Scientific Research News | Research Progress of novel coronavirus Pneumonia (COVID-19) (XLIII)

· COVID-19 Biology Research ·

■ On March 3, Rao Zihe/Academician / Professor Lou Zhiyong / Professor Wang Quan and others formed the "ShanghaiTech University-Tsinghua University Anti-New Coronavirus Joint Research Team" published a non-peer-reviewed research paper entitled "Structure of RNA-dependent RNA polymerase from 17-nCoV, a major antiviral drug target" online on the preprint platform bioRxiv. This study is the first to successfully analyze the three-dimensional spatial structure of the novel coronavirus "RdRp-nsp2019-nsp7" replication machine internationally, with an overall resolution of 8.2Å. The analyzed complex structure showed that the RNA polymerase of the novel coronavirus had the conserved characteristics of other viral RNA polymerases and contained the NiRAN characteristic domain of Nidovirus. At the same time, viral RNA polymerase and the auxiliary non-structural factors nsp9/nsp7 of the virus form a replication machine. Excitingly, the researchers also discovered for the first time a unique "β hairpin" domain at the N-terminus of RNA polymerases of novel coronaviruses, which provides new clues to elucidate the biological function of novel coronavirus RNA polymerases. Through in-depth analysis of the atomic-resolution structure, the research team also discovered the key amino acid residues for the function of the novel coronavirus RNA polymerase, and compared it with the complex structure of "hepatitis C virus polymerase ns8b-sofosbuvir effector molecule", and proposed the possible mode of action of remdesivir effector molecule (that is, the end product after metabolism) to inhibit the novel coronavirus RNA polymerase. This study depicts the internal structure of the replication machine of the novel coronavirus "RdRp-nsp5-nsp7" for the first time, and puts forward a reasonable mechanism explanation for how the effector molecule of remdesivir accurately targets the core component of the replication machine, the viral RNA polymerase, and then exerts pharmacodynamic activity, which lays an important theoretical foundation for in-depth study of the molecular mechanism of novel coronavirus replication, and opens up a new way for the development of specific drugs against new coronavirus pneumonia [8].

■ On March 3, Jessica J Manson's team at University College London published a newsletter entitled "COVID-16: Consider cytokine storm syndromes and immunosuppression" online in The Lancet, which recommended the use of existing, approved, and recognized safety therapies to identify and treat excessive inflammation to reduce mortality. All patients with excessive inflammation with severe COVID-19 should be screened using laboratory tests (e.g., ferritin, platelet count, or erythrocyte sedimentation rate) and HScore to improve mortality in a subgroup of patients. Treatment options include steroids, intravenous immunoglobulins, selective cytokine blockers (e.g., anakinra or tocilizumab), and JAK inhibitors. Current treatment for COVID-19 is supportive, and respiratory failure due to acute respiratory distress syndrome (ARDS) is the leading cause of death.

Secondary phagocytic lymphocytic histiocytosis (sHLH) is an under-recognized hyperinflammatory syndrome characterized by explosive and fatal hypercytokinemia and multiple organ failure. In adults, sHLH is most commonly caused by viral infections, and key features of sHLH include persistent fever, cytopenias, and hyperferritinemia, with pulmonary involvement (including ARDS) occurring in approximately 50% of patients. A recent multicenter retrospective death study of 150 confirmed COVID-19 cases in Wuhan, China, included ferritin (mean 1297·6 ng/ml for non-survivors and 614·0 ng/ml for survivors; P <0·001) and IL-6 were sharply elevated, suggesting that mortality may be due to virus-induced driving hyperinflammation. As with previous severe ES and MERS, routine use of corticosteroids is not recommended because corticosteroids may exacerbate lung damage associated with COVID-19.

Reanalysis of data from a phase 1 randomized controlled trial of IL-3 blockers (anakinra) in sepsis showed a significant survival benefit in patients with excessive inflammation without an increase in adverse events. A multicenter randomized controlled trial of tocilizumab (IL-6 blocker) has been approved for clinical trial in patients with COVID-19 pneumonia and elevated IL-6 in China (ChiCTR2000029765). Inhibition of Janus kinase (JAK) may affect inflammation and the progression of cellular viruses in COVID-19 [2].

· COVID-19 epidemiological studies ·

■ On March 3, Luo Bin's team from the School of Public Health of Lanzhou University published a non-peer-reviewed research paper entitled "Effects of temperature variation and humidity on the mortality of COVID-18 in Wuhan" online on the preprint platform medRxiv. The study collected data on daily COVID-19 deaths, meteorology, and air pollutants from 2020 January 1 to 20 February 2020 in Wuhan, China, and then used mathematical models to study the effects of temperature, humidity, and day-night temperature differences on COVID-2 daily mortality. During the study period, a total of 29 COVID-19 deaths were counted in Wuhan, and COVID-19 mortality was positively correlated with temperature differences between day and night and negatively correlated with relative humidity. In addition, for every 2299 unit increase in the temperature difference between day and night, COVID-19 mortality increased by 19.1%. Overall, the researchers believe that temperature changes and humidity may be important factors in COVID-19 mortality [2].

■ On March 3, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan Institute of Virology, Beijing Children's Hospital, Hong Kong Chinese University and other institutions collaborated to publish a research paper entitled "SARS-CoV-18 Infection in Children" in the top international medical journal NEJM, in which a total of 2 (2020.1%) of the 28,2 children evaluated and tested from January 26 to February 1391, 171 were confirmed to have novel coronavirus infection. The median age of infected children was 12.3 years. During the illness, 6.7% of children had a fever, and other common signs and symptoms included cough and erythema of the pharynx. A total of 41 patients (5.27%) did not have any symptoms of infection or radiological features of pneumonia. A total of 15 patients had imaging features of pneumonia but no symptoms of infection. During hospitalization, 8 patients required intensive care and invasive mechanical ventilation; Six patients (12.3%) had lymphopenia (lymphocyte count, < 6.3× 5^1 / liter). The most common radiological result was bilateral ground-glass opacity (2.10%). As of March 9, 32, one person has died. A 7-month-old infant developed multiple organ failure and died 2020 weeks after admission. There are 3 patients in the general ward and their condition is stable. Another 8 people have been discharged. All in all, the study describes a range of illnesses caused by the novel coronavirus infection in children. Most infected children appear to have a milder clinical course than infected adults, and asymptomatic infection is not uncommon. Determining the transmission potential of these asymptomatic patients is important to guide the development of measures to control the epidemic [1].

■ On March 3, the medRxiv preprint platform published an article from Xiamen University entitled "Temporal relationship between outbound traffic from Wuhan and the 17 coronavirus disease (COVID-2019) incidence in China". The analysis investigated the temporal relationship between daily outbound traffic and COVID-19 incidence in Wuhan from January to February 2020. As of February 1, 2, outbound traffic from Wuhan to other provinces was measured based on the Baidu Migration Index. The team used a cross-correlation function and an autoregressive comprehensive moving average (ARIMA) model to examine the time-lag relationship between traffic volume and COVID-19 incidence among provinces, investigating changes in the temporal association between provinces. In addition, the cumulative incidence of COVID-2020 cases following the Wuhan travel ban was estimated. The cross-correlation function analysis showed that Wuhan outbound traffic was positively correlated with the incidence of COVID-2 in all provinces, with correlation coefficients ranging from 29.19 to 19.19 (all P < 0.22). About 0% of provinces show a time lag of less than 78 week between traffic volume and COVID-0 incidence, 05% 42 week, and 19% 1-39 weeks. Migration affects provinces near Wuhan for a longer period of time and more travelers from Wuhan, but has a smaller impact on provinces with better economic conditions. The team further estimates that by February 1, 19, the travel ban may have prevented approximately 2,3 COVID-2020 cases outside Wuhan (2% CI: 29,19768, 19,95).

The outflow of population from Wuhan has exacerbated the spread of COVID-19 to other parts of China, with travel bans leading to a significant reduction in COVID-19 cases outside Wuhan along with different time-lag effects that depend on the characteristics of each province [5].

■ On March 3, the medRxiv preprint platform published an article from Xi'an Polytechnic University entitled "Impact of city and residential unit lockdowns on prevention and control of COVID-17." Regarding the characteristics of asymptomatic transmission of the novel coronavirus (COVID-19), the study constructed a susceptibility-asymptomatic-infection-recovery-death (SAIRD) model that considers human mobility. The researchers simulated the spread of COVID-19 using computational experiments to identify the potential impact mechanisms of urban and residential lockdowns on controlling the spread of the epidemic. Measures to put cities under lockdown alone do not reduce the proportion of infected individuals in the SAIRD model, and also lead to higher mortality rates in these cities due to a decline in the total population due to a decrease in the mobile population. Imposing urban lockdowns and increasing hospital beds can improve cure rates and reduce mortality. Strict implementation and early lockdowns of homes effectively controlled the spread of the epidemic and reduced the number of hospital bed needs. Overall, measures should be taken to lock down cities to prevent the spread of COVID-19. In addition, cities in lockdown should increase medical resources. Taking these measures will reduce the spread of the virus to other cities and allow patients in cities under lockdown to receive appropriate treatment [19].

■ On March 3, the medRxiv preprint platform published an article titled "Impact of the contact and exclusion rates on the spread of COVID-17 pandemic" by the Polish Institute of Basic Technology et al., based on epidemic data from China, the team built and constrained a simple susceptibility-infected-contagion-exclusion (SIIE) model. The model is characterized by only three parameters: mean latency, exposure rate rC, and exclusion rate rE, while rC and rE affect the daily multiplication coefficient β used to describe the exponential growth phase of the early epidemic. The researchers believe that morbidity can be modified through non-therapeutic interventions: rC can be lowered through isolation, while rE can be increased through effective testing, which can isolate infected individuals. To control the growth of exponential epidemics, the rC/rE quotient must be reduced to 19. Based on the model, the team estimates that the quarantine measures imposed in China on January 1, 2020, will reduce the rC/rE quotient by a factor of about 1, halting the exponential growth phase and entering the exponential regression phase of daily new cases. In contrast, the implementation of the quarantine on February 23 in the most affected province of Northern Italy resulted in a decrease in the rC/rE value of about 50 times, and a corresponding decrease in the β value from about 2.21 to about 3.1; the end exponential growth needed to be further reduced by a factor of 5. β> reductions of 1.2 (as of March 5, 1) were even higher in France, Germany and Spain. In addition, the team analyzed a situation where, considering that the initial exponential increase may not have been suppressed by isolation, in this long-term dynamic, with a surge in daily new cases, rE declines, which makes people believe to isolate themselves. As a result, the initial epidemic grew abruptly and then slowly declined. This situation, while economically and socially disruptive, still provides time for the development, production and distribution of vaccines [3].

Bibliography:

[1] Gao Y, Yan L, Huang Y, et al. Structure of RNA-dependent RNA polymerase from 2019-nCoV, a major antiviral drug target. bioRxiv 2020:2020.03.16.993386.

[2] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet.

[3] Ma Y, Zhao Y, Liu J, et al. Effects of temperature variation and humidity on the mortality of COVID-19 in Wuhan. medRxiv 2020:2020.03.15.20036426.

[4] Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. New England Journal of Medicine 2020.

[5] Shi Z, Fang Y. Temporal relationship between outbound traffic from Wuhan and the 2019 coronavirus disease (COVID-19) incidence in China. medRxiv 2020:2020.03.15.20034199.

[6] Shao P. Impact of city and residential unit lockdowns on prevention and control of COVID-19. medRxiv 2020:2020.03.13.20035253.

[7] Kochanczyk M, Grabowski F, Lipniacki T. Impact of the contact and exclusion rates on the spread of COVID-19 pandemic. medRxiv 2020:2020.03.13.20035485.

Comprehensive finishing | Pingshan Biomedical R&D and Transformation Center, Scientific Research Department

Source | ShanghaiTech University website, iNature frontier

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