Category: medicine

COVID-19 Causes: Exploring the Unanswered Questions

Newswise Live Expert Panel discussion of unique angles to the COVID-19 outbreak of interest to the public and the media, including public health, testing, business and financial markets, 2020 elections, and more. 

Experts from institutions including Binghamton University, AACC, Rutgers, Cornell, University of Virginia, and more will participate in a two-part series of moderated expert panels covering a wide variety of topics, with questions prepared by Newswise editors and submissions from media attendees. 

Thursday

  1. XinQi Dong, MD, Rutgers University (Epidemiology)
  2. Zhaohui Chen, PhD, University of Virginia (Finance)
  3. Ali Khan, M.D., M.P.H, University of Nebraska Medical Center (Public Health)
  4. Valerie Reyna, PhD, Cornell University (Psychology)
  5. Tom Ewing, PhD, Virginia Tech (History)

Monday

  1. Carmen Wiley, PhD, President, American Association for Clinical Chemistry (Lab Testing)
  2. Dean Headley, PhD Wichita State (Airline Industry and Travel)
  3. Jennifer Horney, PhD, University of Delaware (Epidemiology)
  4. Dawn Bowdish PhD, McMaster University (Immunology)
  5. Daniel McKeever, PhD, Binghamton University (Finance)
  6. Dr. Jennie Kuckertz, Ph.D, from McLean Hospital (Psychology)
  7. W. Graham Carlos, MD, Indiana University (Pulmonology)

When: Thursday, March 12 at 2 PM EDT and Monday, March 16 at 2 PM EDT

LJI scientists identify potential targets for immune responses to novel coronavirus

LA JOLLA, CA—Within two months, SARS-CoV-2, a previously unknown coronavirus, has raced around globe, infecting over a 100,000 people with numbers continuing to rise quickly. Effective countermeasures require helpful tools to monitor viral spread and understand how the immune system responds to the virus.

Publishing in the March 16, 2020, online issue of Host, Cell and Microbe, a team of researchers at La Jolla Institute for Immunology, in collaboration with researchers at the J. Craig Venter Institute, provides the first analysis of potential targets for effective immune responses against the novel coronavirus. The researchers used existing data from known coronaviruses to predict which parts of SARS-CoV-2 are capable of activating the human immune system.

When the immune system encounters a bacterium or a virus, it zeroes in on tiny molecular features, so called epitopes, which allow cells of the immune system to distinguish between closely related foreign invaders and focus their attack. Having a complete map of viral epitopes and their immunogenicity is critical to researchers attempting to design new or improved vaccines to protect against COVID-19, the disease caused by SARS-CoV-2.  

“Right now, we have limited information about which pieces of the virus elicit a solid human response,” says the study’s lead author Alessandro Sette, Dr. Biol.Sci, a professor in the Center for Infectious Disease and Vaccine Research at LJI. “Knowing the immunogenicity of certain viral regions, or in other words, which parts of the virus the immune system reacts to and how strongly, is of immediate relevance for the design of promising vaccine candidates and their evaluation.”

While scientists currently know very little about how the human immune system responds to SARS-CoV-2, the immune response to other coronaviruses has been studied and a significant amount of epitope data is available.

Four other coronaviruses are currently circulating in the human population. They cause generally mild symptoms and together they are responsible for an estimated one quarter of all seasonal colds. But every few years, a new coronavirus emerges that causes severe disease as was the case with SARS-CoV in 2003 and MERS-CoV in 2008, and now SARS-CoV-2.

“SARS-CoV-2 is most closely related to SARS-CoV, which also happens to be the best characterized coronavirus in terms of epitopes,” explains first author Alba Grifoni, Ph.D, a postdoctoral researcher in the Sette lab

For their study, the authors used available data from the LJI-based Immune Epitope Database (IEDB), which contains over 600,000 known epitopes from some 3,600 different species, and the Virus Pathogen Resource (ViPR), a complementary repository of information about pathogenic viruses. The team compiled known epitopes from SARS-CoV and mapped the corresponding regions to SARS-CoV-2.

“We were able to map back 10 B cell epitopes to the new coronavirus and because of the overall high sequence similarity between SARS-CoV and SARS-CoV-2, there is a high likelihood that the same regions that are immunodominant in SARS-CoV are also dominant in SARS-CoV-2 is,” says Grifoni. 

Five of these regions were found in the spike glycoprotein, which forms the “crown” on the surface of the virus that gave coronaviruses their name; two in the membrane protein, which is embedded in the membrane that envelopes the protective protein shell around the viral genome and three in the nucleoprotein, which forms the shell. 

In a similar analysis, T cell epitopes were also mostly associated with the spike glycoprotein and nucleoprotein.

In a completely different approach, Grifoni used the epitope prediction algorithm hosted by the IEDB to predict linear B cell epitopes. A recent study by scientists at the University of Texas Austin determined the three-dimensional structure of the spike proteins, which allowed the LJI team to take the protein’s spatial architecture into account when predicting epitopes. This approach confirmed two of the likely epitope regions they had predicted earlier.

To substantiate the SARS-CoV-2 T cell epitopes identified based on their homology to SARS-CoV, Grifoni compared them with epitopes pinpointed by the Tepitool resource in the IEDB. Using this approach, she was able verify 12 out of 17 SARS-CoV-2 T cell epitopes identified based on sequence similarities to SARS-CoV. 

“The fact that we found that many B and T cell epitopes are highly conserved between SARS-CoV and SARS-CoV-2 provides a great starting point for vaccine development,” says Sette. “Vaccine strategies that specifically target these regions could generate immunity that’s not only cross-protective but also relatively resistant to ongoing virus evolution.”

The work was funded in part by the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health through contracts 75N9301900065, 75N93019C00001 and 75N93019C00076.

Full citation: Alba Grifoni, John Sidney, Yun Zhang, Richard H Scheuermann, Bjoern Peters and Alessandro Sette. A Sequence Homology and Bioinformatic Approach Can Predict Candidate Targets for Immune Responses to SARS-CoV-2. Cell, Host and Microbe, 2020.

A pre-proof is available here.

About La Jolla Institute for Immunology

The La Jolla Institute for Immunology is dedicated to understanding the intricacies and power of the immune system so that we may apply that knowledge to promote human health and prevent a wide range of diseases. Since its founding in 1988 as an independent, nonprofit research organization, the Institute has made numerous advances leading toward its goal: life without disease.

What does self-quarantine mean?

As people wrestle with spring travel, many may choose – or be asked – to self-quarantine for a period of time to help deter the spread of COVID-19.

Isolation requires sick people to be separated from those who are not sick, while quarantine restricts the movement of people who are exposed to a contagious disease to monitor if they become sick, according to Luis Ostrosky, MD, professor of infectious diseases at The University of Texas Health Science Center at Houston (UTHealth).

So, what does self-quarantine look like? Susan Wootton, MD, an infectious disease pediatrician at McGovern Medical School at UTHealth, explains.

Wash your hands
  • Separate yourself from other people and animals in your home
  • Stay home except to get medical care
  • Call ahead before visiting your doctor
  • Wear a face mask if you are sick
  • Cover your coughs and sneezes
  • Wash your hands often
  • Avoid sharing personal household items
  • Clean all “high-touch” surfaces daily
  • Monitor your symptoms
  • Receive a green light from health care providers before discontinuing quarantine

Household members, intimate partners, and caregivers who may have close contact with a person exposed to or symptomatic with COVID-19 should monitor their health closely. Call your health care provider right away if you develop symptoms suggestive of COVID-19 including fever, cough, and trouble breathing.

For those who have been to an affected area or exposed to someone who is sick with COVID-19 in the last 14 days, you may have some limitations on your movement or activity. If you develop symptoms during that period, seek medical advice immediately. Call the office of your health care provider before you go, and tell them about your recent travel history and your symptoms. They will give you instructions on how to get care without exposing other people to your illness.

“Infection control and prevention efforts by patients with COVID-19, their household members, and their health care providers, in combination with contact tracing activities, are key to limiting the community spread of disease,” Wootton said.

Stay informed by following updates on Harris County Public HealthTexas Department of State Health ServicesCDC, and World Health Organization.

Endangered species on supermarket shelves

Lab reveals the surprising prevalence of European Eel in Hong Kong’s food supply

Imagine purchasing products from your local grocer, only to find out that those products are comprised of critically endangered species! That’s what a team from the University of Hong Kong, Division of Ecology and Biodiversity has recently discovered on Hong Kong supermarket shelves. A team led by Dr David Baker from the University’s Conservation Forensics laboratory, has recently published the results from an investigation into European eel products on sale in Hong Kong supermarkets.

The study, published in Science Advances, found that nearly 50% of retail eel products, ranging from fillets to snack items from grocers and convenience stores, contained a critically endangered species of fish. According to the IUCN, The European eel (Anguilla anguilla) is at risk of extinction. For this reason, trade in European eels and their food product derivatives is subject to international regulation under the Convention for the International Trade of Endangered Species (CITES). CITES is meant to ensure that permits are required for their import and export in an effort to regulate trade and foster conservation.

Eel, extremely popular in East Asia and particularly Japan, has traditionally been fished from East Asian populations of the Japanese eel (Anguilla japonica). However, overexploitation due to growing demand from Mainland China and a combination of threats ranging from rising ocean temperatures, parasites, and dammed rivers have led to dramatic declines in eel populations. This is true not only for European and Japanese species, but also for their American and Indo-Pacific relatives.

To satisfy demand for eel in East Asia, juvenile eels (known as glass eels) are caught while swimming upstream in their native range spanning Europe and North Africa, and smuggled to Asia to be raised to maturity. To date, captive breeding of eels has not been economically viable; wild-caught glass eels are thus used to “seed” eel farms. In recent years the illegal trade has been highlighted by a number of high-profile investigations and increasing prosecutions.

“The illegal export of glass eels from Europe to Asia has now been recognised as one of the world’s greatest wildlife crimes and Europol has estimated the scale of over 300 million eels (2018 data) annually. The next step is to investigate the global consumer markets to identify where these trafficked eels are eventually consumed. The numbers from Hong Kong are very alarming and reflect the huge amounts of European eels that are being farmed in Asia. It is now up to individual countries to investigate the scale of European eels entering their national food chains illegally.” -Florian Stein, Sustainable Eel Group

The international trade in glass eels is incredibly lucrative. One kilogram of glass eels can contain up to 3,500 individuals and has been recorded selling for over HKD$50,000 on the black market. This highly profitable trade has attracted the attention of international criminal syndicates, who smuggle glass eels in suitcases from Europe to Asia for resale. In their juvenile stages, eels are extremely difficult to identify to the species level. The two most common cousins of the endangered European eel (the Japanese and American eel) are not listed in CITES, therefore no permit is required for their trade. Because of the challenges in visual identification, endangered European eels can be laundered along with their legally traded relatives.

Already, the existence of Europe-Asia smuggling routes has been documented, but the ultimate destination of the smuggled eels remained elusive. Originally conceived as an undergraduate project looking at seafood mislabeling, the investigation into European eel took off when students noticed a surprising amount of European eel present in supermarket products.

“The eel project is the most exciting thing I have done during my undergraduate study in HKU. I once thought research was only for postgraduates and professors, but it turns out I, even as a student, was able to do meaningful research that actually made an impact in illegal trading. This has made me more determined to continue work in environmental fields.” -Haze Chung, Year 4 Undergraduate Researcher

The study covered a wide range of Hong Kong supermarkets and convenience stores across all districts. Surprisingly, almost 50% of the eel products surveyed were determined to be European eel. The results from this study suggested that large scale smuggling networks trafficking European eels are interwoven with local supplier chains, resulting in endangered species ending up on supermarket shelves, totally unbeknownst to consumers.

Does smoking increase your risk for dementia and cognitive decline?

Photo by Abhishek Koli on Unsplash

Scientists from the Uniformed Services University (USU), Emory University and the University of Vermont have found that cigarette smoking is linked to increased lesions in the brain’s white matter, called white matter hyperintensities.  White matter hyperintensities, detected by MRI scan, are associated with cognitive decline and Alzheimer’s disease. These findings may help explain the link between smoking and increased rates of dementia and other forms of cognitive decline.

The study, “Associations of cigarette smoking with gray and white matter in the UK Biobank” was published online in the journal, Neuropsychopharmacology, https://rdcu.be/b1jPS

In June 2019, the Surgeons General of the Army, Navy, Air Force, and United States, released an open letter stating that tobacco use is a threat to the health and fitness of U.S. military forces and compromises readiness. This burden also extends to care provided by the Veterans Health Administration, which spends more than $2.5 billion annually on smoking-related care.  In response, Dr. Joshua Gray, assistant professor of Medical and Clinical Psychology and Neuroscience at USU, and colleagues, examined the association between cigarette smoking and brain structure. Cigarette smoking is associated with increased risk for myriad health consequences including increased risk for neuropsychiatric conditions, but research on the link between smoking and brain structure is limited.

Their study was the largest of its kind, including MRI brain scans from more than 17,000 individuals from the UK Biobank, a large cohort of volunteers from across the United Kingdom. They found that smoking was associated with smaller total gray and white matter volume, increased white matter lesions, and variation in specific gray matter regions and white matter tracts. By controlling for important variables that often co-occur with smoking, such as alcohol use, this study identified distinct associations between smoking and brain structure, highlighting potential mechanisms of risk for common neuropsychiatric consequences of smoking such as depression and dementia.

“Cigarette smoking is known to elevate risk for neuropsychiatric conditions such as depression and dementia. We found that smoking is associated with multiple aspects of brain structure, in particular with increased white matter lesions. White matter lesions are linked to many of the same neuropsychiatric diseases as smoking,” said Gray.  “Although further research is needed to understand to what extent smoking is a cause or consequence of these aspects of brain structure, our findings suggest a mechanism that links smoking to increased risk for dementia, depression, and other brain diseases.”

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How to prepare in the event of a pandemic

As COVID-19, also known as coronavirus, becomes more prevalent around the world, University of Alabama at Birmingham experts share tips to help you prepare yourself, your family and your home should the virus continue to gain momentum.

Photo by Pixabay on Pexels.com

What is COVID-19?

Human coronaviruses are the second most common cause of colds and generally cause mild to moderate symptoms. Sometimes, coronaviruses that infect animals can evolve and become a new human coronavirus, as in the case of Severe Acute Respiratory Syndrome (SARS) in 2003 or the novel coronavirus, COVID-19, which first appeared in late 2019.

“This has become dangerous because this is a first-of-its-kind type of coronavirus, and all humans do not have immunity built up to fight it,” said Rachael Lee, M.D., UAB Medicine’s health care epidemiologist and assistant professor in the Division of Infectious Diseases

The Centers for Disease Control and Prevention (CDC) is closely monitoring the evolving epidemic of respiratory illness caused by the novel coronavirus, which was first identified in Wuhan, Hubei Province, China. To date, Chinese health officials have reported thousands of infections with the virus in China, as well as community spread in other locations such as South Korea, Italy and Iran.  To date, the United States has had a minimal number of cases. The CDC anticipates that the virus could spread and affect countries worldwide, including the United States. 

Based on early reports of COVID-19, symptoms typically include fever, runny nose, headache, cough and a general feeling of being unwell; these are the same symptoms of the common flu virus.

If you begin to experience flu-like symptoms, UAB doctors recommend seeking medical care as soon as possible.

Wash your hands

Caroline Cartledge, a nurse practitioner with UAB Student Health Services, details the right way to make sure your hands are as clean as possible. 

 “Wash your hands as much as you can,” she said. “We always recommend handwashing before you eat anything, before you make food for other people and after you use the restroom. I wash my hands anytime I touch a doorknob; if there is hand-sanitizer around, I always use it.

People touch their faces more often than they realize. Every time you touch a door handle and then scratch your nose, you are susceptible to contracting viruses.” 

Cartledge recommends lathering your hands with soap and water for at least 20 seconds. 

“A good rule of thumb is to sing or hum ‘Happy Birthday’ to yourself twice,” she said. 

Traveling and more

Lee says to follow the CDC and local health care authorities’ guidance regarding travel to areas with active disease. She recommends using common sense to be safe and careful in traveling. 

“As with any respiratory virus, the main recommendations hold true with the novel coronavirus,” Lee said. “Wash your hands, cover your cough with your arm, and stay home if you feel sick. Wearing surgical masks out in public is not recommended, as brief exposure to the virus in public is unlikely to make a person sick. Most cases have occurred when there has been prolonged contact, such as with health care professionals or family members serving as a caregiver. Use of masks is recommended for health care professionals, caregivers and those with disease symptoms.” 

Lee adds that, in the United States, we have seen very few cases of COVID-19. However, we are still seeing a large number of influenza cases that are causing many hospitalizations across the United States. 

“It’s important at this time to get to your flu shot if you have not already done so,” Lee said. 

She also suggests that, if you have symptoms and need to see a health care professional, call ahead to your health care provider, so that they can take appropriate precautions to treat you and safeguard themselves and others in the clinic or hospital when you arrive. 

Building immunity

While washing your hands is always recommended, Jessica Grayson, M.D., assistant professor with the UAB Department of Otolaryngology, says certain foods and supplements can help boost your immune system, potentially protecting your body from germs. 

“Foods that contain indole-3-carbinols have been found to reduce the number of viral infections — while this hasn’t been specifically tested in coronaviruses, the prevention of any viral illnesses that may weaken your immune system is and will be important,” Grayson said. “These foods include leafy greens like kale, spinach, collard greens, turnip greens, mustard greens, etc. They can be cooked or raw.”

Grayson adds that elderberry has certain compounds that have been approved by the FDA for use in flavoring of food. 

“There are many studies on the antiviral and antimicrobial activity of elderberry,” Grayson said. “It has been shown in some studies to bind to some subtypes of the flu virus to prevent cell entry. However, there are still more studies needed to confirm whether this is true substantial benefit.” 

You can also boost your immune system by maintaining a healthy lifestyle, says Lee. Eat a balanced diet, get plenty of rest, and avoid stress. 

Grayson also says there is no data to support that increased Vitamin C helps prevent or shorten viral illnesses. In fact, studies looking at this have shown no benefit. Utilizing the leafy greens above in a smoothie can be an easy way to increase intake, but strictly drinking orange or pineapple juice does not have proof of benefit. 

Protect your home and loved ones

Ian McKeag, M.D., a family and community medicine physician at UAB, says now is the time to disinfect and clean your home. Use isopropyl alcohol, or disinfecting wipes, to wipe down countertops and common areas. 

“Keep the surfaces of your home clean, especially areas where you eat and spend the most time,” McKeag said. “Use soap and water to wash your hands after you touch contaminated areas, such as doorknobs, toilet and faucet handles, and any cooking items. If you do not have access to soap and water, use hand-sanitizer.” 

McKeag adds that it is also a good idea to avoid shaking hands with others right now. If you do, wash your hands or use sanitizer right away, especially before touching your face. 

Grayson says you should limit the amount of time spent in public places and avoid people who are sick, including those who are coughing or presenting symptoms. 

“If you have a fever or other symptoms, stay home,” Grayson said. “If your children have a fever, do not send them to school. Consider working from home if your workplace allows it.” 

Finally, she recommends planning ahead for your daily medications.

“Be sure that you have plenty of the medicines that you routinely take so that if ill you can avoid going out in public to retrieve these things,” Grayson said. “In the case of a pandemic or major outbreak in the U.S., it is a good idea to stock up on non-perishable foods should your community be quarantined.” 

Happy wife, Happy life

A happy partner leads to a healthier future

Photo by Adrienne Andersen on Pexels.com

Science now supports the saying, “happy wife, happy life.” Michigan State University research found that those who are optimistic contribute to the health of their partners, staving off the risk factors leading to Alzheimer’s disease, dementia and cognitive decline as they grow old together. 

“We spend a lot of time with our partners,” said William Chopik, assistant professor of psychology and co-author of the study. “They might encourage us to exercise, eat healthier or remind us to take our medicine. When your partner is optimistic and healthy, it can translate to similar outcomes in your own life. You actually do experience a rosier future by living longer and staving off cognitive illnesses. 

An optimistic partner may encourage eating a salad or work out together to develop healthier lifestyles. For example, if you quit smoking or start exercising, your partner is close to following suit within a few weeks and months. 

“We found that when you look at the risk factors for what predicts things like Alzheimer’s disease or dementia, a lot of them are things like living a healthy lifestyle,” Chopik said. “Maintaining a healthy weight and physical activity are large predictors. There are some physiological markers as well. It looks like people who are married to optimists tend to score better on all of those metrics.” 

The study

Published in the Journal of Personality and co-authored by MSU graduate student Jeewon Oh and Eric Kim, a research scientist in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, followed nearly 4,500 heterosexual couples from the Health and Retirement Study for up to eight years. The researchers found a potential link between being married to an optimistic person and preventing the onset of cognitive decline, thanks to a healthier environment at home. 

“There’s a sense where optimists lead by example, and their partners follow their lead,” Chopik said. “While there’s some research on people being jealous of their partner’s good qualities or on having bad reactions to someone trying to control you, it is balanced with other research that shows being optimistic is associated with perceiving your relationship in a positive light.” 

The research also indicated that when couples recall shared experiences together, richer details from the memories emerge. A recent example, Chopik explained, was Google’s tearjerker Super Bowl ad, “Loretta,” in which an elderly man uses his Google Assistant to help him remember details about his late wife. 

“The things he was recollecting were positive things about his partner,” Chopik said. “There is science behind the Google ad. Part of the types of memories being recalled were positive aspects of their relationship and personalities.” 

With all of its benefits, is optimism something that can be prescribed? While there is a heritable component to optimism, Chopik says there is some evidence to suggest that it’s a trainable quality. 

“There are studies that show people have the power to change their personalities, as long as they engage in things that make them change,” Chopik said. “Part of it is wanting to change. There are also intervention programs that suggest you can build up optimism.” 

Across the board, everyone benefits from a healthy dose of optimism from their partner. For the glass-is-half-empty people, a partner can still quench their thirst. For the glass-is-half-full people? Their cup runneth over. 

Michigan State University has been working to advance the common good in uncommon ways for 160 years. One of the top research universities in the world, MSU focuses its vast resources on creating solutions to some of the world’s most pressing challenges, while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.

Pregnant Women with Very High Blood Pressure Face Greater Heart Disease Risk😔

Photo by Suhyeon Choi

Women with preeclampsia are four times more likely to suffer a heart attack or cardiovascular death, Rutgers study finds

Women with high blood pressure in their first pregnancy have a greater risk of heart attack or cardiovascular death, according to a Rutgers study. 

The study is published in the Journal of Women’s Health

Approximately 2 to 8 percent of pregnant women worldwide are diagnosed with preeclampsia, a complication characterized by high blood pressure that usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Doctors haven’t identified a single cause, but it is thought to be related to insufficiently formed placental blood vessels. Preeclampsia is also the cause of 15 percent of premature births in the U.S.

The researchers analyzed cardiovascular disease in 6,360 women, age 18 to 54, who were pregnant for the first time and diagnosed with preeclampsia in New Jersey hospitals from 1999 to 2013 and compared them to pregnant women without preeclampsia. They found that those with the condition were four times more likely to suffer a heart attack or cardiovascular death and more than two times more likely to die from other causes during the 15-year study period. 

“Women who were diagnosed with preeclampsia tended also to have a history of chronic high blood pressure, gestational diabetes and kidney disease and other medical conditions,” said lead author Mary  Downes Gastrich, an associate professor at Rutgers Robert Wood Johnson Medical School and a member of the Cardiovascular Institute of New Jersey.

Gastrich said the study suggests that all women be screened for preeclampsia throughout their pregnancy and that treatment be given to those with preeclampsia within five years after birth. “Medication such as low-dose aspirin also may be effective, according to one study, in bringing down blood pressure as early as the second trimester​​,” she said. 

 Other Rutgers authors include Stavros Zinonos, Gloria Bachmann, Nora M. Cosgrove, Javier Cabrera, Jerry Q. Cheng and John B. Kostis.

Schizophrenia Is A Disease, Not An Extreme of Normal Variation

“Bipolar disorder and schizophrenia, and many other types of mental illness, are diseases of the brain and should be treated and studied as such,” say Johns Hopkins researchers.

Photo by DESIGNECOLOGIST

Does this statement seem a bit obvious and not exactly rocket science? Although it may, this isn’t how the National Institute of Mental Health (NIMH) — the psychiatry wing of the National Institutes of Health — currently views severe mental disorders such as schizophrenia, autism, bipolar disorder and dementia. The NIMH is the largest federal agency that provides research funding on mental disorders.

For the past decade, the NIMH has used a system called Research Domain Criteria (RDoC) to describe all mental illnesses as dimensions of psychological norms that fall along extremes of too much or too little of common personality traits. For example, everyone has minor fears of things such as spiders, heights or snakes. But, having very strong or unmanageable fears might constitute an anxiety disorder.

While this way of thinking may make sense for anxiety, Johns Hopkins physicians argue that for the most severe of mental disorders — such as autism, schizophrenia or bipolar disorder — the approach will lead clinicians and scientists in the wrong direction. These conditions aren’t the result of too much or too little of a normal human trait. Rather they represent a clear-cut shift outside the typical dimensions of human experience.

In every other field of medicine, researchers use animal models of diseases based on genes and their interactions that contribute to disease risk. However, the current NIMH approach directs psychiatric researchers to focus on normal variation. Research on animal models with genetic variations that increase the risk of diseases often doesn’t get funded, they say.

The researchers lay out their thoughts in two commentaries, both published in Molecular Neuropsychiatry, one published in 2018 and the other in the October 2019 issue.

In their first commentary, the researchers argue that the NIMH approach of thinking of mental illness in dimensional terms is like regressing back to Galen’s Humors of the second century, when all illnesses were attributed to the imbalance of one of the four humors: yellow bile, black bile, blood and phlegm. Then, they argue that a biomedical approach using the tools of genetics, neuroscience and imaging can lead to rational targets for therapies. The second commentary is a point-by-point critique of the NIMH system and its flaws. They say that the RDoC system moves away from the proven power of biomedical research, which explores the causes of diseases and their effects on human biology. They add that the RDoC system doesn’t appropriately address the natural history or progression of a disease.

“Using the RDoC system hasn’t advanced the field of psychiatry, diverts attention from achieving an understanding of underlying mechanisms and ultimately delays discovering rational treatments for these diseases,” says author Christopher A. Ross, M.D., Ph.D., professor of psychiatry, neurology, neuroscience and pharmacology at the Johns Hopkins University School of Medicine.

This change in how the NIMH approaches mental illnesses occurred about a decade ago. Leadership at the NIMH initiated the RDoC system with the best motives in mind, in order to encourage neuroscience research to study how cells communicate with one another in the brain. However, this change to the RDoC system happened before modern genetic and other techniques pointed toward specific causes of major mental illnesses.

“No other NIH institute has adopted a scheme so discordant from modern biomedical research practice,” says Ross.

“The NIMH strategy makes psychiatry — and especially psychiatric research — seem like a strange and esoteric endeavor, not part of mainstream biomedicine, with the consequence of stigmatizing the entire discipline, including its patients,” says co-author Russell Margolis, M.D., a professor of psychiatry and neurology at Johns Hopkins.

Now that investigators have identified some genetic and environmental causes, and are beginning to reveal molecular mechanisms behind these disorders, the researchers say that it’s time for the NIMH to readjust their system. These changes should allow for conditions such as autism, bipolar disorder and schizophrenia to be researched and treated as diseases — and not as fringe versions of normal variation. Moving toward a system that values the biomedical approach, comparable with the other NIH institutes, they say, would guide the NIMH to support studies on mechanisms of disease, so researchers can design more targeted therapies for those with different forms of these illnesses. As psychiatric genetics is complex, so are the genetics of many common medical diseases, such as diabetes and rheumatoid arthritis. Nevertheless, in other fields, scientists successfully use modern biomedical technique to address complex diseases. The authors contend that the field of psychiatry and patients with severe mental diseases deserve no less.

Ross received research support from JNJ/Janssen, Teva, Raptor/Horizon, Vaccinex, uniQure and Roche/Genentech unrelated to these publications, and has consulted for Teva, Sage, uniQure, Roche/Ionis, Azevan, Annexon and the Healthcare Services Group. Margolis received grant support from Teva unrelated to the publications discussed here.

Too Much of a Good Thing? 😜

Photo by Adrienn on Pexels.com

That Italian restaurant with the excellent linguini that you’ve indulged in so often you can no longer face a meal there.

The conference with brilliant but endless keynotes: You start the day full of enthusiasm, but by the fourth breakout you’re flagging. The action movie that has you on the edge of your seat for so long and with so little down time that your brain goes numb long before your legs do.

It’s called satiation. And once you pass the satiation point, consuming more — even of something you love — means enjoying it less. Your senses become clogged by so much of one stimulus; they become tired and don’t process your enjoyment.

Of course, feeling satiated is a temporary state. Taking a break from the restaurant or skipping a few of the keynotes will leave you ready for more in due course.

So how do you know where the satiation point will kick in? And how long does it take to rebuild your appetite for more?

Shedding rigorous scientific light on all of this is new research by Darden Professor Manel Baucells.

EVERYTHING IN MODERATION?

Together with Lin Zhao of the Chinese Academy of Sciences, Baucells has created a mathematical model that charts the satiation state and the time that it takes for satiation to “decay” — in other words, the optimal amount of rest from an experience or activity that is needed in order for enjoyment to resume.  

“We know from research — and common sense — that the old axiom is true: Everything is better in moderation,” says Baucells. “You tire of something if you’re overexposed to it. If you go to a concert, you’re likely to enjoy the first songs more than those that come in the middle, unless the playlist has been carefully calibrated to avoid satiation. We wanted to calculate where satiation kicks in and how it impacts enjoyment. We also wanted to understand how much time needs to elapse until satiation subsides and we start to enjoy something again.”

Understanding these dynamics, says Baucells, can help optimize the design of experiences and activities.

THE SATIATION MODEL

Baucells and Zhao’s satiation model plots three core dimensions: the consumption rate of an experience or activity or product, the satiation level, and the moment-by-moment enjoyment produced by that experience or activity or product. This third dimension is called “instant utility.”

The model is novel in that it is the first to introduce a “de-satiation motive,” charting the time it takes for satiation to decay — and enjoyment rise again.

The satiation model captures three key ideas:

  • The more frequently we consume something, the faster our satiation rate increases.
  • Enjoyment levels go down as satiation levels go up.
  • Resting between experiences decreases satiation and increases the enjoyment of the experiences that come after the break.

The paper also offers a “proof of concept” on how to measure, based on reports from individuals, specific parameters of the model such as how fast the satiation level decays during rest. Such measurements would allow us to improve the design of experiences, make better predictions on how much individuals would like a particular design, or monitor preferences from beginning to end of a time period.

THE SCIENCE IN LEAVING THE BEST FOR LAST

“Right now, a combination of intuition and experience determine how experiential services are design in many spheres of business,” says Baucells. “Intuitively we know when we go to a show or a concert that the best is generally left for last. But if you ask organizers or producers why that is, you’ll likely get a host of different reasons.”

The satiation model brings greater coherence to our understanding of the dynamics at play — a logical approach that can serve to either support or debunk gut feeling.

The model shows that satiation peaks and falls over a period of time. A high-low-high pattern works best for maximum satisfaction: Ideally, we’d still start an experience with a bang, then take things down a notch, then end with a grand finale. Having satiation peak right at the end of an experience or activity won’t penalize that activity because, simply put, nothing comes after the end. There is no further chance for satiation to increase, as the final peak is followed by an indefinite period of decay or rest. Moreover, ending on the highest note leaves one with a positive memory of the experience — an important source of consumer satisfaction.

Baucells’ model also points to how to optimize rests or breaks between activities (e.g., between songs in a concert), or to use variety to minimize satiation and optimize enjoyment.

“It’s the scientific explanation behind why we need to hear acoustic songs in a rock concert, or have our high-energy action interspersed with quieter scenes in a movie.”

So no matter how much you like kayaking or golfing, booking a six-day vacation centered around the activity will not be as fun as booking two separate three-day vacations. And mixing things up with, say, a horseback ride, will do wonders for how much more you appreciate the next golf course.

IMPLICATIONS

Decision-makers would do well to factor this understanding into business models, loyalty programs and marketing efforts, say the researchers.

Managing satiation more scientifically has benefits that span any number of sectors.

Restaurant mangers might want to think about reducing portion size in order to boost the sale of desserts. Customer loyalty efforts might be well served both by prioritising innovation and variety of offers, and by allowing greater periods of time to elapse between promotions.

There are key insights here that can even inform the debate on income inequality, Baucells says.

“The satiation model shows us that people tire of something if they do it too frequently. This can be just as easily applied to high-wealth individuals and spending habits,” says Baucells. “The model tells us that people cannot efficiently spend money on consumption indefinitely, and that has implications for inequality or philanthropy. Individuals with large wealth will eventually reach their satiation points in consumption, and their capacity to make any significant increase in enjoyment by spending more will eventually plateau. Past this point, philanthropy may make more sense.”