COVID-19 spreads faster and more widely throughout U.S. households than previously reported, according to new preliminary research from a multicenter study led by Vanderbilt University Medical Center researchers and published in MMWR, a weekly report from the Centers for Disease Control and Prevention (CDC).

A man who refused to protect himself says his views were changed by a battle with Covid-19.

Cases are levelling off in the north east of England, even as they rise overall.

Today humans are exposed to thousands of man-made chemicals. Yet the effects on people’s health are still not fully understood.

In 2020 the number of registered chemicals reached 167 million. Every day people are exposed to them through food, water, contaminated air, drugs, cosmetics and other man-made substances. Less than 1% of these chemicals were tested for toxicity, and those that were tested demonstrate ability to disrupt almost every biological process in our body. Can we infer how cumulative exposures shape our health?

I am an environmental toxicologist studying effects of man-made chemicals on our health. I decided to develop a computational approach to objectively compare sensitivity of all genes to all chemicals and identify the most vulnerable biological processes.

Unbiased approach

For our study, my research colleagues and I used data from the Comparative Toxicogenomic Database. The Comparative Toxicogenomic Database collects information from thousands of published studies on how chemicals change the activity of genes. Genes are sections of DNA that encode proteins which perform a broad range of functions in cells, from building tissues to metabolisng nutrients. When chemicals affect genes, that results in increased or decreased production of proteins.

Modern methods of molecular biology can detect changes in activity of all genes in the genome in response to a chemical insult. I developed an approach that overlays lists of altered genes from different studies to calculate how many times each gene was affected. The resulting numbers reflect sensitivities of genes to chemicals generally.

Using 2 169 studies on mice, rats, humans and their cells, my research group ranked the sensitivity of 17 338 genes to chemical exposures. These studies tested the impact of 1 239 diverse chemicals ranging from prescription drugs to environmental pollutants.

At the next step we ran tests to ensure that this sample of over 1 000 chemicals was large enough to reliably represent all classes of man-made chemicals people are exposed to. To do so, we measured sensitivity of genes for one half of this list and then for another to test if even a smaller number of chemicals can reliably identify sensitive genes. The results were encouraging – the values of gene sensitivities were almost identical in the two trials.

Cellular defense system responds to chemicals

Our cells are not completely helpless when exposed to chemical insults. In fact, they possess strategies for dealing with stress and damage induced by chemicals. Our data confirm that these safeguards become active in response to exposures.

This line of defense includes enzymes that eliminate toxic chemicals, alleviate oxidative stress (the accumulation of reactive radicals in cells), repair damaged DNA and proteins, and identify highly damaged cells to trigger their death and prevent them from turning cancerous.

Metabolism of lipids and carbohydrates is vulnerable

Surprisingly, we found that molecular networks involved in the regulation of cellular metabolism are most sensitive to chemical exposures. One of them is PPAR signaling. PPARs are a group of proteins that regulate energy balance and metabolism of lipids and glucose.

Rises or falls in PPARs activity contribute to obesity, metabolic syndrome, diabetes and fatty liver disease. The ability of some environmental chemicals to affect PPARs was shown before. However, we didn’t expect to see sensitivity of PPARs to a very broad range of compounds.

We also discovered that genes involved in the development of pancreatic beta cells, which secrete insulin and play a key role in glucose metabolism, are suppressed by a majority of chemicals in our list. Dysfunction of beta cells results in diabetes. Thus, cumulative chemical exposures may be a significant risk factor for diabetes.

Today an epidemic of metabolic disease is a major public health issue. The prevalence of obesity nearly tripled between 1975 and 2016. Approximately 40% of Americans will develop Type 2 diabetes during their lives, and 33%-88% have fatty liver. Connection between exposures and metabolic diseases was shown before for some chemicals with endocrine disruptive properties. However, the role of a broadest range of man-made chemicals in this epidemic was not recognised before but can be significant.

Growth, ageing and the immune system

Two hormones involved in growth – growth hormone (GH) and insulin-like growth factor (IGF1) – are also affected by exposure to chemicals.

IGF1 is a hormone secreted mostly by the liver. It is recognised as a major regulator of body growth. Additionally, multiple mouse experiments show that decreased GH-IGF1 signaling results in longer lifespan. This pathway also determines if cells will use energy to build new molecules the body needs, or if they will break down existing molecules to release energy for the organism to use.

The ability of chemicals to affect this central regulator of growth and ageing is a novel finding. What health problems may be due to the sensitivity of GH-IGF1 is yet to be uncovered.

Our analysis indicates that genes that control the immune response are also highly sensitive to chemicals.

Two major outcomes of a dysfunctional immune system are allergy and autoimmunity. Prevalence for both conditions follows upward trends. Food allergies increased from 3.4% to 5.1% between 1997 and 2011 among children in the U.S. Skin allergies increased from 7.4% to 12.5% during the same period. Another study showed a 5% increase in blood marker of autoimmune disease in Americans during the period 1988-2012.

All molecular pathways are sensitive to chemicals

Overall we found that almost every known pathway may be affected by chemicals. That finding has significant implications for regulatory toxicology.

With ever-increasing numbers of man-made chemicals, society needs to develop rapid and cost-efficient methods of toxicity testing.

One important question that remains unanswered is what pathways should be covered by testing to ensure that regulators do not approve chemicals that harm or disrupt critical molecular circuits. Our data suggests that we need to develop tests that cover every known molecular pathway without exception.

Our study outlines new priorities for toxicological research, including the role of chemical exposures for metabolic health, immune system, development and ageing.

Alexander Suvorov, Assistant Professor, University of Massachusetts Amherst

This article is republished from The Conversation under a Creative Commons license. Read the original article.

• According to the World Health Organization (WHO), tobacco kills up to half of its users
• Teenage girls who smoke are especially vulnerable to developing breast cancer later in life
• In South Africa, Protect Our Next aims to improve tobacco control legislation and educate the public on its harmful effects 

The month of October is breast cancer awareness month.

It marks a special time for survivors of breast cancer, reminding them of what they have overcome. It is also a painful reminder of the dreadful effect of the disease on those who have lost loved ones as a result. Most importantly, Breast Cancer Awareness Month allows us to reflect and educate ourselves on ways in which we can lower our risk of developing cancer.

Protect Our Next is a partnership between CANSA, the National Council Against Smoking (NCAS), the South African Medical Research Council (SAMFC), and the Heart and Stroke Foundation South Africa (HSFSA). The aim of this partnership is to improve tobacco control legislation and also educate the public on the harmful effects of tobacco usage. 

Lowering the risk of developing cancer

In a press release, Protect Our Next recently expressed that teenage girls who smoke are especially vulnerable to developing breast cancer later in life. The risk is even higher for those who have a family history of cancer.

While the risk for breast cancer can be due to family history, a study published in the Journal of Breast Cancer confirmed that smoking is associated with an increased risk of breast cancer. A fact sheet on the World Health Organization (WHO) website also shows that tobacco kills up to half of its users. 

Controlling the consumption of tobacco, especially among the youth, is therefore a vital part of lowering the risk of developing cancer. Lorraine Govender of the Cancer Association of South Africa (CANSA) expressed, “We must ensure that we have policies in place that protect young people from these toxic, carcinogenic products. Too many lives are lost through cancers resulting from tobacco addiction, and we need to reduce every risk factor.”

Govender went on to say that implementing a new Bill that makes it harder to obtain and use tobacco-related products will be a step in the right direction.

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Virginia Van Wyk

Researchers in the University of Georgia’s Center for Tropical and Emerging Global Diseases have found that a more intensive, less frequent drug regimen with currently available therapeutics could cure the infection that causes Chagas disease, a potentially life-threatening illness affecting up to 300,000 people in the United States.

A University of Massachusetts Amherst environmental health scientist has used an unprecedented objective approach to identify which molecular mechanisms in mammals are the most sensitive to chemical exposures.

Marrying two layers of graphene is an easy route to the blissful formation of nanoscale diamond, but sometimes thicker is better.

• There is a different Covid-19 phenomenon called ‘Multisystem Inflammatory Syndrome in Adults’ – or MIS-A 
• This is affecting patients’ heart, digestive tract and nervous systems 
• MIS-A might not be driven directly by the virus itself but by a post-infectious immunologic response 

When the new coronavirus pandemic first began, respiratory distress immediately became the hallmark of severe Covid-19 illness. News reports focused on the inability to breathe, low oxygen saturation levels and the alarming need for ventilators.

But six months later, experts are becoming increasingly concerned about a very different Covid-19 phenomenon, one that spares the lungs only to take direct aim at the patient’s heart, digestive tract and nervous system.

Called “Multisystem Inflammatory Syndrome in Adults” – or MIS-A – the condition was first spotted last spring in children and teens.

“The symptoms are very similar among adults and children,” explained Dr Alisa Femia, director of both in-patient dermatology and autoimmune connective tissue disease at NYU Langone Dermatologic Surgery & Cosmetic Associates, in New York City.

A shock-like state

“Fever is characteristic,” Femia noted, sometimes accompanied by a rash, skin discolouration and chapping, chest pain and gastrointestinal issues.

“Some patients develop muscle pain and a general feeling of unwellness. And some experience a shock-like state, which means that blood pressure is dropping, the heart rate is up, and the patient appears very, very ill and in immediate need of hospitalisation,” she added.

Femia was part of a team that first reported on the paediatric version of the condition – known as MIS-C – back in July. To date, there have been more than 1 000 cases of MIS-C in the United States, resulting in 20 deaths.

Femia ultimately went on to treat the first reported case of MIS-A. Now, the US Centers for Disease Control and Prevention is zeroing in on the adult version, with an analysis outlined recently in the CDC’s Morbidity and Mortality Weekly Report.

The CDC report focused on 27 MIS-A patients ranging in age from 21 to 50. Of those, 10 ended up in the intensive care unit and two of those patients died.

“The lack of respiratory symptoms at presentation represent the main distinction between patients with severe Covid-19 and MIS-A,” said Dr Sapna Bamrah Morris, lead author of the CDC report. She’s an infectious disease specialist and clinical lead of the Health Care Systems and Worker Safety Task Force for the CDC’s Covid-19 Response Team.

In fact, said Morris, in some cases, MIS-A patients “may have multiorgan dysfunction without [any] history of showing symptoms of Covid-19”.

Many patients show no ‘typical’ COVID-19 symptoms

That speaks to the bewildering nature of MIS-A, Femia said. MIS-A patients are testing positive for Covid-19 antibodies, but absent classic respiratory symptoms, many had no idea they were infected. But several weeks or even months later, they suddenly end up hospitalised with serious MIS-A symptoms. At that point, they are often no longer positive for active Covid-19.

“The timing of all of this is very difficult to establish,” Femia said. “We really don’t know how long after an infection with Covid this can happen, because antibodies can remain positive for a couple of months. I would say that, from a doctor’s perspective, our best guess is that this is likely to happen four to six weeks after infection, but it could be three to four months. We really don’t know.”

Dr David Hirschwerk is an infectious disease specialist at Northwell Health in Manhasset, New York. “The timing of all of this suggests that MIS-A is driven not directly by the virus itself but by a post-infectious immunologic response that causes damage to the body,” he said.

“We think that it is relatively rare,” Hirschwerk added. “But we are all on the lookout for it now.”

Femia acknowledged that wasn’t always the case, given that in the early days of the pandemic “hospitals were overwhelmed, and it was a new disease, and this condition just wasn’t on the radar, which means we honestly don’t really know how many adults have gotten this”.

So, who is most at risk for MIS-A? Hirschwerk pointed to the CDC finding that “the vast majority of patients with MIS-A belonged to racial or ethnic minority groups”.

More prevalent in children

But, “like many things with Covid-19, it is all very new to us,” he added. “It requires more study, more data and more time.”

Femia agreed. But she noted that some characteristics of MIS-A are becoming both clear and worrisome. For example, “this has been seen in otherwise healthy patients, as well as among patients with underlying conditions, like obesity. So, the overall suspicion is that you probably don’t need as may co-morbidities to be at risk,” she explained.

“MIS also seems to be more prevalent in children than adults,” she noted. “Why, we just don’t know.”

The good news: “It is treatable,” Femia said. Apart from anti-clotting meds and aspirin, “the most consistent treatment that’s given is IV immunoglobulins”, which are proteins that function as antibodies. “We don’t usually use that to treat acute Covid infection, but it’s borrowed from treatments for other hyper-inflammatory conditions, like Kawasaki disease,” a pediatric illness that causes blood vessel inflammation.

“There’s a lot we don’t know about this,” said Femia. “And many patients will have a very difficult hospital course before they come back to health. But in the end, the majority of patients do survive.”

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The 23-year-old says she posted the picture to mark three months of breastfeeding her baby girl.