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Cell Biology

Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection – Scientific American

Smoking or vaping could make you more vulnerable to a severe infection with the novel coronavirus, some experts say.

Although there have not been many studies investigating this link specifically, a wealth of evidence suggests that smoking suppresses immune function in the lungs and triggers inflammation. There have been far fewer investigations of vaping, but preliminary research suggests it may do similar damage. And both long-term smokers and e-cigarette users are at a heightened risk of developing chronic lung conditions, which have been associated with more severe cases of COVID-19, as the disease caused by the new virus is called. Scientists say it therefore seems reasonable to assume that smokingand possibly vapingcould increase the risk of developing a serious infection from the coronavirus.

All these things make me believe that we are going to have more severe casesespecially [in] people who are [long-term] smokers or vapers, says Melodi Pirzada, chief of pediatric pulmonology at NYU Winthrop Hospital on Long Island.* She has not treated COVID-19 patients herself, but it is definitely common sense to think that once you have a history of smoking or vaping, the whole airways, the defense mechanism of your lungseverything changes, she says.

Very little research has looked directly at whether smoking or vaping increases a persons risk of severe COVID-19. A preprint study in China found that men were slightly more likely than women to be hospitalized for coronavirus infections, and scientists say this observation could be related to the fact that in the country, vastly more men than women smoke. (The paper, which has not been peer-reviewed, has been withdrawn because it was based on early data. It will be replaced with a more up-to-date version soon, the authors write.) Another study, which has been published online in the Chinese Medical Journal, involved 78 patients with COVID-19 and found that those with a history of smoking had a 14 percent higher risk of developing pneumonia.

There is substantial scientific literature showing that smoking inflames the lungs and suppresses immune function. For regular smoking, we know it inhibits the ciliary clearance of the airways, Pirzada says. We have these little [hairlike] structures known as cilia, and they are responsible for taking the toxins and the mucus out of our airways and clearing the lungs when we cough. We know that that is affected when you smoke and when you vape.

During a respiratory infection in the lungs, there tends to be an influx of white blood cells called neutrophilsthe first responders that start killing the pathogenfollowed by an influx of lymphocyteswhich are responsible for clearing the infection. Theres a very coordinated series of events that take place when you do become infected with a virus, says Ray Pickles, an associate professor of microbiology and immunology at the University of North Carolina at Chapel Hill. These are probably the events that take place in the vast majority of us as individuals, whether were infected by influenza or whether were infected by SARS-CoV-2, as the new coronavirus is known. I think once you start perturbing this sequence of events in any which way or direction, thats when things can go awry.

Smoking is a known risk factor for influenza, says Robert Tarran, a professor of cell biology and physiology at Chapel Hill. People who smoke are immunosuppressed to some degree, Tarran says. They make more mucus. It doesnt clear the lungs as well. There are pro-inflammatory changes; immune cells are changed as well. And all that leads up to, basically, theyre more likely to get viruses and have a worse outcome.

Vapers risk of viral infections has not been studied much, although there are some epidemiological studies suggesting they are more likely to get respiratory infections, Tarran says. And animal studies provide some clues. Mice that were exposed to e-cigarette aerosol and then inoculated with Streptococcus pneumoniaebacteria or influenza A were less likely to survive. And vaping may interfere with neutrophil function, some studies suggest. Scientists at Chapel Hill have shown that e-cigarette use suppresses the activity of immune- and inflammatory-response genes in nasal cellsmore so even than smoking. And a preprint study found that the gene that encodes the receptor ACE2, which the novel coronavirus uses to infect cells, is more active in smokers than nonsmokers.

Of course, none of these studies directly show that smoking or vaping increases the severity of COVID-19 infections; it is not clear to what extent they can be extrapolated to the current pandemic. But given that smoking and vaping do well-established harm to the immune system, it seems prudent to assume they might make coronavirus infections worse.

I think that a sensible thing to do for people is to stop smoking and stop vapingand avoid secondhand exposure, says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. We dont have every little detail on this nailed down, he says. But based on what we know, generally, about smoking and e-cigarettesand in particular about smoking and COVID-19 from people who are already sick, from one study in Chinait stands to reason that you would lower your risk if you stopped doing these things. After all, Glantz adds, whats the downside?

*Editors Note (3/17/20): Thissentencewaseditedafter posting toupdateMelodi Pirzadas title.

Read more about the coronavirus outbreakhere.

Original post:
Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection - Scientific American

Cell Biology

University restricts research in effort to prevent COVID-19 spread – The Brown Daily Herald

While people turn to scientists for the latest updates on COVID-19, laboratories across campus will more or less go dark after 5 pm today. The constant hum of machines mixing samples will grow quiet as equipment is shut off, new experiments are canceled and entry is limited to essential personnel only.

The decision to ramp down research efforts was released March 15th in a message from Provost Richard Locke P 18 and Vice President for Research Jill Pipher that was posted on Browns COVID-19 website.

The ramping down of research laboratories is in support of social distancing to smooth the curve of expected COVID-19 cases and the potential to overwhelm our local healthcare system which has limited resources, Director of Browns Environmental Health and Safety Stephen Morin wrote in an email to The Herald.

As the University increased efforts across the board to stop the spread of COVID-19, by Sunday, it became pretty clear that we would be going into a completely different mode and everything would be conducted remotely, said Mark Johnson, Royce family associate professor of teaching excellence, associate professor of biology and director for the molecular biology, cell biology and biochemistry graduate program.

My sense is that everybody really wants to cooperate. Everyone appreciates the leadership of the Provost on this and is doing their best to comply, Johnson said.

Laboratories and research in general are a vital function of Brown University and it takes a campus community to support their operations, Morin wrote. He added that many groups ranging from faculty to student researchers, as well as facilities management, environmental health and safety staff and administrative personnel, are crucial for the everyday work of laboratories on campus.

It could be a risk to all these groups to allow them to continue under normal operations, Morin wrote.

Only those who need to enter for critical work will have access to laboratory buildings, Morin wrote. Examples of critical work include equipment maintenance such as preservation (or) maintenance of cell lines, changing out gas tanks or cryogens, filters and water checks.

Animals that are currently maintained as research subjects will also receive continued veterinary care, Morin wrote.

Labs working with bacteria and other cells are able to preserve the organisms grown for their experiments through cryogenic storage the process of freezing cells in liquid nitrogen. But for labs reliant on more complex living organisms, the solution is not so simple.

Among the University faculty winding down their research this week is Assistant Professor of Molecular Microbiology and Immunology Shipra Vaishnava, who uses mice at the Universitys Biomedical Center to investigate how diet and bacteria in the gut impact immunity against infections and diseases. The mice are kept in a gnotobiotic mouse facility in a germ-free environment. These now paused long-term studies require mice to be bred for months, prompting researchers to reduce their mouse populations and cryo-preserve the sperm of their mouse lines for propagation whenever research can resume. Weve lost a lot of time that weve already invested in these experiments, so anywhere between three to six months, she said.

Many labs typically have teams of researchers conducting experiments from early morning until late evening, including many weekends. This level of activity has already dropped significantly due to COVID-19 concerns. Aside from the scurry of mice, the only other source of movement in the Vaishnava Lab will now be from the two essential personnel at a time looking after the labs animals for only two to three hours each week.

Critical work that is permitted to continue also includes work whose interruption would result in irretrievable or unrecoverable loss of data or samples, or loss of time for an ongoing experiment that could not be recovered within a reasonable period, Vice President for Research Jill Pipher wrote in a statement to The Herald.

Pipher added that Brown is carefully reviewing, on a case-by-case basis, every request to continue critical work.

In early March, Johnsons lab began a new study on the relationship between temperature and plant production. Following the new restrictions,the laboratory-based components of the project will be put on hold. But he is grateful that the lab collected a data set a couple weeks ago that they can now analyze remotely.

In a way projects dont really have beginnings and ends. There are always new things that you want to try in the lab, Johnson said. Now that labs are being closed, its hard to sort of wrap your head around the idea that you cant do that.

The closure of the labs is also impacting research trainees, including undergraduate, graduate and postdoctoral students, who cannot continue their work away from the lab bench. Undergraduate students were asked to leave campus by Tuesday evening, The Herald previously reported.

Vaishnava had undergraduate students doing for-credit research in her lab. For the rest of the semester, she said they will have to instead concentrate on readings, discussions and designing future experiments. Graduate students timelines to collect data and finish their research papers may now have to shift, and postdoctoral students can no longer attend the workshops and conferences that were important parts of their education, Vaishnava said.

The interruption of experiments delays publication of their own findings which factors into researchers career promotions. But Vaishnava hopes since this is such a worldwide, global phenomenon, there would be a mindfulness about it.

Samuel Rasche GS, a second-year masters student in the Laboratory for Cognitive and Perceptual Learning and a visiting research fellow from the University of Amsterdam, has also had to pause his work because of necessary restrictions on human subjects research. His research depends on people who attend numerous sessions involving a series of complex tasks that they could not perform remotely on their own.

Similar to Vaishnavas lab, researchers working in the same lab as Rasche are practicing social distancing by not permitting more than one person to be in a room at the same time, Rasche said.

For now, Rasche plans to stay in Providence. The University of Amsterdam has not yet requested that he return home, but a lot of other students and supervisors I know that are from abroad went back (home), so that kind of pressures me too to go back, he said.

I just try to stay positive and productive, Rasche said. Its a sad situation because I also met a lot of people here and literally everybody left. Its a big change.

Sarah Berman 20.5 said that the decision for research to shut down made the transition of leaving campus easier. Honestly, if the lab had stayed open, I would have stayed. If labs are able to reopen for student research during the semester, Im absolutely coming back, she said. She is able to do some remote work at home on the project that will become her thesis in the fall.

Researchers have also lost time needed to train students. We have lost this overlap period of a couple of months that is critical for passing down skills and materials and samples from graduating researchers to those still in the lab who would be taking over the projects, Vaishnava said.

With the global, national and state-wide situation surrounding COVID-19 rapidly changing, the current protocols are also subject to change. The University will continue to monitor and re-evaluate the situation, issuing updates and guidance for researchers as often as necessary, Pipher wrote.

While the context of COVID-19 is unprecedented, EH and S has previously worked to safely close laboratories in the event that a professor left the University or in the case of renovation. This week they developed a set of guidelines for researchers to follow to assist researchers in thinking about the steps to be taken to safely close the space temporarily.

COVID-19 is a serious public health issue, and we all have to do our part. As scientists, we should understand this more than anyone else why these steps are needed, Vaishnava said. Its hard, but I think its something we need to do.

The health and safety of the research community is our top priority, Pipher wrote.

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University restricts research in effort to prevent COVID-19 spread - The Brown Daily Herald

Cell Biology

Blocking sugar structures on viruses and tumor cells – Biophotonics.World

Prof. Skerra's current research findings are paving the way for the development of new types of binding proteins for biological sugar structures, which play a significant role in cancer as well as infectious diseases. - What you can see here: A model sugar ligand (yellow) binds to the boric acid group (green) in the pocket of a binding protein (pink).

Image source: TUM-Chair of Biological Chemistry

The laboratory directed by Arne Skerra, Professor of Biological Chemistry, has its focus on designing artificial binding proteins for therapeutic applications. The laboratory's current research findings are paving the way for the development of new types of binding proteins for biological sugar structures, which play a significant role in cancer as well as infectious diseases.

Recognizing biological sugar structures

"The recognition of specific sugar molecules, or so-called carbohydrates, is of vital importance in many biological processes," Prof. Skerra explains. Most cells carry a marker consisting of sugar chains which are attached to the outside of the cell membrane or to the membrane proteins, thus enabling the body to identify where these cells belong or whether certain cells are alien. Pathogens also have sugar structures of their own, or they can bind to these.

Proteins, which perform a wide range of functions within cells, generally have only low affinity to sugars. Thus, their molecular recognition poses a challenge. The reason: water molecules look similar to the sugar molecules, meaning that they are basically hidden in the aqueous environment of the cells. Prof. Skerra's research group therefore set out to design an artificial binding protein with a peculiar chemical composition which makes it easier to bind to biological sugar structures.

A boric acid group implemented into a protein as amino acid

Amino acids are the building blocks of proteins. As a rule, nature only uses 20 amino acids in all living organisms. "Using the possibilities opened up by synthetic biology, we have employed an additional artificial amino acid," reports researcher Carina A. Sommer.

"We have succeeded in incorporating a boric acid group, which exerts intrinsic affinity to sugar molecules, into the amino acid chain of a protein. In doing this, we have created an entirely new class of binding protein for sugar molecules," Sommer explains. This artificial sugar-binding function is superior to natural binding proteins (so-called lectins) both in strength and with regard to possible sugar specificities.

"The sugar-binding activity of boric acid and its derivatives has been known for nearly a century," says Prof. Skerra. "The chemical element boron is common on earth and has low toxicity, but so far has largely remained unexplored by organisms."

"By using X-ray crystallography, we have succeeded in unraveling the crystal structure of a model complex of this artificial protein, which allowed us to validate our biomolecular concept," explains scientist Dr. Andreas Eichinger.

The next step: towards medical application

Following approximately five years of fundamental scientific research, the findings from Prof. Skerra's laboratory can now be applied to practical medical needs. Prof. Skerra points out: "Our results should not only be used to support the future development of new carbohydrate ligands in biological chemistry, but should also pave the way for creating high-affinity agents for controlling or blocking medically-relevant sugar structures on cell surfaces."

Such a "blocking agent" could be used for conditions in which strong cell growth is evident or when pathogens are attaching themselves to cells, for example in oncology and virology. If we are successful in blocking the sugar-binding function and in slowing down the progress of a disease, this would give the patient's immune system sufficient time to mobilize the body's natural defense.

Source: Technical University of Munich

Related journal article:http://dx.doi.org/10.1002/cbic.201900405

Read more:
Blocking sugar structures on viruses and tumor cells - Biophotonics.World

Cell Biology

Singapore researchers find common therapeutic vulnerability for a deadly blood cancer – The Medical News

Reviewed by Emily Henderson, B.Sc.Mar 18 2020

CML is a blood cancer that can be controlled by continuously taking an expensive type of medicine called a tyrosine kinase inhibitor (TKI). In almost all patients, stopping TKI treatment results in recurrence of CML. While most CML patients respond well to life-long TKI usage, about 10 per cent of patients become resistant to TKIs, and progress to late-stage or blast crisis (BC) CML. Patients with BC almost always die from their disease. While many genetic mutations are known to be associated with BC progression, the mechanisms by which they and other factors cause BC remain largely unknown. This knowledge gap prevents clinicians from identifying which CML patients are at risk of BC progression, and treating BC when it occurs.

To fill these critical gaps, we employed the latest molecular approaches to establish that the so-called 'polycomb repressive complex', or PRC, alters the regulation of a set of genes which drive BC progression. We found that the consequences of altered PRC activity were common to the majority of BC cases, regardless of the different leukemia-causing mutations we also found in them."

Dr. Tun Kiat Ko, Research Fellow at Duke-NUS' Cancer and Stem Cell Biology (CSCB) program

Using this increased understanding, the team devised novel drug combinations, which reverse the downstream effects of the PRC in BC. At the same time, they also developed methods to identify CML patients who were at increased risk of developing TKI-resistance and progressing to BC.

"Our discovery is like finding the 'one ring that rules them all'. Since there are many cancer-causing genetic mutations that occur when chronic phase CML transforms to blast crisis, it has been very challenging to determine which ones are critical to BC, and therefore important to target. By discovering this 'one ring' and how to 'destroy' it with a novel drug combination, we open the door to treating this deadly cancer with the same combination of drugs regardless of the myriad mutations that exist in any particular patient. In addition, our study demonstrates the ability of scientists and clinicians to make exciting discoveries that can be translated to the improved health of patients all over the world, as well as Singaporeans," said Associate Professor Ong Sin Tiong from the Duke-NUS CSCB programme and corresponding author of this study.

"The multi-omics approach was critical to the success of the study. Each layer of information provided us corroborative evidence and insight into the dysfunction of the polycomb repressive complex leading to the progression to blast crisis stage of CML," asserted Asif Javed, co-corresponding author of the study.

"This study is another example of how interdisciplinary research leads to new insight," says Axel Hillmer, Group Leader at the GIS who led the genomics part of the project.

Patrick Tan, Executive Director of GIS, adds, "Due to technology advancements over the last years, it is now possible to apply more complex genomic analyses to translate such findings into routine diagnostics."

"As a hematologist treating patients with advanced blast crisis CML, it is disheartening when we run out of treatment options for them. And that is why we are very encouraged by the study findings and certainly hopeful that our patients may one day benefit from the efforts of our collaboration," Associate Professor Charles Chuah, Senior Consultant, Department of Haematology, SGH.

The team is currently working on approaches to identify CML patients who are at risk of BC transformation, and also to determine why the key PRC-related events occur in the first place.

Source:

Journal reference:

Ko, T.K., et al. (2020) An integrative model of pathway convergence in genetically heterogeneous blast crisis chronic myeloid leukemia. Blood. doi.org/10.1182/blood.2020004834.

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Singapore researchers find common therapeutic vulnerability for a deadly blood cancer - The Medical News

Anatomy

This Ancient Fish Represents The Earliest Known Evolutionary Evidence of Fingers – ScienceAlert

The four-limbed animals of the world have several things in common. Spines. Bilateral symmetry. And most of us have (or, in the case of birds, had) five digits at the end of each of our four limbs.

When and how these digits emerged in animals has been something of a mystery. Palaeontologists have just found the earliest evidence of this anatomical feature, in the fin of a fish that lived 380 million years ago.

The rudimentary digit bones may not look like much, but they mark one of the most important transitions in vertebrate evolution.

"We have made a major breakthrough in the origin of how the hand was first formed for all vertebrates," palaeontologist John Long of Flinders University in Australia told ScienceAlert.

"This is the first time that we have unequivocally discovered fingers locked in a fin with fin-rays in any known fish. The articulating digits in the fin are like the finger bones found in the hands of most animals," he said in a statement.

The transition from aquatic fish to four-limbed creature (tetrapod) is one of the most important in evolutionary history, yet there are significant gaps in our knowledge. One of those gaps has been the point at which fish emerged from the depths and started foraging in shallower waters - what's considered to be an intermediate step before crawling out onto land.

In order to complete that transition, animals would have needed something pretty vital for crawling - that is, hands and feet, digits and all.

This is where a specimen of an ancient lobe-finned fish called Elpistostege watsoni enters the picture. It's a type of tetrapod-like fish belonging to an order called Elpistostegalia, on the ancestral line that leads to tetrapods; our understanding of the emergence of tetrapods largely relies on what we know about that order.

(Cloutier et al., Nature, 2020)

But the elpistostegalian fossil record has been pretty scarce, with incomplete pectoral fin skeletal anatomy. Until 2010, when an almost complete 1.57-metre (5.15-foot) fossilisedE. watsoni skeleton was found in the Escuminac Formation of Miguasha in Quebec, Canada.

Long and his colleague palaeontologist Richard Cloutier from Universite du Quebec a Rimouski in Canada have been carefully studying the fossilised bones to see what they can tell us about this mysterious animal. This paper is the first in a series, and it describes how the pair and their team used CT scanning to discover the skeletal anatomy of the fin.

"We focused on the discovery of digit bones in the fin as this was a really spectacular discovery - the first definite (not controversial) case of a fish with finger bones," Long told ScienceAlert.

"Once we had compared our fin skeleton of Elpistostege with the arm and hand skeletons of terrestrial animals, it became clear that the rows of small digit bones were - in the evolutionary sense - the same as to phalange bones in the hands of land animals (like us)."

Comparison of early tetrapod limb anatomy. (Richard Cloutier and John Long)

The bones are not exactly true fingers, since they're tucked inside the fin like a mitten, and can't move freely. The fin still retains the outer fringe covered in fin-ray bones, called lepidotrichia; the fingers wouldn't be able to move freely unlessE. watsoni lost those.

But it does confirm the animal as an intermediate between fish and tetrapods. Although some have thought digits and carpals may be unique to tetrapods, we have had hints otherwise; for instance, the tetrapod-like arrangement of humerus, radius and ulna bones was discovered in lobe-finned fishes all the way back in 1892.

"The origin of digits relates to developing the capability for the fish to support its weight in shallow water or for short trips out on land. The increased number of small bones in the fin allows more planes of flexibility to spread out its weight through the fin," Cloutier explained.

"The other features the study revealed concern the structure of the upper arm bone or humerus, which also shows features present that are shared with early amphibians. Elpistostege is not necessarily our ancestor, but it is the closest we can get to a true 'transitional fossil', an intermediate between fishes and tetrapods."

The next part of the team's work describing the fossil will focus on the head and parts of the skull, making comparisons with early tetrapods to further trace those evolutionary connections.

"It's a truly amazing specimen indeed," Long said.

The research has been published in Nature.

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This Ancient Fish Represents The Earliest Known Evolutionary Evidence of Fingers - ScienceAlert

Genetics

In historic first, Ferrari to present its ‘pure blood’ SUV with speed genetics – Hindustan Times

When Enzo Ferrari launched the Italian luxury carmaker back in 1939, he could have never thought that his sports cars will have an SUV variant.As recently as 2016, former Ferrari boss Sergio Marchionne had said, You have to shoot me first." But the world has moved beyond their times. And the current global trend demands more SUVs from all kind of carmakers.

For the first time in its history, Ferrari has decided to to take the plunge most others have already taken and mastered. In 2021 Ferrari will debut its first SUV called Purosangue, that's Italian for "thoroughbred" or "pure blood", which will be a hybrid crossover with tints of Gran Turismo.

This modelwill have five doors, four seats in 2+2 configuration and front-center engine, and it is believed that it will be developed by the generational change of theFerrari GTC4Lusso,with the aesthetic features of this model, but with a higher body.

Although Louis Camilleri, the CEO of Ferrari, has emphasised that this product will not be an SUV, but a five-door model with an exterior design inspired by the coupes tells a different story.

As for the engines, there will be a hybrid version with turbo with six or eight cylinders,so you could enjoy powers close to 700 hp. That would mean the Ferrari Purosangue SUV will give Lamborghini Urus a run for its money.

The price of the Ferrari Purosangue SUV is likely to start from approximately300,000 euros ( 2.45 crore) to 500,000 euros( 4.10 crore).

Ferrari has already run into trouble over the name Purosangue. An anti-doping non-profit charity organisation Purosangue Foundation. Ferrari claims the charity 'has not made sufficient commercial use of the name to warrant exclusivity', and that the 'registration should be removed because of lack of use over the past five years'.

See more here:
In historic first, Ferrari to present its 'pure blood' SUV with speed genetics - Hindustan Times

Embryology

Keep calm and… stop? Fertility treatment in a pandemic – BioNews

16 March 2020

The spread of a novel coronavirus (SARS-CoV-2), which causes the disease COVID-19, presents UK fertility clinics and patients with a unique set of challenges. Some of this is because we simply don't know enough about the effects of the infection on fertility, fertility treatment and early pregnancy. Early data, summarised in the Royal College of Obstetricians and Gynaecologists guidance, are reassuring, but the number of reported cases is still small.

Clinics could face logistical challenges if large numbers of staff are unable to work due to quarantine requirements, or if elective work in hospitals is shut down to make space for emergencies. Should this prospect impact the advice we give patients? The UK Government, at the time of writing, has held back from the more radical social distancing measures implemented in other countries. This leaves clinics with a dilemma of whether to continue to offer fertility treatment to unaffected patients, or to go beyond current Government advice and suspend services.

Patients' anxieties are understandable and those who wish to delay their treatment should be accommodated. It makes sense for anyone who meets the criteria for self-isolation (which are also evolving as we write) to be advised not to start treatment and indeed to stop active treatment if already commenced.

Some would go further and say that all elective fertility treatment should be delayed. The European Society forHuman Reproduction and Embryology advises that all fertility patients should 'avoid becoming pregnant at this time'. A Twitter poll targeting reproductive medicine clinicians found 45.5 percent support for delaying frozen embryo replacement in patients in areas with a high COVID-19 burden.

The question then arises, for how long should treatment be delayed? It is reported that the UK will see the peak of infections three months from now, with a tail persisting into the autumn and a potential second peak after this. If we were to delay all fertility treatment, UK clinics may struggle with the capacity to cope with demand when treatments re-start. One could easily envisage a delay of six months, which may well harm the chances of conception for some patients. Hence the need for advice to be tailored to each individual patient's situation. Delaying treatment, in effect closing clinics, would have other impacts including financial strain (particularly for smaller stand-alone clinics) and loss of morale among the more vulnerable fertility patients.

Furthermore, Chinese researchers have identified that testicular Leydig cells and seminiferous tubules express the angiotensin-converting enzyme 2 (ACE2) receptor, which is used by the virus to gain entry into cells. This short discussion paper has not been peer-reviewed and there is no evidence to suggest that the virus is found in the testes, as reported in BioNews 1039. However, this paper does alert to the need for further research into whether male fertility may be affected by COVID-19, so that patients can be adequately counselled.

The fact is that this is a fast-moving situation, with facts and knowledge changing daily. This makes it hard for professional bodies to issue meaningful guidance to practitioners and patients. The American Society for Reproductive Medicine even calls its guidance 'suggestions', showing the tentative nature of such advice. As far as UK clinics are concerned, unless restriction of movement is introduced, it is reasonable to continue treatment for those who are well and wish to continue. However, centres must be prepared to terminate or complete treatment (including through cycle cancellation, oocyte or embryo freezing) and cease initiating new treatments as and when 'lock-down' commences.

Clinicians have in their toolbox measures, which can be taken proactively, to reduce the risk to patients who find themselves in a situation where treatment has to stop. A patient may develop symptoms, or fall into a risk group, for COVID-19 after having started ovarian stimulation. Patients on a g onadotropin-releasing hormone (GnRH) antagonist regime could be managed by stopping follicle-stimulating hormone (FSH) administration and continuing antagonist administration until the patient's ovarian response has settled. Data from small case studies indicate that GnRH antagonist continuation after the trigger of final oocyte maturation is effective in reducing the risk of ovarian hyperstimulation syndrome (OHSS). Where concern exists about a high ovarian reserve, consideration should be given to co-treatment with letrozole, keeping oestradiol levels low and reducing concern about the risk of OHSS.

The key is anticipation of problems, both clinical and organisational. All centres should have a contingency plan in place that describes a stepwise reduction in their activities. This allows prioritisation down to a minimal activity if needed. It is unlikely that any licensed fertility clinic can shut down completely; work goes on behind the scenes, in particular around the maintenance of storage banks. There are practical considerations for this maintaining tanks for example but also the regulatory issues around consent expiry and data management. Urgent medical issues will still arise, and it may be appropriate to maintain a fertility preservation service for cancer patients. This prioritisation must take into account national and local pandemic policies, as well as recognition of likely reduced levels of staffing due to illness and isolation. Mitigation policies may include replacing consultations with phone- or video-calls and making sure there is a good communication policy for patients who have treatment-related problems.

We must also bear in mind the anxiety that is generated by how this pandemic is playing out. In our connected world, news, including fake news, travels faster than the virus. It is hard to escape the sense of a storm looming or a tidal wave about to break. In some countries, of course, the storm is now raging and the tide has overwhelmed even well-resourced health systems.

Fittingly for the first pandemic of the social media age, there have been extensive informal discussions on these issues among clinicians across many social media platforms. US colleagues have collated a number of measures, gleaned from social media, that clinics should consider in their response to this challenge.

Things are moving apace, and we must respond in a safe and effective way, but without panic. The British Fertility Society and the Association of Reproductive Clinical Scientists are committed to providing guidance to UK clinics as the situation evolves.

Link:
Keep calm and... stop? Fertility treatment in a pandemic - BioNews

Embryology

COVID-19 Throws A Wrench Into Surrogacy (Along With Everything Else In The World) – Above the Law

(Image via Getty)

COVID-19 is affecting every facet of our lives, and the world of surrogacy is no exception. The news is changing so fast that anything written today will likely be out of date tomorrow. However, in the effort to provide helpful information, heres the latest.

Expect Delays.We are all being told to stay home and not leave unless its an absolute necessity. So it is no surprise that we are seeing delays and postponements for clinical and other providers. The European Society of Human Reproduction and Embryology (ESHRE) issued astatementon March 14.That date was a Saturday, so you know things are really drastic.

The statement from the European entity said: As a precautionary measure and in line with the position of other scientific societies in reproductive medicine we advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19infection, should avoid becoming pregnant at this time. For those patients already having treatment, we suggest considering deferred pregnancy with oocyte or embryo freezing for later embryo transfer.

So halt everything for now.But thats Europe.

What about in the United States? I spoke with fertility specialist Dr. Althea OShaughnessy, on Monday, March 16, as to what she is seeing in the United States and with her practice. At that time (two days ago), she explained that things were generally still full speed ahead but subject to change. The next day, March 17, her clinic announced that all noninitiated frozen embryo transfers and intrauterine inseminations were cancelled or indefinitely postponed. Shortly after that announcement, the American Society for Reproductive Medicine (ASRM), the American counterpart to ESHRE, issued new guidance with the following recommendations.

OShaughnessy explained that if a patient was actively in a cycle - meaning that her body has been subject to the medical protocol to prepare for an egg retrieval, for example, and there was a risk of hyperstimulation if she did not go through with the retrieval - then even if the patient was showing active signs of illness, the clinic may go forward with the procedure for the safety of the patient. The clinic would, of course, take all precautions for its staff. Moreover, OShaughnessy clarified that the clinic was proceeding with IVF cycles for cancer patients needing to freeze eggs or embryos prior to gonadotoxic chemotherapy.

COVID-19, so far, isnt believed to be like the Zika virus, where there was a reason to fear birth defects for pregnant women who contracted the disease. But the evidence for that good news is scant so far, and at least one country has designated pregnant women as an at risk group.

Have A Plan AZ. Or At Least Through C.

Of course, in more urgent matters, numerous intended parents are awaiting the imminent birth of their children via surrogacy. And while everyone is concerned for the health of the surrogate and the child, there is also a basic problem of logistics. Many intended parents do not live locally to their surrogates, and some are in Europe or China, making travel especially difficult.

I spoke withCarey Flamer-Powell, the director of a surrogacy matching and support program in the United States. Flamer-Powell explained that while the current situation is stressful for many, her organization has always required a three-step plan for intended parents to be responsible for their children in case they are unable to make it to the birth. For Plan A, intended parents should be doing everything they can to be sure at least one of them can make it to the birth to care for their child from the first moment. She noted that one parent she worked with from China recently had to route through Thailand, go through a 14-day quarantine, and then was allowed to proceed to the United States. He missed his childs birth by two days, but was thankful to have made it fairly close behind.

For Plan B, all intended parents must have a local caregiver ready to take care of the child. That can be as simple as having a local friend or family member or a paid caregiver. Flamer-Powell explained that Plan C was that her organization would step in and provide care. (For an example of this happening, check out this podcast episode.) She has worked with other professionals in the field to form a network of people throughout the United States, and they are ready and willing to step in and provide care for a newborn if called to do so. That is one of those heartwarming moments where it is nice to see competitors coming together during difficult times, collaborating for the greater good.

Limiting In-Person Contact May Be Especially Significant.One provision of every basic surrogacy contract addresses who is permitted to be in the delivery room. Generally, the concern is only an issue when a C-section is necessary and the anesthesiologist limits persons present in the room. It may result in a difficult choice between the surrogates spouse (or other support person) or one of the intended parents being there to see their child come into the world. Now, that choice may become standard even if the birth isnt by C-section, or, worse, a surrogate may be on her own, without anyone aside from medically necessary persons present as hospitals work on evolving protocols to minimize risk. And, if intended parents, or support persons, meet certain risk criteria, they may not be permitted in the hospital at all!

Legal Problems Ahead. In almost every state, the law presumes that a woman giving birth is the legal parent of the child. A judicial process is used to correctly name the intended parents as the legal parents of the child, and to relieve the surrogate of any presumed responsibility. As courts close, these legal presumptions are likely to become a bigger problem. Temporary fixes will need to be utilized - such as delegations of power - and birth certificates may be issued late or may need to be amended.

In the meantime, some of the routine work of surrogacy, such as the legal contracts, is charging ahead and incorporating new COVID-19 clauses. These are predictable so far; basically that everyone agrees to follow doctors recommendations to minimize risk. And I suspect these will expand to requiring parties to also follow governmental edicts and recommendation.

Of course, the situation could look very different in a week. Or tomorrow. Heres to hoping it doesnt get that much worse, and that we see improvement soon. In the meantime, take all of this seriously. Listen to what the professionals are saying. And be safe. For you and your future children.

Ellen Trachman is the Managing Attorney ofTrachman Law Center, LLC, a Denver-based law firm specializing in assisted reproductive technology law, and co-host of the podcastI Want To Put A Baby In You. You can reach her atbabies@abovethelaw.com.

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COVID-19 Throws A Wrench Into Surrogacy (Along With Everything Else In The World) - Above the Law

Embryology

From the Goat’s View – newberryobserver.com

The following was written by Columnist Lisa Stone, in the point-of-view of Cappie the goat.

It has been a busy Semester let me tell you! Students have been hard at work on my new closure and Im looking forward to getting some new friends and a place I can call my own. Ive been watching all the students in the greenhouses plant veggies and flowers (best place to munch on some hidden weeds) for this springs plant sale opening mid-March! They sure are pretty.

Students are also building their own palace of a chicken coop! The program already has a number of chickens that students have hatched in class (big thank you to Alana West, Newberry 4-H agent and her Embryology project). I didnt know what to think when I heard all that peeping during class, but I soon get distracted by students going here and there. I love welcoming and watching the students come and go. They always give me a smile and a good rub on the side, maybe a Cheerio or two.

I am sad; however, that I couldnt help support our students at Laurens High School while they compete in Tool Identification and Creed Speaking for the FFA. Ive watched them study and am anxious to see how they do. Ms. Stone said Ill just have to wait since Im not allowed my own phone (for obvious reasons she clarifies).

Another big thank you to Mr. Chad Morris for speaking to Ms. Stones Agricultural Mechanization class. I learned so much about the history of electricity, gauges of wires and got a goat kick out of his electricity demonstrations.

I do have to say, I have not taken kindly to all the rain. Ms. Stone wanted me to thank Newberry Recycling for donating mulch for the garden/rice paddy. Looks to me theyre going to have to build up that whole garden to keep it from becoming a new pond.

Students are still selling Discount Travel cards for $10, much of this goes to support our FFA in travel and competition expenses and dearly appreciated. Mrs. Holly Havird wanted to welcome everyone out for our annual plant sale as well!

A bit about the author; Cappuccino or Cappie was donated by Luke Morris, a student in the agriculture program. She has become a staple of everyday activities and loves exploring classrooms and eating cheerios from students. This four month old will soon be housed at the career center for the needs of the agriculture curriculum, as well as the school

Cappuccino or Cappie

Lisa Stone teaches Agricultural Education at the Newberry County Career Center. She can be reached at lstone@newberry.k12.sc.us.

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From the Goat's View - newberryobserver.com