Discussion of the hematologic complications of vaccination for severe acute respiratory syndrome coronavirus-2 (COVID-19) has primarily focused on the development of vaccine-associated immune thrombosis with thrombocytopenia (VITT). Other hematologic complications are uncommon. We report the case of a patient who developed immunoglobulin G (IgG)-mediated autoimmune hemolytic anemia (AIHA) after the Moderna COVID-19 messenger ribonucleic acid (mRNA) vaccine.

Activation of the innate immune system via pattern recognition receptors (PRRs) is key to generate lasting adaptive immunity. PRRs detect unique chemical patterns associated with invading microorganisms, but whether and how the physical properties of PRR ligands influence the development of the immune response remains unknown. Through the study of fungal mannans, we show that the physical form of PRR ligands dictates the immune response. Soluble mannans are immunosilent in the periphery but elicit a potent pro-inflammatory response in the draining lymph node (dLN). By modulating the physical form of mannans, we developed a formulation that targets both the periphery and the dLN. When combined with viral glycoprotein antigens, this mannan formulation broadens epitope recognition, elicits potent antigen-specific neutralizing antibodies, and confers protection against viral infections of the lung. Thus, the physical properties of microbial ligands determine the outcome of the immune response and can be harnessed for vaccine development.

Nous sommes toujours aux prises avec la pandémie de SARS-CoV-2 plus de deux ans après son début. Le virus a depuis accumulé de nombreuses mutations qui ont mené à différentes souches virales au long de la pandémie. Plusieurs de ces mutations sont récurrentes: il y a un excès de mutations C > U dans les génomes viraux, certains codons sont fréquemment mutés vers différents acides aminés et certaines mutations sont convergentes, c’est-à-dire que la même substitution est apparue de manière indépendante sur différentes lignées. Dans ce mémoire, nous avons identifiés différentes manières par lesquelles le SARS-CoV-2 évolue à travers l’étude de ces mutations récurrentes et évaluons leur impact sur l’évasion immunitaire. Premièrement, nous avons déterminés que les mutations C > U sont responsable de l’introduction et du retrait préférentiel d’acides aminés spécifiques dans les épitopes viraux. Nous avons déterminé la significativité statistique de ces patrons de mutation à l’aide de simulations génomiques virales. Deuxièmement, nous avons participé à la surveillance des variants au Québec durant la deuxième vague de la pandémie, qui s’est déroulée d’août 2020 à mars 2021. C’était une période intéressante pour la diversité virale, puisque les restrictions de déplacement ont créé de multiples poches de variants locaux en compétition les uns avec les autres qui partagent des mutations convergentes. Notamment, nous reportons que les lignées B.1.160 et B.1.1.176 comptaient pour 50% des échantillons séquencés au sommet de la deuxième vague dans la province. Finalement, nous avons analysé les patrons mutationnels intra-hôte qui sont apparus de novo dans le contexte d’infections au SARS-CoV-2 de longue durée chez des patients atteints de cancers hématologiques. Une de ces patientes est une patiente québécoise infectée par B.1.160 et dans laquelle nous avons identifié la présence d’un réservoir viral. Nous avons également trouvé des éléments probants montrant différentes quasiespèces virales avec des propriétés d’évasion immunitaire. Nos résultats permettent de mieux comprendre les différentes manières dont les pressions sélectives façonnent l’évolution virale. / We are still living in the SARS-CoV-2 pandemic over two years after its start. The virus has since accumulated many mutations that have led to different viral strains throughout the pandemic. Several of these mutations are recurrent: there is an excess of C > U substitutions in viral genomes, some codons are frequently mutated to different amino acids, and some mutations are convergent, meaning that the same substitution has occurred independently on different lineages. In this thesis, we identified different ways in which SARS-CoV-2 evolves through these recurrent mutations and assess their impact on immune escape. First, we determined that C > U mutations drive the preferential introduction and removal of specific amino acids in viral epitopes. Using genetic simulations, we determined the statistical significance of these patterns. Second, we participated in the surveillance of variants in Quebec during the second wave of the pandemic that went from the end of August 2020 to the end of March 2021. This was an interesting period of viral diversity owing to imposed travel restrictions that created competition between multiple pockets of local strains that share convergent mutations. Notably, we found that lineages B.1.160 and B.1.1.176 account for 50% of samples sequenced at the height of the second wave in the province. Finally, we analyzed intra-host mutational patterns that arose de novo in the context of long-term infections of patients with hematological cancers, one of which was from Québec and infected by B.1.160. We have identified a pattern consistent with the presence of a viral reservoir in this patient. We have also found evidence of different viral quasispecies with immune escape properties. These results shed light on different ways in which selective pressures shape the evolution of SARS-CoV-2.

Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case– control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA- 1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk.

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No description available.

The protein Ataxin-2 is a known positive regulator of stress granules in humans, mice and yeast (known as yeast PBP1). Due to the role that stress granules play in diseases including Amyotrophic Lateral Sclerosis (ALS) and cancer, this thesis investigates the role of Ataxin-2 and its protein binding partners in stress granule development and its effects on various metabolic phenotypes of the cell. PAS kinase is a sensory protein kinase, conserved from yeast to man, which regulates respiration and lipid biosynthesis. Our lab discovered that PAS kinase phosphorylates and activates Ataxin-2 in yeast, and that PAS kinase overexpression enhances localization of Ataxin-2 to stress granules. Our preliminary results from yeast show that PAS kinase positively regulates stress granule formation in response to metabolic stress. Ataxin-2 normally functions to promote stress granule formation and it has been specifically shown to sequester and inhibit mammalian target of rapamycin complex I (mTORC1), a major player in the regulation of cell growth, to stress granules in both yeast and mammalian cells. To build upon this knowledge we performed a large-scale yeast interactome to identify Pbp1 binding partners through yeast-two hybrid and mass spectrometry. We identified 32 novel putative binding partners. A protein of note was Ptc6, a known regulator of mitophagy with human homolog PPM1K, which is not known to be involved in stress granules. Through colocalization with Ppb1 we determined that Ptc6 is sequestered to stress granules under glucose depravation. Under Pbp1 overexpression, Ptc6 was shown to increase localization to a stress granule marker, Pab1, showing that Pbp1 may be actively promoting Ptc6 to stress granules. We investigated the effects of eliminating Pbp1 and Ptc6 in yeast cells, including on mitophagy, mitochondrial quantification, whole cell respiration and mitochondrial reactive oxidative species. In a separate project, due to the outbreak of a worldwide pandemic and early concerns that currency could be a potential SARS-CoV-2 fomite, we investigated whether the virus could survive on varying types of currency. We conducted environmental studies and found no viable virus on bank notes or money cards. In vitro studies with live virus suggested SARS-CoV-2 was highly unstable on banknotes, however SARS-CoV-2 displayed increased stability on money cards with live virus detected after 48 hours.

This review explores and positions the value of serology testing to support current immunization policies and the broader policy response to the coronavirus disease 2019 (COVID-19) crisis in Europe. We applied an exploratory approach to analysing existing evidence, international recommendations, and national policies using desk research from secondary sources, document analysis, and expert information. Regional and country-level resources from five focus countries were included: France, Germany, Italy, Spain, and the United Kingdom. Seven experts in the fields of COVID-19 immunization, serology testing, seroepidemiology, and vaccine safety and effectiveness studies contributed to the review and convened in two online panel sessions. The paper includes an overview of (1) the impact of the pandemic to date, (2) testing strategies, (3) COVID-19 vaccination policies, (4) lessons on using serology testing to support immunization, (5) current policies and recommendations on the use of a serology testing strategy, and (6) implementation barriers and challenges. Finally, this paper also provides a set of knowledge-based recommendations to advance the effective and timely inclusion of serology testing and resolve impeding knowledge gaps. The recommendations herein are intended to support timely decision-making, raise awareness, guide advocacy initiatives, and inspire future studies.

Under covid-19-pandemin har avloppsvattenbaserad epidemiologi (WBE) använts i stor utsträckning som ett komplement till kliniska tester över många delar av världen. Detta projekt syftade till att detektera och kvantifiera belastningen av Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) i avloppsvattenprover med hjälp av Revers transkriptas kvantitativ polymeraskedjereaktion (RT-qPCR). De analyserade proverna kom från fyra olika avloppsreningsverk i Sverige, under perioden november 2022 till maj 2023. Studien omfattade en översikt över olika provtagnings- och analytiska tekniker och normaliseringsmetoder som används i WBE-studier, vilket betonade vikten av metodval. SARS-CoV-2-RNA upptäcktes i alla analyserade prover och infektionstrender kunde identifieras effektivt, inklusive COVID-19-vågen som observerades under semesterperioden. De dominerande varianterna som upptäcktes under denna övervakningsperiod var omikron variantens undergrupper, BA.2. och BA.2.75. Den veckovisa kvantifierade SARS-CoV-2-belastningen i avloppsvattenproverna visade en signifikant positiv korrelation till de kliniska fall som rapporterats i motsvarande avrinningsområden. Denna associering förstärktes ytterligare genom att normalisera SARS-CoV-2-innehållet med fekal biomarkör peppar milt fläckvirus (PMMoV). Dessutom har två metoder för tidig varning, nämligen medelvärdet plus två standardavvikelser (MSD) och positiv procentuell förändring (PPC), implementerats på avloppsvattendata, vilket pekar på vikten av att tillämpa sådana varningsmetoder för att ge förståeliga och tolkbara resultat. Denna studie ger värdefulla insikter om övervakning och analys av SARS-CoV-2 i avloppsvatten, vilket bidrar till utvecklingen av robusta system för tidig varning och folkhälsostrategier. / During the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been applied extensively as a complementary tool to clinical testing across many parts of the globe. This project aimed to detect and measure the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) load in wastewater samples using Reverse transcriptase quantitative polymerase chain reaction (RT-qPCR). The analyzed samples were from four different wastewater treatment plants (WWTPs) in Sweden, covering the period from November 2022 through May 2023. The study encompassed an overview of various sampling and analytical techniques and normalization approaches employed in WBE studies, highlighting the importance of method selection. SARS-CoV-2 RNA was detected in all the samples analyzed, and infection trends could be identified effectively, including the COVID-19 peak observed during the holiday season. The dominant variants detected during this monitoring period were the omicron variants; omicron BA.2. and omicron BA.2.75. The weekly quantified SARS-CoV-2 load in the wastewater samples showed a significant positive correlation to the clinical cases reported in the corresponding catchment areas. This association was further enhanced by normalizing SARS-CoV-2 content with the fecal biomarker pepper mild mottle virus (PMMoV). Furthermore, two early warning methods, namely the mean plus two standard deviations (MSD) and positive percentage change (PPC), were implemented on the wastewater data pinpointing the importance of applying such warning methods to provide understandable and interpretable results. This study provides valuable insights into the monitoring and analysis of SARS-CoV-2 in wastewater, contributing to the development of robust early warning systems and public health strategies.

Viruset SARS-CoV-2 binder till det membranbundna enzymet angiotensinkonvertas 2 (ACE2). ACE2 är även en del av Renin-Angiotensin-Aldosteron-systemet (RAAS) och Kallikrein-Kinin-systemet (KKS). Den enzymatiska delen av ACE2 klyvs från cellmembranet vid inbindningen av viruset eller genom enzymet ADAM17 och bildar då cirkulerande ACE2 (sACE2). Syftet med den här litteraturstudien var att undersöka om sACE2 kan kopplas till allvarlighetsgraden av covid-19. Studierna visade blandade resultat. Tre artiklar visade ökande halter sACE2 vid svår covid-19. Två studier visade sjunkande halter sACE2 vid svår covid-19. Två artiklar visade ingen koppling mellan sACE2 och allvarlighetsgraden av covid-19. Då forskningsområdet omkring SARS-CoV-2 är nytt finns det stora variationer i studiernas upplägg, vilket resulterar i att resultaten är osäkra och svåra att jämföra med varandra. Eventuellt kan det finnas en koppling mellan mängden sACE2 och allvarlighetsgraden av covid-19. Mer forskning behövs för att säkerställa om sACE2 i kombination med andra tester kan användas för att upptäcka patienter i risk för allvarlig covid-19. / The virus SARS-CoV-2 binds to the enzyme Angiotensin Converting Enzyme 2 (ACE2) which causes shedding of the extracellular part of the enzyme and produces soluble ACE2 (sACE2). ACE2 is also a part of Renin-Angiotensin-Aldosterone-system (RAAS) and Kallikrein-Kinin-system (KKS). The enzyme ADAM17 also causes ACE2 to shed during inflammation. Since inflammation is an important part of the Covid-19 pathogenesis, the sACE2 levels may affect the pathogenesis of Covid-19. The purpose of this literature study was to investigate a possible connection between sACE levels and Covid-19 severity. Three articles showed high levels of sACE2 in severe Covid-19. Two articles showed low levels of sACE2 in severe Covid-19. Two articles showed no connection between severity of Covid-19 and sACE2 levels.  Due to the novelty of the research area, there are variations in the study set-up. Although inconclusive study results, sACE2 may be used as a secondary biomarker to detect indications of severe Covid-19, but more research is needed.