Johns Hopkins Medicine researchers are working tirelessly to find ways to better understand, treat and eventually eliminate COVID-19 and the illness that results from infection. New discoveries and observations from Johns Hopkins that we share here, especially those related to clinical therapies, are almost uniformly early in concept. They will require rigorous research, testing and peer review before solid conclusions for clinical care and disease prevention can be made.
The ongoing COVID-19 pandemic has severely impacted the manufacturing and supply chains for many products. But while shortages of toilet paper, disinfectant cleaners and hand sanitizer get most of the news coverage, the diminishing reserve of one item — kidney dialysis fluid, also known as dialysate — presents a grave threat to the lives of people with acute kidney injury (AKI), including the approximately 3% to 9% of COVID-19 patients who develop the disorder.
Without the special type of 24-hour, slowly administered dialysis — called continuous veno-venous hemodialysis, or CVVHD — that is given to AKI patients in an intensive care unit, damaged kidneys cannot remove wastes and excess fluids from the blood as they normally do. Unfortunately, the COVID-19 pandemic has severely tapped dialysate supplies across the nation.
When two New York-based hospitals recently contacted Derek Fine, M.D., clinical director of nephrology at the Johns Hopkins University School of Medicine, to seek spare dialysate to help meet their need for some 3,000 liters per day (for all of their AKI patients in ICUs, both with and without COVID-19), he and Chirag Parikh, M.D., Ph.D., M.B.B.S., director of the medical school’s Division of Nephrology, came up with a better idea to remedy the problem.
Their solution was to replace the dwindling stocks of pre-mixed, commercially produced dialysate required for short-term ICU kidney dialysis machines with a suitable substitute manufactured by conventional hemodialysis devices and designed for long-term treatment.
The latter creates its own dialysate in real time from ultrapure water and concentrated chemical solutions.
Fine, Parikh and colleagues from their division studied the workings of a conventional dialysis machine, learned how it manufactures dialysate and then adjusted the system to override alarms, which if triggered would automatically shut down dialysate production. However, one major obstacle remained: how to get the newly minted dialysate into bags.
No problem, thanks to students from the Johns Hopkins University Department of Biomedical Engineering. In just 12 hours, they designed a connector and used a 3D printer to render the plastic piece.
“When we tried it out, we were successfully able to capture the dialysate, and that was the eureka moment,” Parikh says.
The U.S. Food and Drug Administration has already provided guidelines for the method, calling for all dialysate produced to be tested intermittently for bacteria and used within 12 hours from its origin.
Date Posted: May 29, 2020 | Disclaimer
With a $195,000 grant from the National Science Foundation, Johns Hopkins researchers will use machine learning to study how to predict heart problems, such as heart failure, sustained abnormal heartbeats, heart attacks, cardiogenic shock and death, in people with COVID-19.
Heart problems are a common occurrence in COVID-19 patients, the researchers say, however, there is currently no predictive tool to specifically predict such problems in patients.
"This project will provide clinicians early warning signs and ensure that resources are allocated to patients with the greatest need," says bioengineering expert Natalia Trayanova.
Collecting Data and Testing
In the first phase of the one-year project, researchers will collect data on heart tests, vital signs and imaging data from more than 300 COVID-19 patients. This data will be used to train a computer algorithm.
Then, the researchers will test the algorithm with data from COVID-19 patients with heart injury. The hope is to create a predictive risk score that can determine, up to 24 hours ahead of time, which patients are at risk of developing heart problems.
"As a clinician, major knowledge gaps exist in the ideal approach for new heart problems that are common and may be life-threatening. These patients have varying clinical presentations and a very unpredictable hospital course,” says cardiologist Allison G. Hays.
Making the Tool Widely Available
This project will shed more light on how COVID-19-related heart injury could result in heart dysfunction and sudden cardiac death, which is critical in the fight against COVID-19. The project will also help clinicians determine which biomarkers are most predictive of the potential for harm to the patient.
Once the research team creates and tests their algorithm, they will make it widely available to any interested health care institution to implement.
Date Posted: May 26, 2020 | Disclaimer
As the COVID-19 pandemic was initially spreading, data from China and Italy suggested that only about 15% of people under the age of 50 were being hospitalized. However, when the disease reached the United States, physicians anecdotally noted what seemed like an uptick in the number of younger patients with COVID-19 serious enough to require intensive care.
Risk Factors for Severe COVID-19 Illness
Although preexisting conditions such as heart disease, diabetes or high blood pressure have been linked to greater susceptibility to the virus, obesity wasn’t on the radar as a risk factor early in the coronavirus outbreak. That’s because only about 6% of Chinese people and 20% of Italians are obese. The United States, on the other hand, has a 40% rate of obesity in adults, making researchers wonder if this might factor into the younger population’s showing up with severe disease.
Obesity and COVID-19
In a correspondence published on April 30, 2020, in The Lancet, Johns Hopkins researchers examined the link between age and obesity of American patients with COVID-19 hospitalized in intensive care units (ICUs).
- Seventy-five percent of the patients had a body mass index (BMI) of 26 or greater, indicating the person as overweight.
- 25% had a BMI higher than 35, designating the person as morbidly obese.
In general, they found that those patients in the ICU that were younger had higher BMIs, suggesting that younger Americans with obesity are likely at greater risk from COVID-19. The researchers say that young people should pay attention to social distancing and stay vigilant about when to seek medical treatment in the early stages of their disease to help reduce the risks.
Date Posted: May 22, 2020 | Disclaimer
During the COVID-19 pandemic, most medical researchers have focused their studies on better understanding the direct effects of the disease in order to develop treatments and hopefully in the near future, a cure. However, two Johns Hopkins pediatric neurovirologists, Emily Severance, Ph.D., and Robert Yolken, M.D., are planning a study that will look for evidence of a possible secondary, long-term impact of COVID-19: greater susceptibility to serious psychiatric illnesses such as schizophrenia.
Researchers have long suspected that prenatal (before birth) and perinatal (during and immediately after childbirth) exposure to respiratory viruses — including coronaviruses such as the one behind the current outbreak — may increase a person’s chances of later developing a psychiatric disorder. In a 2011 study, Severance and Yolken showed that more than 90% of adults diagnosed with psychoses had high levels of antibodies to one or more of four coronaviruses common at that time.
Severance and Yolken now plan to look for a similar immunological link between psychiatric disorders and SARS-CoV-2, the virus that causes COVID-19.
Date Posted: May 14, 2020 | Disclaimer
As COVID-19 spreads around the globe, the disease has a severe impact on the lungs and may, unexpectedly, affect other parts of the body as well. One area of particular concern among researchers is the virus’s potential impact on the brain.
Among the first symptoms of COVID-19 is the loss of smell and taste, and there are reports of people in recovery struggling with cognitive impairment or stroke. According to researchers, these symptoms could be caused by neurons degenerating or damage to blood vessels that feed the brain.
“We need to get an understanding of how brain cells are affected by COVID-19, which cells are affected and how we can slow the damage,” says Valina Dawson, Ph.D., director of the neuroregeneration and stem cell programs at Johns Hopkins’ Institute for Cell Engineering.
Cell Types Affected by Coronavirus
Dawson plans to study cells in the nervous system that may be susceptible to damage from the virus. A Johns Hopkins team will start with the basic question of which cell types are affected by the coronavirus, looking at neurons as well as supportive cells in the brain, called glia and microglia, and the brain’s blood cells. Then, the team aims to use human stem cells to create “minibrains” in the laboratory that replicate how COVID-19 infections may affect the human brain.
“If we know how the disease progresses and in which brain cells, we can help inform future treatments,” says Dawson.
Studying Long-term Outlook for COVID-19 Patients
A second facet of the study will look at the long-term outlook for COVID-19 patients. Dawson aims to collaborate with pathology experts to examine the brains of people who died from COVID-19 illness. They will examine proteins in the brain, such as Tau and alpha synuclein, that are susceptible to misfolding. This trait causes them to aggregate in the brain, leading to damage to the surrounding tissues. These are the same proteins Dawson believes are responsible for the progression of neurodegenerative disease including Parkinson’s disease, Alzheimer’s disease and amytrophic lateral sclerosis (ALS).
Dawson suspects that the stress of a coronavirus infection on a person’s brain could drive these proteins to accumulate more quickly.
“We want to know if we could potentially face a tsunami of increased neurodegenerative disease onset among COVID-19 survivors,” says Dawson.
Read more about Valina Dawson’s work on Parkinson’s Disease in the Institute for Cell Engineering.
Date Posted: May 12, 2020 | Disclaimer
The COVID-19 tracker app is part of a research trial
Identifying the next COVID-19 outbreak may seem impossible to predict, but a new app that collects body temperature recordings may give researchers advance warning of an impending hotspot of illness.
The app, available through Google Play and the Apple App Store, asks users to record their body temperature and respond to questions about key COVID-19 symptoms. The data, which is not connected to a person’s name to protect privacy, is linked to a randomly generated ID and stored on a secure server. Temperature and symptom data are mapped geographically to provide a display of anomalies occurring across the country.
“This type of data tracking could be really useful to enable targeted large-scale testing efforts,” says Robert Stevens, M.D., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “It could allow us to identify beforehand areas that are at increased or decreased risk and inform decisions regarding mitigation and lifting social distancing restrictions.”
Stevens worked with Frank Curriero at Johns Hopkins University’s Bloomberg School of Public Health and Ralph Etienne-Cummings at the Whiting School for Engineering to develop the app, which they dubbed ‘COVID Control – A Johns Hopkins University Study.
The team will analyze the data collected to identify unexplained increases in body temperatures and generate real-time risk estimates of potential COVID-19 outbreaks. This predictive tool will allow healthcare systems and government agencies to better deploy resources to mitigate the effects of the disease.
Read a recent article about the app in the HUB.
Date Posted: May 11, 2020 | Disclaimer
It’s one of the tiniest machines on the planet — about a hundred times smaller than the average cell. It’s so small that no scientist can spot it through a typical light microscope. Only with an electron microscope can we see its spiky surface. It’s not alive, and it’s not what most of us would think of as “dead.” This teensy machine seems to survive in a kind of purgatory state, yet it has traveled across continents and oceans from host to host, and brought hundreds of nations to a standstill.
Despite its diminutive size, the novel coronavirus, dubbed SARS-CoV-2, has seemingly taken the world by surprise with its virulence. However, it’s not a surprise to cell biologist Carolyn Machamer, who has studied viruses for the past 45 years. Understanding the complex interaction between viruses and the cells they infect can help scientists develop better ways to prevent and treat the illnesses they cause.
Date Posted: May 6, 2020 | Disclaimer
A clinical guidebook is now available to help hospitals and medical centers rapidly increase their ability to deliver so-called convalescent plasma therapy, which leverages immune system components found in the plasma portion of blood from people who have recovered from COVID-19.
Right now there are no therapies or effective vaccines for treating COVID-19. The U.S. Food and Drug Administration has paved the way for researchers at Johns Hopkins to proceed with clinical trials to test convalescent plasma therapy in people who are at high risk for severe COVID-19 and have been exposed to people who have tested positive for the virus that causes it.
Date Posted: May 6, 2020 | Disclaimer