immune system map correct in this map if somebody goes cytotoxic pathway then they are mildly not even mildly they are asymptomatically going to manage the situation the paper misses one thing and that is the nk cells nk cells if they engage on the innate arm they are robust against the covet and we know that from children and if the nk cells are robust in adults as well i believe they also have milder symptoms and how do we get the nk cells we have done this discussion many times one should relax you know forest plants the plants that luffy destroys over here all of those things relaxation yoga that help improve nks health or generally less stress less stress hormones will allow nk cells to bounce up and then there are diets and there are foods and there are other ways to have nk cells in increase as well but the first thing nk cell based response is good second thing cytotoxic t cell based response is good now the bad part if too much of innate arm is activated especially macrophages and dendritic cell that would convert into macrophage activation syndrome and that can cause long covet and that can cause severe covet if too much of this pathway is activated then that would also cause severe can cause not also can cause severe or long now i want to add one more thing and we have been talking about macrophage mast cell activation syndrome so the mast cell activation syndrome also is a path that is this path that is the helper 2 path although ma mast cell directly do not have anything to do with the t helper 2 pathways establishment or function but we know that mast cell will not function until they are primed by antibodies against some specific antigen for example if somebody is allergic to something that allergy is manifested when the mast cells have gotten the antibodies launched on them or fixed on them against that antigen so let's talk about peanut peanuts so let's say if i am allergic to peanuts which i'm not if let's say if i'm allergic to peanuts i take peanuts my body develops antibodies which would be through this pathway b cell pathway my body develops antibodies those antibodies get lodged on a mast cell then when i eat peanuts again and those antigens come and attach with the antibodies on the mast cell mast cell would now independently degranulate and mass cell activation would occur this is one way of deactivation mass cells if you can see the expression here they're just upset for every single thing they're like really moody so they can become upset with the mechanical changes with the water you know on our skin with the temperature changes with heat and so on so it's not necessary that they are always only attached to the antibody and they are activated that way however in cases of infections when they become degranulated one of the reason is priming of the mast cell with the antibodies so if you think about it in the pathology of severe pathologies in long haul this pathway has all the components that allow various pathologies to occur mass cell activation is on this pathway antibody production is on this pathway [Music] and then the other pathways are better so this is the basic um discussion for what they have found out what they found out is the helper one pathway is better for our immune system now the question to answer is going to be that number one and they ask this question as well in this article they say fine now that we can figure it out in the beginning that where is the immune system leaning how do we then prevent immune system to go bad and i think one of the answers is going to be steroids steroids indiscriminately would kind of suppress the immune system so if that means if someone has a propensity towards long covert or towards the severe covet in the beginning of the covet then steroids will be very very useful and this is what i i feel amazed that doctors in india and pakistan have been saying that hey we very beginning we start giving the steroids and some of the therapies and we are get we are done in five days so that may be because they kind of suppress the immune system to not go towards too much towards the b cell and that that helps as well so this is the discussion i'm going to stop this one and then i'm going to come back for a chit chat and we will talk more about the long-haul discussion that we had today um i had one more point here yes so there was one more point that i i thought i needed to discuss and that was in the study as well and that is abnormal immune cells abnormal immune cells is something that i have been talking about for some days now is not some days some weeks months to the to a point where there is a cool bean there was a cool bean who used to become very upset with me that why do i say that the immune cells can become abnormal and they would only be abnormal if and only if there is a virus that is persisting in the body eventually she stopped joining us but there was a cool being i remember very clearly who used to become very upset about this but here it is today we have that research paper what happens is let's say this is a stem cell the definition of a stem cell is a cell that can make other cells for let's say this cell is making a macrophage and and the stem cell can make its own kind as well that is the definition of a stem cell when we uh we are in distress with an infection our body is ordering a lot of immune system cells to be produced so we are producing a lot of wbcs we are producing a lot of macrophages we are producing a lot of natural killer cells t cells b cells so production of these cells have increased when the production of these cells have increased there are two important things to keep in mind one is the stem cells are continuously replicating they're continuously dividing secondly these cells for example b cell or t cell they themselves can proliferate as well and make their own copies too now in this whole process it is possible that when these cells are becoming generated and they are having their genes opened up when a cell does a specific function the dna in in the cell has certain genes that open up to perform that function for example if the cell is going to make cytocytokines then the cytokine genes will open up and allow the cytokine for messenger rna to be formed that would allow the cytokines to be formed and so on so when we continuously make such cells then there are going to be some some some such cells that are going to hang around regardless of if the virus is present or not this is called virus hit and run virus is gone the immune system is still going mad and it would continue to go mad for some more time and then it would calm down so the researcher found that out as well that it is possible that the immune system somewhere over here the immune system they call them abnormal immune system cells they continue to work for longer period of time so let me actually find that here so here the team found that profound alterations in many immune cell types often persists persisted for weeks or even months after saskov2 infection often persisted weeks or even months beyond the infection and these problems resolve themselves very differently depending on the type of immune cell that has become abnormal and that is what they're calling non covet so my suspicion for this mechanism was correct and finally one more thing that they found was the researchers found no evidence of a relationship between viral load and progression to inflammatory disease so this has been a very common question here in youtube and other channels to my videos that hey is there a relationship of viral load in the beginning to the severity so there is no viral load so here progression to inflammatory disease is not related to the vital load however once inflammatory disease was established viral load was associated with subsequent outcomes so if the inflammatory the cytokine storm has started and the virus load is also increased at that time or in in a greater amount then the immune system becomes too much mad as well so these are some very fascinating outcomes in this study although i believe they miss the natural killer cell part and the rest seems good so this is the discussion thank you very much for listening in please like subscribe and share like at least and then if you would like to support this work as well please uh there are three links in the description one is if you don't want to use paypal you can just buy me coffees they don't use paypal or you can become a patron or you can support this channel via paypal as well so thank you very much and i'm gonna see you in a few minutes and talk about long-haul discussion that we had

Channel: Drbeen Medical Lectures

Views: 25,378

Keywords: drbeen, medicine, nursing, med school, microbiology, sars-cov-2, covid-19, coronavirus, usmle, mbbs, nclex, cytokines, Health (Industry), Medicine (Field of Study), Pathology (Medical Specialty), what is, nursing (field of study), Nursing school (organization), long covid, uk study

Id: NflA3z32w0w

Length: 19min 51sec (1191 seconds)

Published: Sat May 01 2021