An Engineered IgG-VHH Bispecific Antibody against SARS-CoV-2 and Its Variants

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibodies are shown to be effective therapeutics for providing coronavirus disease 2019 (COVID-19) protection. However, recurrent variants arise and facilitate significant escape from current antibody therapeutics. Bispecific antibodies (bsAbs) represent a unique platform to increase antibody breadth and to reduce neutralization escape. Herein, a novel immunoglobulin G-variable domains of heavy-chain-only antibody (IgG-VHH) format bsAb derived from a potent human antibody R15-F7 and a humanized nanobody P14-F8-35 are rationally engineered. The resulting bsAb SYZJ001 efficiently neutralizes wild-type SARS-CoV-2 as well as the alpha, beta, gamma, and delta variants, with superior efficacy to its parental antibodies. Cryo-electron microscopy structural analysis reveals that R15-F7 and P14-F8-35 bind to nonoverlapping epitopes within the RBD and sterically hindered ACE2 receptor binding. Most importantly, SYZJ001 shows potent prophylactic and therapeutic efficacy against SARS-CoV-2 in three established mouse models. Collectively, the current results demonstrate that the novel bsAb format is feasible and effective, suggesting great potential as an inspiring antiviral strategy.

Quality changes of workplace health promotion in Austrian companies over time

Background

Workplace health promotion (WHP) is effective when it is implemented in a high-quality and sustainable manner. Companies in the Austrian quality management system can apply for a WHP quality certificate every three years. More and more companies are integrating WHP into their regular operations. This work investigates the WHP quality system and how the companies develop over time.

Methods

WHP quality is measured using 15 holistic quality criteria, which are assessed by an external, independent institute. For the period 2014-2021, evaluations from n = 570 companies with two and from n = 278 companies over three measurement points in time are available (initial and renewal awards). The (potential) change of the WHP quality is examined with a longitudinal design by the means of confirmatory factor analyses and autoregressive models with latent variables.

Results

The measurement of WHP quality shows acceptable to good measurement accuracy (internal consistency-reliability: α = 0.85-0.89), validity (convergent and discriminant validity) and metric measurement invariance over time. At structural level, relative stability of WHP quality can be demonstrated for the measurement points (β = 0.40-0.52, p < 0.001). Both the quality of WHP and the temporal stability differentiate significantly according to the firm size and the experience of the company with WHP structures and processes.

Conclusions

The use of the criteria allows a reliable, valid and objective quality assessment of WHP quality due to the concept of the assessment process. WHP quality is a relatively stable characteristic of the company, which, however, varies according to temporal, structural and process-related aspects. Company size moderates to a lesser extent of quality changes over time. This is in line with expectations, but also indicates that small companies should be clearly motivated and supported for their WHP measures. The insights help to further develop quality assurance in WHP and public health.

Key messages

• The criteria used allow a reliable, valid and objective assessment of WHP quality.

• Because firm size moderates the change in WHP quality, small firms should be continuously encouraged and supported.

Defining variant-resistant epitopes targeted by SARS-CoV-2 antibodies: A global consortium study

Antibody-based therapeutics and vaccines are essential to combat COVID-19 morbidity and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple mutations in SARS-CoV-2 that could impair antibody defenses propagated in human-to-human transmission and spillover or spillback events between humans and animals. To develop prevention and therapeutic strategies, we formed an international consortium to map the epitope landscape on the SARS-CoV-2 spike protein, defining and structurally illustrating seven receptor binding domain (RBD)–directed antibody communities with distinct footprints and competition profiles. Pseudovirion-based neutralization assays reveal spike mutations, individually and clustered together in variants, that affect antibody function among the communities. Key classes of RBD-targeted antibodies maintain neutralization activity against these emerging SARS-CoV-2 variants. These results provide a framework for selecting antibody treatment cocktails and understanding how viral variants might affect antibody therapeutic efficacy.

Factors influencing (health-promoting) telework during COVID-19: A company sample in Austria

Background

Many companies had to switch to teleworking (TW) due to COVID-19 pandemic in spring 2020. However, TW conditions (home office) are not always health promoting. The question was: To what extent companies enabled TW before, during and after the first lockdown (time points t1-t3) and what is the role of workplace health promotion (WHP) in the establishment of health-promoting TW?

Methods

Using TAM, hypotheses were operationalised using a standardised questionnaire. At the beginning of 2020, a selection of 1858 Austrian companies were asked to participate in an online survey. The n = 192 responses from company representatives cover a broad mix of different sectors, industries, company sizes and regions in Austria. The analysis was carried out using structural equation models.

Results

Both the extent of TW implemented (means: mt1=3.7, mt2=18.4, mt3=8.6 days per month/employee) and the proportion of the workforce that could make use of TW (mt1=17.3%, mt2=58.6%, mt3=40.1%) increased significantly during the 1st lockdown and did not return to the pre-lockdown level afterwards. The degree of TW depended on how well the companies were prepared for it (β = 0.271). The (a) experience with TW and the (b) willingness to continue offering TW depended on the preparation (a: 0.243; b: 0.453) and on the actual degree of implementation of TW (a: 0.228; b: 0.193). For the intention to implement health-promoting TW in the company, the general willingness for TW (0.415) but also the existing WHP structures are central requirements (0.446; all p < 0.050).

Conclusions

Far more than before COVID-19, TW is of central interest for public health and WHP. In terms of a holistic health understanding of TW, companies have to adapt to the changing conditions (eg technical, communication) and to establish comprehensive WHP structures and processes. Support for companies can come from training or further education to raise awareness and develop an appropriate health-promoting company culture.

Key messages

Health promoting telework conditions need to be assessed and developed further. Companies need to be supported when implementing health-promoting telework, eg with guidelines, further education.

Rational development of a human antibody cocktail that deploys multiple functions to confer Pan-SARS-CoVs protection

Structural principles underlying the composition and synergistic mechanisms of protective monoclonal antibody cocktails are poorly defined. Here, we exploited antibody cooperativity to develop a therapeutic antibody cocktail against SARS-CoV-2. On the basis of our previously identified humanized cross-neutralizing antibody H014, we systematically analyzed a fully human naive antibody library and rationally identified a potent neutralizing antibody partner, P17, which confers effective protection in animal model. Cryo-EM studies dissected the nature of the P17 epitope, which is SARS-CoV-2 specific and distinctly different from that of H014. High-resolution structure of the SARS-CoV-2 spike in complex with H014 and P17, together with functional investigations revealed that in a two-antibody cocktail, synergistic neutralization was achieved by S1 shielding and conformational locking, thereby blocking receptor attachment and viral membrane fusion, conferring high potency as well as robustness against viral mutation escape. Furthermore, cluster analysis identified a hypothetical 3rd antibody partner for further reinforcing the cocktail as pan-SARS-CoVs therapeutics.

The tissue renin-angiotensin system (tRAS) and the impact of its inhibition on inflammation and bone loss in the periodontal tissue

Recently, the existence of the tissue renin-angiotensin system (tRAS) has been described for multiple tissues in humans, suggesting its fundamental role in the progression of inflammation and fibrosis. Evidence arises that tRAS might have an impact on the progression of periodontitis and bone loss. However, neither the role of tRAS nor its impact as a therapeutic target have been systematically evaluated for periodontal tissue. The present study sought to characterise tRAS in the periodontal tissue and the effect of its inhibition on periodontal inflammation and bone loss. This systematic review was performed according to the preferred reporting items for systematic reviews and meta analyses (PRISMA) statement. Literature was searched using Web of Science core collection (Web of Science), Medline (Ovid), Cochrane central register of controlled trials (Ovid), Cochrane database of systematic reviews (Ovid), Google Scholar databases and the references of the retrieved studies in March 2020. Information on study design, sample size, population, procedure, type of intervention, observation time, as well as information on sources of bias, was extracted and evaluated. From 455 identified articles, 17 were included in the qualitative synthesis and 11 were included in the quantitative synthesis. Outcomes of studies indicated that the inhibition of tRAS components led to a reduction of periodontal bone loss and inflammation, dependent on the inhibitor used. The findings suggested an important role of tRAS in the periodontal tissue and indicate a potential therapeutic approach for periodontal diseases.

The tissue-renin-angiotensin-system of the human intervertebral disc

Symptomatic intervertebral disc (IVD) degeneration accounts for significant socioeconomic burden. Recently, the expression of the tissue renin-angiotensin system (tRAS) in rat and bovine IVD was demonstrated. The major effector of tRAS is angiotensin II (AngII), which participates in proinflammatory pathways. The present study investigated the expression of tRAS in human IVDs, and the correlation between tRAS, inflammation and IVD degeneration. Human IVD tissue was collected during spine surgery and distributed according to principal diagnosis. Gene expression of tRAS components, proinflammatory and catabolic markers in the IVD tissue was assessed. Hydroxyproline (OHP) and glycosaminoglycan (GAG) content in the IVD tissue were determined. Tissue distribution of tRAS components was investigated by immunohistochemistry. Gene expression of tRAS components such as angiotensin-converting enzyme (ACE), Ang II receptor type 2 (AGTR2), angiotensinogen (AGT) and cathepsin D (CTSD) was confirmed in human IVDs. IVD samples that expressed tRAS components (n = 21) revealed significantly higher expression levels of interleukin 6 (IL-6), tumour necrosis factor α (TNF-α), a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 4 and 5 compared to tRAS-negative samples (n = 37). Within tRAS-positive samples, AGT, matrix-metalloproteinases 13 and 3, IL-1, IL-6 and IL-8 were more highly expressed in traumatic compared to degenerated IVDs. Total GAG/DNA content of non-tRAS expressing IVD tissue was significantly higher compared to tRAS positive tissue. Immunohistochemistry confirmed the presence of AngII in the human IVD. The present study identified the existence of tRAS in the human IVD and suggested a correlation between tRAS expression, inflammation and ultimately IVD degeneration.

Anesthesia for double lung transplant in a patient with confirmed COVID-19 infection: a case report

Introduction

Lung transplantation has been performed in a small number of patients suffering from COVID-19 related pulmonary fibrosis or end-stage COVID-19 pneumonia. (1) There are no reports of lung transplantations to receipients with positive Covid-19-PCR at the time of the operation.

Methods

A 42-year-old woman without comorbidities was hospitalized and diagnosed with COVID-19 pneumonia. After being intubated and tracheotomized, VV-ecmo support had to be initiated, no tendency of improvement ensued. Lung transplantation proceedings were made despite viral RNA test results from BAL being consistently positive (while negative culture growth suggested no active viral disease) since a small intracerebral bleeding had occurred after 45 days on ECMO. An adequate donor organ was found, double lung transplantation was performed.

Two experienced anesthetists, two nurse anesthetists and a runner provided anesthesia. The OR was set to positive pressure and 26 air changes h-1, the team wore full PPE (multilayer gloves, gown/overall, FFP-3 masks, glasses, faceshield).

Videolaryngoscopic intubation using a ViVaSight® (Ambu, Denmark) left double lumen tube with integrated camera was performed, TEE and bronchoscopy were avoided. We used near infrared spectropscopy and total intravenous anesthesia with Propofol 5,5mg kg-1 h-1 and Sufentanil 5mcg kg-1 h-1. Being on VV-Ecmo with 4,7l of blood and 5,5l O2 flow min-1 we used a second, centrally cannulated parallel ecmo circuit with 3l of blood and 2l of oxygen flow min-1, the VV circuit was reduced.

The operation was prolonged due to adhesions, coagulopathy, rupture of the dilated right atrium. Transfusion of 30 units of packed red cells, 40 units of fresh frozen plasma, 5 units of platelets, 2000IE of PPSB, 30mcg of desmopressin acetate, 5 grams of fibrinogen concentrate guided by repetitive viscoelastic testing was performed. Bilateral pulmonary edema occurred, leading to an oxygenation index of 72 on 1l min-1 VV ecmo flow. We therefore switched to a femorally cannulated VA-ecmo circuit to minimize hemodynamic stress for the newly transplanted lungs.

At the end of the operation the patient was stable with oxygenation index of 76 with 2,8l min-1 blood flow of ECMO support, sedated with Propofol 5,5mg kg-1 h-1 and Sufentanil 5mcg kg-1 h-1 and received Norepinephrine 0,06 mcg kg-1 min-1. We proned the patient immediately. COVID-19 polymerase chain reaction testing was performed in all team members and was negative in all cases.

Results

Discussion: Double lung transplantation is possible in selective patients suffering from COVID-19 pneumonia, intraoperative care is troublesome and strains resources due to open lung surgery and airway maneuvers increasing infection risk exponentially. (2)

Challenges and opportunities of digitalization for health and well-being at work

Background

Developments in the working world (e.g. digitalization) are imposing new demands on employees. However, it remains unclear how digitalization affects health and well-being at work and how companies can respond to emerging challenges and opportunities. In order to stimulate the discussion of these issues, the Austrian Health Promotion Fund supported 20 projects focusing on ‘Workplace Health Promotion (WHP) in the Working world 4.0'. The central research questions were: What challenges and opportunities regarding “Work 4.0” were identified and what measures have the companies developed?

Methods

We used a combination of different qualitative and quantitative research methods and instruments. As a first step in this multi-stage process, we conducted workshops with the WHP project managers of each company. Subsequently, we carried out a document analysis of the developed catalogues of measures to identify the underlying opportunities and challenges. To quantify and validate these results, we invited the project leaders and team members to participate in an online survey.

Results

As the WHP projects in the companies progressed, the focus shifted from the challenges to the opportunities offered by digitalization. On average, opportunities were rated more important than challenges in the online survey. The most important challenges were sensitization of managers, permanent accessibility as a health risk and mental stress and strain. The most important opportunities were the optimization of knowledge transfer, communication and documentation. The measures implemented ranged from the use of innovative tools, to knowledge transfer on methods and health-related content, to changes in materials and organization.

Conclusions

The examination of digitalization in the context of health and well-being at work has highlighted the positive aspects of digitalization. The health promotion measures implemented can serve as examples of good practice for other companies.

Key messages

As companies began to consciously examine digitalization in the context of health and well-being at work, the focus shifted from the challenges of digitalization to the opportunities it offers. To meet the challenges of digitalization and to act on emerging opportunities, companies have implemented numerous different measures that can serve as examples of good practice for other companies.

Testing a self-assessment tool for HP competencies with participants of training courses in Austria

Background

High quality health promotion (HP) depends on a competent workforce for which professional development programmes for practitioners are essential. The “CompHP Core Competencies Framework in HP” defines crucial competency domains but a recent review concluded that the implementation and use of the framework is lacking. The aim was to develop and validate a self-assessment tool for HP competencies, which should help evaluate training courses.

Methods

A brief self-assessment tool was employed in 2018 in Austria. 584 participants of 77 training courses submitted their post-course assessment (paper-pencil, RR = 78.1%). In addition, longitudinal data are available for 148 participants who filled in a pre-course online questionnaire. Measurement reliability and validity was tested by single factor, bifactor, multigroup, and multilevel CFA. A SEM proved for predictive and concurrent validity, controlling gender and age.

Results

A bifactor model (X2/df=3.69, RMSEA=.07, CFI=.95, sRMR=.07) showed superior results with a strong general CompHP factor (FL>.65, wH=.90, ECV=.85), configurally invariant for two training programmes. On course level, there was only minimal variance between trainings (ICC<.08). Structurally, there was a significant increase in HP competencies when comparing pre- and post-course measurements (b=.33, p<.01). Participants showed different levels of competencies due to prior knowledge (b=.38, p<.001) and course format (b=.16, p<.06). The total scale had good properties (m = 49.8, sd = 10.3, 95%-CI: 49.0-50.7) and discriminated between groups (eg by training length).

Conclusions

The results justify the creation of an overall scale to assess core HP competencies. It is recommended to use the scale for evaluating training courses. The work compensates for the lack of empirical studies on the CompHP concept and facilitates a broader empirical application of a uniform competency framework for HP in accordance with international standards in HP and public health.

Key messages

The self-assessment tool provides a good and compact foundation for assessing HP competencies. It provides a basis for holistic, high quality and sustainable capacity building or development in HP.

A Novel Simple Approach to Material Parameters from Commonly Accessible Rheometer Data

When characterizing the viscoelastic properties of polymers, shear rheological measurements are commonly the method of choice. These properties are known to affect extrusion and nozzle-based processes such as fiber melt spinning, cast film extrusion and 3D-printing. However, an adequate characterization of shear thinning polymers can be challenging and still insufficient to not only describe but predict process relevant influences. Furthermore, the evaluation of rheological model systems in literature is mostly based on stress–relaxation experiments, which are rarely available for various polymeric materials. Therefore, a simple approach is presented, that can be used to evaluate and benchmark a wide range of rheological model systems based on commonly accessible frequency sweep data. The approach is validated by analyzing alginate PH176 solutions of various concentrations, a thermoplastic poly-urethane (TPU) Elastollan 1180A melt, the liquid silicon rubber Elastosil 7670 and a polycaprolactone (PCL) fiber-alginate composite system. The used rheological model systems, consisting of simple springs and dashpots, are suitable for the description of complex, viscoelastic material properties that can be observed for polymer solutions and gel-like systems. After revealing a suitable model system for describing those material properties, the determination and evaluation of relevant model parameters can take place. We present a detailed guideline for the systematic parameter revelation using alginate solutions of different concentrations as example. Furthermore, a starting point for future correlations of strut spreading in 3D-bioprinting and model parameters is revealed. This work establishes the basis for a better understanding and potential predictability of key parameters for various fabrication techniques.

Antibody-Mediated Rejection in a Multiple Lung Transplant Patient: A Case Report

Lung transplant is an effective way to treat many end-stage lung diseases. However, one of the main barriers of allograft organ transplant is still the immunologic rejection of transplanted tissue, which is a response of the HLA molecules. Rejection is a complex process involving both T-cell-mediated delayed-type hypersensitivity reactions and antibody-mediated hypersensitivity reactions to histocompatibility molecules on foreign grafts. We report the case of a 25-year-old female patient with cystic fibrosis who underwent 2 lung transplants because of her initial diagnosis and appearance of bronchiolitis obliterans syndrome after the first transplant. Only 13 months after the second transplant, despite the therapies applied, a new rejection occurred associated with high mean fluorescent intensity donor-specific antibody levels, which resulted later in the death of the patient. The present case draws attention to the importance of matching HLA molecules between donor and recipient in addition to immunosuppressive therapy.

The impact of genome evolution on the allotetraploid Nicotiana rustica - an intriguing story of enhanced alkaloid production

BACKGROUND

Nicotiana rustica (Aztec tobacco), like common tobacco (Nicotiana tabacum), is an allotetraploid formed through a recent hybridization event; however, it originated from completely different progenitor species. Here, we report the comparative genome analysis of wild type N. rustica (5 Gb; 2n = 4x = 48) with its three putative diploid progenitors (2.3-3 Gb; 2n = 2x =24), Nicotiana undulata, Nicotiana paniculata and Nicotiana knightiana.

RESULTS

In total, 41% of N. rustica genome originated from the paternal donor (N. undulata), while 59% originated from the maternal donor (N. paniculata/N. knightiana). Chloroplast genome and gene analyses indicated that N. knightiana is more closely related to N. rustica than N. paniculata. Gene clustering revealed 14,623 ortholog groups common to other Nicotiana species and 207 unique to N. rustica. Genome sequence analysis indicated that N. knightiana is more closely related to N. rustica than N. paniculata, and that the higher nicotine content of N. rustica leaves is the result of the progenitor genomes combination and of a more active transport of nicotine to the shoot.

CONCLUSIONS

The availability of four new Nicotiana genome sequences provide insights into how speciation impacts plant metabolism, and in particular alkaloid transport and accumulation, and will contribute to better understanding the evolution of Nicotiana species.

European Pact for Mental Health and Wellbeing

Mental health is crucial for public health and prosperity. Yet, mental health was first brought to the EU agenda only in late 1990s. To put mental health firmly on the political agenda, the focus was placed on the positive mental health at a population level. The European Pact for Mental Health and Wellbeing is the most recent mental health policy initiative of the European Commission. It aims at promotion of mental health and prevention of mental disorders, by putting emphasis on five priority areas: prevention of depression and suicide; youth and education; workplace settings; older people; and combating stigma and social exclusion. The Pact calls for co-operation between the EU Member States and the Commission, to identify best practices to tackle the problems in the priority areas and to develop recommendations and action plans. The Pact is currently being implemented by a series of conferences on the priority areas. The European Parliament called for a European Strategy on Mental Health in 2009, but it is unclear whether there is sufficient support for a strategy level document in the Member States and Commission. The implementation process is however expected to culminate in an overall reference framework for promoting mental capital during the Hungarian EU Presidency in 2011. Irrespective of the final outcome, the ongoing process has already increased awareness in Europe of the need for actions to promote mental health.