Association between monoclonal antibody therapy, vaccination, and longer-term symptom resolution after acute COVID-19

Effective therapies for reducing post-acute sequelae of COVID-19 (PASC) symptoms are lacking. Evaluate the association between monoclonal antibody (mAb) treatment or COVID-19 vaccination with symptom recovery in COVID-19 participants. The longitudinal survey-based cohort study was conducted from April 2021 to January 2022 across a multihospital Colorado health system. Adults ≥18 years with a positive SARS-CoV-2 test were included. Primary exposures were mAb treatment and COVID-19 vaccination. The primary outcome was time to symptom resolution after SARS-CoV-2 positive test date. The secondary outcome was hospitalization within 28 days of a positive SARS-CoV-2 test. Analysis included 1612 participants, 539 mAb treated, and 486 with ≥2 vaccinations. Time to symptom resolution was similar between mAb treated versus untreated patients (adjusted hazard ratio (aHR): 0.90, 95% CI: 0.77-1.04). Time to symptom resolution was shorter for patients who received ≥2 vaccinations compared to those unvaccinated (aHR: 1.56, 95% CI: 1.31-1.88). 28-day hospitalization risk was lower for patients receiving mAb therapy (adjusted odds ratio [aOR]: 0.31, 95% CI: 0.19-0.50) and ≥2 vaccinations (aOR: 0.33, 95% CI: 0.20-0.55), compared with untreated or unvaccinated status. Analysis included 1612 participants, 539 mAb treated, and 486 with ≥2 vaccinations. Time to symptom resolution was similar between mAb treated versus untreated patients (adjusted hazard ratio (aHR): 0.90, 95% CI: 0.77-1.04). Time to symptom resolution was shorter for patients who received ≥2 vaccinations compared to those unvaccinated (aHR: 1.56, 95% CI: 1.31-1.88). 28-day hospitalization risk was lower for patients receiving mAb therapy (adjusted odds ratio [aOR]: 0.31, 95% CI: 0.19-0.50) and ≥2 vaccinations (aOR: 0.33, 95% CI: 0.20-0.55), compared with untreated or unvaccinated status. COVID-19 vaccination, but not mAb therapy, was associated with a shorter time to symptom resolution. Both were associated with lower 28-day hospitalization.

Real-world use of nirmatrelvir-ritonavir in COVID-19 outpatients during BQ.1, BQ.1.1., and XBB.1.5 predominant omicron variants in three U.S. health systems: a retrospective cohort study

Background

Ritonavir-boosted Nirmatrelvir (NMV-r), a protease inhibitor with in vitro activity against SARS-CoV-2, can reduce risk of progression to severe COVID-19 among high-risk individuals infected with earlier variants, but less is known about its effectiveness against omicron variants BQ.1/BQ.1.1/XBB.1.5. We sought to evaluate effectiveness of NMV-r in BQ.1/BQ.1.1/XBB.1.5 omicron variants by comparing hospitalisation rates to NMV-r treated patients during a previous omicron phase and to contemporaneous untreated patients.

Methods

We conducted a retrospective observational cohort study of non-hospitalised adult patients with SARS-CoV-2 infection using real-world data from three health systems in Colorado and Utah, and compared hospitalisation rates in NMV-r-treated patients in a BA.2/BA.2.12.1/BA.4/BA.5 variant-predominant (first) phase (April 3, 2022-November 12, 2022), with a BQ.1/BQ.1.1/XBB.1.5 variant-predominant (second) phase (November 13, 2022-March 7, 2023). In the primary analysis, we used Firth logistic regression with a two-segment (phase) linear time model, and pre-specified non-inferiority bounds for the mean change between segments. In a pre-specified secondary analysis, we inferred NMV-r effectiveness in a cohort of treated and untreated patients infected during the second phase. For both analyses, the primary outcome was 28-day all-cause hospitalisation. Subgroup analyses assessed treatment effect heterogeneity.

Findings

In the primary analysis, 28-day all-cause hospitalisation rates in NMV-r treated patients in the second phase (n = 12,061) were non-inferior compared to the first phase (n = 25,075) (198 [1.6%] vs. 345 [1.4%], adjusted odds ratio (aOR): 0.76 [95% CI 0.54-1.06]), with consistent results among secondary endpoints and key subgroups. Secondary cohort analyses revealed additional evidence for NMV-r effectiveness, with reduced 28-day hospitalisation rates among treated patients compared to untreated patients during a BQ.1/BQ.1.1/XBB.1.5 predominant phase (198/12,061 [1.6%] vs. 376/10,031 [3.7%], aOR 0.34 [95% CI 0.30-0.38), findings robust to additional sensitivity analyses.

Interpretation

Real-world evidence from major US healthcare systems suggests ongoing NMV-r effectiveness in preventing hospitalisation during a BQ.1/BQ.1.1/XBB.1.5-predominant phase in the U.S, supporting its continued use in similar patient populations.

Funding

U.S. National Institutes of Health.

An Innovative Model of Urgent Care for the Underserved: A Case Report of an Urban Hospital-Affiliated Federally Qualified Health Center Urgent Care Clinic

Medically underserved patients experience significant barriers to affordable acute care. This brief report describes an innovative urban hospital-affiliated federally qualified health center urgent care clinic that successfully meets a medically underserved population's need for accessible, appropriate, and affordable acute care.

Identification and analysis of the maize P700 chlorophyll a apoproteins PSI-A1 and PSI-A2 by high pressure liquid chromatography analysis and partial sequence determination

We recently described a pair of partially homologous maize chloroplast genes, one of which was shown to code for an apoprotein of the P700 chlorophyll a complex of photosystem I (Fish, L.E., Kück, U., and Bogorad, L. (1985) J. Biol. Chem. 260, 1413-1421). Two chlorophyll-free apoprotein bands from maize chlorophyll-protein complex I (CPI) can be resolved on lithium dodecyl sulfate (LDS)-urea polyacrylamide gels. Proteins in both bands react with antibodies prepared against CPI, but antibodies prepared against two synthetic peptides corresponding to predicted sequences of PSI-A1 react only with the upper band. The presence of products of the two genes, ps1A1 and ps1A2, in CPI was verified by analysis of cyanogen bromide (CNBr) fragments of the lower apoprotein band obtained from LDS-urea polyacrylamide gels by reverse-phase high pressure liquid chromatography. Amino-terminal sequencing of five CNBr fragments indicates that the lower band contains a product of the ps1A2 gene. The possibility of extensive processing was investigated because the apparent molecular masses of the maize CPI proteins are about 58-70 kDa on LDS-polyacrylamide gels rather than the predicted sizes of about 83 kDa. Antibodies against a synthetic peptide corresponding to a predicted sequence in PSI-A1 were used to determine that the amino-terminal end of PSI-A1 is intact beyond about position 52. The amino-terminal CNBr fragment of PSI-A2 was identified by sequencing, indicating that the amino-terminal end of PSI-A2 is not processed. The carboxyl-terminal CNBr fragment of PSI-A2 was also identified by sequencing. These results indicate that the PSI-A1 and PSI-A2 polypeptides are not extensively processed, although some processing at the carboxyl-terminal end has not been ruled out.

Two partially homologous adjacent light-inducible maize chloroplast genes encoding polypeptides of the P700 chlorophyll a-protein complex of photosystem I

The maize chloroplast chromosome contains two light-inducible genes, ps1A1 and ps1A2, that code for 45% homologous polypeptides of 83.2 and 82.5 kDa designated A1 and A2, respectively. Two types of immunochemical evidence show that the upstream gene, ps1A1, codes for a P700 chlorophyll a-protein at the reaction center of photosystem I of the photosynthetic apparatus. Antibodies against a synthetic peptide with a sequence deduced from the DNA sequence of an unconserved segment of A1 react with polypeptides of P700 chlorophyll-protein (CPI) complexes of maize and pea photosystem I; antibodies prepared against barley CPI immunoprecipitate products of in vitro transcription and translation directed by cloned chloroplast DNA containing this gene. The extensive homology between maize polypeptides A1 and A2 suggests that both may be components of CPI, although CPI has been generally considered to be comprised of two molecules of a single protein of only 66 to 70 kDa. The hexapeptide Asp-Pro-Thr-Thr-Arg-Arg in A2 is also present in another chlorophyll protein, the P680 chlorophyll a-protein of photosystem II, and is partially duplicated in A1. The number and locations of histidyl residues, which have been suggested to serve in chlorophyll binding, are highly conserved between A1 and A2.

Permeability of chloroplast envelopes to mg: effects on protein synthesis

When suspended in media lacking free Mg(2+), chloroplasts from young pea plants (Pisum sativum CV Progress No. 9) lose 25 to 75% of their stromal Mg(2+) content to the medium, without breakage. This effect amounts for the inhibition of protein synthesis in the dark by ATP in excess of the Mg(2+) provided, since free ATP chelates Mg(2+). The rate of loss is from 1 to 4.5 microgram-atoms Mg(2+)/milligram Chl/hour; and depleted chloroplasts take up Mg(2+) from the medium at even faster rates, to a total amount not much more than that present originally (0.8 to 1.8 microgram-atoms/milligram Chl with an average of 1.33 +/- 0.32 mug-atoms/mg Chl). Leakage is completely prevented by 0.25 to 0.40 millimolar external Mg(2+). Addition of Mg(2+) at a level sufficient to prevent leakage from intact chloroplasts results in approximately 20% stimulation in light-driven protein synthesis.

High rates of protein synthesis by isolated chloroplasts

Improvements are described in the preparation and in vitro conditions of an intact pea (Pisum sativum Progress No. 9) chloroplast system which provides high efficiency for translation of endogenous messenger RNA, using light as an energy source. High rates result in the incorporation into protein of up to 100 nanomoles tritiated leucine per milligram chlorophyll. These rates suggest extensive reinitiation, and repeated utilization of the messenger RNA that code for thylakoid proteins. Up to 39 radioactive thylakoid peptide bands were detected by fluorography after labeling with tritiated leucine.

Light-induced increase in the number and activity of ribosomes bound to pea chloroplast thylakoids in vivo

Within 8 to 10 minutes of illumination, chloroplast thylakoids of pea (Pisum sativum) became enriched 30 to 100% in ribosomes bound by nascent chains. Following (or, in some experiments, coincident with) this apprarent redistribution was a 25 to 65% increase in the total bound ribosome population, which was then maintained at this higher level during the normal light period. On transfer of plants to darkness, the bound ribosome population decreased to the lower dark level. White, blue (400 to 520 nanometers), and orange (545 to 690 nanometers) light were all effective in producing an increase in the bound ribosome population. The level of bound ribosomes in the oldest leaves of 16-day-old plants was 15-fold less than in the still-maturing leaf but was still increased by illumination.In vivo experiments with chloramphenicol and lincomycin indicated a requirement for protein synthesis by the 70S ribosomes both for the light-induced shift to the population bound by nascent chains and for the increase in the total thylakoid-bound population. When thylakoids from plants in darkness or exposed to light for increasing periods were incubated in an Eschericia coli cell-free protein synthesizing system, 15 minutes of prior illumination in vivo produced a 60% increase in [(3)H]leucine incorporation. This stimulation preceded the increase in total bound ribosomes but corresponded in time to observed increases in the ribosomes bound by nascent chains.A light intensity of 100 micromoles per meter(2) per second, but not 25 micromoles per meter(2) per second, caused a significant increase in bound ribosomes over a 30-minute period. Strong inhibition in vivo by 3',4'-dichlorophenyl-1, 1-dimethylurea suggests that noncyclic electron flow is essential for light-induced ribosome redistribution.