Credit: Graphic created by M.E. Newman, Johns Hopkins Medicine, with public domain images and background transplant surgery photograph courtesy of Johns Hopkins Medicine

Organ Transplant Recipients and COVID-19 Vaccines

In a series of studies, Johns Hopkins Medicine researchers showed that although two doses of a vaccine against SARS-CoV-2 — the virus that causes COVID 19 — confers some protection for people who have received solid organ transplants, it’s still not enough to enable them to dispense with masks, physical distancing and other safety measures.

The research was published in several articles in the Journal of the American Medical Association.

Read more about the studies that show the vaccine’s effect in these patients and how a third dose may help.

Date Posted: May 5, 2021 | Disclaimer

Credit: Robert Stevens

Mobile App Tracks COVID-19 Outbreaks

Can scientists predict a COVID-19 outbreak? It turns out there’s an app for that. Johns Hopkins Medicine scientists launched the “COVID Control” app, which uses crowd-sourced data on COVID-19 symptoms to identify where outbreaks will appear.

While studying the app, the Johns Hopkins team has looked at how user-reported COVID-19 symptoms can predict potential outbreaks, enabling public health leaders to enact measures to contain the virus’ spread.

More than 19,000 users in 1,019 counties in every state across the U.S. have logged more than 174,000 data entries to anonymously report symptoms. A closer look at the data showed that the app’s reports from people in Baltimore City and Baltimore County in Maryland correlated with locations of increased COVID-19 prevalence. 

Read more about our research in our Newsroom

Date Posted: May 5, 2021 | Disclaimer

Credit: Jeff Siewerdsen and Mahadevappa Mahesh

Could Ultraviolet Light Disinfect CT Scanners?

Johns Hopkins biomedical engineer Jeff Siewerdsen and medical physicist Mahadevappa Mahesh are investigating the use of UV light to disinfect the inner bore of CT scanning machines, a cramped space that is exposed to exhaled particles from patients and is difficult to reach by manually wiping it down.

Siewerdsen and Mahesh are studying UVC rays, which can eliminate a high proportion of SARS-CoV-2 virus from hard surfaces, not the typical UVA rays, which tend to cause skin cancer and other problems.

If the UVC procedure for CT scanners proves useful, the process could be used in addition to the manual wipe down of CT scanners, improve the safety of personnel and patients, and be applicable to many health care facilities around the globe.

Note: Exposure to UVC light could harm health. UVC lamps should not be used without proper training and safety precautions.

Read the full story in our Newsroom

Date Posted: May 4, 2021 | Disclaimer

Credit: Graphic created by M.E. Newman, Johns Hopkins Medicine, using public domain images.

Immunology of COVID-19 to be Studied at New Center

The Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health will receive more than $2 million per year in a five-year grant from the National Institutes of Health’s National Cancer Institute to form a center for studying the immune response to SARS-CoV-2, the virus that causes COVID-19.

The goal of the Johns Hopkins Excellence in Pathogenesis and Immunity Center for SARS-CoV-2 (JH-EPICS) is to provide a deeper understanding of how the virus impacts the immune system in order to facilitate development of effective treatments and vaccines against it.

Read more about the center in our Newsroom

Date Posted: April 29, 2021 | Disclaimer

Youngest COVID-19 Patients Most Likely to Avoid Severe Illness, Recover With Care

A Johns Hopkins Medicine study found that if infants less than 3-months-old get COVID-19, they experience mild to moderate cases and usually recover with supportive care.

These tiny patients have still-developing immune systems and frequently come in close contact with their caretakers, making them potentially more vulnerable to infection with the virus compared with older infants and other young children.

Of 63 patients evaluated for the study, 13 (21%) were admitted to an intensive care unit and two (3%) required invasive mechanical ventilation. No deaths were reported.

Read more about the research in our Newsroom

Date Posted: April 27, 2021 | Disclaimer

April Pruski, M.D.

Like Polio, COVID-19 Underscores the Importance of Rehab Medicine

When historians reflect on the last polio outbreak in the United States, they typically focus on Jonas Salk’s 1955 vaccine that led to near eradication of the crippling disease.

But Johns Hopkins rehabilitation physician April Pruski says we also learned an important lesson from the thousands of patients who contracted polio in the 20th century: the importance of rehabilitation.

Pruski says 2020’s COVID-19 pandemic has shone a similar light on the field of rehabilitation medicine. The first weeks and months of COVID-19 treatment at The Johns Hopkins Hospital brought hundreds of patients with a sudden need for extensive rehabilitation services.

Patients in post-acute care for COVID-19 can have physical, mental and even cognitive impairments. According to a journal article published in the September 2020 issue of the Archives of Physical Medicine and Rehabilitation and co-authored by Pruski and her division colleagues, nearly 900 patients with COVID-19 were admitted to The Johns Hopkins Hospital between March 12 to July 22, many of whom were transferred from other hospitals when their illnesses worsened. Pruski estimates that from 60% to 70% of those patients required care from the Physical Medicine and Rehabilitation Department — the largest such surge the department has ever experienced.

Read more about physical medicine and rehabilitation and COVID-19 in Clinical Connections

Date Posted: February 12, 2021 | Disclaimer

Lessons From Aging Disease May Block Coronavirus Infection

An enzyme linked to a premature aging disease called progeria may also defend against viruses, including SARS-CoV-2, which causes COVID-19.

The enzyme, called membrane-associated zinc metalloprotease ZMPSTE24, was discovered by the laboratory of Susan Michaelis. She has spent the last several decades studying the enzyme and its effect on a protein called lamin A, which is critical to maintaining the structure of the nucleus, a cell’s control center.

Mutations in the genes that encode either ZMPSTE24 or lamin A cause progeria, the disease that accelerates aging from birth and is often fatal by the time children are in their teens.

Other researchers have shown that ZMPSTE24 also has a role in the immune system response to many viruses. Michaelis’ team is now studying whether ZMPSTE24 can block SARS-CoV-2 from entering a host cell and how the enzyme manages to do this.

The findings, says Michaelis, may reveal a way to provide cells with a better defense against SARS-CoV-2.

Read about the research in our Newsroom

Date Posted: December 1, 2020 | Disclaimer

Colorized scanning electron micrograph of a cell (purple) heavily infected with SARS-CoV-2 virus particles (yellow). A recent study by Johns Hopkins Medicine shows that blocking a specific protein in a biological pathway may prevent SARS-CoV-2 infection and keep the virus from misdirecting the immune system against healthy cells and organs. Credit: National Institute of Allergy and Infectious Diseases, National Institutes of Health

Blocking Immune System Pathway May Stop COVID-19 Infection, Prevent Severe Organ Damage

A recent study by Johns Hopkins Medicine shows that blocking a specific protein in a biological pathway may prevent infection with SARS-CoV-2, the virus that causes COVID-19, and keep the virus from misdirecting the immune system against healthy cells and organs.  

Based on their findings, the researchers believe that inhibiting the protein, known as factor D, also will curtail the potentially deadly inflammatory reactions that many patients have to the virus. 

To infect cells, proteins on the surface of the SARS-CoV-2 virus grab hold of heparan sulfate, a large, complex sugar molecule found on the surface of cells in the lungs, blood vessels and smooth muscle making up most organs. Then, the virus uses another cell-surface component, the protein known as angiotensin-converting enzyme 2 (ACE2), as its doorway into the attacked cell. 

The Johns Hopkins Medicine team discovered that when SARS-CoV-2 ties up heparan sulfate, it prevents factor H from using the sugar molecule to bind with cells. Factor H’s normal function is to regulate the chemical signals that trigger inflammation and keep the immune system from harming healthy cells. Without this protection, cells in the lungs, heart, kidneys and other organs can be destroyed by the defense mechanism nature intended to safeguard them. 

Robert Brodsky, M.D., director of the hematology division at the Johns Hopkins University School of Medicine, led the research team. They found that by blocking another protein, known as factor D, which works immediately upstream in the pathway from factor H, they were able to stop the destructive chain of events triggered by SARS-CoV-2. 

Read more about the research in our Newsroom

Date Posted: November 25, 2020 | Disclaimer

Dialysis Patients at Greater Risk of Coronavirus Infection

It’s widely known that the SARS-CoV-2 virus, which causes COVID-19, can spread rapidly among residents in nursing homes and other long-term care facilities, leading to high numbers of cases and deaths in a very vulnerable population. According to a new study led by researchers at Johns Hopkins Medicine, residents receiving hemodialysis for chronic kidney disease may be at even greater risk for infection from the virus.

The researchers investigated an outbreak of COVID-19 that occurred in April 2020 in a 200-bed Maryland nursing home with an independently operated, on-site hemodialysis center. The researchers reported that 15 of the 32 residents (47%) on dialysis tested positive while only 22 of the other 138 residents (16%) did.

“Based on our results, we believe that nursing home residents undergoing dialysis are more likely than others in a facility to have repeated and prolonged exposures to the SARS-CoV-2 virus, and therefore may be at greater risk of infection and subsequent COVID-19,” says Benjamin Bigelow, a fourth-year medical student at the Johns Hopkins University School of Medicine and the study’s lead author.

“Our study suggests that to prevent COVID-19 outbreaks, nursing homes and dialysis centers need to maintain clear and constant communication to improve infection prevention practices throughout the process of transporting residents to dialysis and during the dialysis itself,” says Morgan Katz, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of the study. “Residents who undergo dialysis should be carefully monitored, and testing prioritization must account for any contact with dialysis staff who may have been exposed to SARS-CoV-2.”

Read more about the study in our Newsroom

Date Posted: September 4, 2020 | Disclaimer

Inside a Coronavirus-Infected Cell

To build a better vaccine, stop a virus from replicating or attaching to host cells, help the immune system fight the virus, or any type of remedy to the current pandemic of COVID-19, scientists need to understand how coronaviruses work. These scientists focus on the so-called “basic” or “fundamental” biology of viruses.

For example, coronaviruses are known to invade and replicate within host cells, and newly made viruses escape through the host cell’s outer membrane. But instead of going straight to the cell membrane to get ready to be shipped out of the host cell, coronaviruses stop at a pancake-like structure in the cell called the Golgi complex, a kind of post office that sorts and processes proteins and spits them out of the cell after enclosing the proteins in a compartment called a vesicle.

Johns Hopkins scientists have been working to determine why coronaviruses make this extra stop in their replication and escape process. One reason, they found, is that coronaviruses neutralize the acidity of the Golgi complex, potentially paving a better path to help the viruses, with their spiky halo, escape cells.

Date Posted: August 4, 2020 | Disclaimer

Do Medications that Reduce Immune Response Raise Risk for COVID Complications?

Gastroenterologist Brindusa Truta and her colleagues are surveying 3,000 patients with inflammatory bowel disease (IBD), which is often treated with medications that suppress the immune system and reduce inflammation, to determine whether those with IBD are at higher risk of complications from COVID-19 illness.

“There is absolutely no data regarding IBD and the virus,” Truta says. “Therefore, we decided to go ahead and interview our patients from time to time about their infection status, their medications and other risk factors.”

It’s not yet clear how being on immunosuppressive medications can alter the variables and risk factors for contracting the pandemic coronavirus compared with typical adults not taking the medications, says Truta. IBD clinic staff at Johns Hopkins will be interviewing patients during telemedicine checkups or through questionnaires about their daily habits and activities, employment status, transportation and living arrangements. If patients have no symptoms of COVID-19 at the time of the interview, clinic staff members follow up with them later. If they do become infected, they’re asked to call the clinic to let them know, and to potentially have their medications adjusted.

“Every step in unlocking the economy is going to come with more interactions among people and more exposure,” she says. “Some of our patients will return to work, so we wanted to deploy our questionnaire at different points of time trying to capture what happens.”

So far, patients have been very willing to share their information. Some who did develop symptoms called the clinic to say what they were doing and how they think they became infected. Based on the evidence gathered so far, says Truta, the virus does not currently appear to impact this population any worse than the general population. Most patients infected and on immunosuppression seem to recover without going to the hospital, with some variations based on age and whether a person has two or more chronic health conditions. 

“You would expect that patients who are on medications to lower their immune response, as many of our IBD patients are, would have a higher risk of getting infected [with coronavirus] and a poorer outcome, but based on our data so far, we are not seeing that,” Truta says. “They don’t have better outcomes than the general population, but I think that they are better than we expected.”

Read more about the research in Inside Tract

Date Posted: July 23, 2020 | Disclaimer

Fluorescence image of neuron-derived extracellular vesicles. Credit: Kenneth Witwer, Ph.D.

Cell's 'Postal System' Studied to Diagnose, Monitor and Treat COVID-19

Tiny, spherical pods float from one cell to another through the crowded space of other cells and fluids such as blood and mucus. These package-like pods are unassuming. They slip past other cells and complex tissues, intent on delivering their contents to the intended recipient.

After pinching off from the cell, these packets carry specific content from the cells they came from, much like a letter in the mail.

These postal pockets that are ferried between cells are known by scientists as extracellular vesicles. Since they carry contents from within a cell, scientists believe these packets can provide clues about pathogens or diseases that may be harboring within cells.

For decades, this valuable insight has led researchers to explore the possibilities extracellular vesicles might hold for disease diagnosis, monitoring and even treatment.

Johns Hopkins Medicine researcher Kenneth Witwer, Ph.D., has studied extracellular vesicles for much of his career and is the executive chair of science and meetings for the International Society for Extracellular Vesicles.

Witwer suggests that extracellular vesicles may be able to help researchers studying COVID-19 in three ways:

• Make a stronger vaccine for COVID-19,
• Develop a way to repair lung damage and autoimmune responses to COVID-19 and
• Monitor COVID-19 treatment effectiveness in patients.

Read about the COVID-19 fighting potential of extracellular vesicles

Date Posted: July 6, 2020 | Disclaimer

Elective Surgeries in the U.S. May be Backlogged Up to a Year Due to COVID-19

A new study by Johns Hopkins researchers found that it may take between seven and 16 months for surgeons across the U.S. to complete the backlog of elective orthopaedic surgeries that have been suspended during the COVID-19 pandemic. Elective surgeries, not necessarily optional, are ones that can be planned in advance. This accounts for more than a million surgeries in the U.S. for spinal fusion and knee and hip replacements.

The study was published online May 12 in The Journal of Bone and Joint Surgery.

Lead author Amit Jain, M.D., chief of minimally invasive and outpatient spine surgery and associate professor of orthopaedic surgery and neurosurgery at the Johns Hopkins University School of Medicine, says that in fields such as orthopaedic surgery, where procedures are frequently performed in an inpatient setting, the ramp-up may be slower than surgeries typically done in outpatient facilities. “We will keep adding to the backlog as long as we are not operating at 100% capacity,” states Jain.

Jain and his colleagues used the Agency for Healthcare Research and Quality National Inpatient Sample, a national database that contains hospital inpatient data, to model the number of current and forecasted spinal fusion and hip and knee replacement surgeries in the United States. The researchers found that, in an optimistic scenario where most elective surgeries are back to full capacity in June, it would take approximately seven months to get through the backlog. Delays to the ramp-up to full capacity could extend the backlog to 16 months.

To help ease the backlog, Jain proposes several strategies to increase surgical throughput, including more use of telemedicine. At Johns Hopkins, telemedicine use has skyrocketed. He also suggests making more timeslots available in operating rooms for orthopaedic surgeries, increasing care coordination resources and shifting care to ambulatory surgery centers as much as possible.

Along these lines, researchers in the Johns Hopkins dermatology department are working with the Johns Hopkins Carey School of Business to study the impact of deferred procedures on health care operations and finances, the effects on disease and patient-reported outcomes and how to solve the problems that ensue.

Date Posted: June 19, 2020 | Disclaimer

New Method to Make Kidney Dialysis Fluid for Patients with COVID-19

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.

Read about how our team has shared details on the new method

Date Posted: May 29, 2020 | Disclaimer

Obesity Linked to Severity of COVID-19 Infection in Younger Adults

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 physical distancing and stay vigilant about when to seek medical treatment in the early stages of their disease to help reduce the risks.

Listen to scientist David Kass discuss these findings

Date Posted: May 22, 2020 | Disclaimer

Image credit: Chirag Vasavda.

Does COVID-19 Affect the Brain?

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

Thin section electron micrograph of a cell infected with the coronavirus infectious bronchitis virus showing virus particles assembling in a Golgi region. These virus particles will eventually be exported by vesicles to the cell surface where they are released. Credit: Carolyn Machamer, Johns Hopkins Medicine

The Weird Way Coronaviruses Assemble Their Offspring

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.

Read more about how coronaviruses assemble

Date Posted: May 6, 2020 | Disclaimer