I WOULD LIKE TO THANK YOU ALL
FOR JOINING US TODAY AND WELCOME
YOU TO THE WORKSHOP ON SEX AND
GENDER SPECIFIC COVID-19
OUTCOMES AND MANAGEMENT,
RELEVANT FOR HEART, LUNG AND
BLOOD SLEEP DISORDERS FROM BENCH
TO BEDSIDE, MY NAME IS
JASMINA VARAGIC, CHAIR OF THE
NHLBI AND CHAIR OF THIS
WORKSHOP.
THE CORONA VIRUS DISEASE OF 2019
ARE CAUSED BY THE SARS-COV-2
VIRUS, HAS CHANGED THE WORLD IN
A MAJOR WAY, MORE THAN 1 MILLION
IN THE U.S. AND MORE THAN
6 MILLION WORLD WIDE SO FAR.
INFECTED PEOPLE COULD HAVE A
WIDE RANGE OF SYMPTOMS FROM MILD
SYMPTOMS TO SEVERE ILLNESS
ISSUES IT IS INITIALLY
CONSIDERED AS A RESPIRATORY
DISEASE BUT SARS COVID CAN
AFFECT MANY OTHER ORGANS
INCLUDING CARDIOVASCULAR SYSTEM,
KIDNEY, BRAIN, SERVOUS SYSTEM
AND CAN CAUSE A VARIETY OF
LONG-TERM SYMPTOMS KNOWN AS LONG
COVID.
SCIENTISTS ARE PUTTING IN AN
EXTRAORDINARY EFFORT TO BETTER
UNDERSTAND UNDERLYING
MECHANISMS, CLINICAL
PRESENTATION AND DEVELOP
RELEVANT, PREVENTED AND
THERAPEUTIC APPROACHES.
IMPORTANTLY SEX AND GENDER ARE 1
OF THE NATIONAL CONTRIBUTORS TO
THESE DISEASES AND EMERGING
EPIDEMIOLOGICAL DATA REVEAL
SIGNIFICANT SEX AND GENDER
DISPARITIES IN CARDIOVASCULAR,
PULMONARY AND CARDIOVASCULAR
DISORDERS RELATED TO COVID-19.
IT'S OBVIOUS REPORTING THE
DATABASE IN SEX AND GENDER IS
NOT AS COMMON IN COVID-19.
THEREFORE WE ORGANIZE THIS
WORKSHOP FOCUSED ON SEX AND
GENDER DIFFERENCES IN COVID-19
OUTCOMES AND MANAGEMENT AND WE
HAVE SEVERAL OBJECTIVES, NEXT
SLIDE, PLEASE.
WE WANTED TO BRING TOGETHER
SCIENTISTS AND CLINICIANS TO
REVIEW THE STATE OF THE SCIENCE
IN SEX AND GENDER DIFFERENCES IN
COVID-19 OUTCOMES THAT ARE REEL
KEEPSAKES VABT TO HEART, LUNG,
BLOOD, AND SEEP DISORDERS.
WE ALSO WANTED TO FACILITATE SEX
AND GENDER CONSIDERATION IN
COLLECTING, ANALYZING AND
INTERPRETING COVID-19 HEART,
LUNG, BLOOD AND SLEEP DISORDERS
TO IDENTIFY KNOWLEDGE GAPS AND
WE WANTED TO EXPLORE STRATEGIES
TO FACILITATE TRANSLATION OF
BASIC BIOLOGICAL DISCOVERIES
INTO CLINICAL APPLICATIONS TO
IMPROVE OUR ABILITY TO DEVELOP
SEX AND GENDER SPECIFIC
PREVENTION AND INTERVENTION
STRATEGIES FOR COVID-19 RELATED
HEART LUNG BLOOD AND SLEEP
DISORDERS.
NEXT SLIDE, PLEASE.
IN THIS 2 DAY WORKSHOP, WE HAVE
SPEAKERS AND MODERATORS WHO
DELIVERING COMPLIMENTARY
EXPERTISE.
DURING THE FIRST DAY OF THE
WORKSHOP, THEY WILL FOCUS ON
MECHANISMS OF SEX DISPARITIES IN
COVID-19 OUTCOMES, IMPACT OF
SOCIAL DETERMINANTS OF HEALTH ON
GENDER RELATED COVID-19 HEART,
LUNG, BLOOD AND SLEEP DISORDERS,
AS WELL AS PREGNANCY AND OTHER
CONDITIONS THAT MAY AFFECT
SUSCEPTIBILITY TO SARS-COV-2.
THE SESSIONS ON DAY 2 WILL FOCUS
MORE ON HEART, LUNG, BLOOD AND
SLEEP DISORDERS, ADDRESSING SEX
AND GENDER RELATED MECHANISMS
WHICH UNDERLIE COVID-19
CONSEQUENCES IN NEEZ DISEASE
DOMAINS.
THROUGHOUT THE WORKSHOP, WE WILL
ALSO HAVE COMMUNITY
REPRESENTATIVES AND WE ARE VERY
GRATEFUL FOR THEIR WILLINGNESS
TO SHARE THEIR STORIES ABOUT
COVID-19.
WE WILL CONCLUDE WITH 2 BREAK
OUT ROOMS ON MECHANISTIC, AND
TRANSLATIONAL PRECLINICAL AND
CLINICAL RESEARCH AND WITH A KEY
AIM TO EXPLORE RESEARCH
OPPORTUNITIES TO IMPROVE OUR
UNDERSTANDING OF SEX AND GENDER
DIFFERENCES IN COVID-19
OUTCOMES.
NEXT SLIDE, PLEASE.
IT IS MY GREAT HONOR AND
PLEASURE TO INTRODUCE THE CHAIRS
OF THE WORKSHOP, DR. KATHRYN
SANDBERG AND DR. YOGEN KANTHI,
DR. SANDBERG S&P THE PROCESSOR
AND VICE CHAIR FOR RESEARCH
CENTER FOR STUDY OF SEX
DIFFERENCES AT GEORGETOWN
UNIVERSITY.
DR. SANDBERG FOCUSES ONLET
[INDISCERNIBLE] SYSTEM,
ESPECIALLY REGARDING THE IMPACT
OF [INDISCERNIBLE] HORMONES AND
SEX CHROMOSOMES ON THE
PATHOPHYSIOLOGY OF HYPERTENSION
AND ASSOCIATED VASCULAR AND
RENAL DISEASE.
AMONG NUMEROUS ACCOMPLISHMENTS,
LEADERSHIP ROLES AND,A WARDS, I
UNDERLINE SHE WAS THE FOUNDING
PRESIDENT OF THE ORGANIZATION OF
THE STUDY SEX DIFFERENCES AND
PRESIDENT OF WOMEN IN NEPHROLOGY
AND RECEIVED AN AWARD FROM THE
AMERICAN HEART ASSOCIATION.
DR. YOGEN KANTHI, IS A LASKER,
INVESTIGATOR, DISTINGUISHED
SCHOLAR, AND COMEEF VASCULAR
THROMBOSIS AND INFLAMMATION
LABORATORY AT THE NHLBI.
HE UNDERSTANDS THE MOLECULAR
SIGNALS THAT INTEGRATE IMMUNITY
IN CANNED WHAT NETWORKS WITH A
GOAL OF DEVELOPING NEW TREATMENT
APPROACHES FROM INFLAMMATION,
HIS THEME RECEIVED NHLBI
DIRECTOR'S AWARD FOR INNOVATION,
HAS MADE SEMINOLE CONTRIBUTION
FOR THE BEDDING OF I CLOM BOYD
INFLAMMATION IN ASHING 19 AND
I'M TAKE THANKSGIVING
OPPORTUNITY TO EXPRESS OUR
XREERKZ FOR THEIR AVAILABLE
INVOLVEMENT IN ORGANIZE 8 HOURS
THIS WORKSHOP.
WITHOUT THEIR COMPLIMENTARY
EXPERTISE AND TREMENDOUS EFFORTS
WE WOULD NOT HAVE AS
COMPREHENSIVE AND STIMULATING AN
AGENDA AS WE HAVE TODAY.
NEXT SLIDE, PLEASE.
I WOULD ALSO LIKE TO THANK ALL
MEMBERS OF THE NIH PLANS
COMMITTEE WHICH AS YOU CAN SEE
REFLECT THE BROAD COLLABORATIVE
EFFORT IN ORGANIZING THIS
WORKSHOP.
I HOPE YOU WILL ENJOY THE
MEETING AND I HOPE WE HAVE
DR. GOFF, HERE?
I WOULD LIKE TO TURNOVER TO HIM?
DR. GOFF IS DIRECTOR OF THE
DIVISION OF CARDIOVASCULAR
SCIENCES AT THE NATIONAL HEART
LUNG AND BLOOD INSTITUTE.
TO GIVE HIS OPENING REMARKS,
DR. GOFF?
>> THANK YOU DR. VARAGIC, I AM
HERE AND I'M DELIGHTED TO BE
HERE TO WELCOME THIS GROUP FOR
THIS PURPOSE.
I JUST LEFT A GROUP OF NEW
EMPLOYEES TO NHLBI WHO ARE GOING
THROUGH THEIR NEW EMPLOYEE KIND
OF ORIENTATION AND I HAVE TO
SAY, I'M KIND OF--I'M EXCITED
ABOUT THE NEW FOLK WHO IS ARE
JOINING US AT NHLABOUT, I
BECAUSE I THINK THEY WILL HELP
US MOVE OUR MISSION FORWARD IN
THIS AREA THAT WE'RE TALKING
ABOUT TODAY BUT ACROSS THE BOARD
IN OUR MISSION.
SO IF I'M BEAMING IT'S BECAUSE I
JUST LEFT A PLACE WHERE THERE
ARE ALSO SOME WONDERFUL FOLKS
JOINING OUR TEAM AND I'M COMING
TO A PLACE WHERE ALL OF YOU HAVE
ELECTED TO REALLY GIVE SOME TIME
TO US AND TO OUR MISSION BY YOUR
PARTICIPATION IN THIS REALLY
IMPORTANT WORKSHOP.
SO, THANK YOU.
WE KNOW YOU HAVE MANY WAYS YOU
COULD BE SPENDING YOUR TIME.
EVERYBODY'S REALLY BUSY TODAY
AND CHOZZING TO SPEND YOUR TIME
WITH US IN THIS WAY, MEANS A LOT
TO US AND WE THINK IT'LL MEAN A
LOT TO THE PUBLIC IN TERMS OF
IMPROVED HEALTH AS WE WORK ON
TURNING DISCOVERY INTO HEALTH
FOR THE NATION, ESPECIALLY I
WANT TO THANK DR. SANBBERG AND
KANTHERI, BECAUSE THAT'S A
HIGHER LEVEL OF CONTRIBUTION IN
TERMS OF TIME YOU'RE GIVING TO
THIS EFFORT.
SO REALLY APPRECIATE THAT.
WE TAKE YOUR INPUT VERY
SERIOUSLY, FROM THIS WORKSHOP,
HOW WILL WE USE IT?
WELL, WE HOPE AT THE VERY LEAST,
WHEN YOU GO BACK HOME OR GO BACK
TO YOUR OFFICE AFTER THIS
WORKSHOP, YOU'LL HAVE NEW IDEAS,
NEW COLLABORATIONS, NEW
RELATIONSHIPS, AND YOU'LL PURSUE
NEW RESEARCH OPPORTUNITIES TO
ADDRESS THESE IMPORTANT ISSUES,
RELATED TO SEX AND GENDER
DIFFERENCES AND COVID THAT MAY
HAVE IMPACT WELL BEYOND COVID
INTO OTHER CONDITIONS RELATIVE
TO HEART LUNG BLOOD AND SLEEP
AND BEYOND.
YOU KNOW THE VAST MAJORITY OF
THE RESOURCES THAT WE USE TO
SUPPORT RESEARCH IN THE U.S. AND
BEYOND GO TO INVESTIGATOR
INITIATED PEER REVIEWED
APPLICATIONS.
SO, YOU KNOW KEEP THEM COMING
IN.
I OFTEN TELL PEOPLE IT'S SIMPLE
TO GET MONEY FROM US, RIGHT A
GOOD APPLICATION, GIVE A GOOD
SCORE, WE LOVE TO GIVE MONEY
AWAY, I DIDN'T SAY IT WAS EASY,
JUST SIMPLE.
BUT WE ALSO USE YOUR
RECOMMENDATIONS TO GET WORKSHOP
REPORTS OUT TO THE PUBLIC, SO WE
WANT TO GET THAT INFORMATION OUT
PROMPTLY WHILE IT'S STILL TIMELY
SO WE WILL BE WORKING TO GET A
SUMMARY OF RECOMMENDATIONS AND
SUGGESTIONS TO US ON OUR WEBSITE
IN THE NOT TOO DISTANT FUTURE,
HOPEFULLY WITHIN A MONTH OR 2,
WE CAN GET AN EXECUTIVE SUMMARY
ON OUR WEBSITE TO SHARE WITH THE
EXTRAMURAL COMMUNITY.
YOU MIGHT DECIDE YOU WANT TO
WRITE A WHITE PAPER FOR
PUBLICATION AND A SCIENTIFIC
JOURNAL, THAT'S GREAT.
IF YOU DECIDE YOU WANT TO DO
THAT, WE'LL HELP SUPPORT THAT
AND AGAIN WE WOULD LIKE TO GET
THAT DONE IN A TIMELY MANNER SO
THAT IT GETTINGS OUT TO THE
COMMUNITY BEFORE THE CONCEPTS
ARE NO LONGER TIMELY SO WE WOULD
APPRECIATE GETTING THAT OUT
QUICKLY TO IT IF YOU CHOOSE TO
DO THAT.
SOMETIMES WE PUT OUT
OPPORTUNITIES THAT ARE INFORMED
BY THE INPUT THAT YOU GIVE US
AND WE CAN'T DO THAT FOR EVERY
WORKSHOP WE HAVE, BUT TIMES WE
DO WHEN THERE'S ESPECIALLY AN
OPPORTUNITY ISSUE THAT IS ARISES
AND SO THAT MAY HAPPEN AS WELL.
WE ALSO HAVE A PROCESS WE CALL
THE COLLECT PAY PROCESS, AND WE
DO THIS AND OTHER INSTITUTES DO
THIS AS WELL WHERE WE HAVE SOME
FUNDS WE RESERVE TO BE ABLE TO
PICK UP SOME HIGHLY STRATEGIC
APPLICATIONS THAT MAYBE JUST ON
THE WRONG SIDE OF THE PAY LINE
THAT ARE HIGHLY ASLIEN WIDE A
STRATEGIC PRIORITY.
SO THE IDEAS AND OPPORTUNITIES
THAT YOU IDENTIFY MAY ALSO HELP
INFORM OUR SELECT PAY DECISIONS.
SO THE POINT OF GOING THROUGH
THAT IS TO GIVE YOU AN IDEA OF
HOW WE USE THE INFORMATION THAT
YOU PROVIDE TO US, HOW IMPORTANT
IT IS TO US IN OUR ABILITY TO
DRIVE THE MISSION.
WITH NAI WANT TO GET OUT OF THE
WAY SO CAN YOU GET INTO THE
WONDERFUL DISCUSSIONS YOU WILL
BE HAVING, I THINK I TURN THE
BATON BACK TO DR. VARAGICS OR ON
TO DR. SANDBERG AND CONFI, BUT
IN ANY CASE, I WILL BE THANKING
YOU FOR BEING HERE AND WHAT
YOU'RE CONTRIBUTING.
THANK YOU VERY MUCH.
>> THANK YOU VERY MUCH DR. GOFF,
FOR YOUR OPENING REMARKS AND ALL
THE SUPPORT FOR THIS WORKSHOP.
AND WE HAVE A TIGHT TIMELINE FOR
EXECUTIVE SUMMARY TO GO, BUT
THANK YOU.
THANK YOU VERY MUCH.
AND I WOULD LIKE NOW TO TURNOVER
TO DR. JANINEAUSTIN CLAYTON
ASSOCIATE DIRECTOR FOR RESEARCH
ON WOMEN'S HEALTH AND DIRECTOR
OF THE OFFICE OF RESEARCH ON
WOMEN'S HEALTH AT THE NATIONAL
INSTITUTE OF HEALTH.
>> CAN YOU SEE THE SLIDE?
>> YES.
>> WELCOME TO THE WORKSHOP, I AM
PLEASED AND HONORED TO HELP OPEN
THIS FIRST OF A KIND WORKSHOP, A
COMPREHENSIVE LOOK AT HOW SEX
AND GENDER INFLUENCE HOW
COVID-19 AFFECTS A WIDE RANGE OF
HEALTH CONDITIONS.
AS WE BEGIN OUR 2 DAYS OF
DISCUSSION, IT'S IMPORTANT THAT
WE UNDERSTAND THE WAY THAT NIH
THINKS ABOUT THE HEALTH OF
WOMEN.
ONE OF THE MOST IMPORTANT
DEVELOPMENTS OF THE PAST 30
YEARS HAS BEEN THE
TRANSFORMATION OF WOMEN'S HEALTH
FROM A NARROW FOCUS ON
REPRODUCTIVE HEALTH TO A BROADER
WHOLISTIC MULTIDIMENSIONAL
CONCEPT.
MORE SPECIFICALLY THIS APPROACH
CONSIDERING THE INTERNAL AND
EXTERNAL FACTORS THAT AFFECT
WOMEN'S HEALTH FROM HEAD TO TOE
AS WELL AS ACROSS THE LIFE
FORCE.
INTERNAL FACTORS SUCH AS SEX
HAVE INFLUENCES AT GENETIC, IN
LECULAR, AND PHYSIOLOGIC LEVELS,
OTHER FACTORS INCLUDING POLICY
AND OTHER SOCIAL DETERMINANTS OF
HEALTH AFFECT THE HEALTH OF
WOMEN, VERY MUCH RELATED TO THE
MULTIDIMENSIONAL FRAMEWORK IS
THE CONSIDERATION HOW SEX AS A
BIOLOGICAL VARIABLE HAS AFFECTS
AT MULTIPLE LEVELS OF BIOLOGY.
AS 1 UNDERSTANDS HOW SEX HAS
EFFECTS AT EACH OF THESE LEVELS,
IT BECOMES INCREASINGLY CLEAR
HOW IMPORTANT IT IS THAT THE
KNOWLEDGE BASE OF SEX AND GENDER
INFLUENCES BE TRANSLATED INTO
EFFECTIVE TREATMENTS THAT WORK
FOR EVERYONE.
WOMEN AND MEN.
APPLYING A SEX AND GENDER LENS
IS KEY TO UNDERSTANDING
COVID-19.
IT IS ALSO KEY TO TRANSLATING
KNOWLEDGE INTO INTERVENTIONS,
THEREFORE IT'S CRITICAL THAT WE
DEVELOP RESEARCH METHODS THAT
WILL INFORM OUR UNDERSTANDING OF
FACTORS THAT INFLUENCE THE
TRANSMISSIBILITY AND
PATHOGENICITY OF SARS-COV-2
WHICH CONTRIBUTES ITSELF TO
INFECTIONS VERSUS LONG COVID AND
RECURRENCE OF INFECTION, IT WILL
INFORM OUR UNDERSTANDING OF THE
PATHOLOGY OF THIS DISEASE AT THE
PRECLINICAL LEVEL AS WELL AS THE
HIGHLY VARIABLE CLINICAL
PRESENTATIONS OF COVID-19.
ACCOUNTING FOR SEX AND GENDER
INFLUENCES WILL CREATE
OPPORTUNITIES TO INTERVENE WITH
THE BEST DIAGNOSTICS AND EARLY
TREATMENT MODALITIES PRECISELY
TAILORED TO INDIVIDUALS AND
INTEGRATING SUCH A ROBUST AND
SEX AND GENDER AWARE APPROACH TO
OUR WORK ESTABLISHES RIGOR AND
RESILIENCE TO RESEARCH TO
ACCOUNT FOR FUTURE VARIANTS AND
FUTURE VACCINATIONS, AND
ENHANCES THE PRECISION OF
LABORATORY TESTS, AND THE
VALIDITY AND FIDELITY OF
BIOMARKERS NEEDED TO DETECT AND
MONITOR DISEASE PROGRESSION FOR
EVERYONE.
FINALLY IT HAS THE POETIC
PENTINE REGIMENNIAL TO ENHANCE
EFFICACY DURING DIFFERENT STAGES
OF DISEASE COURSE AND ILLNESS
AND 1 FINAL NOTE HERE ON BEST
PRACTICES, IT'S IMPERATIVE THAT
THAT LENS BE CONSIDERED AS WE
FURTHER OUR INSIGHTS ON HOW TO
CARE AND COORDINATE CARE FOR
BOTH ACUTE INFECTION AND LONG
COVID AND ITS INTERSECTIONS WITH
OTHER HEART, LUNG, BLOOD AND
SLEEP DISORDERS AND COMORBID
DISEASES OVER THE LIFE COURSE.
AND THIS IS A WORLD WE IMAGINE.
WE IMAGINE A WORLD WHERE SEX AND
GENDER ARE INTEGRATED ACROSS THE
RESEARCH CONTINUUM FROM
PRECLINICAL THROUGH
TRANSLATIONAL TO CLINICAL WORK,
TO SEX ANALYSIS, SEX SPECIFIC
REPORTING, AND HEALTHCARE THAT
ULTIMATELY LEADS TO HEALTHY
PEOPLE.
IMAGINE A WORLD WHERE THIS WAS
ACTUALLY OCCURRING ACROSS THE
SPECTRUM.
WE'VE GOT TO TAKE
INTERSECTIONALITY INTO
CONSIDERATION AS WELL.
SO SEX AND GENDER, RACE
ETHNICITY, AGE AND OTHER FACTORS
HAVE--ARE SO IMPORTANT TO GET TO
THAT CENTRAL CIRCLE WHERE WE
HAVE HEALTHY PEOPLE.
IN STATES AS DIFFERENTAGE
GEORGIA AND MICHIGAN, BLACK
WOMEN HAVE HIGHER MATERNAL
MORTALITY RATES FROM COVID-19
THAN DO WHITE MEN AND WE STILL
HAVE A LOT TO LEARN ABOUT SOCIAL
DETERMINANTS OF HEALTH OR SHALL
I SAY SICK CARE, THE SYSTEM WE
HAVE IN THE U.S.
WOMEN MAKE SEIVET% OF HEALTHCARE
DECISIONS, HELT RELATED
DECISIONS AND HAVE SIGNIFICANT
INFLUENCES ON WHETHER CHILDREN
AND OTHER FAMILY MEMBERS RECEIVE
COVID-19 VACCINES FOR EXAMPLE.
IT'S IMPORTANT TO REMEMBER HOW
CRITICAL IT IS TO MEET PEOPLE
WHERE THEY ARE TO COLLABORATE
WITH TRUSTED MESSENGERS TO
DEVELOP AND MAINTAIN LONG-TERM
RELATIONSHIPS IN COMMUNITIES AND
BE OPEN TO NEW HEALTHCARE
DELIVERY MODELS INCLUDING THOSE
INVOLVES COMMUNITY HEALTH
WORKERS, FAITH BASED SETTINGS
AND DIGITAL HEALTH.
THE ASHING 19 PANDEMIC HAS
AFFECTED WOMEN
DISPROPORTIONATELY.
WOMEN MAKE UP THE MAJORITY OF
FRONT LINE WORKERS, THEY KEPT US
GOING THROUGH DELIVERING
GROCERIES OR PREPARING FOOD OR
PERFORMING THE CUSTODIAL WORK TO
KEEP HOSPITALLING AND WORKPLACES
SAFE AND CLEAN, TAKE WOMEN IN
THE BIOMEDICAL WORKFORCE, THEY
REPORTED WORK HOURS, INCREASED
CARE GIVING RESPONSIBILITIES AND
THEY'RE LEAVING THE BIOMEDICAL
WORKFORCE.
THIS PANDEMIC HAS EXACERBATED
THAT.
PREEXISTING ECONOMIC HEALTH AND
THE CARE GIVING CRISIS THAT HAVE
DISPROPORTIONATELY AFFECTED
WOMEN LONG BEFORE THE PANDEMIC
STRUCK.
THIS HAS LED TO BURN OUT AND
STRESS.
SO WE NOT ONLY HAVE TO CONTEND
WITH THE STRESSORSOT HEALTHCARE
SYSTEM, BUT WE ALSO NEED TO
EVALUATE OUR APPROACH TO
BIOMEDICAL RESEARCH, INCLUDING
THAT ON COVID-19.
ONE FINAL OBSERVATION, TODAY'S
WORKSHOP SO EXCITING BECAUSE IT
COMBINES CROSS DISCIPLINARY
RESEARCH AND TRANSLATIONAL
RESEARCH.
THAT'S THE FUTURE.
LOOK AT THE AMAZING SESSION
TITLES AND THEIR TOPICS, THEY
RANGE FROM SEX DISPARITIES IN
COVID-19 OUTCOMES TO SOCIAL
DETERMINANTS OF IMPACT ON GENDER
RELATED HEART LUNG AND BLOOD
SLEEP OUTCOMES AND PREGNANCY AND
OTHER CONDITIONS AFFECTING THE
SUSCEPTIBILITY OF SARS-COV-2.
EACH AND EVERY 1 OF THESE TOPICS
COULD BE ITS OWN MEETING AND
CROSS DISCIPLINARY APPROACHES
EXPOSE RESEARCHERS TO THE FULL
SPECTRUM INCLUDED.
I'LL END BY SAYING,
INCORPORATING SEX AND GENDER
ACROSS THE RESEARCH CONTINUUM
HAS THE POTENTIAL TO ADVANCE
RIGOR, DISCOVERY, INNOVATION AND
EQUITY IN COVID-19 RESEARCH AND
BEYOND.
THANK YOU.
>> THANK YOU VERY MUCH
DR. CLAYTON FOR YOUR OPENING
REMARKS AND UNDERLYING SO NICELY
WHY WE NEED TO CONSIDER SEX AND
GENDER CONTEXT IN STUDY DESIGN,
COLLECTION, ANAM SIS AND
REPORTING OF RESEARCH DATA.
I WOULD LIKE NOW TO TURN THIS
MEETING OVER TO OUR CO CHAIRS
DR. SANBERG AND DR. KANTHI.
>> GOOD MORNING EVERYBODY, IT'S
A REAL PLEASURE TO CO CHAIR THIS
WHOLE MEETING WITH JASMINA AND
DR. KANTHI.
I HAVE TO FIRST SAY SOMETHING
THAT HASN'T BEEN SAID YET.
I THINK IT WAS MARCH SEVENTH,
YOU CAN CORRECT ME BUT IT WAS
MARCH 7th THAT JASMINA, THAT
WE HAD A CONSIDERATION ABOUT
WHAT DO YOU THINK ABOUT PUTTING
ON THIS WORKSHOP ON SEX AND
GENDER WITH COVID-19, IT COULD
BE IN JUNE BUT THEN WE COULD DO
IT IN SEPTEMBER AND WHAT DO YOU
THINK, SO IF WAS A NORMAL PERSON
I WOULD SAY WHAT ARE YOU CRAZY,
I MEAN REALLY CAN WE REALLY PUT
TOGETHER A MEETING IN 3 MONTH?
S AND THEN I REALIZED OH YES,
THIS IS--THIS IS JASMINA, THE
WOMAN I MET AT WAKE FOREST WHEN
HE WAS ON THE FACULTY AND I SAID
OH YEAH, YOU CAN DO IT IN JUNE.
JUST THINK ABOUT PUTTING 40
PEOPLE, SCIENTISTS ALL OVER THE
WORLD AND MEETING WITH EACH 1
AND TALKING WITH EVERYONE AND
ORGANIZING WITH THE MODERATORS
IS A TREMENDOUS AMOUNT OF WORK
AND I THINK WE ALL OWE THIS
TERRIFIC MEETING TO JASMINA, AND
ALL THE OTHER ORGANIZERS WERE
VERY, VERY IMPORTANT BUT REALLY
WE HAVE TO ACKNOWLEDGE JASMINA'S
GREAT CONTRIBUTION AND I ALSO
ROLELY AM THRILLED ABOUT BEING
PART OF THIS BECAUSE DR. CLAYTON
I'VE BEEN WORKING WITH HER FOR
MANY YEARS AND YOU KNOW SHE'S 1
OF OUR GREAT AMBASSADORS FOR SEX
AND GENDER RESEARCH AND IT'S
SUCH AN HONOR TO BE--TO BE
INVOLVED IN ANYTHING THAT SHE
SUPPORTS.
SO I WOULD LIKE TO TURN IT OVER
AT THIS POINT TO MY CO-CHAIR AND
THEN I WILL INTRODUCE OUR
MODERATOR AND KEY NOTE SPEAKER
FOR OUR FIRST SESSION.
DR. KANTHI?
>> WONDERFUL, THANK YOU
DR. SANDBERG AND TO THE NHLBI
FOR THEIR SUPPORT AND
PARTICIPATION.
MOST IMPORTANTLY I WANT TO
ACKNOWLEDGE THE PLANNING
COMMITTEE AND KEY MEMBERS, WHO
LIFTED THIS WORKSHOP FROM
CONCEPT TO EXECUTION IN A VERY
SHORT PERIOD OF TIME.
AND CERTAINLY IT'S DIFFICULT
TASK IN THE CURRENT ENVIRONMENT
AS DR. GOFF MENTIONED WE ALL
HAVE A LOT OF THINGS TO DO, BUT
THE THEY ACCOMPLISH THIS WITH
INNOVATIVE IDEAS, PERSISTENT
HARD WORK AND MAYBE SOME
CAFFEINE BUT THEY REALLY DO HAVE
A REMARKABLABILITY TO REACH
ACROSS DIFFERENT FIELDS AND
CONNECT WITH EXPERTS LIKE
YOURSELF WHICH IS VITAL TO
CONTRIBUTING TO THE SUCCESS OF
THIS WORKSHOP.
I ALSO WANT TO THANK PARTNERS AT
SYNERGY FOR FACILITATING THE
INFRASTRUCTURE OF THIS WORKSHOP
AND HELPS US CONNECT WITH YOU
REMOTELY.
I ENJOYED HEARING THE OPENING
REMARKS FROM DR. DAVID GOFF, AND
DR. JANINE, AUSTIN, CLAYTON
WHICH SETS THE STAGE FOR THE
WORKSHOP.
WE HAVE A DYNAMITE PROGRAM
AHEAD, STARTING WITH A KEY NOTE
LECTOR BY DR. OERTELT-BRIGIONE,
THIS WILL ADDRESS THE
EPIDEMIOLOGY, BIOLOGY AND
CLINICAL STUDIES OF SEX AND
GENDER SPECIFIC NUANCES OF
COVID-19 AND IT'S IMPORTANT TO
STEP BACK AND THINK A LITTLE BIT
ABOUT WHAT COVID IS DOING.
IT'S TEACHING US MORE THAN JUST
WHAT HAPPENS WITH SARS-COV-2
INFECTION, IT'S TEACHING US
ABOUT PHYSIOLOGY, SOCIETAL
DETERMINANTS OF HEALTH,
COLLECTING DATA, CLINICAL TRIALS
AND HOW WE INTERPET ALL THIS IN
THE OUR SOCIETY, THE GOAL IS TO
IFENT THIS AND CLOSE GAPS.
WE WANT TO BRING THIS TOGETHER
TO A SINGLE FORM AND THANK TO
YOU PARTICIPANT WHO IS ARE HERE
TO REMIND US OF THE POTENTIAL
IMPACT TO ADVANCE HUMAN HEALTH.
SO IN PURSUIT OF THIS GOAL, OUR
AUDWHY ENSEL ARE VITAL TO THE
SUCCESS OF THE WORKSHOP, I
ENCOURAGE TO YOU ENGAGE WITH OUR
SPEAKERS, MAKING COMMENTS,
ASKING QUESTIONS, PARTICIPATE
NOTHING THE DISCUSSION PERIODS
TO BRING YOURED WHYS UP FOR
DISCUSSION AND AS YOU HEARD,
THERE WILL BE 2 BREAK OUT
SESSIONS TOMORROW THAT WILL BE
VERY ENGAGING AND WE HOPE THAT
AS DR. GOFF MENTIONED EARLIER,
YOU WILL LEAVE WITH NEW IDEAS,
NEW RELATIONSHIPS AND NEW
COLLABORATIONS.
SO THANK YOU AND I WILL STOP
HERE AND HAND IT BACK TO
DR. SANDBERG.
>> THANK YOU DR. KANTHI FOR
GIVING US AN OVERVIEW OF WHAT
THE WORKSHOP WILL BE NOW I WILL
INTRODUCE OUR MODERATOR FOR THE
KEY NOTE LECTURE, SADIYA, KHAN,
SHE'S THERE AT THE FINE BERG
SCHOOL OF MEDICINE NORTHWESTERN.
HER CLINICAL EXPERTISE AND FOCUS
IN RESEARCH IS ON EPIDEMIOLOGY,
PREVENTION AND GENETICS OF HEART
FAILURE AND SHE PARTICULARLY IS
INTERESTED ON SEX SPECIFIC RISK
FACTORS.
DR. KAHN'S RESEARCH SPANS THE
SPECTRUM FROM PRECLINICAL BASIC
RESEARCH TO HUMAN CLINICAL
TRIALS AND POPULATION BASED
EPIDEMIOLOGY.
AND HER ROLE ON THE LOOKING AT
THE GEOGRAPHICAL VARIATION AND
HEALTH DISPARITIES HAS
DEMONSTRATED THERE ARE
SIGNIFICANT DIFFERENCES IN A
VARIETY OF HEALTH OUTCOMES THAT
ARE BASED ON GEOGRAPHY AND THESE
INCLUDE CARDIO METABOLIC
DISEASES, LUNG DISEASE AND
COVID-19.
--WE WILL HEAR FROM HER LATER
ON, AND HER RESEARCH HAS BEEN
SUPPORTED BY MANY GRANTS WITH
THE NATIONAL INTUITYS OF HEALTH.
WHAT'S AMAZING ABOUT DR. KAHN,
ONLY RECENTLY SHE WAS AN EARLY
STAGE INVESTIGATOR BUT IT
DOESN'T REALLY MAKE SENSE SINCE
SHE'S ALREADY PUBLISHED OVER 180
PEER REVIEWED SCIENTIFIC
PUBLICATIONS AND THESE ARE IN
OUR TOP MEDICAL JOURNALS AND HER
WORK IS HAS BEEN CITED OVER
NEARLY 10,000 TIMES AND IS
ASSOCIATE EDITOR FOR A KEY
JOURNAL IN OUR FIELD, JAMA
CARDIOLOGY AND SERVES AS VICE
CHAIR OF THE AMERICAN HEART
ASSOCIATION EPIDEMIOLOGY
PUBLICATIONS COMMITTEE SO WE'RE
REALLY THRILLED SHE'S GOING TO
MODERATE THIS KEY NOTE LECTURE
WHICH BRINGS ME TOO D
R. SABINE OERTELT-PRIGIONE, AND
SHE'S A PHYSICIAN, RESEARCH AND
COACH.
SHE'S CHAIR OF GENDER AND
PRIMARY TRANSMURAL CARE AT THE
[INDISCERNIBLE] UNIVERSITY IN
[INDISCERNIBLE] IN THE
NETHERLANDS.
SHE'S ALSO PROFESSOR OF SEX AND
GENDER SENSITIVE MEDICINE ADDED
THE UNIVERSITY OF
[INDISCERNIBLE] IN GERMANY.
SHE'S A MEMBER OF THE EUROPEAN
UNION COMMISSION EXPERT GROUP
CALLED GENDERED INNOVATIONS 2
AND SHE'S CURRENTLY CHAIR OF THE
EXPERT GROUP GENDER AND
COVID-19.
HER RESEARCH AND ON TD
IMPLEMENTATION OF SEX AND GENDER
SENSITIVE RESEARCH THROUGHOUT
THE ANAL SILLS OF PRACTICES,
DEVELOPMENT OF METHODS AND
ENGAGEMENT OF STAKEHOLDERS OF
VERY, VERY IMPORTANT, IMPORTANT
ROLE IN SCIENCE.
SHE'S ALSO DEVELOPED SEVERAL
OPEN ACCESS RESOURCES FOR SEX
AND GENDER SENSITIVE RESEARCH
SPANNING FROM DATABASES TO OPEN
ACCESS BOOKS AND METHOD LOGICAL
TOOL BOXES AND I CAN SAY AS A
USER OF THESE THAT I--I HAVE
CITED HER OFTEN IN MY PRESENT
ANTICIPATIONS.
IN ADDITION TO ACTIVITIES SHE
ALSO HELPS WITH ORGANIZATIONS
FOR IMPLEMENTATION MEASURES
AGAINST GENDER DISCRIMINATION
AND HARASSMENT.
IT'S SUCH A WONDERFUL
OPPORTUNITY FOR US TO HEAR FROM
DR. OERTELT-PRIGIONE, ON THE
OVERVIEW OF THE EPIDEMIOLOGY OF
COVID-19 FOCUSING ON SEX AND
GENDER.
>> WELL, DR. SANDBERG FOR SUCH A
WONDER OF INTRODUCTION.
THANK YOU FOR INVITING ME AND
IT'S WONDERFUL TO BE HERE AND
EXCHANGE HERE AND LEARN FROM YOU
ALL, A LOT OF PEOPLE COULD GIVE
THE KEY NOTE SO I'M THRILLED AND
HONORED FOR THIS OPPORTUNITY.
AS I SAID BEFORE, I AM AT THE
MOMENT CHAIRING A EUCOMMISSION
EXPERT GROUP CALLED THE GENDER
DIFFERENCESSER AND COVID-19
ACTIVITY, SO MAYBE IT WILL GIVE
US DISCUSSION LATER ON BUT THIS
IS NOT THE MAIN TOPIC I'LL BE
ADDRESSING TODAY.
TODAY I WILL BE TALKING ABOUT
BROAD TERMS IN SEX AND GENDER
AND HOW THEY DO AND CAN INTERACT
WITH COVID-19 AND I WILL BRIEFLY
START WITH A TERMINOLOGY JUST SO
WE'RE ALL ON THE SAME PAGE OF
WHAT WE WILL BE DISCUSSING THESE
DAYS AND I WILL BREFLY IMPACT
THE POINTS OF SEX ON OF COURSE
19 AND THEN I WILL MOVE ON TO
SOME GENDER ASPECTS OF COVID-19,
OF COURSE I'VE BEEN GIIVE 20
MINUTES SO I WON'T BE ABLE TO GO
IN DEPTH, BUT I HOPE TO GIVE YOU
SEVERAL POINTS WE CAN PICK UP
THROUGHOUT THE DISCUSSION AND WE
COULD POTENTIALLY COME BACK TO I
WILL START BY SAYING A FEW
THINGS ABOUT THE INTERSECTION OF
CONTENT AND CONTEXT IN RESEARCH
ESPECIALLY IN THIS CONTEXT.
NOW I WOULD LIKE TO START WITH
THIS SLIDE WHICH IS A FIGURE
FROM [INDISCERNIBLE] AND
COLLEAGUES PUBLISHED IN THE
LANCET EDITION IN GENDER AND
HEALTH IN 2019.
I CAN ONLY RECOMMEND THIS
EDITION WITH MULTIPLE
PUBLICATIONS TACKLING ALL KINDS
OF DIFFERENT ASPECTS OF SEX AND
GENDER AND HEALTH AND I THINK
THIS IS A REALLY GOOD SUMMARY OF
WHAT WE WILL BE ADDRESSING.
SO AS DR. CLAYTON MENTIONED,
THIS HAS IS WHAT WE WILLUC
TALKING ABOUT MOSTLY IN THESE 2
I DAS, I WOULD ASSUME.
WE ARE ALL BORN WITH THESE
FEATURES, WHAT WE MOSTLY ANALYZE
IN THIS FIELD OF STUDYING SEX
SPECIFIC FACTORS ARE GENES,
GONADS OR GENITALIAL, SOME CAN
BE INFLUENCED SUCH AS HORMONES
OTHERS SUCH AS GENES CAN ONLY BE
MARGINALLY CHANGED.
BUT THEN HOWEVER, WE ARE BORN
INTO A SOCIAL WORLD, WE DON'T
LIVE IN ISOLATION, IN THIS WORLD
WHERE WE GROW UP AND INTERACT
WITH OTHERS THERE ARE POWER
STRUCTURES AND NORMS AND THESE
ARE WHAT CONSTITUTES GENDER AND
IT STARTS ALREADY IN OUR
FAMILIAR ENVIRONMENT, THEN IT
MOVES ON TO OUR COMMUNITIES, THE
INSTITUTIONS WE LEARN IN, WE
STUDY IN, WE WORK IN, FURTHER
MORE THORS THE STRUCTURES AND
POLICIES THAT GOVERN OUR
COUNTRIES, THE DECISIONS ARE
BEING MADE AT A POLITICAL LEVEL
AND ALL OF THESE IN 1 WAY OR
ANOTHER, CONSCIOUSLY OR
UNCONSCIOUSLY OFFER SOME
GENDERED ASPECT TO IT WHICH IN
INTERACTION WITH OTHER ASPECTS,
INTERSECTIONALITY HAS BEEN
MENTIONED BEFORE LEAD TO THE
FACTS THAT DIFFERENT INDIVIDUALS
IN OUR SOCIETIES HAVE DIFFERENT
OPPORTUNITIES FOR LEADING A
HEALTHY LIFE AND HAVE DIFFERENT
ACCESS TO HEGHT CARE.
AS MENTIONED BEFORE AND AS
ENVISIONED HERE, THESE FACTORS
CAN BE ABILITY, AGE, CLASS, RACE
AND ETHNICITY AND WHICH WOULD
DETERMINE HOW FAR AS INDIVIDUALS
WE HAVE ACCESS TO HEALTHCARE, WE
HAVE THE OPPORTUNITY TO LEAD
HEALTHY LIVES OR THESE THINGS
ARE DENIED TO US AND WE'RE
EXPOSED TO SOME FORM OF INEQUITY
OR POTENTIAL DISCRIMINATION IN
HEALTHCARE.
NOW, HOW DOES THAT RELATE TO
COVID-19.
SO WE MOVE DIRECTLY TO THE
SUBJECT WE WILL BE TACKLING IN
THE NEXT 2 DAYS, THIS IS A
SUMMARY OF SLIDES LOOKING AT THE
MOMENT OF INFECTION AND HOW FAR
YOU COULD POTENTIALLY SPLIT
THESE TOPICS INTO SEX RELATED
FACTORS AND GENDER RELATED
FACTORS.
AS YOU SEE HERE, THESE ARE
EMOTIONAL NEUROLOGICAL
INTERACTIONS THAT WE CAN STUDY
THAT CAN HAVE SEX SPECIFIC
ASPECTS RELATED TO THEM
POTENTIALLY TO SEX DIFFERENCES
ON THE RIGHT HAND SIDE YOU SEE A
LOT OF GENDER RELATED FACTORS,
AS I SAID MOSTLY CONNECTED TO
THE MOMENT OF INFECTION, SO WHO
GETS EXPOSED, WHO HAS ACCESS TO
TESTING, TO POTENTIAL THERAPIES
AND SO FORTH.
WE WILL USE A BIT OF THIS SCHEME
THROUGHOUT THE TALK.
WHAT THIS ALSO SHOWS US AS THE
FIGURE BEFORE IS THAT THERE ARE
SEVERAL LAYERS WE CAN TAKE INTO
ACCOUNT HERE AND I WOULD SAY
THAT THE SEX SPECIFIC RESEARCH
THAT WE WILL MOSTLY BE
DISCUSSING IS MOSTLY OF THE
CONTENT LAYER WE'RE TALKING
ABOUT BUT HOWEVER THIS IS HIGH
HE INFLUENCED BY CTEXT
LAYER, WHERE GENDER MIGHT BE
MORE RELEVANT IN WHICH IS
INTERTWINED WITH THE CONTENT
LAYER SO WE'LL TALK BRIEFLY
ABOUT BOTH OF THOSE.
LET'S START WITH THE CONTENT.
NOW NOW THIS IS A GOOD SUMMARY
RESOURCE FOR ANYBODY LOOKING FOR
SEX DISA AGGREGATED DATA I WOULD
RECOMMEND YOU HAVE A LOOK AT THE
GLOBAL HEALTH 5050 INITIATIVES
THAT HAS BEEN TRACKING COVID SEX
DISAGGREGATED NUMBERS SINCE THE
LAST 2 YEARS, THIS WAS
SPEARHEADED MOSTLY BY SARRA
HAWKS OUT OF LONDON, WITH
SEVERAL OTHER COLLEAGUES WHO
HAVE BEEN WORKING MOSTLY FOR
FREE ON THIS.
TO MAKE THIS DATA AVAILABLE TO
US ALL, SO WE SHOULD ALL BE VERY
GRATEFUL TO THEM, WHAT IT
SUMMARIZES IS AGGREGATED
INTERNATIONAL DATA AND IT'S
IMPORTANT TO SAY THAT BECAUSE IF
WE LOOK AT THAT IN A MORE
NUANCED FASHION, WE MIGHT SEE
DIFFERENT PICTURES, HOWEVER IF
WE ELECTRIC AT INTERNATIONAL
AGGREGATED DATA THERE IS ABOUT
THE SAME NUMBER OF CASE KASP A R
IN BIOLOGICAL FEMALES AND
BIOLOGICAL MALE WHEN IS WE START
LOOKING HOWEVER AT THE CLINICAL
ASPECT, HOSPITALIZATIONS ICU
ADMISSIONS AND DEATH, WE SEE
DEFINITELY HIGHER NUMBERS IN
MALES.
NOW THIS IS RELATIVELY WELL
KNOWN, THIS IS 2 YEARS INTO THE
PANDEMIC, THIS IS THE
AVAILABILITY OF SEX
DISAGGREGATED DATA WHICH YOU CAN
ALSO FIND ON THE WEBSITE I
MENTIONED BEFORE AND WHAT YOU
SEE HERE IN GREEN OTHER
COUNTRIES ARE PROVIDING
AGGREGATED DATA ON CASES AND
DEATH AND HAVE PROVIDED THESE IN
THE LAST 2 MONTHS, YELLOW
PROVIDED 1 OF THE 2 AND RED HAVE
PROVIDED NEITHER OF THE 2.
SO EVEN AFTER 2 YEARS THERE IS
STILL A NUMBER OF COUNTRIES THAT
DON'T GIVE US ENOUGH DATA SO
THAT WE CAN ACTUALLY
INVESTIGATOR THE SEX DIFFERENCE.
NOW WHEN IT COMES TO COVID-19
RIGHT FROM THE START WHEN
FINDING OUT THAT THE RECEPTOR OF
THIS VIRUS WAS THE ACE 2
RECEPTOR POSITIONEDOT
X-CHROMOSOME, IT WAS QUITE
LIKELY AND SPORTSMANSHIPPED BY
WHAT MANY SCIENTISTS WORK
NOTHING THE FIELD THAT THERE
WOULD BE DIFFERENCES FOR THE
VIRUS, I THINK THESE WILL BE
MENTION TD THROUGHOUT THE
WORKSHOPS, I WON'T GO INTO
DETAILS BUT THERE ARE SEVERAL
FACTORS CONNECTED TO SEX
DIFFERENCES WHO ARE ALREADY
PREDICTABLE IN THE BEGINNING AS
I SAID, THE RECEPTOR ON THE
X-CHROMOSOME IS 1 OF THEM, OTHER
MOLECULES CONNECTED TO THE
INTEGRATION OF THE VIRUS INTO
THE CELLS ARE RELEVANT.
INNATE IMMUNE RESPONSE WAS
ALREADY A TARGET IN THE
BEGINNING, TOLL-LIKE RECEPTOR
MORE RECEPTORS RELEVANT HERE, WE
ALREADY KNEW THAT TLR7 IS QUITE
RELEVANT IN AUTOIMMUNE DISEASES
AND HAS BEEN ASSOCIATE WIDE SEX
DIFFERENCES IN AUTOIMMUNE
DECEASE DISEASES AND ALSO
PEESHED ON THE X-CHROMOSOME AND
WE HAVE SEEN WITH THE RESEARCH
GOING ON IN THE LAST 2 YEARS
THAT THERE'S ALSO SEX
DIFFERENCES IN ADAPTIVE IMMUNE
RESPONSE.
NOW THESE DIFFERENCES HAVE IN
PART AT LEAST EXPLAINED SOME OF
THE CLINICAL DIFFERENCES WE'VE
SEEN AS I MENTIONED BEFORE, THE
NUMBERS, AT LEAST IN THE FIRST 3
WAVES, I WOULD SAY WE HAVE SEEN
THESE PATTERNS OF MORE MEN
POTENTIALLY DYING OF THE
DISEASE, MORE NEED FOR INVASIVE
THERAPY, MORE NEED FOR
HOSPITALIZATION, ALTHOUGH AS I
SAID, THIS IS AGGREGATED DATA
AND WE'RE DEFINITELY SEEING A
SHIFT IN CHANGE HERE.
NOW AS LARGER NUMBERS IN THE
POPULATION ARE BEING VACCINATED
AND AS ALSO THE VARIANTS OF
CONCERN THAT ARE EMERGING
POTENTIALLY HAVE A SLIGHTLY
DIFFERENT BEHAVIOR, THIS MIGHT
AS WELL CHANGE AND WE SEE
FORTUNATELY AT LEAST IN HIGHLY
VACCINATED POPULATIONS, A
DECREASE OF HOSPITALIZATION AND
NEED FOR INVASIVE THERAPY, THIS
OF COURSE DOES NOT APPLY TO
UNVACCINATED INDIVIDUALS BUT
WITH THESE CHANGES IN THE VIRUS
AND IMMUNOLOGY, AT THE
POPULATION LEVEL WE MIGHT SEE
DIFFERENT PAT E-PRESCRIBINGS ALL
THE TIME.
ONE THAT IS ALREADY EMERGING AS
LONG COVID.
LONG COVID IS A COMBINATION THAT
IS STILL BEING DEFINED OF
DIFFERENT TYPES OF SYMPTOMS THAT
CAN CLUSTER.
THEY CAN AFFECT THE
CARDIOVASCULAR, NEUROLOGICAL,
GASTROINTESTINAL AND COGNITIVE
SYMPTOMS.
THEY SEEM TO BE MORE PREVALENT
IN WOMEN, AT LEAST FROM WHAT
WE'RE SEEING RIGHT NOW FROM
WORLD WIDE DATA ESPECIALLY ALSO
PREMENOPAUSAL WOMEN SO THERE
SEEM TO BE DIFFERENT EFFECTS
COMING TOGETHER.
WHAT IS IMPORTANT TO SAY AND
THIS WAS ALREADY MENTIONED BY
DR. CLAYTON INITIALLY IS THAT WE
ALSO NEED TO TAKE INTO
CONSIDERATION THAT AGGREGATED
DATA ARE NOT VERY SPECIFIC WHEN
WE LOOK AT SPECIFIC GROUPS.
SO FOR EXAMPLE, FROM DATA FROM
THE U.S. AND THE UK AND OTHER
COUNTRIES, IF WE LOOK AT
SOCIALLY DISADVANTAGED GROUPS
AND ETHNIC MINORITIES WE WILL
SEE THAT THESE SIMPLE
DISTINCTIONS BETWEEN MEN AND
WOMEN DON'T WORK QUITE THIS WAY
ONCE WE TAKE OTHER FORMS OF
DISADVABTAGE INTO ACCOUNT AND
MIGHT ACTUAL LOAMACYY REVERSE
THE TRENDS THAT WE'RE SEEING.
OF COURSE WHAT WE'RE INTERESTED
IN AND THIS IS WORK THAT HAS
BEEN PUBLISHED LAST YEAR
TOGETHER WITH MY COLLEAGUES IN
DENMARK THAT YOU SEE MENTIONED
HERE, WE WERE INTERESTED IN HOW
FAR OUR PRACTICE ACTUALLY CHANGE
WIDE SO MUCH ATTENTION TO SEX
DIFFERENCES.
SO WOO BEING LOOKED AT A NUMBER
OF LARGE REGISTERED TRIALS FROM
COVID-19 2020-2021, MORE THAN
5000 STUDIES AND WE LOOKED
SPECIFICALLY HOW FAR THEY
MENTIONED SEX AND GENDER AS
RECRUITMENT CRITERIA AND HOW FAR
THE REPORTED INTENTION TO
CONSIDER SEX AND GENDER UPON
ANALYSIS.
NEEDLESS TO SAY IT WAS QUITE
DEPRESSING, ABOUT 1 IN 5
EXPLICITLY MENTIONED SEX AND
GENDER AND 1 IN 2 OF THESE
STUDIES SAID IT WOULD LOOK AT
SEX AND GENDER UPON ANALYSIS.
OF COURSE, NOT ALL STUDIES ARE
REGISTERED, ARE ACTUALLY CARRIED
OUT OR COME TO AN END.
WE ALSO LOOKED AT THE CLINICAL
PHARMAICOLOGICAL TRIALS THAT
WERE PUBLISH INDEED JANUARY 2021
AND IN THAT CASE, WE SAW AN
IMPROVEMENT, SO FROM 1 IN 20, WE
GOT TO 1 IN 5 BUT THAT STILL
MEANS THAT IN ABOUT 80% OF THE
CASES WE DIDN'T HAVE ANY SEX
DISAGGREGATED INFORMATION AND
PROBABLY 1 OF THE MOST
DEPRESSING THINGS WAS THAT GOING
THROUGH THAT YEAR WITH MORE AND
MORE INFORMATION ABOUT POTENTIAL
EFFECTS DIFFERENCES WITH THE
CONFIRMATION OF DIFFERENCES IN
EPIDEMIOLOGY, THE PATTERNS
DIDN'T CHANGE, SO THE INCLUSION
WAS ABOUT THE SAME.
ONE ACCOUNTED OF COURSE SAY,
WELL, THINGS ARE GETTING BETTER
AS WE MOVE FORWARD, THEY DO BUT
TO A CERTAIN DEGREE, THIS IS
DATA PUBLISHED BY THE DUTCH AND
NATIONAL PHARMAICOLOGICAL
ORGANIZATION TOGETHER WITH
COLLEAGUES FROM THE EMA, LOOKING
AT AVAILABILITY OF HERE, SEX
SPECIFIC SAFETY INFORMATION OF
THE 6 DRUGS OR VACCINES THAT ARE
LICENSED IN EUROPE.
THE DATA FROM KD--SALLY ARE
PROPRIETARY, IS A PLUS AS WELL,
BUT IN 50% OF THESE CASES 2
MONTHSS AGO, WE HAVE SEX
SPECIFIC SAFETY INFORMATION AT
THE E-MAIL LEVEL.
SO THERE'S STILL A LOT TO DO.
ON NOW LET'S MOVE ON TO THE
CONTEXT LEVEL TO PUT THIS IN A
SOMEWHAT BROADER PERSPECTIVE.
THIS IS JUST TO SHOW YOU WHICH
AREAS CAN BE AFFECTED BY GENDER.
I'M OF COURSE NOT GOING TO GO
INTO DETAIL OF ALL OF THESE, WE
DON'T HAVE THE TIME FOR THAT BUT
THIS IS JUST TO SHOW IN HOW FAR
AND HOW PERVASIVE GENDER ASPECTS
ARE AND HOW FAR THEY AFFECT ALL
OF THESE DOMAINS.
LET'S START WITH 1 OF THE MOST
OBVIOUS 1S WE ALL EXPERIENCED,
SOMEWHAT THROUGHOUT THE
PANDEMIC, WELL, THE BALANCE
BETWEEN WORK AND CARE.
THIS IS DATA THAT IS
PREPANDEMIC, SO IT'S DATA FROM
THE INTERNATIONAL LABOR
ORGANIZATION IN THE YEAR 2018
THAT SHOWS US THAT WORLD WIDE,
NOT ONLY DO MEN SPEND LESS TIME
WORKING THAN WOMEN BUT MOST
IMPORTANTLY, THEY SPEND MUCH
MORE TIME IN PAID WORK WHILE THE
AMOUNT OF PAID WORK DONE BY
WOMEN WORLD WIDE AND AGAIN THIS
IS AGGREGATED GATE DATA IS MUCH
SMALLER THAN THAT OF MEN.
NOW COMING FROM THAT, WE MOVED
TO THE PANDEMIC AND THIS IS DATA
FROM THE FIRST WAVE INI ITALY AS
YOU KNOW ITALY HAS BEEN HIT VERY
HARD BY THE FIRST WAVE.
THIS IS DATA FROM HETEROSEXUAL
COUPLES DURING THE APRIL 2020
LOCK DOWN, ITALY HAS HAD VERY
INTENSIVE AND EXTENSIVE LOCK
DOWNS, AND WHAT YOU SEE HERE,
THESE ARE HETEROGENEOUSERY ON
SEXUAL COUPLES HOW FAR THAT
SPEND TIME IN HOUSE WORK AND
CHILDCARE.
YOU HAVE WOMEN SAID IT WAS QUITE
A SIGNIFICANT INCREASEOT OTHER
HAND HERE YOU HAVE THE PARTNERS
THAT ALSO MENTIONED A
SIGNIFICANT INCREASE ALTHOUGH
HERE MORE IN CHILDCARE ON THE
WOMEN'S SIDE, MORE IN HOUSE
WORK.
BUT IT WAS OF COURSE TO LOOK AT
WHAT WAS IT LIKE BEFORE THE
PANDEMIC AND WHAT WE SEE HERE IS
THAT ABOUT 20% OF THE PARTNERS
THEY SPENT 0 HOURS, DURING THE
DAY IN HOUSE WORK OR CHILDCARE,
ABOUT 50% OF THEM HAD 0 TO 1
HOUR OF CHILDCARE AND HOUSE
WORK.
IN THE CASE OF THE WOMEN ABOUT
50% OF THEM SAID I SPEND 1-2
HOURS IN CHILDCARE AND HOUSE
WORK AND THE OTHER PERCENTAGES
DISTRIBUTED EQUALLY SOAL WE SEE
AN INCREASE ON BOTH SIDES, THE
STARTING POINT WAS QUITE
DIFFERENT AND OF COURSE THAT
IMPACTS AND THAT DOESN'T JUST
IMPACT PEOPLE WORKING IN SERVICE
JOBS FOR EXAMPLE, AS WE SEE HERE
IT OF COURSE IMPACTED US IN
ACADEMIA, COME AND THIS IS DATA
FROM THE BEGINNING OF THE
PANDEMIC SO JANUARY TO
APRIL 2020 WHERE WE COULD
RAPIDLY SEE AN INCREASE IN
PUBLICATION IN OUR MALE
COLLEAGUES, SOMEWHAT LESS THAN
OUR FEMALE COLLEAGUES AND WE'VE
SEEN QUITE DISCIPLINARY
RENTIATED TRENDS THROUGHOUT THE
PANDEMIC.
MOST REEL KEEPSAKES VABT IS WE
HAVE LOST A LOT OF TALENTED
COLLEAGUES TO THE PANDEMIC AM IN
MULTIPLE WAYS.
AND WE HAVE LOST A LOT OF
COLLEAGUES TO THE PANDEMIC IN
THE ACADEMIC FIELD AND THIS HAS
HIT DISPROPORTIONATELY WOMEN.
--ABOUT 30% AS YOU SEE HERE FROM
SOME SELECTED COUNTRIES
THROUGHOUT THE WORLD THIS WAS
MOSTLY AT THE TIME OF LOCK DOWNS
BUT ALSO IN GENERAL THROUGHOUT
THE PANDEMIC, THE ROOT CAUSES
ARE PROBABLY VERY DIVERSE
RANGING FROM CHANGING GENDER
ROLES, INSECURITY, STRESS,
UNCERTAINTY ABOUT THE FUTURE,
BUT WE CAN OF COURSE ALL SAY
THESE MIGHTING CAUSES BUT NONE
OF THEM CAN BE A JUSTIFICATION
FOR INTIMATE PARTNER VIOLENCE.
THIS IS WORK BY COLLEAGUES VERY
DIVERSE GROUP AMONG RPGHTS ALSO
WITH WOMEN IN GLOBAL HEALTH THAT
LOOKED AT 27 COUNTRIES AND
IDENTIFIED 115 COVID-19 DECISION
MAKING BODIES AND THEY LOOKED AT
GENDER PARENTING.
WHAT TURNED OUT WAS THAT 85%
WERE MAJORITY MEN AND ONLY
ABOUT
MAKING BODY AND GENDER PARITY
WAS OPERATIONALIZED BETWEEN 40
AND 60%.
WHY IS THIS IMPORTANT BECAUSE OF
COURSE YOU NEED TO SIT AT THE
TABLE TO MAKE DECISIONS TO SET
PRIORITIES AND TO POETIC TEBTIAL
LYE SUGGEST SOLUTION.
I WOULD LIKE TO INCLUDE THIS
BECAUSE IT'S IMPORTANT IN
RESEARCH, AS WE 'EM BARK INTO
THESE 2 DAYS LOOKING AT SEX AND
GENDER DIFFERENCES AND THE
RELEVANCE OF SEX AND GENDER FOR
COVID-19, I WOULD LIKE TO REMIND
YOU OF THIS PUBLICATION LOOKING
AT WOMEN IN A FULL AUTHOR OF
RESEARCHERS ON THE IMPACT OF
THAT ON THE LIKELIHOOD OF
FINDING SEX AND GENDER SENSITIVE
ANALYSIS IN THE PUBLICATION I
DON'T THINK I NEED TO SAY MUCH
HERE, THE LIKE HE HOOD IS MUCH
HIGHER AND ALSO HERE
REPRESENTATION DOES HAVE AN
IMPACT ON THE TOPICS RESEARCHED
AND THE PRIORITIES BEING
ASSESSED AND WITH THAT I THANK
YOU VERY MUCH FOR YOUR ATTENTION
AND LOOKING FORWARD TO YOUR
QUESTIONS AND TO A VERY EXCITING
DAY, THANK YOU.
>> THANK YOU SO MUCH FOR SETTING
THE STAGE IN WHERE WE ARE AND
WHERE WE NEED TO GO TO ADDRESS
SEX AND GENDENER COVID-19 BUT
ALSO BROADLY IN CARDIOVASCULAR
DISEASES AND HAD HEART, LUNG,
BLOOD AND SLEEP DISORDER AS
WELL, 1 OF THE POINTS YOU MADE
STRUCK ME IN TERMS OF ORDER TO
ADDRESS INIQUITIES WE NEED TO
DESCRIBE INIQUITIES OR DESCRIBE
THEM.
AND CAN YOU SPEAK TO WHAT
SOLUTIONS MAY BE AVAILABLE TO
HELPING TO ADDRESS THIS BARRIER
IN SEX SPECIFIC REPORTING?
>> YEAH, WELL, I THINK WHEN WE
LOOK AT THE DAILY BASIS THE
BECAUSE IT WAS AN IMPORTANT
MOMENT FOR ACTION AND IT HAS
BEEN PICKED UP BY QUITE A NUMBER
OF BODIES IN SEVERAL LEGISLATE
OURS IN EUROPE, BY THE EUROPE
COMMISSION, IT ENDED UP AT THE
E-MAIL AS WELL SO I CONTINUING
MOVED A BIT, SO IT IS FIRST OF
ALL IMPORTANT TO DESCRIBE THIS
BUT IT ALSO SHOWED US THAT WE
ARE 'EM BARKING ON A PROCESS AND
WE'RE IMPROVING BUT THERE'S A
LOT TO DO.
SO A LOT OF FOCUS ON THE MOMENT
IS ON THE NUMBER OF WOMEN AND
MEN INCLUDED AND TENTIALLY
GENDER DIVERSE PEOPLE, THIS
WASN'T MENTIONED IN MOST OF
THESE STUDIES AT ALL.
SO WE'RE MOSTLY LOOKING AT THAT
AND TRYING TO ACHIEVE
REPRESENTATION, WE'RE DOING
BETTER BUT WE'RE NOT WHERE WE
WOULD LIKE TO BE BUT DEFINITELY
IMPROVED OVER THE LAST 20 YEARS
BUT I THINK THE NEXT STEP AND
THAT'S DEFINITELY A RIECIAL 1
WHAT I WOULD LIKE TO KNOW ABOUT
THIS THERAPEUTICS IS ARE THEYA
AS EFFECTEDDIVE IN WOMEN AND MEN
OR ARE THERE DIFFERENCES IN SIDE
EFFECTS AND THIS DATA WHICH I
THINK FROM A CLINICAL STANDPOINT
IS REALLY CRUCIAL WAS NOT
AVAILABLE IN MOST OF THESE
STUDIES.
WE DO KNOW WHAT'S INCLUDED.
WE HAVE A TABLE THAT SEPARATES
OUT WHO'S INCLUDED AND IF THERE
ARE DIFFERENCES BUT WHEN WE MOVE
ON TO THE ANALYSIS, THERE'S
STILL TO DO THIS.
SO BY THE TEEM I KNOW WHO'S
INCLUDED DOING AGGREGATE AFALSIS
AND PUTTING THEM IN THE
SUPPLEMENTARY TABLES WOULD BE
POSSIBLE BUT WE HAVEN'T SEEN
THAT AND I THINK THIS IS
DEFINITELY SOMETHING THAT WOULD
BE EASILY ACTIONABLE AND COULD
PROVIDE US WITH A LOT MORE DATA
THAT WOULD BE AVAILABLE FOR NOW
FOR EXAMPLE.
>> IT'S EXCELLENT AND WE HAVE A
COMMENT IN THE CHAT AS ABOUT,
THE IMPORTANCE OF REPORTING NOT
JUST BY SEX BUT BY GENDER
IDENTITY AND INSURING WE HAVE AN
UNDERSTANDING OF NOT JUST THE
BIOLOGY AND PERHAPS HOW COVID-19
MAY DIFFER BASED ON OUTCOMES AND
HOSPITAL TREATMENTS AND IT MAKES
SENSE AS WELL.
AS WE WILL TALK LATER ON ABOUT
BIOLOGICAL DIFFERENCES BETWEEN
SEXES FOR COVID-19 THAT
THERAPIES MAY BE DIFFERENT AND
THIS HAS BEEN THE CASE IN
CARDIOVASCULAR THERAPIES.
ONE OF THE CHALLENGES I OFTEN
HEROR THE PUSH BA BEING IS EVEN
IF WE KNOW WHO REPORTED SEX, IF
THE NUMBER OF PEOPLE INCLUDE IS
TOO SMALL WHERE SEX SPECIFIC
REPORT SUGGEST UNDERPOWER AND
DELIVER DOESN'T HAVE VALUE, WHAT
WOULD YOU SAN FRANCISCO I TO
THAT?
>> I THINK THERE'S 2-POINTS TO
THIS.
SO FIRST OF ALL IT IS TRUE THAT
IT SHOULDN'T BE AN AFTERTHOUGHT
AND THAT'S WHAT WE SAW IN THE
PAPERS AS WELL, IT IS REALLY AN
ISSUE OF AWARENESS, BECAUSE TO
DO PROPER ANALYSIS, YOU NEED TO
TAKE THIS INTO ACCOUNT WHEN YOU
ARE PLANNING YOUR TRIAL AND WHAT
WE SAW WAS REALLY THE REALLY
LARGE TRIAL WHICH HAD GOOD
PREPARATION WHERE YOU HAD
DETAILED PROTOCOLS BEFORE HAND
WERE ALSO THE 1S THAT WERE DOING
SOMEWHAT BETTER, OF COURSE THE
NUMBERS ARE ALSO BIGGER BUT
THERE WAS A LOT OF THOUGHT THAT
WENT INTO PLAN THAGOREAN AND I
THINK THAT'S POINT NUMBER 1.
POINT NUMBER 2 IS OF COURSE, WE
DON'T WANT UNDERPOWERED SUBGROUP
ANALYSIS.
HOWEVER, AT THAT POINT, WITH A
MOVEMENT TOWARDS OPEN ACCESS AND
DATA AND I SAY THAT SPEAKING TO
THE NETHERLANDS WHERE WE PLACE A
LOT OF VALUE ON THAT, YOU COULD
MAKE YOUR DATA AVAILABLE.
SO EVEN IF YOU SPECIFICALLY
CANNOT DO A SUBGROUP ANALYSIS
BECAUSE IT'S UNDERPOWERED WHICH
IS PROBLEMATIC IN ITSELF, WE
COULD HAVE THOUGHT ABOUT IT
BEFORE BUT IF IT'S UNDERPOWERED
YOU COULD MAKE YOUR DATA
AVAILABLE AND SOMEONE ELSE DOING
A SIMILAR STUDY COULD MAKE THEIR
DATA AVAILABLE AND WE COULD POOL
THOSE AND HAVE MORE INFORMATION
COMING FROM THOSE.
SO IT IS NOT IDEAL BUT DATA CAN
BE MADE AVAILABLE AND AT LEAST
ALLOW US ON A METALEVEL TO USE
THAT AND MOVE FORWARD, BUT AS I
SAID BEFORE, IT IS REALLY A
MATTER OF PLANNING OF RESEARCH
AND IT SHOULD BE SOMETHING THAT
SHOULD BE TAKEN INTO
CONSIDERATION IN THE PLANNING
PROCESS OF THE TRIAL.
AND IF WE THINK ABOUT THE
PLANNING PROCESS, WE HAVE A
QUESTION IN THE Q&A,
PARTICULARLY YOUR POINT ABOUT
REPRESENTATION ON EXPERT PANELS
IN TERMS OF WHOSE MAKING POLICY
DECISIONS BUT IT ALSO APPLIES TO
STEERING COMMITTEES OF TRIALS,
WHOSE MAKING THE PROTOCOL AND
WHO'S DECIDING AND DEFINING WHAT
SUBGROUPS CAN BE DONE SO MEN AND
WOMEN ARE POTENTIAL SOLUTIONS
AND I KNOW YOU'VE BEEN WORKING
ON THIS TO ADDRESS THIS INEITY
SOONER.
>> YEAH, WE HAVE SOME DATA.
WE KNOW THAT THE REPRESENTATION
OF WOMEN, THIS IS JUST LOOKING
AT WOMEN.
IT DOESN'T EVEN LOOK AT
DIFFERENT CATEGORIES OF
DIVERSITY SO WE STILL LACK A LOT
OF INFORMATION BUT JUST LOOKING
AT WOMEN, WE SEE THAT WHEN IT
COMES TO CARDIOVASCULAR TRIALS
FOR EXAMPLE, THE FIELD OF HEART
FAILURE, WE THAT 15-20% OF THESE
TRIALS ARE LED BY WOMEN.
NOW I DON'T WANT TO SAY THAT MEN
DON'T LIKE THE TOPIC AND DON'T
WANT TO INVESTIGATE SEX
DIFFERENCES BUT THERE IS AS WE
SAW A SOMEWHAT HISTORICAL TREND
THAT HAVE PAID MORE ATTENTION TO
THAT AND OF COURSE, WE ALL HAVE
A DIFFERENT LIFE, DIFFERENT
PERSPECTIVES, WE SEE DIFFERENT
PROBLEMS, WE MIGHT ASK THIS
QUESTION, SO THIS REPRESENTATION
AND DIVERSITY LOOKING BEYOND SEX
AND GENDER IDENTITY IN THIS CASE
IS REALLY IMPORTANT TO ASK
QUESTIONS, THAT CAN BENEFIT THE
WHOLE OF SOCIETY.
SO THE QUESTIONS WE ASKED ARE
SOMEWHAT CONNECTED TO WHO WE ARE
AND THE PROBLEMS WE SEE, THE
QUESTIONS THAT NEED TO BE
ADDRESSED AND THE WAYS WE WOULD
LIKE TO INVESTIGATE TO IMPROVE
HEALTH ARE INDIVIDUALIZED IN 1
WAY OR ANOTHER.
SO AS RESEARCHERS WE BRING THAT
TO THE TABLE AND I THINK THAT'S
A REALLY IMPORTANT POINT IN
LOOKING AT THE--WELL THE
DIRECTION OF TRIALS BUT ALSO OF
COMMITTEES AND SO FORTH, WHO IS
REALLY SITTING AT THE TABLE
BECAUSE WHAT WE SEE IS THAT BY
INCREASING THE DIVERSITY, IT HAS
QUITE SOME RESEARCH FROM THE
ORGANIZATIONAL AND MANAGEMENT
FIELD INCREASES THE QUALITY OF
WHAT WE PRODUCE.
>> I THINK 1 OF THE OTHER
COMMENTS THAT'S COME IN THE
CHAT.
WE FOCUSED A LOT ON ADULT
COVID-19 OUTCOMES BUT ALSO IN
CAPTURING THE FULL SPECTRUM OF
THE LIFE COURSE INCLUDING IN
PEDIATRIC DATA AS WELL AS IN
OLDER ADULTS AND HAVING THAT
SAME EMPHASIS ON SEX ASK GENDER
AS WELL, IF WE SHIFT GEARS A
LITTLE BIT, I THINK YOU TALKED
ABOUT INTIMATE PARTNER VIOLENCE
AND OTHER SOCIAL FACTORS THAT
HAVE ALSO BEEN EXACERBATED
DURING THE COVID-19 PANDEMIC.
ARE THERE DATA AVAILABLE IN
TERMS OF SPECIFICALLY SEX
TRAFFICKING DURING THE PANDEMIC
OR OTHER SOCIAL FACTORS THAT MAY
BE HARMING THE HEALTH AND WELL
BEING OF WOMEN?
>> WELL, WE DO KNOW THAT A LOT
OF--WELL, INTIMATE PARTNER
VIOLENCE PER SE INCREASED AND
AND I WOULD SAY IF I HAVE TO
GIVE EXACT NUMBERS TO THE
TRAFFICKING I WOULD HAVE TO
REFER TO COLLEAGUES BECAUSE I
CANNOT REALLY SPEAK TO THAT
TOPIC SPECIFICALLY BUT WE KNOW
THAT ALL OF THESE THINGS HAVE
SOMEWHAT INCREASED BECAUSE
PEOPLE HAVE BEEN PUT IN MORE
PRECARIOUS POSITIONS, AND BEING
PUT IN MORE PRECARIOUS POSITIONS
DOES EXACERBATE THE RISK FOR
VULNERABLE GROUPS AND WE'VE SEEN
THAT AT MULTIPLE LAYERS AND
WHAT'S MOST IMPORTANT IS OF
COURSE, BEING VULNERABLE AND
BEING STRESSED AND TRAUMATIZED
HAS AN EFFECT ON OTHER SYSTEMS
OF OUR BODY, IT HAS AN EFFECT ON
CARDIOVASCULAR HEALTH, IT HAS AN
EFFECT ON THE IMMUNE SYSTEM, SO
THERE ARE ALSO CONNECTIONS
BETWEEN THESE SOCIAL DIMENSIONS
OR CONSEQUENCES OF SOCIAL
INIQUITIES OF VIOLENCE, OF
TRAUMA DIRECTLY ON PHYSIOLOGICAL
PROCESSES THAT ARE HAPPENING.
I THINK THIS CONNECTION IS
DEFINITELY SOMETHING THAT NEEDS
TO BE INVESTIGATED MUCH MORE,
THERE IS WORK GOING INTO THAT
DIRECTION, WE ALSO HAD WORK
BEFORE THE PANDEMIC LOOKING INTO
THE EFFECT OF TRAUMA ON
IMMUNOLOGY, ON CARDIOVASCULAR
AND SO FORTH BUT I THINK THAT'S
DEFINITELY SOMETHING THAT COULD
BE INVESTIGATED FURTHER NOW AND
ESPECIALLY NOW THAT WE'RE IN A
DIFFERENT PHASE OF THE PANDEMIC
AND WE MIGHT HAVE OTHER
DIFFERENT PHASES AHEAD OF US AND
SEE HOW THAT AFFECTS ALSO THE
WELL BEING OF PEOPLE IN GENERAL
AND IT MIGHT BECOME A SOCIAL
QUESTION AS WELL.
>> PARTICULARLY BECAUSE THE
PANDEMIC AFFECTED SO MANY SOCIAL
FACTORS BEYOND THE VIRUS ITSELF
BUT THE PANDEMIC, I THINK 1 OF
THE THINGS THAT'S REALLY BECOME
FRONT AND CENTER HAS BEEN FOOD
INSECURITY AND UNSTABLE HOUSING
AND HOW DO THOSE POTENTIALLY
INTERSECT WITH SEX AND GENDER AS
WELL.
>> WELL, THERE ARE MOSTLY GENDER
DIMENSIONS AT FIRST INTERSECTING
WITH THIS.
WE KNOW THAT WHEN IT COMES TO
POVERTY, WOMEN TEND TO BE MUCH
MORE AFFECTED WHEN IT COMES TO
OD AND OTHER SOCIAL SUPPORT, I
SAY I HAVE A DIFFERENT
PERSPECTIVE BECAUSE I LOOK AT
THIS TIME FROM EUROPE AND
ALTHOUGH WE ALSO HAVE MANY OF
THESE PROBLEMS, SOME ARE
BUFFERED MORE BY THE SOCIAL
SUPPORT IN RELATION TO THE
POPULATION BUT IN GENERAL
POVERTY HAS A GENDER DIMENSION,
ACCESS TO HEALTH RESOURCES HAS A
GENDER DIMENSION AND IT GOES FOR
WOMEN IN GENERAL HAVING THIS
ACCESS GENDER DIVERSE INDIVIDUAL
FREQUENTLY BEING EVEN MORE
DISCRIMINATED, EVEN MORE EXPOSED
VIOLENCE AND TRAUMA AND HAVING
LESS ACCESS TO RESOURCES, STILL,
SO, THESE DIMENSIONS WERE
PRESENT BEFORE AND AS WE SEE
THEM EXACERBATING THEY LIMITED
THE ABILITY OF PEOPLE TO LEAD
HEALTHY LIVES.
TO HAVE ACCESS TO THE HEALTHCARE
THEY NEED BECAUSE OF COURSE WHAT
ARE YOU PRIORITIZING, THIS
AIVETS ALSO YOUR RISK
PROTENTIALLY OF BEING EXPOSED TO
COVID-19.
CAN YOU STAY HOME?
DO YOU HAVE TO GO TO WORK?
WHAT KIND OF JOB IS THIS A JOB
THAT EXPOSE YOU MORE THAN
OTHERS?
WHAT HAPPEN FIST YOU LOSE YOUR
JOB?
THE STRESS OF LOSING THAT, SO
THERE'S ALL THESE SOCIAL LAYERS
AND ASPECTS THAT COME INTO PLAY
AND CAN POTENTIALLY MAKE YOU
MORE VULNERABLE PHYSICALLY, NOT
JUST BECAUSE YOU'RE EXPOSED BUT
YOU'RE ALSO EXPOSED TO STRESS
WHICH HAS CONSEQUENCES ON YOUR
IMMUNE RESPONSE, AND SO FORTH SO
THEY'RE ALL SOMEWHAT
INTERTWINED, AND MOST OF THEM DO
HAVE A GENDER DIMENSION THAT
COMES INTO PLAY.
>> I THINK WE'RE WRAPPING UP
HERE, I THINK I WILL WRAP UP
WITH COMMENTS AT THE END HERE
THAT YOU MADE CLEAR AND
DEMONSTRATABLE DIFFERENCES ON
SEX AND GENDER AND WE HAVE TO
EXPLORE IT TO BE ABLE TO ADDRESS
IT AND 1 OF THE COMMENTS THAT
CAME IN THROUGH THE CHAT AS WELL
IN TERMS OF THEM TAKING THE NEXT
STEP AND ENGAGING COMMUNITIES
AND INDIVIDUALS IN KEY STEAK
HOLDERS IN ORDER TO ADDRESS
THESE SOCIAL DETERMINANTS AS
WELL.
THANK YOU SO MUCH FOR THAT
WONDERFUL OVERVIEW AND THIS
REALLY RIVETTING DISCUSSION INTO
ALL THE PANELISTS AND AUDIENCE
MEMBERS FOR THEIR QUESTIONS, I
WILL TURN IT OVER TO
DR. SANDBERG.
>> GOOD AFTERNOON EVERYBODY AND
THANK YOU SO MUCH FOR THAT
FANTASTIC OVERVIEW,
DR. OERTELT-PRIGIONE, AND THANK
YOU DR. KHAN FOR MODERATING.
THAT WAS WONDERFUL.
>> I THINK YOU MUTED YOURSELF.
>> THANK YOU.
I WILL INTRODUCE MICHAEL
SIEVERTS, HE WAS THE NATIONAL
SCIENCE FOUNDATION BUDGET
DIRECTOR FROM 2010-2017 AND HE'S
HAD A LOT OF SENIOR POSITIONS, A
LOT OF SENIOR POSITIONS
OVERSEEING FINANCIAL AND GRANTS
MANAGEMENT AND LEGISLATIVE
PUBLIC AFFAIRS AND HE HAS A
MASTERS FROM UC BERKELEY AND A
BATCHER'S PHYSICS FROM GILL FORD
COLLEGE IN NORTH CAROLINA BUT
TODAY HE IS NOT PARTICIPATING IN
THAT CAPACITY OF ALL HIS CAREER,
BUT MORE HE'S GOING TO BE
PARTICIPATING IN HIS PERSONAL
CAPACITY, SO HE'S NOT A
REPRESENTATIVE OF THE NATIONAL
NSF, HE'S GOING TO TALK TO US AS
A PATIENT AND AN ADVOCATE AND
IMPORTANT STAKEHOLDER OF COURSE,
BECAUSE HE'S BEEN LIVING WITH
COVID-19 AND HE'S A--WITH LONG
COVID AND HE HAD ACUTE INFECTION
IN MARCH, 2020 AND HE'S GOING TO
TALK TO US A LITTLE BIT ABOUT
THAT AND HE'S PLAYED A REALLY
GREAT ROLE.
HE'S PART OF THE PATIENT-LED
RESEARCH COLLABORATIVE ON THE
LONG COVID ALLIANCE AND
STRATEGIES FOR HIGH IMPACT ON
EFFORTS TO ADVANCE RESEARCH ON
LONG COVID AND TO IMPROVE
PATIENT OUTCOMES.
SO, THANK YOU SO MUCH, MICHAEL
SIEVERTS, WITH ABOUT THE
COMMUNITY'S PERSPECTIVE AND YOUR
PERSONAL EXPERIENCE WITH COVID.
THANK YOU VERY MUCH.
>> THANK YOU.
DPLAD TO BE HERE, I JUST WANT TO
MAKE SURE I'M ON MY AUDIO, VIDEO
COMING ACROSS OKAY?
GOOD.
>> SO AS YOU HEARD, 35 YEARS IN
FEDERAL PROGRAMS, RESEARCH,
RESEARCH PROCESSES, GROUNDING
AND THAT'S SHAPED HOW I APPROACH
THIS EXPERIENCE.
SO LET'S GO BACK, MY ACUTE
INFECTION WAS IN MARCH 2020.
JUST BEFORE THAT, I HAD TAKEN AN
EARLY RETIREMENT FROM MY NSF
POSITION AND I WAS SETTING UP
CONSULTING WORK AND CONTINUED
WORK WITH NSF AND ALSO MIX OF
OTHER THINGS LIKE BECOME A YOGA
INSTRUCTOR, I WAS SETTING MYSELF
UP TO BE A SKI INSTRUCTOR, AND
SO I THOUGHT OF MYSELF BEING IN
EXCELLENT HEALTH IN MARCH 2020.
NOW, I'M VERY LIMITED, I'M
MOSTLY HOUSE BOUND.
I HAVE A VERY SEVERE DIZZINESS
NAUSEA, FATIGUE 24/7, I HAVE THE
SYMPTOM KNOWN AS BRAIN FOG, IT'S
LIKE HAVING A PERMANENT
CONCUSSION, I'M FLOATING AROUND
WHEREVER I AM, VERY SENSITIVE TO
BRIGHT LIGHT, SUN LIGHT IS 1 OF
MY WORST TRIGGERS SO I HAVE THIS
CONFIGURURATION WITH DIFFERENT
LIGHTS SO I'M NOT REALLY IN
DIRECT LIGHT MOST OF THE DAY.
IF YOU LEARNED ANYTHING ABOUT
LONG COVID, YOU HEARD THE TERM
P. E. M., VERY HARD TO DESCRIBE
BUT IT'S--MUCH MORE THAN
CORRESPONDING AMOUNT OF
TIREDNESS FOR A GIVEN LEVEL OF
ACTIVITY.
IT'S AN EXPONENTIAL INCREASE IN
THE SEVERITY OF YOUR SYMPTOMS,
VERY OFTEN DELAYED THE NEXT DAY
AFTER YOU'VE DONE SOME KIND OF
EXERTION AND THAT CAN BE FIZZ
KALG EXERTION, COGNITIVE
EXERTION, YOU KNOW IT'S--IT GETS
YOU.
I HAVE A VERY NOTICEABLE SEVERE
FORM OF ORTHOSTATIC INTOLERANCE
SO MY BODY HAS DIFFICULTY
REGULATING ITSELF IF I'M
STANDING OR SITTING UPRIGHT, MY
SYMPTOMS WORSEN SO MY
CONFIGURURATION FOR WORK AND MY
FEET ARE ELEVATED, I'M BASICALLY
IN A RECLINED POSITION, I'M IN
STUDIES AT THE CLINICAL CENTER,
AND I DO TILT TABLE TESTS AND
GIVE THEM LOTS OF GOOD DATA, MY
FAINTING IS VERY GOOD FOR THE
DATA.
AND I USE THE METAPHOR OF A
COMPUTER IN SAFE MODE TO
DESCRIBE HOW I AM, SO IF A
COMPUTER PC WILL GO BO SAFE MODE
WHEN IT NEEDS TO PROTECT ITSELF
FROM SOMETHING AND WE OFTEN CALL
THOSE THINGS VIRUSES, COMPUTER
VIRUSES AND IN THAT STATE, THE
COMPUTER CAN ONLY UNDERTAKE A
VERY LIMITED NUMBER OF THINGS.
I THINK OF MYSELF THE SAME WAY,
I'M OPERATING IN A VERY LIMITED
STATE FOR WHATEVER REASON, MY
BRAIN, MY BODY THINK I NEED
PROTECT FREE RADICALS GENERATED
LOTS OF THEY THINKS SO IT KEEPS
ME IN A STATE WHERE I'M
REGULARLY RECLINED, LYING DOWN,
GETS MAD AT ME IF I STAND UP OR
DO TOO MUCH AND I SORT OF THINK,
OKAY, SOMETHING'S GOING ON IN MY
BODY, MY BRAIN THINKS I NEED
PROTECTING FROM SOMETHING.
WHEN THE VIRUS HIT ME, IT GAVE
IT THAT SIGNAL AND THE MY BODY
GOT STUCK IN THAT SUBROUTINE.
IF YOU KNOW THE VARIOUS
BENCHMARKS OUT THERE, 1 OF THE
1S I HAVE FOUND USEFUL TO
EXPLAIN THINGS IS THE CARNOFSKI
SCORE, MY SCORE IS A 70 WHICH
MEANS KICARE FOR MYSELF BUT I'M
UNABLE TO DO NORMAL ACTIVITY OR
ACTIVE WORK.
SO HOW DID I GET FROM THE
PRECOVID STATE PREMARCH 2020 TO
WHERE I AM NOW?
MY ACUTE ILLNESS WAS--STARTED
MARCH 18th 2020, HAD A FEVER
THAT DAY, WAS VERY EARLY, THAT
WAS--I WAS 1 OF THE FIRST WAVE.
THAT WAS JUST 1 WEEK AFTER
AWARENESS GREW OF THE PRESENCE
OF THE CORONA VIRUS.
I WAS 1 OF THE FIRST HUNDRED
PEOPLE TO TEST POSITIVE IN THE
COUNTY THAT LIVE IN THIS
VIRGINIA, THAT WAS ON PLARCH
24th AND FOR ABOUT 2 WEEKS I
HAD A BAD FEVER THAT I MANAGED
WITH OVER THE COUNTER
MEDICATION, WAS NEVER
HOSPITALIZED, I HAD AN ALTERED
SENSE OF TASTE AND SMELL, BAD
HEADACHE, BUT DIDN'T REALLY HAVE
SERIOUS RESPIRATORY ISSUES AND I
DIDN'T REALLY THINK OF IT
AS--YOU KNOW I THOUGHT IT WAS
THE WORST CASE OF THE FLU I HAD
EVER HAD IN MY LIFE BUT I DIDN'T
PUT IT ON REALLY EXTRAORDINARY
PLATE OF SEVERE ILLNESS.
SO AROUND APRIL 1st I WAS
GETTING BETTER, I WOULD SAYING I
WOULD SICK, I'M GETTING BETTER,
MIGHT BE OUT AWHILE BUT I COULD
NOT PUT GOOD DAYS TOGETHER IN A
ROW.
ABOUT A MONTH OF 2 OF THINKING I
WAS RECOVERING THAT'S WHEN I WAS
REALLY REALIZED I WAS IN THIS
PATTERN, THE 24/7 DIZZINESS,
NAUSEA FATIGUE, THE BRAIN FOG,
YOU KNOW JUST AND THAT'S PRETTY
MUCH WHERE I'VE BEEN SINCE THEN
FOR 2 YEARS.
AROUND THAT TIME, THE SUMMER OF
2020 I WAS LEARNING I WASN'T THE
ONLY PERSON HAVING THIS
EXPERIENCE, YOU KNOW GOING
THROUGH THIS POST COVID
RECOVERY--PROLONGED RECOVERY.
I'VE BEEN INVOLVE WIDE A GROUP
CALLED BODY POLITIC, THEY'RE A
SUPPORT GROUP.
ONE OF THEIR CONFOUNDERS, 1 OF
THE NEW YORK TIMES HAD AN OPED,
THAT DID AN ARTICLE CALLED WE
NEED TO LOOK AT WHAT CORONA
RECOVERIES LOOK LIKE.
AROUND THIS SAME TIME,
RESEARCHERS WARN COVID-19 COULD
CREATE LONG-TERM DEBILITATING
ILLNESS IN SOME PEOPLE.
THAT THOSE WERE EYE OPENING FOR
ME.
I STARTED LEARNING ABOUT CHRONIC
FATIGUE SYNDROME, MILITEIS AND
HOW COMMON AND WELL DOCUMENTED
POST VIRAL SYMPTOMS ARE AND LONG
COVID IS IN THAT SUITE OF POST
VIRAL CONDITIONS THAT HAVE BEEN
KNOWN FOR GENERATIONS.
THAT ALSO LED ME TO THE WORK
THAT DR. [INDISCERNIBLE] ARE
DOING AT NINDS.
I RESPONDED TO JUST SOME E-MAIL
BOXES ABOUT STUDIES THEY WERE
DOING AND WHEN THEIR LONG COVID
STUDY RAMPED UP ABOUT OCTOBER OF
2020, I WAS 1 OF THE FIRST
PATIENTS--PATIENTS TO ENROLL AND
BE PART OF STUDIES AT THE
CLINICAL CENTER.
FOR ME IT WAS VERY IMPORTANT TO
BE PART OF THE RESEARCH BECAUSE
THAT'S WHERE I CAME FROM, MY
CAREER, WITH THE NATIONAL
SCIENCE FOUNDATION AND BEEN
INVOLVED IN COMMUNICATIONS AND
POLICY ANALYSIS AND LOT OF MY
CAREER HAS BEEN ABOUT EXPLAINING
THE IMPORTANCE OF BASIC
RESEARCH, LOOKING AT THE MOST
FUNDAMENT QUESTIONS THAT ADVANCE
KNOWLEDGE.
SO ON THE FIRST CONSENT FORM I
GOT FOR THE STUDY, ABOUT 7 PAGES
IN AND THIS QUESTION: HOW WILL
I BENEFIT FROM PARTICIPATING IN
THE RESEARCH?
AND THE ANSWER IS, YOU WILL NOT
BENEFIT FROM PARTICIPATING IN
THE RESEARCH.
AND I THOUGHT, OH, I BELONG
HERE.
I'M AT HOME WITH THIS.
AND SO I FELT LIKE THIS IS A
REAL OPPORTUNITY TO ADVANCE THE
SCIENCE, I KNOW THE SCIENCE
NEEDS ADVANCING AND I COULD BE
PART OF IT.
THERE'S MORE IMMEDIATE PIECES OF
IT THAT MATTER, A LOT OF
VALIDATION THAT COMES FROM BEING
PART OF THE RESEARCH AT NIH,
JUST FINALLY UNDERSTOOD PEOPLE
WHO KNEW WHAT I WAS GOING
THROUGH AND HAVING TESTS THAT
WOULD DOCUMENT THAT YES,
SOMETHING'S DIFFERENT ABOUT YOU
GOING ON.
COUPLE MORE THINGS BUYER I WRAP
UP, A LOT OF PEOPLE ASK ABOUT
HOW THE VACCINATION AFFECTED ME
WHEN THE VACCINATIONS CAME OUT,
THERE WAS A LOT OF PRESS ABOUT
PEOPLE GETTING BETTER AFTER
RECEIVING THE VACCINE.
THAT'S PLAUSIBLE, 1 OF THE
THEORIES IS THAT THERE'S
RESIDUAL VIRUS THAT IS
CONSTANTLY KEEPING OUR IMMUNE
SYSTEMS RAMPED UP, THAT WASN'T
MY EXPERIENCE.
I DON'T THINK IT'S AN EXPERIENCE
WITH MOST PEOPLE WITH LONG
COVID.
NOW ANY VACCINE I GET, THE
ORIGINAL 1, BOOSTERS, VACCINE,
I'M BEDRIDDEN FOR 2-4 DAYS AFTER
THE SHOT AND THEN I RETURN TO
THIS LIMITED STATE THAT I'VE
BEEN OPERATING IN.
>> MR. SIEVERTS, WE HOPE YOU ARE
PARTICIPATING WITH US
APPROXIMATE BECAUSE YOUR POINT
OF VIEW IS ABSOLUTELY CRITICAL
FOR THE SCIENTISTS, THE BASIC
SCIENTISTS AND THE CLINICAL
INVESTIGATORS, IS SO WE REALLY U
SHARING YOUR PERSONAL STORY
BECAUSE WITHOUT THE PATIENT WE
MAY BE STUDYING THE WRONG THINGS
AND SO, YOU BRING US BACK TO
WHERE WE REALLY NEED TO PUT OUR
ATTENTION AND THE SYMPTOMS ARE
ABSOLUTELY CRITICAL IN MODELING
THIS AND ANIMAL, BASIC SCIENCE
STUDIES AS WELL AS FOR THE
CLINICAL INVESTIGATORS TO
ADDRESS THE MOST IMPORTANT
THINGS THAT ARE AFFECTERRING THE
PATIENT SO WE REALLY, REALLY
APPRECIATE YOUR COMING AND
SHARING THIS WITH US.
BUT UNFORTLY WE HAVE A VERY
TIGHT SCHEDULE, WE HAVE--WE HAVE
A WHOLE LOT OF PEOPLE THAT ARE
GOING TO BE TALKING TODAY, SO
PLEASE PARTICIPATE GOING
FORWARD.
>> LET ME THANK YOU ALL, HAPPY
TO PARTICIPATE.
I'LL DO WHAT I CAN, I'M VERY
GLAD THAT ALL OF YOU ARE
FOCUSING ON THIS, BECAUSE
IT'S--IT'S VERY IMPORTANT TO ME
SO I APPRECIATE YOUR TACKLING
THIS AND TAKING ON THIS PUZZLE.
>> AND YOU REPRESENT A LOT OF
OTHER PEOPLE BY COMING FORWARD
IT'S REALLY, REALLY HELPS ALL
THEM, TOO, SO THANK YOU AGAIN.
SO NOW WE'RE GOING TO TURNOVER
TO MARK CHAPPELL, WHO WILL RUN
THE NEXT SESSION AND IF YOU
COULD MAYBE EXIT YOUR SCREEN
MR. SIEVERTS, SO MARK WILL BE
ABLE TO HOLD THE SCREEN.
THANK YOU.
SO MARK CHAPPELL, IS AN OLD
COLLEAGUE OF MINE.
HE'S BEEN AROUND FOR A LONG
TIME.
HE'S A TENURED PROFESSOR IN THE
VASCULAR RESEARCH CENTER AT WAKE
FOREST.
I'VE KNOWN HIM FOR MANY YEARS
BECAUSE HE KEEPS PUBLISHING ALL
THIS SEMINOLE RESEARCH, LIKE
THERT YEARS OF SEMINOLE RESEARCH
WHICH IS THE AREA THAT MY LAB
STUDIES.
SO HE'S PARTICULARLY AN EXPERT
IN ACE 2, AND OTHERWISE KNOWN AS
THE RECEPTOR FOR SARS-COV-2
WHICH UNDERLIES COVID-19.
ACE 2 BECAUSE IT GETS A BAD RAP
BEING THE RECEPTOR FOR THE VIRUS
IS ACTUALLY A REALLY GOOD GUY
AND DR. CHAPPELL HAS STUDIED
THIS ROLE IN HYPERTENSION AND
RENAL DISEASE AND FETAL
PROGRAMMING AND IN DIABETES IT'S
REALLY A GOOD PLAYER.
SO DR. CHAPPELL, IS 1 OF THE
FIRST TO INVESTIGATE SEX
DIFFERENCES IN HYPERTENSION.
A LONG TIME BEFORE IT WAS A HOT
TOPIC AND HE FINALLY CONVINCED
PEOPLE TO COME OVER TO THIS
REALIZATION THAT THERE'S
SOMETHING REALLY IMPORTANT HERE
THAT THERE'S THIS IMPACT OF
BYOLOGICAL SEX AND 1 OF THE
THINGS HE DOES IS HE ESTABLISHES
REALLY IMPORTANT RAT MODEL WHICH
IS 1 OF THE MOST STRIKING
EXAMPLES OF SEX DIFFERENCES IN
HYPERTENSION.
AND IT'S REALLY BEEN REALLY
IMPORTANT MODEL FOR BASIC
SCIENTISTS TO USE IN STUDYING
THE MECH INFORMS THAT ARE
UNDERLYING THESE DIFFERENCES.
HIS FUNDING HAS BEEN ENVIABLE, I
THINK HE GOT FUNDED FROM--AS A
PREDOCTORAL STUDENT AND AS A
POST DOC AND HE CONTINUES TO BE
FUNDED.
IT'S CONTINUOUS, IT'S
UNINTERRUPTED SINCE 19 INTERRUPN
ENVIABLE PUBLICATION RECORD, 200
JOURNAL ARTICLES THAT HAVE BEEN
CITED OVER 23,000 TIMES.
HE'S A FELLOW OF THE AMERICAN
HEART ASSOCIATION ON THE COUNCIL
ON HYPERTENSION AS PLAYED A BIG
ROLE IN THE AMERICAN HEART
ASSOCIATION IN MANY WAYS OF
DOING SERVICE, AND HE'S FROM
GRANT REVIEWS TO BEING MEMBERS
OF LEADERSHIP AND PROGRAM
COMMITTEES.
HE'S 1 OF THE THINGS THAT'S
WONDERFUL ABOUT DR. CHAPEL IS
NOT ONLY IS THE INCREDIBLE
SCIENTIST, HE'S ALSO TAKEN THE
TIME TO MENTOR AND TRAINED OVER
60 UNDERGRADUATES AND JUNIOR
FACULTY AND HE'S A REALLY STRONG
SUPPORTER AND ADVOCATE FOR
INCREASING CULTURAL AND ETHNIC
DIVERSITY AND SCIENCE AND I
APPLAUD HIM FOR THAT AND HE'S
ALSO THE DIRECTOR OF THE U.S.
BRAZIL BIOMEDICAL SCIENCES
EXCHANGE PROGRAM AND HE'S GOING
TO MODERATE OUR SESSION TODAY,
OUR NEXT SESSION ON THE
MECHANISMS UNDERLYING SEX
DISPARITIES IN COVID-19
OUTCOMES.
SO, MARK, TAKE IT,A WAY.
>> CAN WE HAVE SOME HELP?
>> PLEASE UNMUTE YOUR MIC AND
TURN ON YOUR CAMERA.
ANOTHER INTERESTING FACT ABOUT
DR. CHAPPELL, IS THAT HE'S AN
ARTIST.
I HAVE SEVERAL PHOTOGRAPHS HE'S
DONE IN MY LIVING ROOM AND HE'S
GOTTEN INTO SOUND SO IF YOU HAVE
ANY STEREO QUESTIONS, GO
DIRECTLY TO HIM, MARK?
>> OKAY, OKAY, WE GOTTA STOP
NOW, THIS IS GETTING--[LAUGHTER]
THANK YOU VERY MUCH.
THAT WAS A WONDERFUL
INTRODUCTION.
I'M TRYING TO GET BACK TO MY
POWER POINT AND THE OVERVIEW OF
THE SLIDES.
>> DO YOU SEE THEM SIR?
>> ARE YOU ABLE TO PULL THEM?
>> SURE, I HAVE THEM RIGHT HERE.
>> GREAT MUCH.
>> OKAY, THANK YOU, GREAT.
>> NO PROBLEM.
CAN YOU SEE THEM SIR?
>> YEAH.
JUST TELL ME NEXT SLIDE.
I WILL ADVANCE THEM.
>> THANK YOU AGAIN.
THANK YOU FOR THE WONDERFUL
INTRODUCTION.
LET ME JUST ALSO REPLY TO
KATHRYN AND I HAVE KNOWN EACH
OTHER FOR A LONG TIME AND IT'S
BEEN AN INTERESTING PROFESSIONAL
RELATIONSHIP GROUNDED IN OUR
INTERESTS IN CARDIOVASCULAR
REGULATION IN SEX DIFFERENCES
AND I'VE REALLY ENJOYED MY
RELATIONSHIP WITH KATHRYN OVER
THE YEARS, ATTENDING MEETINGS,
BEING ON STUDY SECTION,
REVIEWING EACH OTHERS PAPERS AND
I THINK IT'S ALWAYS A BENEFIT TO
ME, AND CERTAINLY 1 I WOULD
CONSIDER HER 1 OF MY BEST
COLLEAGUES PARTICULARLY IN TERMS
OF SEX REGULATION AND
CARDIOVASCULAR DISEASE.
SO I JUST WANT TO REITERATE AS
PREVIOUSLY MENTIONED THIS
WORKSHOP, THE ATTEMPT OF THIS
WORKSHOP IS TO BRING TOGETHER
BASICALLY CLINICAL SCIENTISTS TO
REVIEW THE CURRENT KNOWLEDGE AND
KNOWLEDGE GAPS IN OUR
UNDERSTANDING OF SEX AND GENDER
DIFFERENCES OF COVID-19 OUTCOMES
THAT ARE RELEVANT TO THE HEART,
LUNG, BLOOD AND SLEEP DISORDERS.
THE GOAL IS TO PROMOZ STRATEGIES
TO FACILITATE THE TRANSLATION OF
BASIC BIOLOGICAL DISCOVERIES,
ALWAYS RATHER DIFFICULT INTO
CLINICAL APPLICATIONS TO IMPROVE
OUR ABILITY TO DEVELOP SEX
GENDER SPECIFIC PREVENTION,
INTERVENTION AND IMPLEMENTATION
STRATEGIES FROM COVID-19 RELATED
DISORDERS AND I THINK SPRVEGLY
FOR THIS SESSION, WHAT WE'RE
ATTEMPTING TO DO IS IDENTIFY
MECHANISMS REGARDING SARS-COV-2
INFECTION THAT UNDERLIE SEX
SPECIFIC DIFFERENCES IN COVID-19
OUTCOMES, BEING THE ACUTE
DIFFERENCES IN TERMS OF INITIAL
INFECTION OR APPRECIATING NOW
THESE LONG-TERM OUTCOMES
PARTICULARLY THOSE THAT AGAIN
DISTINGUISHING ACUTE LONG-TERM
COVID RELATED DISORDERS, LET ME
ALSO ACKNOWLEDGE THE TREMENDOUS
EFFORTS OF THE ORGANIZING TEAM
FROM NIH AND SYNERGY AND
DR. [INDISCERNIBLE], AND CO
CHAIRS THAT HAVE PLANNED AND
CONSTRUCTED THESE SESSIONS.
LET ME ALSO ACKNOWLEDGE MICHAELS
TESTIMONY AND SHARING HIS
PERSONAL VIEWS ON COVID AND AS
KATHRYN SAID FOR BASIC
RESEARCHERS, CLINICAL
RESEARCHERS, IT'S REALLY
CRITICAL TO HEAR FROM PATIENTS
AND THEIR PERSONAL VIEWS, IN
THIS CASE ON THE MANIFESTATIONS
OF COVID-19.
NEXT SLIDE.
SO TO BEGIN THIS SESSION, LET ME
FIRST INTRODUCE OUR EXCEPTIONAL
PANEL OF SPEAKERS TO ADDRESS
THESE TOPICS INCLUDING STANLEY
PERLMAN, DANIEL BAROUCH,
EILEEN SCULLY, AND DR. JOHN
TSANG, TO BEGIN WITH
DR. PERLMAN, OUT OF IOWA, HIS
LONG EXPERTISE FOCUS ON CORONA
VIRUS PATHOGENESIS AND INCLUDING
DEMILENNATION AND THE SARS,
MERSS AND COVID-19, PARTICULARLY
MECHANISMS BY WHICH AGE PATIENTS
IN MICE DEVELOP MORE SEVERE
DISEASE THAN YOUNGER INDIVIDUALS
AFTER INFECTION WITH SARS COV1
AND 2 AS WELL AS MALE
PREDOMINANCE OF PATIENTS WITH
MORE SEVERE DISEASE, AND THAT'S
OBVIOUSLY HIGHLY REALLY VANT FOR
TODAY'S SESSION.
DR. BAROUCH, IS THE PROFESSOR OF
IMMUNOLOGY AT HARREGARDVILLE
CENTER AND THE CENTER FOR
VIROLOGY AND VACCINE RESEARCH AT
BETH-ISRAEL MEDICAL CENTER IN
MASSACHUSETTS AND HIS EXPERTISE
FOCUS ON THE VIRAL INFECTIONS
DEVELOPING NOVEL VACCINE AND
TREATMENT STRATEGIES.
THIS GROUP HAS ALSO LED TO THE
DEVELOPMENT OF VACCINE
CANDCANDIDATES AND TEBERKULOSEIS
AND SARS KICKOFF-2 WHICH
CONTRIBUTED TO THE JOHNSON AND
JANUARY COVID-19 VACCINE AS WELL
AS OTHER MULTIPLE COVID VACCINE
AND THERAPEUTICS.
DR. SCULLY IS INFECT YOWZ
DISEASES AND PHYSICIAN
SPECIALIZING IN CARE OF PEOPLE
LIVING WITH HIV INFECTION, LEADS
A LOT OF INVESTIGATIVE IMMUNE
RESPONSES TO HIV AND HIV CURE
INTERVEKSS THAT FOCUSES ON
BIOLOGICAL SEX, IMMUNE RESPONSES
AND HIV AND SARS-COV-2 SYNDROMES
AND FINALLY DR. TSANG IS A
SENIOR INVESTIGATOR AT THE IN,
IH, INTRAMURAL PROGRAM FOCUSING
ON SYSTEMS QUANTITATIVE
IMMUNOLOGY WITH THE NIAID, AND
CHIEF OF THE MULTISCALE SYSTEMS
BIOLOGY SECTION AND CO DIRECTS
THE TRANS-CENTER IN IMMUNOLOGY
AND LEADS THE PROGRAM IN
IMMUNOLOGY, HIS WORK INVOLVES
SYSTEMS BIOLOGY AND IMMUNE
RESPONSE FOR SARS-COV-2 AND
FINALLY AS YOUR MODERATOR I AM A
PROFESSOR AT WAKE FOREST
UNIVERSITY SCHOOL OF MOODS --MEE
AT NORTH CAROLINA, I HAVE
STUDIED CARDIOVASCULAR DISEASE
FOR THE PAST 40 YEARS THAT
INCLUDES SEX DIFFERENCES IN
PRESSURE AND DAMAGE ORGANS AND
MORE RECENTLY THE IMPACT OF
COVID-19 RELATED EVENTS ON THE
RENAL AND ANGIO TENSEIN SYSTEM.
NEXT SLIDE.
SO IN OUR SESSION WE HAVE 5
SCHEDULED TALK THAT WILL BE
FOLLOWED BY DISCUSSION PERIOD AT
THE END OF THE LAST TALK.
I WILL LEAD OFF THIS SESSION
WITH A PRESENTATION ON SIGNALING
AND SARS-COV-2 ENTRY REGULATION
AND EFFECTS, THIS WILL BE
FOLLOWED BY DR. PERLMAN'S TALK
ON ANIMAL MODELS FOR OOSK 19 AND
DR. BAROUCH'S TALK ON SEX
DIFFERENCES ON OOSK 19 VACCINES
AND THEN FOLLOWED BY
DR. SCULLY'S TALK ON IMMUNE
RESPONSE IN COVID-19 AND THEN
MULTIOMICS SINGLE CELL
DISSECTION OF INFLUENZA VACCINE
REVEAL SEX DEPENDENT IMMUNE
IMPRANTS AFTER RECOVERY FROM
MILD COVID-19, BY DR. TSANG AND
SINCE I'M BEING PAID BY THE
WORD, I APPRECIATE DR. TSANG'S
TITLE BECAUSE I CAN VACATION
DOWN AT MYRTLE BEACH.
SO I WANT TO EMPHASIZE THESE
EFFECTS IN TERMS OF OF THE
CARDIOVASCULAR SYSTEM OF ACUTE
EFFECTS OF SARS AND ITS
RELATIONSHIP TO THE ANGIO
TENSIVE SYSTEM.
I HAVE NO CONFLICTS OF INTEREST
TO DECLARE CONCERNING THIS
PRESENTATION.
NEXT SLIDE.
SO AS MENTIONED IN THE PREVIOUS
TALKS, IT'S NOW WELL ESTABLISHED
THAT ACE 2 OR ANGIO TENSEINS 2
IS THE ACE RECEPTOR, ACE 2 IS A
LARGE PEPTIDE O EDUCATIONAL ACE
THAT'S PREMARKET AUTHORIZATION
BRAIN BOUND OR SURFACE BROWN
ALTHOUGH THOSE ARE FOUND IN
BLOOD, URAN AND IT METABOLIZES
VARIOUS PEPTIDES THAT ARE
RELATED TO CARDIOVASCULAR SYSTEM
PARTICULARLY IN THE RENAL AND
ANGIO TENSEINS SYSTEM, IT
PRESENTS MULTITETARGETS FOR THE
SARS VIRUS, IT'S GENTLEMENLY
CONSIDERED THE POINT OF ENTRY
FOR THE SARS VIRUS BUT ACE 2
EXHIBITS DISTRIBUTION LIKE GUT,
HEART, BRAIN, KIDNEY, OVARY, AND
SO NOT ONLY IS IT A POINT OF
ENTRY FOR SARS BUT SARS
INFLUENCING ACE 2 EXPRESSION CAN
THEN IMPACT THE ORGAN FUNCTION
OF EACH OF THESE TISSUES THROUGH
THE REGULATION OR DISREGULATION
OF THE ANCHLIO TENSEIN SYSTEM,
EXPERIMENTAL EVIDENCE SUGGEST
THAD BLOCK AID OF THE SYSTEM
PARTICULARLY THRIEWS ACE
INHIBITORS OR PROTAGONIST FOR
THE CARDIOVASCULAR AGENTS
INCREASE ACE 2 EXPRESSION AND
ACTIVITY AND HIGHER ACE TBO
ACTIVITY THAT MAY CONTRIBUTE TO
THE BLOOD PRESSURE LOWERING
CARDIOVASCULAR EFFECTS OF RAS
BLOCKADE IN PATIENTS.
THIS COULD PRESENT ISSUES IN
TERMS EVER IS IT FACILITATING
SARS ENTRY INTO TISSUES, AND IT
HAS LED TO A LOT OF CONTROVERSY
ABOUT TAKING PATIENTS OFF THESE
AGENTS TO CONTROL BLOOD
PRESSURE.
SARS IS--ACE 2 IS LOCATED ON THE
X-CHROMOSOME AND THIS SEX,
LOCALIZATION OF ACE 2 MAY
REFLECT DIFFERENCES ON ACE 2
EXPRESSION OR ITS PRODUCT, THAT
COULD CONTRIBUTE TO
CARDIOVASCULAR PROTECTION
PARTICULARLY IN WOMEN.
AND FINALLY, ACE 2 COMPLEXES
WITH THE SERIES POINTSINE
PROTEASE, TMPRSS 2 WHICH IS
NECESSARY TO STIMULATE THE
INTERNALIZATION OF SARS-CCROSS
LINKING V-2 FOR INFECTION.
NEXT SLIDE.
I WAS SHOWN IN THIS SLIDE, THIS
IS A BRIEF INTRODUCTION TO THE
BINDING, AND INTERNALIZATION OF
SARS, WITH THE ACE 2 TMPR
COMPLEX, THE SPIKE DOMAIN WHICH
THE SPIKE PROTEIN COMPRISED THIS
1 AND IT INITIALLY BINDS WITH
HIGH AFFINITY TO SURFACE BOUND
ACE 2, THIS CASES A COMPLEX WITH
TMPRSS2 WHICH CLEAVES THE S1
DOMAIN CAUSING CONFIRMATIONAL
CHANGE IN SARS VIRUS ACE 2
COMPLEX AND INTERNALIZATION, AND
IMMUNE RESPONSES BY THE SARS
VIRUS AS WELL AS DOWN REGULATION
BASE 2 AND TARGET TISSUES, NEXT
SLIDE.
I'M SORRY, CAN YOU GO BACK 1?
I SHOULD ALSO MENTION THAT THIS
EXISTING SEARCH THAT SUGGESTS
THAT BOTH ACE 2 AND TMPRSS2 ARE
ANDROGEN RESPONSIVE MEANING THAT
ANDROGENS CAN INCREASE THE
EXPRESSION OF BOTH TMPR AND ACE
2 THAT MAY REFLECT THE
DIFFERENCES OF THE SEVERITY OF
SARS-COV-2 INFECTION IN MALES.
NEXT SLIDE.
AND INDEED LEACH AND COLLEAGUES
SHOWED THAT THE ANDROGEN
RECEPTOR TMPRSS2, AND THESE ARE
CO LOCALIZED WITHIN HUMAN
PULMONARY TISSUE WITHIN THE TYPE
2 ALVEOLAR CELLS SUGGESTING
THESE MAY WORK IN CONCERT TO
REGULATE THIS VERSION OF THE
TMPRS 2 AND THESE INVESTIGATORS
ALSO FIND AND RECEPTOR AND
GLUTEMID AND ENSWRO GLUTEMID
ANDROGEN RECEPTOR ANTAGONIST
REDUCE THE INTERNALIZATION OF
THE SARS-SPIKE PROTEIN AND A549
CELLS THESE ARE HUMAN ALVEOLAR
CELL LINE AND THEY ALSO REDUCED
THE VIRAL INFECTION IN THESE
CELLS, SO SUGGESTING THAT
BLOCKADED ANDROGEN RECEPTOR MAY
INFLUENCE THE SARS INFECTION.
NEXT SLIDE.
AND SO THIS LED TO THIS
HYPOTHESIS THAT BLOCKING
ANDROGEN RECEPTORS TO REDUCE THE
EXPRESSION OF TMPRSS2 AND
POSSIBLY ACE 2 MAY BE A
PREVENTATIVE MECHANISM IN
ATTENUATING SARS BINDING AND
INFECTION OF THE CELLS
PARTICULARLY IN THE LUNG, NEXT
SLIDE.
HOWEVER, [INDISCERNIBLE] ET ALL
REPORTED ALMOST NO SEX
DIFFERENCES IN TERMS OF ACE 2
EXPRESSION IN THE LUNGS OF MALES
AND FEMALES THEY ALSO FOUND NO
EVIDENCE OF ANDROGEN REGULATION
OF THE MURINE TMPRSS2, THAT'S
OCCURRING IN PROSTATE NOW THEY
DID FIND THAT MALES EXHIBITED
HIGHER EXPRESSION OF ACE 2 THAN
MALE NONSMOKERS OR FEMALE
SMOKERS SUGGESTING THAT SMOKING
AT LEAST FOR MALES MAY BE A RISK
FACTOR FOR HIGHER SARS INFECTION
AND SEVERITY OF INFECTION.
NOW 2 CLINICAL TRIALS LOOKING AT
ANDROGEN BLOCKADE, THEIR
FINDINGS WERE RECENTLY PUBLISHED
AND THIS INCLUDED THE HITCH AND
THE NSAID TRIAL THE HITCH
RELEASE WITH DEGA RELIX HOUR,EN
THIS TRIAL WAS TERMINATED EARLY
AND IT FAILED TO SHOW BENEFIT
FROM THE PRIMARY OR SECONDARY
OUTCOMES.
IN TERMS OF COVIDENZA, USED
AN ANTAGONIST TO BLOCK IT AND
SHOWED POSSIBLY WORSENED
COVID-19 SYMPTOMS IN BOTH MEN
TAKING ENZALUTAMIDE, AND THIS
WAS PRIMARILY TERMINATED DUE TO
LACK OF BENEFIT.
NEXT SLIDE.
NOW IN THAT STUDY FROM THE COVID
TRIAL, THEY ALSO LOOKED AT
PRIMARY LUNG ALVEOLAR CELLS AND
LOOKED AT ENZOLUTAMID ON ACE 2
EXPRESSION AND CONSIST WENT THE
RESULTS OF THE TRIALS OF
PATIENTS, THESE INVESTIGATORS
FAILED TO DEMONSTRATE THAT
BLOCKADE AND ANDROGEN RECEPTORS
HAD ANY EFFECT ON SARS-COV-2
INFECTION EITHER IN MALES OR
FEMALES OF PRIMARY LUNG CELLS,
AND THEY ALSO SHOWED THAT
ANDROGEN BLOCKADE FAILED TO
EFFECT THE EXPRESSION OF TMPR OR
ACE 2 IN THESE PULMONARY CELLS
SUGGESTING THAT INDEED ANDROGEN
BLOCKADE MAY NOT BE THE
MECHANISM FOR SEVERITY IN MALES
IN THESE PATIENTS, NEXT SLIDE.
>> ABOUT 2 MINUTES.
>> SO WHAT ABOUT, IS IT POSSIBLE
THAT SEX DIFFERENCES MAY REFLECT
ALTERATIONS IN RAS, THIS SLIDE
IS ESSENTIALLY DEPICTING THE 2
ARMS OF THE RAS WHERE SARS CAN
DOWN REGULATE ACE 2 AND WE DO
SAY THE 1-7 ARM ESTROGEN CAN
BUFFER THIS EFFECT, GENERALLY
ESTROGEN HAS BENEFITS IN TERMS
OF 1-7 ACCESS, IN CONTRAST SARS
MAY ENHANCE THE EDGE 2 ACCESS
VIA INFLAMMATORY EFFECTS AND
ANDROGENS GENERALLY HAVE A
STIMLATTORY EFFECT ON THE
X-AXIS.
NEXT SLIDE.
NEXT SLIDE--GO BACK 1.
BACK.
YEAH, SO INDEED, LEE WAS THE
FIRST TO REPORT THAT ACTUALLY
THERE'S AN ACTIVATED INTENSIVE
SYSTEM IN COVID-19 PATIENTS THEY
SHOWED THAT PLASMA LEVELS WERE
MARKEDLY ELEVATED IN COVID-19
PATIENTS AND THAT THE PLASMA
LEVELS ASSOCIATE WIDE THE VIRAL
LOAD OF PASHTS AND THESE DATA
ALBEIT IN A SMALL NUMBER OF
PATIENTS ACTUALLY SUPPORTED THE
TENET THAT COULD IT LEAD TO
HIGHER LEVELS OF ANG II IN THE
EXPANSE OF 1-7.
NEXT SLIDE.
JUST TO BRIEFLY GO OVER SOME OF
THIS DATA, WE ACTUALLY OBTAINED
THE LINES THAT WERE USED BY
[INDISCERNIBLE] AND ACTUALLY
FOUND THAT THESE EALIZA KITS
WERE ACTUALLY NOT SPECIFIC AND
COULD NOT RECOGNIZE THE ANG II
OR PLASMA LEVELS OR OUR
STANDARDS AND WE HAVE GRAVE
CONCERNS ON WHAT LEE WAS
MEASURING WHETHER THIS REALLY
REFLECTS ALTERATIONS IN ANGIO
TENSEIN 2 AS WELL AS A NUMBER OF
STUDIES THAT HAVE BEEN PUBLISH
THAD UTILIZE THESE EALIZAS IN
1-7 AND IN SOME CASES IN COVID
PATIENTS.
NEXT SLIDE.
>> YOU NEED TO WRAP UP, PLEASE.
>> LOCK THESE LINES WE WERE ABLE
TO SHOW WE SAW NO DIFFERENCES IN
OUR LEVELS OF ANGIO TENSIVE 1 TO
2 OR 7 IN MILD FORMS OF SEVERE
COV-2 SO THESE ARE ALL
HOSPITALIZED PATIENTS, WE ALSO
NOTED NONAPOPTOTIC DIFFERENCES
IN SERUM ACE OR ACE 2 ACTIVITY.
IN COVID-19 PATIENTS AND THE
PRIMARY OUTCOME OR END POINTS IS
OXYGEN 3 DAYS, OR DAYS ALIVE OR
SUPPLEMENTAL OXYGEN ASK THERE
ARE 2 TREATMENT ARMS TO THIS
LARGE TRIAL 1 IS TXA TO 127 OR
1-7 LEVELS THAT MAY BE DEPLETED
IN SARS COV-2 PATES AS WELL AS
TRV027 THIS IS AN AGONIST AND
BOTH ARE GIVEN FOR ABOUT 5 DAYS
NOW RECENTLY AND THIS IS A
FAIRLY LARGE TRIAL WITH 900
PATIENTS INCLUDING MA SEEB OS,
NOW THIS TRIAL WAS STOPPED AS
BOTH THE 1-70 AND THE RECEPTOR
AGONIST WERE SHOWN TO BE
INFERIOR PLACEBO ARM IN COVID
PATIENTS.
MORE OVER IN A SEPARATE TRIAL
PREEMENT WITH THE ATR BALAPSE
ALSO FAILED TO IMPROVE COVID-19
OUTCOMES SO I THINK THE TAKE
HOME MESSAGE IS THAT REGULATION
OF THE SYSTEM TARGETED THE
SYSTEM AT LEAST IN THE ACUTE
EFFECTS IN COVID-19 PATIENTS IS
REALLY DOES NOT IMPROVE
OUTCOMES.
I DO NOT THINK THAT ACCOUNTS FOR
SEX DIFFERENCES IN THE TERMS OF
COVID-19 EMPLOY THIS LEADS ME TO
REALLY INTRIGUING DATA THAT
[INDISCERNIBLE] AND COLLEAGUES
PUBLISHED RECENTLY AND THESE ARE
ON THE LONG-TERM EFFECTS OF
COVID-19 IN TERMS OF
CARDIOVASCULAR DISEASE
PARTICULARLY SHOWING A GREATER
RISK IN CARDIOVASCULAR DISEASE
IN PATES WHO DO NOT HAVE
UNDERLYING CARDIOVASCULAR
DISEASE, PARTICULARLY ATRIIOLE
FIBRILLATION AND HEART FAILURE,
NEXT SLIDE.
AND I WANT TO FOCUS ON THE
POSSIBILITY IN TOMORROWS OF
IMMUNE RESPONSES AND THE
GENERATION OF AUTOANTIBODIES
PARTICULARLY TO THE AT1 RECEPTOR
AND ACE 2 IN COVID PATIENTS.
RODRIGUEZ AND PEREZ SHOWS
THERE'S INCREASE IN THESE
AUTOANTIBODIES THAT MAY BE
STIMLATTORY FOR THE RECEPTOR OR
INHIBITORY FOR ACE 2 IN COVID-19
PATIENTS AND IT'S QUITE
INTERESTING TO NOTE THAT BOTH
MALES AND FEMALES HAVE A
COMPARABLE RESPONSE IN THESE
AUTOANTIBODIES.
>> NEXT SLIDE.
THESE ACE 2 ANTIBODIES IN
COVID-19 PATIENTS SHOWING BOTH
THESE ANTIBODIES INDUCE
ACTIVATION OR ADDITION, ALTHOUGH
THE MAJORITY OF THESE ANTIBODIES
ARE ACE 2 INHIBITORYS AND OTHERS
ARE SHOWN THAT THESE ANTIBODIES
MAY NOT EFFECT AT ALL BUT MAY
STIMULATE THESE RELEASE SO
THRESHOLD'S REALLY A MYRIAD OF
ACTIONS OF THESE AUTOANTIBODIES.
NEXT SLIDE.
AND FINALLY, I WANT TO END WITH
VERY INTRIGUING DATA BY
[INDISCERNIBLE] AND HER
COLLEAGUES RECENTLY PUBLISHED IN
NATURE SHOWING NOT ONLY ARE
THERE GENERATION OF THESE
RESOAPTORS BUT OTHER EFFECTOR
SYSTEMS LIKE THE BK1 RECEPTOR
WHICH IS INVOLVED IN
INFLAMMATION AND I SPECULATE
THAT THEN THE GENERATION OF
THESE AUTOANTIBODIES TO OTHER
GTCR RECEPTORS MAY UNDERLIE THE
CONTRIBUTION IN TERMS OF THE
LONG-TERM ACTIONS OF COVID
IMPACTING CARDIOVASCULAR
DISEASE, PARTICULARLY IN
ADDITION TO THE NATURAL LIGASE
FOR THESE RECEPTORS INCLUDING
THE ANCHLIO TENSEIN 2 WITH THE
RECEPTOR, THE BK1 RECEPTOR AND
THE OTHER RECEPTORS THAT AGAIN
MAY CONTRIBUTE TO LONG-TERM
ACTIONS ON CARDIOVASCULAR
DISEASE IN ADDITION TO THE FACT
THAT COMPENSATORY SYSTEMS SUCH
AS THE [INDISCERNIBLE] SYSTEM
AND THE PEPTIDES MAY BE DOWN
REGULATED IN THEEZ SYSTEMS IN
LONG-TERM EFFECTS OF COVID.
AND ADDRESS GAPS IN KNOWLEDGE,
4-PINTS HERE, I WOULD EMPHASIZE
THE EFFECTS OF PEPTIDES AND WITH
THE ANCHLIO TENSIVE SYSTEM IN
MALE AND FEMALE COVID-19
PATIENTS.
I WOULD POINT TO ORGANELLES MAY
BE MORE APPROPRIATE IF THEY ARE
REPRESENTING THE RIGHT POINT OF
THOSE.
AS A THIRD POINT, I THINK THIS
RUNS THROUGH ALL OF THESE
PRESENTATIONS IS DISTINGUISHING
THE ACUTE VERSUS THE LONG-TERM
EFFECTS OF COVID-19 INFECTION,
PARTICULARLY THE INCREASED RISK
IN CARDIOVASCULAR DISEASE AND I
WILL END FINALLY WITH
IDENTIFYING OTHER POTENTIAL
REGULATORS WITH THE SYSTEM AND
THEIR POETIC TEBTIAL INTERACTION
WITH ADDITIONAL EFFECTOR
SYSTEMS, BOTH STIMLATTORY AND
COMPENSATORY IN LONG-TERM
COVID-19.
I THANK YOU VERY MUCH FOR
ALLOWING ME A COUPLE EXTRA
MINUTES TO COMPLETE MY TALK.
I THINK THE NEXT TALK WILL BE BY
DR. PERLMAN.
>> DR. PERLMAN, PLEASE UNMUTE
YOUR MICROPHONE AND TURN ON YOUR
VIDEO.
>> OKAY, I AM GOING TO START
GONE BECAUSE I THINK I WAS
MUTED.
SO I WANT TO THANK THE
ORGANIZERS FOR INVITING ME AND
DR. CHAPPELLFOR INTRODUCING ME
BUT I WILL TALK TODAY ABOUT IS
ANIMAL MODELS FOR SEX AND GENDER
DIFFERENCES IN COVID-19.
AND I'M GOING TO START BY
DESCRIBING SOME OF THE THINGS WE
THOUGHT ABOUT FOR SEVERAL YEARS
BECAUSE, I WAS DESCRIBED EARLIER
WE'VE BEEN WORKING WITH CORONA
VIRUSES FOR MANY, MANY YEARS AND
IT WAS NOTICED EARLY ON THAT
THERE WERE DIFFERENCES IN
OUTCOMES IN MALES AND FEMALES
WITH SARS-COV-THE ORIGINAL SARS
IN 2003.
SO, THE--THE KINDS OF THINGS
THAT WE WANTED TO DO IS WE DO
WORK MOSTLY WITH MICE, SO WE
WANTED TO SEE IF WE COULD MIMIC
SOME OF THESE DIFFERENCES IN
MICE AND I HAVE TO SAY THAT WHEN
WE STARTED LOOKINGA THE THIS, IT
TURNED OUT THAT THERE WAS NOT
ACTUALLY THAT MUCH DAT ABOUT
HUMANS WHO ARE INFECT WIDE SARS
WHETHER MEN OR WOMEN DID WORSE
AND THERE WERE 2 STUDIES I COULD
COME UP AND WE CAME UP WITH
SEVERAL YEARS AGO, SO THIS IS 1
STUDY THAT SHOWED THAT MALES HAD
A 21.9% MORTALITY AND FEMALES AT
13.2% MORTALITY SO A RELATIVE
RISK OF 1.62.
ANOTHER STUDY IN SING ON PORE
SHOWED THE ODDS RATIO WAS 3.1 SO
AGAIN MALES HAVE WORSE OUTCOMES
AND LOOKING AT A SECOND HUMAN
CORONA VIRUS INFECTION,
MERS COV, THIS WAS TRICKIER TO
FANATIC OUT, FOR MERS IT'S BEEN
A TOTAL OF 25 CASES IN THE WORLD
AND THE VAST MAJORITY ARE IN MEN
BECAUSE THEY'RE EXPOSED TO
CAMELS AND THIS IS A CAMEL
DISEASE.
SO THE WAY THIS DISEASE WORKS,
IT SPILLS OVER FROM CAMELS TO
PEOPLE PERIODICALLY, THERE'S
VERY, VERY LITTLE BETWEEN HUMAN
SPREAD WHEN THE BEGINNING OF THE
OUTBREAK OF MERS THAT WAS HUMAN
TO HUMAN SPREAD, BUT THAT WAS
MOSTLY IN HOSPITALS BECAUSE
PROCEDURES WEREN'T FOLLOWED AND
AEROSOLIZATION AND PEOPLE WERE
BT WEARING PROPER PPE.
BUT TRYING TO GO BACK AND ASK IF
THERE ARE SEX DIFFERENCES IN 1
STUDY FROM SAUDI ARABIA, AND IT
WAS FOUND THAT MEN HAD A 52%
MORTALITY AND WOMEN HAD 23%
MORTALITY.
THE GENERAL MORTALITY FOR MERS
AND 35%.
SO THESE NUMBERS ARE QUITE HIGH.
THE SIMILAR STUDY WAS DONE IN
KOREA, NOW IN KOREA THERE WAS A
SINGLE CASE OUTBREAK OF MERS.
FELLOW CAME BACK FROM THE MIDDLE
EAST ISSUES WAS NOT RECOGNIZE AS
HAVING MERS, WENT TO 5 DIFFERENT
EMERGENCY ROOMS AND ENDED UP
INFECTS 186 PEOPLE BUT THERE WAS
NO SUBSEQUENT INTRODUCTION SO IT
WAS ALL JUST FROM THIS SINGLE
PERSON.
AND THESE STUDIES BY THE KOREAN
INVESTIGATORS AND PATIENTS WERE
CAREFULLY ANALYZED IN KOREA, THE
MORTALITY WAS 23.4% IN MEN AND
16% IN WOMEN.
AGAIN, SHOWING MALE
PREDOMINANCE.
SO WE STARTED SEVERAL YEARS AGO
TRYING TO MIMIC THIS IN MICE.
THESE EXPERIMENTS WERE DONE BY A
POST DOCTORAL FELLOW IN MY LAB
[INDISCERNIBLE] WHO IS NOW ON
THE FACULTY AT OKLAHOMA STATE,
AND WHAT HE DID IS HE
DOESICISMEM EXPERIMENTS OF
INFECTING YOUNG AND OLD MICE
WITH SARS IN THIS CASE, SARS 1,
NOT WITH SARS 2.
AND HE FOUND THAT EITHER IN MICE
THAT WERE 9 MONTHS OLD OR MICE
THAT WERE 20 MONTHS OLD, THERE
WAS AIAN DIFFERENCE IN OUTCOMES
SO MALE MICE GENERALLY SUCCUMB
TO THE INFECTION, FEMALE MICE
SURVIVED AND THERE WERE NO
DIFFERENCES IN YOUNG MICE.
I SHOULD SAY 1 OF THE THINGS
THAT I MENTION THIS AGAIN, IS
C57 BLACK MICE TURN OUT TO BE A
GREAT MOUSE MODEL FOR AGE
DEPENDENT CENTER FOR EXCELLENCE
ON AGINGS FOR SARS AND SARS 2.
AND ALSO FOR DIFFERENCES IN
OUTCOMES BETWEEN MALE AND FEMALE
MICE.
SO THIS WAS THE FIRST STUDY AND
WE--THEN HE COULD ALSO DO THIS
IN BALB-C MICE BUT THE RESULTS
WERE NONAPOPTOTIC AS IMPRESSIVE.
FEMALES AT THE LOW DOSE SURVIVED
AND MALE MICE DIED.
OTHERS LOOKED AT SARS-COV-2, AND
FOR MERS WE COULD NEVER FIND SEX
DIFFERENCES IN OUTCOMES, THIS
MAY BE BECAUSE OF THE MODELS WE
USE OR WHATEVER, BUT WE COULD
NEVER REALLY PURSUE THIS TO ANY
GREAT EXTENT.
SO FOR SARS KICKOFF 2, IT
SUPPORTED THE NOTION THAT THE
OUTCOMES WERE WORSE IN MALE THAN
THIS FEMALE MICE.
SO FROM THIS PARTICULAR STUDY,
WHAT 1 CAN SEE HERE WITHOUT
READING THE LEDGE SEND THAT THE
RED LINE, SOME MICE SURVIVED,
THEY WERE FEMALE, NONE OF MALES
DID, THIS IS MORE STRIKING FOR
THE SMALLER DOSE OF VIRUS, WHERE
FEMALE MICE, 50% SURVIVE, NO
MALES DID.
SO THERE'S--A SLIGHT TENDENCY IN
THESE MICE FOR THEM TO DO WORSE
THAN FEMALE MICE.
SO THEN IN OTHER SYSTEMS, THE
SEX GENDER DIFFERENCES WERE
STUDIED OR SEX DIFFERENCES WERE
STUDIED IN HAMSTERS, SO THERE'S
NOT A TON OF STUDIES, BUT
THERE'S 1 STUDY HERE FROM
[INDISCERNIBLE] THAT SHOWED THE
MALES SHOWED MORBIDITY, GREATER
WEIGHT LOSS, MOW SIGNS OF
PNEUMONIA RECOVERED MORE SLOWLY,
THIS IS IMMUNE RESPONSE TO THE
VIRUS AND THE FEMALES MOUNTED
STRONGER ANTIBODY RESPONSES AND
THIS IS SOMETHING THAT WE SAW AS
WELL, THE IMMUNE RESPONSES WERE
STRONGER IN FEMALE MICE THAN IN
OTHER MICE.
FEMALE HAMSTERS GEPPED LOWER
VIRUS SHEDDING, MODERATE
SYMPTOMS AND MILD PATHOGENESIS
COMPARED TO MALES.
SO AT THE SAME TIE WE DEVELOPED
SEVERAL MOUSE MODELS FOR
SARS-COV-2 BUT WE HAVEN'T
ANALYZED THEM IN DIFFERENT MALE
AND FEMALE MICE, BUT IN THIS
TODAY WITH A FEW MOUSE ADAPTED
VIRUS THAT WE'RE SLOWLY GETTING
READY FOR PUBLICATION.
WE DID THESE EXPERIMENTS.
IN THIS WE COMPARED 2 GROUPS
WHICH ARE NOT THE BEST TO
COMPARE BUT THIS IS MALE MICE,
THE UPSIDE DOWN TRIANGLES AND
FEMALE MICE AT 7 MONTHS AND
AGAIN THESE ARE B6 MICE
BACKGROUND SO DISEASE SEVERITY
IS WORSE AS MICE AGE.
WHAT 1 CAN SEE HERE IS THAT
WHILE THE MALE MICE ALL DIE AT
THIS DOSE ISSUES THE FEMALE
MICE, 50% SURVIVE AND A LOWER
DOSES ALL THE FEMALES SURVIVED
AND THE MALE MICE IS 50%
MORTALITY.
SO AGAIN, SUPPORTING THE NOTION
THAT OUTCOMES ARE WORSE IN MALE
MICE COMPARED TO FEMALE MICE.
SO WHAT IS THE SUMMARY OF THESE
RESULTS AND I HAVE TO SAY,
LOOKING AT ALL THESE DATA, THIS
IS REALLY NOT A LARGE AMOUNT OF
DATA ABOUT SEX DIFFERENCES IN
EXPERIMENTALLY INFECTED ANIMALS
BUT I THINK THE SYSTEM IS THERE
FOR SOMETHING THAT WILL BE
USEFUL FOR FURTHER STUDY.
SO WITH THESE SMALL STUDIES SHOW
SHOW IS THAT SEX DIFFERENCES IN
HAMSTERS AND MICE EXIST, MALES
DEVELOP MORE SEVERE DISEASE
WHICH PARALLEL THE HUMAN
STUDIES, WE KNOW THAT B6 MICE
RIGHT NOW SEEM TO EXHIBIT THE
GREATEST SEX AND AGE DEPENDENT
DIFFERENCES AND THIS IS
SOMETHING THAT I THINK AS WE GO
FURTHER ALONG WE WILL SEE HOW
TRUE THIS IS, IF OTHER STRAINS
SHOW SIMILARITIES.
FEMALE MICE DEVELOP MORE ROBUST
T-CELL AND ANTIBODY RESPONSES.
MALES MOUNT EXUBERANT BUT
INEFFECTIVE CYTOKINE RESPONSE AS
WE SAW THIS IN OUR SARS
INFECTION TODAY WITH GREATER
NUTRIFILL AND INFLAMMATORY
MONOCYTE INTO THE LUNGS, IN 1
STUDY, THIS WAS AGAIN PART OF
THE STUDY, OUTCOMES WERE
EFFECTED BY FEMALE MORHONES SO
OVERRECTOMY OF FEMALE MICE MADE
THEM SUSCEPTIBLE AS TO INFECTION
AS WAS SEWN FOR MALE MICE, AND
BLOCKADE OF ESTROGEN SIGNALING
EFFECTS AND AT LEAST IN THESE
ANIMALS SEX AND HORMONES SEEM TO
MATTER.
SO WHAT DO WE STILL NEED DO WITH
THESE.
SO WE NEED TO CONFIRM THE ROLE
OF SEX IN LARGER STUDIES OF
SARS-COV-2 IN MICE AND HAMSTERS,
MOST STUDIES USE MALE OR FEMALE
MICE OR HAMSTERS OR BOTH, AND WE
MENTIONED THIS HAS TO CHANGE SO
WE CAN LEARN MORE ABOUT AGE
DIFFERENCES.
WE HAVE SEVERAL MOUSE ADAPTED
VIRUSES THAT CAUSE VARYING
AMOUNTS OF SEVERITY IN MICE, WE
ANTICIPATE THAT USING THESE
INDIFFERENT STRAINS AND
DIFFERENT SEX AND MICE WILL BE
USEFUL FOR LEARNING USEFUL
INFORMATION.
SOME OF THESE--SOME OF THESE
VIRUSES CAUSE MORE SEVERE
DISEASE.
THE 1 I SHOWED PREVIOUS SLIDE
WAS LETHAL BUT WE HAVE OTHERS
THAT ACTUALLY CAUSE MORE SEVERE
DISEASE AT LOWER DOSES.
ADDITIONAL SPECIES COULD BE
EVALUATED INCLUDING NONHUMAN
PRIMATES THIS, IS A CHALLENGE
BECAUSE OF THE EXPENSE AND
SHORTAGE OF NONHUMAN PRIMATES.
I ALREADY MENTIONED MOUSE
STUDIES NEED TO BE EXTENDED TO
OTHER STRAINS, INCLUDING
COLLABORATIVE CROSS MICE.
COLLABORATIVE CROSS MICE ARE
MICE THAT WERE GENERATED BY
CROSSING 8 DIFFERENT BOUNDARY
LINES OF MICE AND THE ORIGINAL
IDEA WAS TO DEVELOP ABOUT A
THOUSAND DIFFERENT LINES WHICH
WOULD BE EXPECTED TO MIMIC
SPECIFIC HETEROGENERATED AITY OF
HUMANS, SEVERAL HAVE BEEN
DEVELOPED WHICH GIVES A GREAT
RANGE OF HETEROGENERATED AITY.
AND THIS WILL BE USEFUL FOR
UNDERSTANDING DIFFERENCES IN SEX
DIFFERENCES IN OUTCOMES IN
COVID-19.
AND 1 THING THAT IS CLEAR FROM
SOME OF THESE STUDIES THAT
SUFFICIENT NUMBERS OF ANIMALS
ARE NOT USED BUT SHOULD BE USED
TO ASSESS VIRAL IMMUNOLOGICAL
PARAMETERS AND AS WAS MENTIONED
EARLIER, DATA SHOULD BE ANALYZE
INDEED TOTAL AND AFTER
CONSIDERATION IN SEX EVER
ANIMALS.
SO HOW CAN WE--HOW ELSE CAN WE
USE THESE MODELS?
SO AS I MENTIONED ALREADY, WE
NEED TO DETERMINE THE SEX
DIFFERENCES AND IMMUNE
RESPONSES.
THIS NEEDS TO BE DELINEATED.
WE NEED TO DETERMINE SEX
DIFFERENCES CAUSED BY HORMONAL
DIFFERENCES AS WE SAW IN THE
FIRST STUDIES RELATED TO
CHROMOSOME GENE DOSAGE
DIFFERENCES AND THIS IS POSSIBLE
TO DO NOW BECAUSE GENETICALLY
MANIPULATED MICE ARE AVAILABLE
FOR STUDIES AND 1 THING WE DON'T
KNOW IS IF THERE'S GOING TO BE
THE SAME KIND OF SEX DIFFERENCES
AND GENDER--SEX GENDER
DIFFERENCES THAT WE SAW EARLY IN
THE COVID-19 PANDEMIC IF THIS IS
GOING TO BE TRUE AS WE NOW HAVE
MORE INFECTIONS WITH THE OMICRON
VARIANTS SOME OF WHICH ARE
DIFFERENT FROM EACH OTHER AND
TEND TO CAUSE MORE UPPER
RESPIRATOR TRACT AND LUNG
INFECTION PARTLY BECAUSE PEOPLE
ARE EITHER IMMUNIZED OR HAVE
BEEN NATURALLY INFECT INDEED THE
PAST.
SO THEY ALL HAVE SOME IMMUNITY
TO THE VIRUS, BUT IT'LL BE
IMPORTANT TO SEE IF THESE
VARIANTS BEHAVE DIFFERENTLY THAN
THE STRAINS OF SARS-COV-2 AND
FINALLY, WAWE UNDERSTAND NOW AS
WE MOVE FORWARD IS INDUSTRY IS A
THEME OR READY IN THIS MEETING
IS LONG ASHING.
SO LONG COVID IS LIKELY TO BE
THE MAJOR ISSUE WE DEAL WITH AS
THE ACUTE PHASE OF THE DISEASE
RECEDES, WE HOPE IT RECEDES.
AND AS MENTIONED ALREADY, LONG
COVID OOSKTS THE LUNG, HEART,
BRAIN, ENDOCRINE SYSTEMS.
SO EARLY IN THE PANDEMIC 1 OF
THE MANIFESTATIONS THAT MY LAB
SAN FRANCISCO INTERESTED IN
NAUSEA, THIS WAS SHOWN TO BE
MORE IN WOMEN THAN IN MEN AND
THIS IS ALSO SEEN IN LONG COVID,
BUT MORE RECENT STUDIES SAY THIS
MAY NOT BE TRUE AND THAT
ANOSMIA, MAY BE COMMON IN BOTH
SEXES AND GENDERS BUT THIS NEEDS
TO BE TEASED OUT MORE AND IS
STUDIES SUGGEST THAT LONG COVID
IS MORE SEVERE IN WOMEN THAN IN
MEN.
AND THIS OF COURSE, THE SEX PART
OF THIS IS AN IMPORTANT THING TO
TRY TO FIGURE OUT AND SOME OF
THESE THINGS CAN BE ASSESSED IN
EXPERIMENTAL ANIMALS BUT SOME
CANNOT.
IT'S HARD TO ASK A MOUSE WHETHER
IT HAS BRAIN FOG OR FATIGUE SO
WE HAVE TO DO OTHER SURROGATE
TESTS AND THEN ALSO, I SAW 1
STUDY THAT SUGGESTED LONG COVID
WAS MORE COMMON IN WOMEN, LESS
THAN 60 YEARS OF AGE.
SO I JUST WANT TO SAY 1 THING,
WE DO HAVE ANIMAL MODELS THAT
MAY BE USEFUL FOR THESE
PHENOMENA, THE MANIFESTATIONS WE
CAN MEASURE, I MENTION THAT,
IT'S MOSTLY IN DOING MOUSE
BEHAVIORIAL STUDIES, I DON'T
KNOW IF ANY STUDIES SO FAR THAT
HAVE LOOKED AT LONG COVID TYPE
SYMPTOMS IN THE HEART OR OTHER
ORGANS OTHER THAN THE BRAIN BUT
THIS IS CLEARLY AN AREA OF
IMPORTANCE FOR UNDERSTANDING
LONG COVID AS WELL AS
UNDERSTANDING SEX DIFFERENCES.
AND WITH THAT I WILL STOP.
>> I THINK YOU ARE ON MUTE, SIR.
>> SO THANK YOU DR. PERLMAN, OUR
NEXT PRESENTATION IS
DR. BAROUCH.
>> THANK YOU MARK, I WILL SHARE
MY SCREEN.
OKAY, CAN YOU SEE MY SLIDE OKAY?
>> YEP.
>> OKAY, VERY GOOD.
SO I JUST HAVE A VERY BRIEF
PRESENTATION TODAY, I WILL BE
THE FIRST 1 TO SAY I DON'T HAVE
A LOT OF DATA ON SEX DRVESES IN
RESPONSE COVID-19 VACCINES.
BUT HOPEFULLY, A FEW WORDS OF
DISCUSSION WILL RAISE SOME
QUESTIONS AND BE USEFUL FOR THE
GROUP AS A WHOLE TO CONSIDER.
IT'S ACTUALLY A BIT IRONIC THAT
THERE'S SO LITTLE DATA ON SEX
DIFFERENCES FOR COVID-19
VACCINES BECAUSE SO MANY HAVE
RECEIVED THESE VACCINES AND SO
IT'S A--SOMEWHAT SURPRISING THAT
THERE'S NOT BEEN MORE ANALYSIS
OF THE IMMUNE EFFICACY OR THESE
VACCINES ACCORDING TO GENDER.
HERE ARE MY DISCLOSURES.
AND I DID SEEK INPUT FROM
COLLEAGUES FOR THIS BRIEF
PRESENTATION, PARTICULARLY
GALIT ALTER AND JERRY SADOFF FOR
DATA AND SLIDES.
SOPHISTICATEDY AS A BRIEF
MENTION OF BACKGROUND, AS HAS
ALREADY BEEN DISCUSSED, THERE
ARE IMPORTANT DIFFERENCES IN
TERMS OF OUTCOMES FOR MALES AND
FEMALES FOLLOWING COVID-19
INFECTION, THAT WAS RECOGNIZED
VERY EARLY ON THAT IT WAS IN THE
ELDERLY IN PARTICULAR COVID-19
INFECTION OFTEN HAD A WORSE
OUTCOME IN MALES AND FEMALES.
BUT THERE IS LESS KNOWN ABOUT
DIFFERENCES IN TERMS OF IMMUNO
GENERATEDISSITY AND OUTCOMES
FOLLOWING VACCINATION.
PRIOR TO THIS PRESENTATION, I
DID REVIEW THE 3 PHASE 3 TRIALS
FROM PFIZER, MODERNA AND J& J
FOR THE COVID VACCINES AND IN
SUBGROUP ANALYSIS THEN THERE WAS
NO SUBSTANTIAL DIFFERENCES IN
TERMS OF EFFICACY FOR THREEZ 3
COVID VACCINES BUT I DON'T THINK
THAT NECESSARILY IS THE FULL
ANSWER TO THE QUESTION.
BECAUSE AS YOU RECALL THOSE
PHASE 3 TRIALS WERE DONE EARLY
IN THE PANDEMIC AND ONLY LOOKED
AT THE POINT OF PEAK IMMUNITY
AND THEA THE TIME EMERGENCE OF
VALID -
-VARIANTS.
AND AT THAT POINT IN TIME THEY
WERE VASTLY HIGHER THAN WHAT
WERE NEEDED.
SO THE FACT THAT WE DIDN'T SEE A
DIFFERENCE BY SEX IN THOSE PHASE
3 STUDIES DOESN'T NECESSARILY
MEAN THAT THERE SUPPORT ANY, IT
COULD JUST MEAN THAT FOR THE INN
TIRE CO SHORT, THERE WAS A
SUBSTANTIAL ANTIBODY PROTECTION,
SO I WANT TO BRING THAT UP BUT I
WANT TO BRING THAT UP THAT IT'S
LARGE PHASE 3 TRIALS THAT
DOESN'T NECESSARILY MEAN THAT IS
THE COMPLETE ANSWER.
SO WORK REALLY LED BY MY
COLLEAGUE AND OTHER GROUPS I
HAVE ALSO REMINDED US THAT
ANTIBODY RESPONSES COME IN MANY
FLAVORS AND IN ADDITION TO
BINDING AND NEUTRALIZING
ANTIBODIES WHICH ARE THE 2 MOST
COMMON ANTIBODY RESPONSES
THERE'S MANY ANTIBODY FUNCTIONS
AND THESE ARE FC FUNCTIONAL
ANTIBODIES AND WORK FROM GALIT,
ALTER HAS SHOWN THERE ARE SEX
DIFFERENCES IN FC FUNCTIONAL
ANTIBODY RESPONSES.
INCLUDING SLIGHTLY HIGHER NK
CELL RESPONSES IN FEMALES AND
SLIGHTLY HIGHER NEWT NUTRIFILL
RESPONSES IN FEMALES BUT PERHAPS
SLIGHTLY HIGHER MACROPHAGE AND
COMPLEMENT RESPONSES IN MALES.
SO ANOTHER STUDY FROM DR. ALTER
SHOWS THAT THERE ARE DIFFERENCES
IN ANTIBODY FUNCTION IN COVID-19
CONVALESCENT INDIVIDUALS.
SO HERE'S A SMALL STUDY IN
CONVALESCENT MALES AND FEMALES,
SUGGESTING THAT CONVALESCENT MAY
HAVE HIGHER ANTIBODIES THAN
MALES SHOWN IN THE RED.
BUT MALES MIGHT HAVE SLIGHTLY
HIGHER IGA RESPONSES SHOWN IN
THE BLUE.
WE DON'T KNOW WHAT THE
FUNCTIONAL SIGNIFICANCE OR THE
SIGNIFICANT DIFFERENCES OF THESE
ARE, BUT THESE ARE STATISTICAL
OBSERVATIONS AT THIS POINT IN
TIME.
SO HERE'S 1 STUDY OF SEX
DIFFERENCES TO THE ASTREZENECA,
STUDY, THIS IS A STUDY IN WHICH
MALES AND FEMALES WERE STUDIED
AND ON THE LEFT ARE BINDING
ANTIBODIES AND ON THE RIGHT IS A
FUNCTIONAL ANTIBODY CALLED
ANTIBODY DEPENDENT CELL OR
PHAGOCYTOSIS, SO IN TERMS OF
BINDING ANTIBODIES WE DON'T SEE
MUCH OF A DIFFERENCE IN BINDING
ANTIBODIES BETWEEN MALES AND
FEMALES.
THIS IS A CROSS DIFFERENT
SUBCLASSES, IGG1, IGG3, IGA,
IGM, FCRECEPTOR A, BINDING,
FCRECEPTOR 3A BINDING AND ACROSS
DIFFERENT VALID AND RELIABLE
YABTS, 501 Y, AND THEN SEVERAL
OTHER VARIANTS.
AND THESE ARE REALLY ESSENTIALLY
ALMOST SMACK ON AS VERY, VERY
SIMILAR TO MALES AND FEMALES.
IF WE LOOK AT THE ASPECT BODY
RESPONSE, THEN CLEARLY THE 2 ARE
STILL OVERLAPPING BUT THERE IS A
SLIGHTLY HIGHER ASPECT BODY
FUNCTIONAL RESPONSE IN FEMALES
COMPARED WITH MALES.
IN A STUDY THAT WE PARTICIPATED
IN, THAT WAS A LARGER J& J
VACCINE STUDY WITH THE
AD26-POINT COV2 S VACCINE, THEN
A COMPLETE ANALYSIS OF THE STUDY
DOES SHOW THAT THERE'S SLIGHTLY
HIGHER NEUTRALIZING EABT BODY
TITERS IN FETAL
COMPARTMENTINALLYS COMPARED WITH
MALES TO THISAC VARMIS BEING
SEEN.
IF YOU LOOK AT DAY 29 OR DAY 71
FOLLOWING VACCINATION, THEN
THERE IS A SLIGHT BUT YET
STATISTICALLY SIGNIFICANT LOWER
ANTIBODY TITERS IN MALES AND
HIGHER ANTIBODIES IN FEMALES,
THIS IS RELATIVELY SMALL, JUST A
.12 LOG ANTIBODY UNITS AND THIS
IS SARS-COV-2 NEUTRALIZATION TO
THE WILD-TYPE VERYIANT LINEAR
REGRESSION OF ACTUAL VALUES
COMPARED WITH THE GENDER
PARTICIPANT AND THE PROTOCOL
SIDE.
SO THIS A COMPLETE ANALYSIS OF
ABOUT 200 INDIVIDUALS ON DAY 29
AND ABOUT A HUNDRED INDIVIDUALS
ON DAY 71 ABOUT I THINK THE
MESSAGE HERE IS THAT ALTHOUGH
THESE DIFFERENCES ARE
STATISTICALLY SIGNIFICANT, IT
DOESN'T NECESSARILY IMPLAY
CLINICAL SIGNATURES 95 XANS AND
I THINK THOSE ARE 2 VERY
DIFFERENT POINTS AND I THINK WE
SHOULD PROBABLY EMPHASIZE THAT
DIFFERENCE.
SO THERE MAY BE A SEX AND GENDER
DIFFERENCE IN ANTIBODY FUNCTION.
WE'VE OBSERVED IN 2 DIFFERENT
VACCINE STUDIES SLIGHTLY HIGHER
FC FUNCTIONALITY OR
NEUTRALIZATION IN E-MAILS
COMPARED WITH MALES TO 2
COVID-19 VACCINES AND THIS IS
CONSIST WENT WHAT WE KNOW ABOUT
VAC SINOLOGY AS A WHOLE WHERE
ANTIBODY RESPONSES TO MMR, DTP
AND FLU VACCINES IN MOST STUDIES
TEND TO BE A BIT HIGHER IN
FEMALES THAN IN MALES.
BUT IT'S NOT CLEAR THAT
PROTECTION IN FEMALES IS BETTER
THAN PROTECTION IN MALES.
SO I THINK THAT WHILE--WHILE
THESE ARE STATISTICALLY
SIGNIFICANT AND THE CLINICAL
RELEVANCE OF THESE DIFFERENCES
REALLY IS A SEPARATE QUESTION
THAT NEEDS TO BE DETERMINED AND
BECAUSE WE REALLY DON'T HAVE THE
ANSWERS TO A QUESTION THAT FOR
WHICH THERE IS CERTAINLY A LOT
OF RAW DATA AROUND THAT I THINK
IT'S AN UNDERSTATED AREA AND IT
REALLY WARRANTS A MORE DETAILED
EVALUATION.
SO, FINAL SLIDE ON KNOWLEDGE
GAPS AND FUTURE OPPORTUNITIES,
SEX DIFFERENCES IN ANTIBODY
FUNCTION REQUIRE CONFIRMATION
ACROSS DIFFERENT VACCINES,
DEMOGRAPHICS AND GEOGRAPHIES.
WE SHOULD ALSO REMEMBER THAT THE
CELL OR THE IMMUNE RESPONSE IS
ALSO VERY IMPORTANT FOR COVID-19
VACCINES AND I THINK THE
IMPORTANCE OF T-CELLS HAS BEEN
EMPHASIZED IN PARTICULAR FOR
VARIANT WHICH IS IS OMIKRON AND
THE SEX DIFFERENCES FOR CELL
IMMUNITY REMAINS TO BE
DETERMINED.
THE DIFFERENCES FOR VACCINE
EFFICACY IS PROBABLY THE MOST
RELEVANT PARAMETER IS MORE
IMPORTANT THAN STRAIGHT FORWARD
DIFFERENCES IN IMMUNO
GENERATEDISSITY AND SHOULD BE
EVALUATED.
AS I MENTIONED THE RANDOMIZED
PHASE 3 TRIALS DO NOT APPEAR TO
SHOW A DIFFERENCE IN VACCINE
EFFICACY ACCORDING TO GENDER,
BUT I THINK WITH A CAVEAT THAT
THAT EFFICACY WAS MEASURED AT A
TIME OF PEAK IMMUNITY AT A TIME
WHEN THERE WERE SO CIRCULATING
VARIANTS.
SO HOW IT PLAYS OUT IN THE REAL
WORLD WHERE THE ANTIBODY TITERS
ARE MARGINALLY SUFFICIENT FOR
PROTECTION AS OPPOSE TO VASTLY
HIGHER THAN NEED FOR PROTECTION
AGAINST VARIANTS THAT LARGELY
ESCAPE THESE REINTONSS, I THINK
REALLY, REALLY RAISES THIS
QUESTION AS A NEW QUESTION.
AND THE CLINICAL RELEVANCE OF
THE OBSERVED, RELATIVELY MODEST
DIFFERENCES OF IMMUNOLOGIC
PARAMETERS NEEDS TO BE DEFINED
AND AS WE HEARD FROM STANLEY,
THESE WILL BE USED FOR THESE
DIFFERENCES AND SO THAT'S MY
LAST SLIDE AND I WILL STOP
THERE.
>> THANK YOU DR. BAROUCH VERY
MUCH, DR. SCULLY?
>> GREAT.
LET ME JUST SHARE MY SCREEN.
DO I LOOK RIGHT?
>> YES.
>> GREAT.
THANK YOU VERY MUCH.
THANK YOU FOR THE TIEWPT TO BE
HERE TODAY, I HAVE NO CONFLICTS
OF INTEREST.
SO I WILL GET STARTED RIGHT
AWAY, BACK EARLY IN THE
PANDEMIC, THERE WAS A SUGGESTION
OF INCREASED RISK OF SEVERE
DISEASE OR DEATH AMONG MALES AND
IN LARGE EPIDEMIOLOGIC STUDIES
INCLUDING MORE THAN 17 MILLION
PEOPLE AND ALMOST 11,000 DEATHS
SHOWN HERE FROM THE UK OPEN
SAFELY DATABASE, THERE WAS AN
ESTIMATED HAZARD RATIO FOR DEATH
OF 1.59 IN THE PULLEY ADJUSTED
MODEL WHICH IS ON-PARWITH SEVERE
OBESITY AND MULTIPLE DEPRIVATION
INDEX, AND WHEN THE COURSE OF
DISEASE THIS OCCURS IS NOT
TOTALLY CLEAR AND THIS AN
IMPORTANT RESEARCH QUESTION TO
CONSIDER.
WHETHER THAT'S PRIOR TO
HOSPITALIZATION, AT
HOSPITALIZATION OR AFTER, BUT
DATA FROM FRANCE DID SHOW THAT
ACROSS AGE GROUPS MALES WERE
MORE LIKELY TO BE HOSPITALIZED
TO BE IN THE ICU AND TO HAVE
SEVERE DISEASE OR DEATH.
IN ADDITION AS HIGHLIGHTED IN
THE WONDERFUL OVERVIEW TALK AT
THEY BEGINNING, THE GLOBAL 50/50
DATA HAS TRACKED THESE
DIFFERENCES IN THE ERA OF
VACCINES AND WE STILL SEE AN
OVERREPRESENTATION OF MALES IN
ICU ADMISSIONS AND DEATHS
COMPARED TO FEMALES AS COMPARED
TO VACCINATION LEVELS AND TEST
POSITIVITY RATES.
WHAT'S THE MECHANISM FOR IN AND
IS IT SEX JERSUS GENDER.
AND THE ANSWER TO THIS QUESTION
IS YES, BECAUSE I THINK BOTH OF
THESE FACTORS CLEARLY HAVE AN
IMPACT, I NOTICED THAT EARLIER
IN THE SESSION, SOMEONE HAD
MENTIONED IN THE CHAT THE
IMPORTANCE OF PARSING SEX AND
GENDER AND I WILL SAY IT'SA AN
IMEULOGIOLOGYIST WHO'S BEEN
THINK BEING THIS IN THE SETTING
OF HIV FOR A NUMBER OF YEARS,
THIS BECOMES EXTREMELY DIFFICULT
TO DO BECAUSE THERE ARE SEX
CHROMOSOME ENCODED IMMUNOLOGIC
DETERMINANTS BUT ALSO HORMONAL
EFFECTS THAT INCLUDE GENE
EXPRESSION IN CELLS, AND HORR
MANYS CAN BE FROM SEX ASSIGNED
AT BERGT ORIGINAL PART OF A
GENDER AFFIRMATION TREATMENT AND
THE SUPER IMPOSITION OF STRESS
WHICH CAN THEN EFFECT GENE
EXPRESSION AT MULTIPLE LEVELS
ALSO HAS A VERY COMPLEX
INTERPLAY WITH IMMUNOLOGIC
RESPONSES SO, WHILE I AGREE, WE
NEED TO BE PRECISE, IT CAN BE
VERY CHALLENGING TO DO.
I WOULD ARGUE THOUGH THAT THIS
IS THE DIRECTION THAT MEDICINE
SHOULD BE MOVING IN AND AS WE
TALK ABOUT TRYING TO GET
PRECISION TREATMENTS FOR ALL
SORTS OF DISEASES, BEING PRECISE
ABOUT THE INDIVIDUAL IN FRONT OF
YOU WITH RESPECT TO BOTH THEIR
BIOLOGICAL SEX AND THEIR
GEPPEDDER EXPRESSION SEEMS LIKE
AN EARLY STEP TOWARDS TARGETING
TREATMENTS FOR MAXIMAL BENEFIT
AND MINIMAL SIDE EFFECTS.
SO EARLY IN THE PANDEMIC THERE
WERE A NUMBER OF PROPOSED
BIOLOGICAL UNDERPINNINGS FOR SEX
DIFFERENCES IN DISEASE OUTCOMES
INCLUDING SOME OF THE ACE 2 AND
LITERATURE THAT WAS BEAUTIFULLY
REVIEWED BY DR. CHAPPELL,
EARLIER.
ALSO THE VIRAL DIFFERENCES THAT
HAVE BEEN SHOWN TO IMPACT OTHER
VIRUSES INCLUDING HIV, AND THE
TLR 7 HAS BEEN POINTED OUT TO BE
A CONTRIBUTOR OF MUTATIONS THAT
ARE OBSERVED IN MALE WHO IS ONLY
HAVE A SINGLE COPY.
AND IN OTHER WORD AUTOANTIBODIES
TO TYPE 1 INTERFERONS HAS BEEN
FREQUENT IN MALES AND MAYBE
DETERMINANT OF SEVERE DISEASE IN
A SUBSET OF CONDITIONS FELT
OTHER DATA LOOKING AT OVERALL
IMMUNE CELL DISTRIBUTION OR
ADAPTIVE RESPONSES HAS BEEN A
BIT MORE DIFFICULT TO PARSE IN
PART DUE TO DIFFERENCES IN
SAMPLING TIME, BASE LINE
DEMOGRAPHIC FACTORS OF PATIENTS
INCLUDED AND COMPLEXITY OF
DETERMINE WHAG IS A PROTECTIVE
AND WHAT IS A DETRIMENTAL IMMUNE
RESPONSE.
SO I WILL TELL YOU TODAY ABOUT
WHAT WE'VE DONE TO TRY TO LOOK
AT THE CLINICAL DIFFERENCES
BETWEEN FEMALES AND MALES IN OUR
JOHNS HOPKINS SYSTEM AND THEN
POTENTIALLY TO EXPLORE SOME OF
THOSE MECHANISMS.
SOPHISTICATED SO FIRST I'M
SHOWING YOU DATA FROM THE
JHH CROWN REGISTRY, THIS SHOWS
THE AGES OF 18-75 AND WE AWE A
HIGHER POSITIVE AMONG MALES AND
AMONG THOSE THAT DID TEST
POSITIVE WE SAW A HIGHER AMOUNT
IN THE AGE STRATEGIC PLAN UMKC
BETWEEN 18-75.
WHEN WE LOOK AT ASYMPTOMATIC
SCREENING TO LOOK AT THE
DIFFERENCES BY SEX IN PEOPLE WHO
WERE CONSIDERED ASYMPTOMATIC FOR
COVID-19 WHEN WE LOOK AT TEST
POSITIVITY RATES AND IN EMERGING
ITS OF RACE AND ETHNICITY WE SAW
A TIGHT MIRRORING OF MALE AND
FEMALE TEST POSITIVITY RATES
WITHIN RACE AND ETHNICITY GROUPS
AND I WILL NOTE HERE THAT THIS
IS DRAWN FROM OUR MEDICAL RECORD
DATABASE AND REVIEW SEX
ASSIGNEDDA THE BIRTH BECAUSE
THERE ARE 2 STEP IDENTIFIERS
COLLECTED BUT THE VALIDATION OF
THE GENDER IDENTITY WAS NOT YET
CARRIED OUT AND THAT WAS
SOMETHING THAT CAN BE DONE IN
THE FUTURE.
SO IN TERMS OF NEXT WE LOOK AT
THOSE PATIENT WHO IS ARE
HOSPITALIZED AND THIS IS LOOKING
AT THE PERIOD BETWEEN MARCH AND
OCTOBER OF 2020 SO IT
PREVACCINATION ERA, THERE ARE
2600 PATIENT WHO IS ARE
HOSPITALIZED DURING THAT TIME
AND THEIR RACE ETHNICITY AND AGE
DEMOGRAPHICS ARE SHOWN ON THE
LEFT.
WE DID SEE THAT ALTHOUGH THE
MEDIAN AGE WAS SIMILAR, WE SAW
DIFFERENCES IN CERTAIN
CO-MORBIDITIES INCLUDING HIGHER
RATE OF ASTHMA AND FEMALES,
HIGHER RATES OF HYPERTENSION AND
KIDNEY DISEASE IN MALES, MORE
SMOKING AND ALCOHOL USE AMONG
MALES AND HIGH RATES OF
DIVERSITY AS SHOWN--DEPICTED IN
THE BAR GRAPH AT THE TOP.
WE ALSO LOOK AT INFLAMMATORY
PROFILES THAT WERE DRAWN HAS
PART OF CLINICAL CARE AND WE SAW
A SYSTEMATICALLY LOW LEVELS OF
INFLAMMATION IN MALES WITH
COVID-19 AS COMPARED WITH MALES
AND GROUPS AT NYU AS WELL.
SHOWN HERE ACROSS ALL THE AGE
DISTRIBUTION AND THESE ARE THE
VALUES WESTBOUND 24 HOURS OF
ADMISSION FOR COVID-19.
SO NEXT WE SOUGHT TO TRY AND
FIGURE OUT WHICH OF THESE
FACTORS, DIFFERENCES IN
CO-MORBIDITIES OR OTHER FEATURES
WERE DRIVING ANY DIFFERENCES AND
WE ESTIMATED THE SEX EFFECT ON
THE ODDS RATIO OF SEVERE DISEASE
OR DEATH CONSIST WENT WHAT'S
BEEN SEEN IN OTHER COHORTS IN
THIS COHORT OF OUR HOSPITALIZED
PATIENTS WE SAW A HIGHER RISK OF
SEVERE DISEASE OR DEATH.
THIS WAS FOR US PRIMARILY
FOCUSED ON THE REPRODUCTIVE AGE
STRATEGIC PLAN UMKC BETWEEN 18
AND 14.
WE ADDED IN MULTIPETRESSABLE
VARIABLE BLOCKS FOR OTHER
FEATURES OF GENDER AND SEX THAT
MAY HAVE CONTRIBUTED TO THESE
OUTCOMES AND WHEN WE ADDED IN
ADMISSION SOURCE, INCLUDING
NURSING HOME BODY MASS INDEX,
COMORBID CONDITIONS SMOKING OR
WHOLE USE, PRESENTING VITALS,
AND GENERAL LABS, WE DID NOT SEE
A SUBSTANTIAL CHANGE IN THIS
RISK ESTIMATE.
HOWEVER WHEN WE,A JUSTED FOR THE
BASE LINE INFLAMMA ARE TOY LABS
WE DID SEE A SUBSTANTIAL CHANGE
IN THE RISK ESTIMATE STILL WITH
SLIGHTLY HIGHER RISK FOR MALES
BUT TO US THIS SUGGEST THAD
WHILE WE DID SEE THIS INCREASING
RISK OF SEVERE DISEASE THAT THE
MODIFICATION BY THE INFLAMMATORY
LABS AND NOT BY OTHER VARIABLES,
SUGGESTED THERE MIGHT BE AN
IMMUNOLOGIC DRIVER IN THE DRIVER
OF THE OUTCOMES WE WERE
OBSERVING.
SO WHAT WERE THE OPEN QUESTIONS
WE WERE LEFT WITH IS THERE A
SUCCESSES SPECIFIC IMMUNE
PROFILE OR JUST A RESPONSE THAT
FEMALE VS LOWER RESPONSES THAT
ARE THE SAME AS MALES OR ARE
THEY QUALITATIVELY DIFFERENT.
AND WILL THEY PERFORM SIMILARLY
IN MALES AND FEMALE FIST THERE
IS A BASE LINE DIFFERENCE AND IN
LATTER QUESTION IS HIGHLIGHTED
IN PART IN JULY OF 2020 THE DATA
REGUARDING THE RECOVERY TRIAL
USE OF DEXAMETHA SEWN WITH A
BENEFIT FOR HOSPITALIZATION FOR
PATIENTS WAS PUBLISHED AND
CHANGED CLINICAL PRACTICE.
IN THE SUBGROUP ANALYSIS LOOKING
AT BENEFIT IN MALES VERSUS FETAL
COMPARTMENTINALLYS THERE WAS NOT
A SUBSTANTIAL BENEFIT OBSERVED
IN FEMALES ALTHOUGH THIS MAY BE
DUE TO HETEROGENERATED AITY OF
THAT GROUP, IT LEFT THE QUESTION
OF WHETHER THESE EQUALLY
EFFICACIOUS IN FEMALES AND
MALES.
SOPHISTICATEDY WE CHOOSE TO
ELECTRIC AT THIS USING A
TRANSCRIPT OHMIC AND PLASMA
CYTOKINE PROFILES APPROACH AND
WE HAVE 2 COHORTS AND 1 OF 95
PATIENTS SUBMITTED BETWEEN APRIL
AND JULY OF TWEBT 20.
AND THE SECOND, 64 PATIENTS
ADMITTED BETWEEN AUGUST IN
JANUARY OF 2021 AND SO ALL
PREVACCINATION, MEDIAN AGE WAS
SIMILAR BETWEEN THE 2 COHORTS.
THE SAMPLE TIME WAS BETWEEN 4
AND 3 DAYS AFTER THEIR TEST AND
AROUND THE TIME OF PEEK DISEASE.
WE DID EXCLUDE PEOPLE WITH
HEPATITIS C OR AUTOIMMUNE
DISEASE, TRY TO FOCUS ON THE
IMMUNE CHANGES THAT WERE
DIRECTLY RELATED TO COVID-19.
SO IN TERMS OF DIFIENTIAL GENE
EXPRESSION FEATURES SHARED BY
BOTH MALES AND FEMALES WE SAW A
CELL ARRA RESPONSE TO HYPOXIA
AND DECREASED OXYGEN WHICH IS
CONNIVITIENT WITH THE DEFINITION
OF SEVERE DISEASE IN THIS COHORT
AND A NICE VALIDATION WE WERE
LOOKING AT SEVERE DISEASE IN
THOSE PATIENTS THAT WE WERE
IDENTIFYING AS SUCH.
IN THE MALES, ONLY, WE SAW AN
INCREASE AND ENRICHMENT OF
NUTRIFILL DEGRANULATION AND
INFLAMMATION AND ACTIVATION OF
THE IMMUNE RESPONSE BUT THAT WAS
NOT OBSERVED IN THE FEMALE
COHORT WHEN COMPARING THOSE WITH
FEMALE DISEASE WITH TO THE
FEMALES WITH MILD DISEASE.
INSTEAD WE SAW UNFOLDED PATHWAYS
THAT WERE LINKED TO THE MHC
PRESENTATION AND MAY HAVE BEEN
RELATED TO MOUNTING A T-CELL
IMMUNE RESPONSE.
WHEN WE LOOK SPECIFICALLY IN THE
COHORT OF THOSE AFTER DEXAMETHA
ZONE TREATMENT WE SAW NO GENES
BETWEEN MALES AND FEMALES AND NO
1 IN MALES ALONE, IN FEMALES WE
SAW GENE PATHWAYS, AND SEVERE
VERSUS MILD DISEASE BUT CLIERLY
THE DEXAMETHA SEWN BLUNTED THE
RESPONSES AND SHIFTED EVEN MORE
DRAMATICALLY IN MALES THAN IN
FEMALES.
>> ABOUT 1 MINUTE LEFT.
>> THANK YOU.
SO THE RELATIONSHIP BETWEEN GENE
EXPRESSION AND PLASMA CYTOKINES
WAS OUR NEXT STEP AND HERE WE
LOOK AT GROUPS OF GENES THAT
WERE RELATED TO CYTOKINES AND
USING THE CLUSTERING DRIVEN BY
FEMALES AND COMPARING WITH MALES
AND I WILL SUMMARIZE THAT IN THE
COHORTS GENE CLUSTERS WITH SEX
DIFFERIENTIAL, WITH CYTOKINES IN
MALES AND TYPE 1 INTERFERON AND
VIRAL DEFENSE SIGNATURES IN
FEMALES SO WHAT WE CONCLUDE
FRIDAY THIS WAS THAT NUTRIFILL
ACTIVATION AND NUTRIFILL
ASSOCIATION HAS BEEN SOASHT WIDE
SEVERE DISEASE IN MANY OTHER
STUDIES AND IN FACT, SOME
STUDIES HAVE SPECIFICALLY SHOWN
PROFILES OF NUTRIFILL ACTIVATION
INTERFERON ACTIVATED VERSUS
IMMUNE SUPPRESSIVE ASSOCIATED
WITH DEC PROGRESSION.
HERE WE'RE SEEING DIFFERENCES
THAT MIGHT SUGGIEST THAT IS
RIGHT OF THIS IS MEDIATED BY SEX
AND THAT FEMALES VERSUS MAILS
MAY BE PART OF WHAT IS DRIVING
SOME OF THE DIFFERENTIAL
NUTRIFILL FUNCTION AND FINALLY
IN TERMS OF THEY RESPONSE TO
DEXAMETHA SEWN, IT DOES APPEAR
THAT THE CLUSTERING SHOWS SEX
SPECIFIC RESPONSES TO TREATMENT
AND SHOWN HERE IS JUST A
NUTRIFILL RATIO TO A CLINICAL
MARKER AND IN THE ORIGINAL
COHORT WITHOUT IMMUNO MODULATION
THIS WAS TIGHTLY CORRELATED
HOWEVER AFTER DEXAMETHA ZONE IT
WAS CORRELATED FOR MALES BUT
LOST THIS IN FEMALES AGAIN
SUGGESTING WE NEED TO CONSIDER
WHETHER THESE RESPONSES FOR
MODLATTORY TREATMENT ARE THE
SAME.
SO QUESTIONS FOR DISCUSSION, HOW
DO SEX DIFFERENCES IN ACUTE
RESPONSES LEAD TO PROTECTIVE
PHENOTYPES, HOW DO SEX
DIFFERENCES INTERSECT WITH
IMMUNO MODULATORY THERAPY AND I
THINK HARKENING BACK TO
DR. BAROUCH'S COMMENTS NEED TO
BE CONSIDERED CAREFULLY AND DO
EARLY RESPONSES HAVE AN IMPACT
ON SEQUEL I, I WILL STOP HERE
AND THANK ALL OF THE PEOPLE WHO
DID THE WORK IN MY LAB AT THE
JOHNS HOPKINS COLLABORATIVE
GROUP AND SPECIFICALLY THE STUDY
PARTIC PLAN TO ANALYZE BY AGES
WHO MADE THESE STUDIES POSSIBLE.
>> THANK YOU DR. SCULLY, FOR AN
EXCELLENT TALK.
THE LAST TALK IS DR. TSANG.
>> THANK YOU FOR ALL THE
SPEAKERS THAT CAME BEFORE ME,
THOSE WERE REALLY EXCELLENT AND
INFORMATIVE TALKS.
SO I WILL WALK YOU THROUGH A
STUDY WE HAD DONE IN 2020 IN
WHICH WE USE INFLUENZA
VACCINATION TO EXAMINE AFTER
INDIVIDUALS WHO RECOVER FROM
MILD COVID-19 WHAT HAPPENS
ESPECIALLY TO THEIR IMMUNE
SYSTEM.
SO I WANT TO ACKNOWLEDGE BROADLY
MY LAB.
SO I HAVE A SYSTEMS IMMUNOLOGY
EXPERIMENTAL IN COMPUTATIONAL
FOLKS IN THE GROUP AS WELL AS
THE CENTER FOR HUMAN IMMUNOLOGY
WITH WHOM WE COLLABORATE ON THIS
STUDY.
AND SO THIS STUDY AS I
MENTIONED, IT WAS DURING 2020
FALL AND SPEARHEADED BY RACHEL
SPARKS ASSIST APT CLINICAL
INVESTIGATOR HERE AT NAIAD AND
THE COMPUTATIONAL WORK LED BY
WILLIAM LAU AND THE
COMPUTATIONAL ANALYSIS LED BY
CAM LOU.
SO THERE'S A LARGE NUMBER OF
COVID-19 CASES MOST OF WHICH
THEY RECOVER AND THESE
INDIVIDUALS NEVER HAVE GONE TO
THE HOSPITAL AND IT'S MOSTLY
MILD AND NONHOSPITALLIZED CASES
THAT WE HAVE WITH THESE REALLY
LARGE NUMBERS.
SO A KEY QUESTION IS HOW DOES
EVEN MILD COVID-19 IMPACT THE
IMMUNE SYSTEM AND POTENTIALLY
IMMUNE FUNCTIONS.
SO THERE ARE EXAMPLES ON HOW
INFECTIONS AND EVEN VACCINATIONS
THEY IMPACT FUTURE RESPONSES TO
NONHOMMOLOGIOUS CHALLENGES, FOR
EXAMPLE, IT'S--IT'S BEEN STUDIED
AND KNOWN THAT MEASLES
INFECTIONS FOR EXAMPLE, COULD
WIPE OUT MUCH OF THE B-CELL
MEMORY REPERTOIRE AND HINDERING
FUTURE RESPONSES TO OTHER
INFECTIONS, THIS IS ALSO BEEN
EXPLORED IN MOUSE MODELS THERE'S
ALSO AFTER VACCINATION, THE
STATUS OF CERTAIN INNATE IMMUNE
CELLS AND PROGENITORS IN THE
BONE MARROW MAY BE ALTERED WITH
REASONABLY LONG-TERM MOLECULAR
MEMORY AND THAT COULD
POTENTIALLY IMPACT FUTURE
RESPONSES.
SO, TO EXPLORE THIS ISSUE, WHAT
WE DID, IT'S BACK IN FALL 2020,
FLU VACCINATION SEIZE, SO RACHEL
AND LAU WERE SO THESE
INDIVIDUALS WHEN WERE THEY WERE
ENROLLED, THEY WERE HEGHTY NO
RESIDUAL SYMPTOMS OTHER THAN
SMELLING DEFECTS, ESPECIALLY
MORE IN FEMALES AND NONE OF
THESE FOLKS HAD ANY OTHER
CO-MORBIDITIES AND THERE'S NO
HISTORY OF OTHER INFECTIONS
WHETHER THEY HAD COVID-19 AND
THE FLU VACCINE AND AS YOU KNOW
THERE'S VIRTUALLY NO INFLUENZA
AND COMMON VIRUSES CIRCULING AT
THAT TIME.
SO, WE THEN ENROLLED THESE
INDIVIDUALS IN IN PARTICULAR
STUDY, ANALYSIS WE HAVE 33 OF
THESE VERSUS 40, AGE AND SEX
GENDER MATCH CONTROLS AND WE
GAVE THEM THE INFLUENZA VACCINE
AND FOLLOWED THEM THROUGH BOTH
THE ACUTE RESPONSE ON DAYS 1 AND
7 AND THEN FOLLOW THEM UP ON 14,
28 AND ALL THE WAY EVERY MONTH.
AND FROM THESE SAMPLES BOTH
PBMCs AND WHOLE BLOOD AS WELL
AS SERUM, WE GENERATED A VARIETY
OF DATA SETS, AND TO ANALYZE THE
RESPONSE.
AND SO WHY THE INFLUENZA AS A
VACCINE?
ONE AT THAT TIME IT'S INDICATED
AND CONVENIENT.
OF COURSE IT OFFS HEALTH
BENEFITS AND IT DOES GENERATE A
VERY SYSTEMIC RESPONSE THAT'S
DETECTABLE IN BLOOD SO WE AND
OTHERS HAVE LOOKED INTO THIS
OVER THE YEARS IN DETAIL FOR
EXAMPLE DISSECTING THE INNATE
RESPONSE ON DAY 1 AND SORT OF
THE MORE PRO DOMINANTLY BMT CELL
RESPONSES ON DAY 7 AND YOU CAN
ALSO CLEARLY DETECT ANTIJUDGED
SPECIFIC RESPONSES TO FLU, AND
THERE'S ALSO OF COURSE CAVEATS.
ONE IT'S PRIOR IMMUNITY AND
HISTORY COULD DRIVE THE
RESPONSE, SO THAT'S 1 OF THE
VARIABLES WE NEED TO TAKE INTO
ACCOUNT.
WE CONSIDERED IT USING MORE
NAIVE ANTIGENS LIKE YELLOW
FEVER, THOSE ARE REALLY
CHALLENGING IN THE SENSE THAT
THOSE ARE LIVE VALENTINEDERAL
VACCINES AND IT'S NOT CLEAR
WHETHER THEY PUT IN AN
EXACERBATE POTENTIAL IN SOME
THESE RECOVER PATIENTS, EVEN
THOUGH THEY LOOK HEALTHY ON THE
SURFACE.
SO 1 OF THE TECHNIQUES WE USED,
IT'S THE SINGLE CELL LANDSCAPE
IN THE RESPONSE, SO WE APPLY A
TECHNIQUE THAT WE'RE NOW USING
IN THE NUMBER OF HUMAN COHORT
STUDIES IN WHICH WE MEASURE BOTH
THE SURFACE PROTEINS IN THIS
CASE, CLOSE TO WHO HUNDRED
SURFACE PROTEINS, THE TRANSCRIPT
OHM, PLUS THE VDJ PLUS
ALTOGETHER IN SINGLE CELLS FROM
THESE INDIVIDUALS.
SO, 1 OF THE KEY ANALYSIS WE DID
WAS TO COMPARE THE RESPONSE
DIFFERENCES, BETWEEN THE NEVER
COVID HEALTHY, HEALTHY AND THEN
THE COVID RECOVER HEALTHY
INDIVIDUALS AND WE FOLLOW THEM
THROUGH DAYS 1-7, AND DAY 28.
ONE THING WE NOTICED EARLY ON IN
INNATE RESPONSE IS THAT THE
COVID RECOVERED MALES TEND TO
HAVE A SIGNIFICANTLY ELEVATED
LEVELS CIRCULATING
INTERFERON-GAMMA COMPARED TO THE
HEALTHY COUNTERPARTS COMPARED TO
FEMALE COUNTERPARTS AND THAT IN
TURN LED TO A VERY PROMINENT
INTERFERON SIGNATURE ACROSS MOST
OF THE MAJOR IMMUNE CELL TYPES
SO THIS A SINGLE GROUP SO AS YOU
CAN SEE--ANDY SPONDY LIGHTISS
NERMALS OF TRANSCRIPTION
RESPONSE, AND LIKELY IMAGES OF
THIS ELEVATION OF THE GAMMA
LEVELS AND CIRCULATION
SYSTEMICALLY.
TD SPECIFIC PLASMA RESPONSES SO
THESE ARE THE CELLS THAT MAKE
THE ANTIBODY AND IN TURN AND
LOOK AT THE RESPONDS AND THERE'S
NOTHING CHANGED IN THE FEMALE,
THAT'S GOOD NEWS IN A WAY THAT
THE COVID RECOVERED INDIVIDUALS
HAD NORMAL TYPE OF RESPONSES,
BUT AGAIN, THE RESPONSE IS A
HEIGHTENED AND INCREASE ACROSS
THE STRAINS IN THE VACCINE, IN
THE MALES.
IN TERMS OF THE FLOW CHANGE.
THIS IS INDEPENDENT OF THE
PREEXISTING ANTIPLURIBU TITERS
AT DAILY BASIS I 0, AND ALSO THE
SELF-REPORTED VACCINATION
HISTORY.
NOW, WHEN WE LOOK INTO THE
COHORT AS A WHOLE, THERE'S A
STRONG CORRELATION, BETWEEN THE
EARLY INTERFERON RESPONSE, AND
THE PLASMA RESPONSE BY DAY 7.
SUGGESTING THAT THAT STRONGER
INNATE RESPONSE BY DAY 1 I WAS A
DRIVER OF THE STRONGER RESPONSE
IN THESE INDIVIDUALS, THE COVID
RECOVERY MALES.
SO THEN WE ASK WHAT ARE THE
CELLS THAT MAY BE RESPONSIBLE
FOR THE ELEVATED CIRCULATING
INTERFERON-GAMMA RECOVERED
MALES, SO 1 OF THE FIRST THINGS
WE DID IS TO SCAN, SO WE HAVE
MEASUREMENTS OF THE 180 OR SO
SURFACE MARKERS ACROSS THE
DEFINITE CELL POPULATIONS, SO WE
WANT TO FIND A SET OF SURFACE
MARKERS THAT COULD MARK
POTENTIALLY CELLS, THAT MAY BE
SIGNIFICANTLY DIFFERENT BETWEEN
THE COVID RECOVERY MALES AND THE
REST OF THE GROUPS AND THE TOP
MARKERB THAT EMERGES WAS VERY
INTRIGUING IT'S GPR 56
EXPRESSION ON CD8 EFFECTOR
MEMORY T-CELLS AT BASE LINE
BEFORE VACCINATION.
THIS MARKER IS THE MOST
SIGNIFICANTLY DIFFERENT ACROSS
THESE 4 GROUPS.
THIS MARKER IS INTRIGUING
BECAUSE IT'S KNOWN THAT THESE
CELLS WHEN YOU STIMULATE A 56
POSITIVE CELLS INVITRO BY
KD--SALLY WHRA, THESE ARE THE
CELLS THAT MAKE MORE GAMMA IN
THESE INVITRO ASSAYS, WE ALSO
ASSESS USING INDEPENDENT
SIGNATURE THAT'S ASSOCIATED WITH
CD29 AND BASICALLY SAW THESE 56
POSITIVE CELLS ARE HIGHLY
ENRICHED FOR THOSE CELLS AS
WELL, SO THEN WE THOUGHT THAT
BECAUSE IT RESPONSE SO QUICKLY
ON DAY 1 IT'S UNLIKELY AN
ANTIGEN SPECIFIC RESPONSE.
WE THOUGHT THESE MAY ACTUALLY
BEEN CELLS THAT WERE ACTIVATED
DURING ACUTE COVID-19 SO WE THEN
LOOK INTO A BI STANDARD
ACTIVATION T-CELL SIGNATURE AND
ALSO FOUND ENRICHMENT, IN THAT
THESE 56 POSITIVE CELLS, THEY
TEND TO BE ENRICHED FOR THESE
CELLS EXPRESSING A BI STANDER
ACTIVATION TIME.
>> TWO MINUTES LEFT.
>> THEN WE THOUGHT THAT MAYBE
THESE CELLS ARE ELEVATED IN
COVID RECOVERED MALES AND INDEED
WE LOOK AT THE FREQUENCY OF 56
POSITIVE DEFECTIVE MEMORY CD8S,
THEIR FREQUENCY IS SIGNIFICANTLY
ELEVATED AND THEN WE ASK DO
THESE CELLS MAKE MORE GAMMA.
SO IF YOU LOOK AT DAY 1 VERSUS
DAY 0, CAN YOU SEE THAT THE
LEVEL OF INTERFERON-GAMMA
TRANSCRIPTS IN THIS CASE,
INCREASE SIGNIFICANTLY IN THESE
CELLS AFTER VACCINATION,
SPECIFICALLY IN THE COVID
RECOVERY MALES BUT NOT IN OTHER
GROUPS.
SO THIS BROUGHT US TO THIS
HYPOTHESIS ABOUT THIS GROUP OF
SALES CALLED INNATE LIKE MEMORY
CD8 T-CELLS SO THIS IS EMERGING
SET OF CELLS THAT WE'RE STILL BY
WE, I MEAN THE FIELD IS TRYING
TO UNDERSTAND BOTH THEIR ORIGIN
AND FUNCTIONS, SO THE CURRENT
THINKING IS THAT THEY EMERGE OUT
OF THE THYMUS AND THEY CAN BE
EXTENDED BY INFLAMMATORY
CYTOKINE ALONE LIKE IL15 IN THE
PERIPHERY AND AS THAT HAPPENS
OVER TIME, THEY BECOME MORE
TAMPER LIKE AND THEY CD122 FOR
EXAMPLE WOULD GO UP AND CD5
WOULD GO DOWN AND THESE ARE
KNOWN TO BE ACTIVATABLE AND CAN
RESPOND ACTIVELY TO CYTOKINE
ALONE SO BEHAVING LIKE INNATE
CELLS.
SO THEN WE LOOK AT THE KNOWN
MARKERS MARKING THESE INNATE
MEMORY CELLS AND INDEED WE SEE A
VERY STRONG CONCORDANCE, CAN YOU
SEE THAT THE 56 POSITIVE CELLS
CD55 LOWER AND THEY ARE EXPRESS
CD5 RA, AND THEY HAVE HIGHER
LEVELS OF 122 FOR EXAMPLE, SO
OUR CURRENT HYPOTHESIS IS THAT
THESE CELLS WERE LIKELY TRAINED
BY IL29 DURING ACUTE COVID-19
AND WE AND OTHERS HAVE SEEN VERY
STRONG ELEVATIONS IN IL15 FOR
EXAMPLE, DURING ACUTE COVID.
>> TIME TO WRAP UP.
>> JUST TO WRAP UP, DAY 7 AND
DAY 28 RESPONSES IN COVID
RECOVERED MALES AND I SHOWED THE
ELEVATED INTERFERON RESPONSE AND
THAT LIKELY CAN BE ATTRIBUTED TO
THE CD8 INNATE LIKE MEMORY CELLS
BEING ELEVATED AT THE BASE LINE
IN THESE INDIVIDUALS AND BY THE
WAY, I DON'T HAVE THE TIME TO
WALK YOU THROUGH MORE DATA, BUT
YOU CAN ACTUALLY SEE THAT AFTER
6 MONTHS ON AVERAGE, THESE ARE
ALL AFTER MYELOID ACUTE DISEASE,
THERE'S A NUMBER OF OTHER
VARIABLES THAT ARE STABLE AND
ESTABLISHED IN THESE
INDIVIDUALS.
SO AS DR. SCULLY, SHOWED YOU,
MALES HAVE A MORE INFLAMMATORY
RESPONSE DURING THESE SO THIS
CONSISTENT WITH THE IL15
HYPOTHESIS AND HOW THEY MAY
EXPAND THE INNATE CD8 CELLS AND
WHEN THEY'RE CHALLENGED BY THE
FLU VACCINE FOR EXAMPLE, IL12 IS
BEING MADE AND THESE--THESE
CELLS ARE LIKELY RESPONDING TO
THOSE KINDS OF INFLAMMATORY SEAT
O KINES.
AND IN TERMS OF LOOKING FORWARD,
1 IMPORTANT--I THINK OBVIOUS
REQUESTY IS HOW THIS RESPONDS
ALLOW US TO READ OUT POTENTIAL
MARKERS AND PREDICTERS OF LONG
COVID.
AND ALSO THERE'S PROVIDE
INFORMATION ON FUTURE SEX
SPECIFIC TRAJECTORIES, RIGHT?
WHAT ARE THE RISK OF DEVELOPMENT
OF OTHER DISEASES SUCH AS
AUTOREACTIVITY OR
AUTOIMFLAMMATORY SYNDROMES AND
HOW LONG DO THESE IMPRINTS LAST
AND CAN THEY BE RESET AND
MODULATED TO IMPROVE FUTURE
OUTCOMES SO WE HAVE DAT ON THAT
AND WE WILL BE HAPPY TO DISCUSS
AS WELL.
THANK YOU.
>> WOW, GREAT, THANK YOU
DR. TSANG, PARTICULARLY ON
POSSIBILITIES FOR LONG COVID
MODULATION.
>> MAY I JUST SAY SOMETHING
BECAUSE WE ARE REALLY SHORT IN
TIME, I WOULD SUGGEST THAT WE
CAN EXTEND THIS DISCUSSION
SESSION TILL LET'S SAY 1:35
BEFORE OUR MALE BREAK AND THEN I
JUST WANT TO SAY THAT THERE ARE
A LOT OF QUESTIONYS ALREADY IN
Q&A AND SOME OF THEM ARE
ANSWERED WHILE FORTHE 1S THAT
ARE NOT--WILL NOT BE ABLE TO
ADDRESS LIVE, THE SPEAKERS WILL
TRY TO VIA TEXT IN THE TOOL, SO
PLEASE USE IT, THANK YOU.
>> OKAY, SO, WE'RE GOING TO
1:35.
I GUESS THE OTHER THING I WOULD
ALSO EMPHASIZE TO ALL THE
PARTICIPANTS SINCE WE'RE SHORT
ON DISCUSSION, PLEASE TAKE
ADVANTAGE OF THE BREAK OUT
SESSIONS TOMORROW TO FOLLOW UP
ON QUESTIONS.
REGARDING THESE ISSUES AND
REGARDING THE TALKS TODAY.
SO IN TERMS OF QUESTIONS?
I GUESS IF OTHER SPEAKERS WANT
TO JUST CHIME IN WITH QUESTIONS
THAT WERE BROUGHT UP ON THE
CHAT?
>> MARK YOU CAN LOOK AT THE Q&A,
LOOK IN THE Q&A FOLDER THERE.
>> YEAH, OKAY.
>> SO, OKAY, I GUESS 1 OF THE
FIRST QUESTIONS IS WE KNOW THE
IMPACT ON SEX AND STEM CELLS AND
PROGENITOR CELLS WITH THE
TREATMENT OF COVID?
DR. BAROUCH, CAN YOU ADDRESS
THAT?
>> I BELIEVE THE QUESTION IS DO
WE UNDERSTAND SEX DIFFERENCES
WITH RESPECT TO STEM CELLS AND
PROGENITOR CELLS AND THE
TREATMENT OF COVID OR
SARS-COV-2?
HAD I'M NOT AWARE OF ANY DATA ON
THAT SO I APOLOGIZE I DON'T KNOW
OF ANY DATA ON SEX DIFFERENCES
FOR THAT TREATMENT.
>> OKAY.
SO I THINK THIS QUESTION ABOUT
HOW DIFFERENT ARE THE RESPONSES
IN MICE IN COMPARISON TO HUMANS,
OR THE MOUSE ADAPTABLE STRAIN,
HOW IMPORTANT IS THAT, HOW
ELVANT IS THAT, CAN DR. PERLMAN
ADDRESS THAT.
>> YES, SO THIS IS ALWAYS A
QUESTION WHEN WE DEVELOP MOUSE
ADAPTIVE DEVICES AND IN MICE,
WE'RE ASKING THE QUESTION, IS
THIS MIMICKING WHAT'S HAPPENING
IN PEOPLE.
SO WHAT WE CAN SAY IS THAT AT
LEAST IT SEEMS LIKE WE HAVE
SYSTEMS WHERE WE'RE SEEING SEX
DIFFERENCES.
WE'RE ALSO SEEING SYSTEMS WHERE
WE'RE SEEING HINTS OF LONG
COVID, BUT AS I MENTIONED IN MY
TALK, IT'S SO HARD TO REALLY SEE
CLINICAL LONG COVID IN MICE.
SO THIS IS DEFINITELY A
CHALLENGE.
WE END UP DOING MOSTLY TESTING
ON THE ANIMALS, BUT ON THE OTHER
HAND 1 HAS TO DO THE BEST 1 CAN
WITH THESE RESOURCES AND THERE'S
CLEARLY THINGS EXPERIMENTAL
ANIMALS WE CAN DO THAT WE CAN DO
IN ANIMALS THAT WE CAN'T DO IN
PEOPLE.
SO WE HAVE TO GET BETTER MODELS
AND DO THE BEST WE CAN.
>> SO A QUESTION, IN YOUR
STUDIES WHERE YOU'RE GETTING
SARS AND YOU'RE LOOKING AT HOW
QUICKLY THE ANIMALS DIE, CAN YOU
ADAPT THAT TO LONG-TERM COVID BY
GIVING SAY, REDUCED LEVELS OF
SARS AND LOOKING AT SAY
COGNITIVE TESTS IN THESE MICE,
THE INFLUENCE, OF
[INDISCERNIBLE] OR I THINK 1 OF
THE PARTICIPANTS BROUGHT UP IN
TEMPERATURES OF ORGAN ECTOMY,
CAN THOSE EFFECTS, WE USE THESE
MICE IN TERMS OF THE LONG-TERM
EFFECTS OR, I GUESS THE OTHER
THING THAT STRIKES ME ARE THE IN
TERMS OF EEVENGHT TODAY, CERTAIN
PATIENTS THEN, RESPOND
DIFFERENTLY NERMALS TO SECOND
HITS AND MAYBE WHETHER COGNITIVE
FUNCTION OR CARDIO VASCULARY
FUNCTION BE COULD NOT BE
RELEVANT IN YOUR MOUSE MOLDLES.
>> NO CSR YEAH, THAT'S SOMETHING
WE'RE NOT INTERESTED IN, THIS IS
DIFFERENT FROM SARS AND MERS,
BECAUSE THEY ONLY DO MOUSE
STUDIES BECAUSE THEY WEREN'T
HUMANS TO THINK ABOUT SARS,
DISAPPEAR INDEED 2004, MERS IS
2500 CASES SINCE TWEBT 12.
SO SO MANY THINGS ARE DONE IN
HUMANS THAT IN MOUSE, THE
DEVELOPMENT THAT MOUSE MODELS
HAS LAGGED MORE THAN 1 MIGHT
THINK IN THE NUMBER OF MOUSE
STUDIES, BUT I THINK THIS WILL
CHANGE AND IN TERMS OF YOUR
SPECIFIC QUESTIONS, I DON'T WANT
TO SPEND TOO MUCH TIME BUT THE
VARIOUS MICE MODELS THAT ARE
AROUND.
K18 MICE ARE HAMPERED BY SOME
MICE DEVELOPING BRAIN INFECTION
AND THIS--WHEN MICE DEVELOP
BRAIN INFECTION THAT'S LETHAL
AND I DON'T THINK IT'S A MODEL
FOR HUMAN DISEASE BECAUSE
THERE'S SO LITTLE EVIDENCE THAT
VIRUS DIRECTLY INFECTS THE BRAIN
BUT WHAT WE CAN SAY IS BY USING
MOUSE ADAPTIVE VIRUSES AND
THERE'S SEVERAL OUT THERE, 1 OR
2, THE 2 THAT MY LAB DEVELOPED
IN SEVERAL OTHER LABS, CAN YOU
DEFINITELY GET A RANGE OF
INFECTIONS, A RANGE OF SEVERE
DISEASE WHICH WILL BE USEFUL FOR
STUDYING THE ACUTE PHASE BUT
THEN BY MODULATING THE AMOUNT OF
VIRUS YOU CAN GIVE, CAN YOU
DEVELOP LONG-TERM COVID-19
MODELS AND ONCE WOHAS THAT WHICH
I THINK WE HAVE 1 CAN DO THE
KINDS OF THINGS THAT YOU ARE
REFERRING TO USING
DIFFERENT--INTRODUCING DIFFERENT
CO-MORBIDITIES, DOING DIFFERENT
KINDS OF MEASUREMENTS, AGAIN
WITH THE CAVEAT THAT MICE ARE
NOT A PERFECT MIMIC, THEY CAN'T
TELL YOU ABOUT BRAIN FOG.
THEY DON'T DO SOME OF THE THINGS
THAT YOU WOULD REALLY LIKE TO
MIMIC WHEN WE THINK ABOUT
EXPERIMENTAL ANIMALS.
BUT YES, THEY'RE ALL DO CALVERT,
IT'S JUST DOING THEM.
>> THANK YOU.
SO THERE WAS A QUESTION IN THE
CHAT, DR. PERLMAN ABOUT WHAT
SARS--WHAT WAS THE STRAIN OF
YOUR SARS-COV-STRAIN YOU USE
INDEED YOUR MOUSE?
>> YEAH, SO WHAT WE QUHA WE
ALWAYS USE IS A NEW DEVELOPMENT
THAT WE DEVELOPED THAT'S
DIFFERENT THAN THE ORIGINAL 1
BECAUSE WE DEVELOPED IT IN HUMAN
ACE 2 KNOCK-IN MICE, NOT OUR
TRANSGENIC MICE BUT KNEW KNOCK
IN MICE, HPV-IT'S JUST THE
SYSTEM WE USE TO LOOK AT SEX
DIFFERENCES.
THIS VIRUS EVEN THOUGH WE
ADAPTED IT IN HUMAN ACE 2 KNOCK
IN MICE, IT CAN EEVENGHT NORMAL
KNOCK IN MICE NOW.
SO IT'S CHANGED ITS ABILITY TO
USE MOUSE 2 BIT BY THE
ADAPTATION AND THE HUMAN ACE 2
EXPW IT'S DIFFERENT THAN ANY
OTHER VIRUS WE'VE SEEN SO FAR
BUT I AM CONFIDENT THAT IF WE
TOOK OUR MA13 VIRUS WHICH WE
WILL HOPEFULLY BE AVAILABLE AT
BEI VERY SHORTLY AND WIDELY
AVAILABLE ANYWAY, THOSE WILL
GIVE A MOUSE--THOSE WILL MIMIC
THOSE SEX DIFFERENCES IN B6
MICE.
I SHOULD SAY WHEN WE'VE DONE
THIS IN BALB-C MICE ANOTHER
STRAIN WE DON'T SEE SEX
DIFFERENCES WITH THE TRAIN, SO
IT'S IMPORTANT WE DO THIS WITH
THE B6 MICE WE COULD USE THIS
NEW VARIANT THAT WE'VE
IDENTIFIED.
SO THE LONG ANSWER TO YOUR SHORT
QUESTION.
>> THAT'S FINE, JUST.
>> YOUR COMMENT ABOUT NOT SEEING
SEX DRVESS DO YOU KNOW IN THAT
PARTICULAR STRAIN, DO YOU KNOW
WHY THAT IS?
>> NO, WE DON'T.
WE LOOKED--WE DID THAT
EXPERIMENT SEVERAL TIMES BECAUSE
WE'VE ALWAYS SEEN SEX
DIFFERENCES WITH SARS-COV IN THE
BALB-C MICE IT'S TRICKIER
BECAUSE THE MICE ARE SORE
SUBSIDIARY SEPTORSIBLE SO YOU
HAVE TO USE USE LESS VIRUS BUT
WE COULDEE THE DIFFERENCES WE
COULD NONAPOPTOTIC THE SEE THEM
WITH THE MA30 VIRUS.
>> SO,--SO QUICKLY WE'RE RUNNING
A LITTLE BIT OUT OF TIME, SO
KATHRYN WAS INTERESTED IS
DR. PERLMAN, DOES OBESITY OR
HYPER TENSIVE MICE DOES THAT
WORSE IN SARS?
IN SARS INFECTION?
>> WE DON'T KNOW.
WE HAVEN'T DONE THAT.
THOSE ARE THE THINGS WE'RE
THINKING ABOUT, I HAVE TO SAY
WITH WE TROO DO THIS EXACT
EXPERIMENT WITH THE ORIGINAL
SARS WITH OBESE MICE, WE MADE
THE MICE OBESE BY DIET, AND WHAT
WE FOUND WAS THAT AS SOON AS THE
MICE WERE INFECTED WITH SARS, 1
WITHIN A FEW DAYS THEY ACTUALLY
LOST THEIR OBESITY.
THEY SHED ALL THEIR WEIGHT SO IT
WAS AN INTERESTING PHENOMENA BUT
IT MADE IT NOT USEFUL FOR
STUDYING OBESITY ANY LONGER.
>> MARK, I THINK THERE IS A
QUESTION FROM OUR CO-CHAIR
DR. YOGEN TO ALL PANELISTS SO
MAYBE IF YOU WANT TO--
>> YES I WAS ABOUT TO GET TO
THAT SO DR. KANTHI WANTED TO
COMMENT ON THE CONCEPT OF NEW
IMMUNE SET POINTS FOLLOWING
INFECTION?
THIS IS OPEN TO ALL PANELISTS?
>> I CAN START, IT'S AN
EXCELLENT QUESTION AND IT'S--I
THINK WE'RE STILL EARLY DAYS SO
I CAN ELABORATE TO WHAT I
ALLUDED TO AT THE END, I
HIGHLIGHTED HOW THEY RESPOND TO
THE VACCINE IS DIFFERENT AND
THOSE CAN BE ATTRIBUTED TO
ACTUALLY A STABLE VARIABLE THAT
WAS SHIFTED AND SO IN THIS CASE
IT WAS CD8 MEMORY CELLS THAT I
MENTIONED, BUT WE ALSO SO
DIFFERENCES IN THE MONOCYTES.
YOU SEE FOR EXAMPLE, A DEPRESSED
SIGNATURE INVOLVING TLRRs AND
AUTOIMMUNE RECEPTOR GENES IN
THESE CELLS AND WHAT WAS VERY
INTRIGUING IS WHEN YOU LOOK AT
THESE INDIVIDUALS ON DAY 1 AFTER
THEY RECEIVED A FLU VACCINE AND
LETTER, YOU SEE A PARTIAL RESET
OF THOSE GENES SO SUGGESTING
THAT THE INFLAMMATION INDUCED
BIER THE VACCINE IT'S HELPING TO
REVERT SOME OF THOSE BACK.
WE DON'T KNOW WHY THERE IS A
GENDER OR SEX DIFFERENCE THERE,
WE SEE IT'S MORE PROMULGATE
FLENT IN THE FEMALES AND THAT
COULD BE BECAUSE OF THE INNATE
RESPONSE TO THE VACCINE AS
DR. SCULLY AND OTHERS ALLUDED
TO, IT CAN BE QUITE DIFFERENT
AND ESPECIALLY IN SOME OF THE
INFLAMMATORY PATHWAYS WITH GENES
ENCODED ON THE X-CHROME ON
STUDIES OF MULTIPLE ENDOCRINE,
TLR 79'S PATHWAY.
SO YEAH, I THINK THERE ARE
MULTIPLE NEW SET POINTS THAT ARE
NOT CORRELATED WITH THE TIME
SINCE ACUTE DISEASE, SUGGESTING
THAT THEY ARE STABLE ALREADY.
BUT OTHER ENVIRONMENTAL FACTORS
AND PROTERBATIONS COMING IN,
SUCH AS VACCINE OR OTHER
INFECTIONS MAY START TO CHANGE
AND SHIFT DOSE VARIABLES IN WAYS
THAT WE STILL NEED TO UNDERSTAND
BETTER INSTITUTE THE FUNCTIONAL
CONSEQUENCES.
>> OKAY, GREAT ANSWER.
WE WILL WRAP THIS UP.
IT'S 1:35.
WE WILL BREAK FOR LUNCH.
AGAIN, I ENCOURAGE ALL FAR TIS
PANTS TO FURTHER THESE DISUGZS
IN THE BREAK OUT SESSIONS
TOMORROW.
I THANK DR. PERLMAN, BAROUCH,
SCULLYAND DR. TSANG FOR AN
EXCELLENT TALK.
THANK YOU VERY MUCH.
WE WILL READJOURN AT 1:55.
>>SO DR. Mc KUSICK, HAS A
DEGREE IN HIGHER EDUCATION,
SHE'S PUBLISHED NUMEROUS
PROFESSIONAL ARTICLES.
AND ALTHOUGH SHE'S CURRENTLY
RETIRED, SHE CONSULTS FOR
ACHIEVING THE DREAM WHICH IS A
FASHIONAL REFORM NETWORK FOR
COMMUNITY COLLEGES HOWEVER SHE'S
NOT GOING TO TOWK TAKEN--THEY US
TODAY ABOUT HER CAREER IN
EDUCATION BUT RATHER SHE'S GOING
TO SHARE OUR EXPERIENCE WITH
HAVING CONTRACTED COVID IN
MARCH 2020 AND IS STILL HAVING
SYMPTOMS.
SO WELCOME DR. Mc KUSICK.
>> THANK YOU VERY MUCH AND THANK
YOU FOR THE OPPORTUNITY TO SPEAK
TODAY.
MY APOLOGIES IF I BREAK UP
COUGHING BECAUSE THAT IS PART OF
WHAT WE'RE TALKING ABOUT TODAY
AND THAT DOES HAPPEN.
I'M A WHITE WOMAN WHO GOES BY
SHE AND HER.
I'M 74 YEARS OLD AND IN MY
INTRODUCTION YOU LEARNED ABOUT
MY BACKGROUND IN TERMS OF MY
HEALTH, I GOT COVID IN MARCH OF
2020 EXCEPT FOR MILD
FIBROMYALGIA AND THE USUAL ACHES
AND MAINS PAINS OF SOMEBODY MY
AGE.
THIS IS MY INITIAL COVID STORY
IN EARLY MARCH 2020 I RODE IN
THE CAR OF A COLLEAGUE TO A
PROFESSIONAL CONFERENCE AND
ABOUT A WEEK LATER HE CALLED TO
IT WILL ME THAT HE WAS SICK WITH
A COUGH, EXTREME FETAL
COMPARTMENT TEAGUE AND DIAGNOSED
AT HOPKINS WITH COVID.
I HAD JUST BEGUN TO EXPERIENCE
SHORTNESS OF BREATH MYSELF.
I WENT TO MY PRIMARY CARE
DOCTOR, SHE PERFORMED THE VERY
FIRST COVID TEST IN HER PRACTICE
THEP THEY WILL NOT RELEASE THE
RESULTS BECAUSE THE LAB WAS TOLD
THAT THEY WERE NOT COMPENSATED
FOR COVID TESTING, THIS MIGHT
MAKE YOU REMEMBER THE CHAOS OF
THE EARLY COVID DAYS AND IT TOOK
HE ANOTHER WEEK OF THE RESULTS
BUT I ALREADY KNEW IT BY THEN.
I HAD SHORTNESS OF BREATH,
COUGH, FATIGUE, NO SMELL OR
TASTE, A SLIGHT FEVER OF 99 FOR
1 NIGHT AND THAT WAS IT.
I WENT INTO A IMMEDIATE
QUARANTINE.
I HAD A BAD COUGH BUT I NEVER
WENT TO THE HOSPITAL.
TWO MONTHS LATER, I WAS STILL
COUGHING IS NO ENERGY, SPRING
WAS COMING ALONG WITH WARM
WEATHER AND I COULDN'T STAND TO
BE IN THE SUN, IT MADE ME FEEL
FAINT AND DIZZY, MY PRAIMARY
DOCTOR HAD A CHEST X-RAY DUN,
RAN BLOOD TESTS, DISCOVERED THAT
MY GFR SCORES HAD DROPPED
SIGNIFICANTLY.
SHE REFERRED ME TO A CARDIOLOGY
OF THED, SHE READ ABOUT COVID
CAUSES, THE CARDIOLOGY RULED OUT
[INDISCERNIBLE].
THERE WAS NO POINT WHERE
SOMEBODY TOLD ME HAVE YOU LONG
COVID.
OF COURSE THAT WOULD HAVE BEEN
DOCUMENTED BUT WHENEVER I WOULD
GO TO NIGH DOCTOR SHE WOULD SAY
WELL IMOAB REALLY KNOWING
ANYTHING ABOUT IT.
SO I BEGAN TO BECOME MY OWN
ADVOCATE AND WENT TO SPECIALISTS
ON MY OWN AND I WOULD TELL THEM
ABOUT MY COVID EXPERIENCE AND I
WOULD GET THAT SAME SHRUG, WE
REALLY DON'T KNOW ANYTHING ABOUT
THIS.
EXCUSE ME.
SO IN THE LAST OVER 2 YEARS, I
HAVE BEEN TO A CARDIOLOGIST FOR
POSSIBLE POTS, AND
NEVERROLOGYIST FOR THE KIDNEY
DISEASE, GASTROINTESTERAL DOC
FOR POSSIBLE REFLUX THAT'S
CAUSING THE COUGH, AN ENT WHO
STUDIED MY LARYNX AGAIN FOR THE
COUGH AND COARSENESS, PULL
MONITORROLOGYIST FOR THE
COUGHING AND ALLERGIST FOR
VOICE, RHEUMATOLOGIST FOR BODY
ACHES WHO TESTED ME FOR SHOGUNS
AND RHEUMATOID ARTHRITIS, A
VOICE THERAPIST TO HELP ME SPEAK
BETTER AND SING AGAIN BECAUSE I
AM A SINGER.
PHYSIOLOGIST FOR BODY ACHES AND
PAINS AND FINALLY AN ORTHOPEDIC
DOCTOR FOR JOINT PAIN AND
CORTISONE SHOTS AND JUST
RECENTLY SURGERY.
EXCUSE ME.
COUPLE SIGNIFICANT THINGS, 1 I
AM FULLY VACCINATED AND
BOOSTERRED.
AND I NEVER HAD ANY KIND OF
STRONG REACTION TO THOSE EVENTS.
IN MAY OF 20 I DECIDED TO DONATE
PLASMA WITH ANTIBODIES, I KNEW I
HAD THOSE ANTIBODIES STILL AND
DONATED IT AT RED CROSS, THE
EXPERIENCE EXPERIENCE WAS REALLY
HORRIFIC, THEY TIE YOUR ARMS IN
PLACE, IT WAS 2 HOURS, I HAD
NAUSEA AND THERE WAS NOBODY
THERE TO HELP ME.
IN DECEMBER OF 21 I HAD COVID
AGAIN, THIS TIME THE SYMPTOMS
WERE EXTREME.
BODY ACHES, FATIGUE, FEVER, BUT
ONLY LASTED FOR 4 DAYS, THANKS
PROBABLY TO THE BOOSTER.
MY PRIMARY CARE DOCTOR GAVE ME A
LOT OF INFORMATION ABOUT
MONOCLONAL INFUSIONS, TRIED TO
ALL HER RESOURCES AND THEY LED
TO DEAD ENDS, SHE TOOK THE
INFORMATION OFF THE INTERNET
WHICH I CAN FIND MYSELF.
I FINALLY LOCATED A SMALL JEWISH
ORGANIZATION IN BALTIMORE THAT
WAS RUN OUT OF AN APARTMENT IN
THE SUBURBS, THEY HAD 5 INFUSION
STATIONS WITH A NURSE RUNNING
THE SHOW.
TWO DOCTORS DONATE ALL OF THE
SUPPLIES AND THEIR TEAM TO THE
CENTER IT WAS AN AMAZING NO COST
COMMUNITY RESOURCE.
BUT I DON'T THINK IT MADE ANY
REAL DIFFERENCE.
I THINK AT THIS POINT I HAD
OMICRON AND I DON'T THINK
THE--YOU YOU ALL KNOW A LOT MORE
ABOUT THIS HAN MOO THAT I WAS
GETTING WAS DIRECTED TOWARD THE
OMICRON.
CURRENT SYMPTOMS I STILL CAN'T
DEAL WITH HEAT.
I HAVE MODERATE KIDNEY DISEASE,
CAN'T TAKE ANY NSAIDS, WHICH IS
SIGNIFICANT BECAUSE I HAVE A LOT
OF MUSCLE AND JOINT PAIN RECENT
KNEE SURGERY, I'VE HAD MANY
CORTISONE SHOTS IN DIFFERENT
JOINTS.
I HAVE A VERY WEIRD INTENSIFIED
SENSE OF SMELL, IT WENT FROM NO
SMELL TO SMELLING THINGS BURNING
ALL THE TIME AND THE MOST
TROUBLESOME ARE NUISANCE SYMPTOM
IS THE EXCESS MOISTURE--I'M
SORRY THE MUCUS IN MY THROAT
THAT LEADS ME TO COUGHING.
SO THERE'S SEVERAL IDEAS, LARGER
IDEAS I WANT TO COMMUNICATE.
I COULD BE WRONG BUT I DON'T
THINK THERE'S A DIAGNOSTIC CODE
FOR POST COVID.
WITH THE ABSENCE OF THAT
EACHICISM THOM IS TREATED
INDIVIDUALLY BY SPECIALIST AS IF
THERE'S NO RELATIONSHIP BETWEEN
THEM.
ALSO INSURANCE BILLING HAS BEEN
VERY CHALLENGING.
I HAD DIFFICULTY GETTING THE LAB
RESULTS BECAUSE OF THIS IT.
HAD DIFFICULTY GETTING PAID BACK
FOR--RHEUMATOLOGIST FOUND MY
EXESESSIVELY DRY MOUTH AND
THROAT COULD BE SHORTENED GRINS
AN AUTOIMMUNE DISEASE AND I
TESTED NEGATIVE BUT YOU GET THE
REAL TEST WHICH WAS A LIT
BIOPSY, I VALID TO GO TO
HOPKINS.
HOPKINS DOESN'T ACCEPT A
MEDICARE ADVANTAGE PROGRAM THAT
I HAD.
SO, AS I SAID, I'VE HAD TO BE MY
OWN ADVOCATE THROUGHOUT.
NONE OF THE DOCTORS SEEM TO KNOW
ANYTHING ABOUT LONG COVID.
AS MY OWN ADVOCATE, I HAVE HAD
TO SEE AND UNDERSTAND THE INNER
RELATIONSHIPS BETWEEN THESE
SYMPTOMS.
FOR INSTANCE IS MY HORSE THROAT
DUE TO HYPOTHYROIDISM?
IS IT BET TORE TRY UP THE MUCUS
WITH AN OVER THE COUNTER DRUG?
IS IT RELATED TO BLOOD PRESSURE
MEDS, ET CETERA.
I'M SPEEDING UP BECAUSE I THINK
MY 5 MINUTES IS PROBABLY UP, MY
FRIENDS HAVE BEEN SUPPORTIVE
WHEN THEY SAY ARE YOU BETTER
YET?
I HAVE TO SAY I DON'T KNOW
BECAUSE SOME DAYS I FEEL BETTER
BUT THEN THE VERY NEXT DAY I'LL
BE WORSE AGAIN.
I'M VERY WARY OF IT, I HAVE SOME
DEPRESSION BECAUSE OF IT, I HAVE
BASICALLY GIVEN UP ON ANSWERS
AND I'VE JUST COME TO THE POINT
WHERE I FEEL LIKE I HAVE TO
PURSUE THIS IN TERMS OF
GRATITUDE THEY DIDN'T GET
ANYTHING WORSE.
BUT IF I WERE TO SAY 1 THING TO
THE WONDERFUL RESEARCH PEOPLE
WHO ARE TESTIFYING TODAY TODAY I
QUESTION WHETHER THE RESEARCH IS
REACHING THE PRACTITIONERS AND I
WILL LEAVE IT AT THAT.
>> THANK YOU DOCTOR, WE REALLY
APPRECIATE THAT AND BY THE WAY,
JD DAVIS POSTED A CODE AND I
THINK IT'S BECAUSE OF PATIENTS
LIKE YOU WHO BROUGHT IT TO THE
ATTENTION AND ALL THEAX SPECTS
OF LONG COVID BEING A NEW
EMERGING DISEASE, IT'S BECAUSE
OF PEOPLE LIKE YOU WHO HAVE
REALLY PUSHED THE ENVELOPE HERE
SO THANK YOU FOR SHARING WITH
US, YOUR PERSONAL ACCOUNT AND
ALSO THANKS FOR YOU KNOW HELPING
ALL THE INDIVIDUALS OUT THERE,
WHO HAVE GOTTEN UNFORTUNATELY
LONG COVID AND AGAIN, AS I SAID
BEFORE IT'S SO IMPORTANT FOR THE
SCIENTISTS AND THE POLICY MAKERS
TO HEAR YOUR STORY BECAUSE WE
REALLY WANT TO BE WORKING ON THE
RIGHT MODEL AND THE AND ASK THE
RIGHT QUESTIONS SO THANK YOU SO
MUCH FOR YOUR TIME.
SO NOW WE'RE GOING TO MOVE TO
OUR SESSION ON THE COMMUNITY'S
PERSPECTIVE AND THE SOCIAL
DETERMINANTS OF--THE
COMMUNITY'SER PERSPECTIVE AND
HOW NOW THAT KIND OF TRANSLATES
INTO THE SOCIAL DETERMINE NABTS
OF HEALTH AND IMPACT ON GENDER
RELATED COVID OUTCOMES AND FOR
THIS WE HAVE HEATHER
SHATTUCK-HEIDORN, AND SHE'S A
BIOLOGICAL ANTHROPOLOGIST.
SHE HAS BEEN WORKING AT THE
INTERSECTION OF PUBLIC HEALTH,
GENDER THEORY AND HUMAN BIOLOGY,
AND SHE USES THIS PLATFORM TO
EXAMINE HOW OUR SOCIAL LIVES
BECOME 'EM BODIED AND REFLECT IN
OUR HORMONES AND IMMUNE DISPUNKZ
OTHER BIOLOGY SO SEVERAL OF HER
CURRENT RESEARCH RIGHT NOW IS TO
USE LARGE DATA SETS TO LOOK AT
THE EFFECTS OF GEBDER ON ASPECTS
OF IMMUNE FUNCTION AND SHE AS A
COMMUNITY BASED PROJECT
INVESTIGATING HOW GENDERED
EXPERIENCES INFLUENCE STRESS AND
ALOE STATIC LOAD IN ADOLESCENCE.
THANK YOU SO MUCH HEATHER FOR
SHARING THIS MODERATING THIS
SESSION.
HI, THANK YOU KATHRYN, CAN
EVERYBODY HEAR ME OKAY?
>> YES.
>> GREAT.
FIRST WELCOME TO THE SECOND
SESSION, THANK YOU TO JASMINA
FOR ORGANIZING THIS EVENT AND
THE CO CHAIRS AND EVERYBODY AT
THE NIH, THAT WORKED ON THIS.
AND THIS SESSION, I WILL GO
AHEAD AND INTRODUCE THIS
FABULOUS TEAM OF PRESENTERS THAT
WE HAVE AND I WILL ALSO GIVE A
QUICK INTRODUCTION TO THIS
SESSION AND TURN IT OVER TO
DR. SPRINGER.
SO I HAVE TAKEN THE LIBERTY OF
SUMMARIZING THE FOLKS WE HAVE
PRESENTING HERE, THEIR BRACK
GROUNDS BUT YOU CAN FIND THEIR
FULL BIOS IN THE WORKSHOP
MATERIAL MATERIALS AND WE'RE
LUCKY TO HAVE THESE PEOPLE HERE
TODAY.
>> SO FIRST CHRISTEN SPRINGER IS
AN ASSOCIATE OF SOCIOLOGY, AND
SHE FOCUS ON THE INTERACTIVE
INFLUENCE OF SOCIOLOGY AND HER
WORK HAS BEEN PUBLISHED AND
FEATURED IN MAJOR NATIONAL AND
INTERNATIONAL RESOURCES SUCH AS
THE NEW YORK TIMES.
I SKIP MYSELF BECAUSE KATHRYN
DID SO AND YOU WILL LEARN MORE
ABOUT MY OWN WORK IN MY OWN TALK
AND I WILL MOVE TO TO CINDY LIU,
SHE'S A LICENSED CLINICAL
PSYCHOLOGIST, THE DIRECTOR OF
DEVELOPMENT AT RISK AND CULTURAL
RESILIENCE PROGRAM AND AN
ASSISTANT PROESES FESSOR AT HARD
VALID AND RELIABLE MEDICAL
SCHOOL, THE AREAS OF
INVESTIGATION INCLUDE
MEASUREMENT AND MECHANISMS OF
STRESS AND IMPACT ON MENTAL
HEALTH ACROSS KEY POINTS IN THE
LIFE SPAN AND SHE IS CURRENTLY A
PRINCIPLE INVESTIGATOR FOR
SEVERAL PANDEMIC AND MENTAL
HEALTH STUDIES INCLUDING WOKNOW
THAT SEEKS TO UNDERSTAND THE
EXPERIENCES OF PREGNAPT AND POST
PART NUM WOMEN.
AS WELL AS MENTAL EXPHELGT WELL
BEING IN DIVERSE YOUNG ADULTS.
WE ALSO ARE--HAVE SADIYA KHAN,
CARDIOLOGIST AT NORTHWESTERN AND
PREVENTIVE MEDICINE HER RESEARCH
FOCUS OTS EPIDEMIOLOGY, GENETICS
AND HEART FAILURE WITH EMPHASIS
ON SPECIFIC RISK FACTORS AS WELL
ON THE ROLE OF GEOGRAPHIC
VARIATION IN MAYBOR HOOD FACTORS
AND HEALTH DISPARITIES AND SHE
HAS AN EXTENSIVE PUBLICATION
RECORD AND IS HIGHY INVOLVED IN
HER FIELD.
AND FINALLY JOINED BY DR. PHIL
EPIGENETICS AND THEY'RE IN THE
MEDICAL SOCIAL SCIENCES AND
PREVENTATIVE MEDICINE AT
NORTHWESTERN AND HAS DEDICATED
HIS CAREER TO STUDIES THE
FACTORS THAT DISPROPORTIONATELY
IMPACT THE HEALTH OF MINORITIZED
INDIVIDUALS.
PARTICULARLY THOSE WHO ARE
SEXUAL AND/OR GENDER MINORITIES.
HE ALSO LEADS THE CHICAGO
DEPARTMENT OF PUBLIC HEALTH
FUNDED EVALUATION CENTER.
DR. PHIL EPIGENETICS IS 1 OF THE
LEADS OF STUDYING DISPORTIONATE
IMPACT ON SEX AND MINORITY
POPULATIONS AND HE USES A
COMMUNITY LED APPROACH FOR ALL
HIS WORK AND HAS STRONG
PARTNERSHIPS IN CHICAGO AND
BEYOND.
SO I AM DELIGHTED TO HAVE THESE
SPEAKERS HERE WITH US AND I
INVITED THISEM TO BE PART OF
THIS WORKSHOP BECAUSE MY GOAL
THROUGH THIS WORKSHOP IS TO
STORT OF STEP THROUGH IN 2
DIFFERENT WAYS FOR THEORIES OR
METHOD LOGICAL PRESENTATION AND
HELP TO START UNPACK THE SEX AND
GENDER DIFFERENCES IN TERMS OF
COVID OUTCOMES AND KRIOF THE
KNOW AND DR. KHAN WILL DO
SOMETHING SIMILAR IN TERMS OF
INTRODUCING INTERSECTIONAL
ANALYSIS ASK UNDERSTANDING HOW
GENDER AND RACE IMPACT BOTH
MENTAL HEALTH AND PHYSICAL
HEALTH IN COVID OUTCOMES AND
THEN DR. PHIL EPIGENETICS WILL
TALK TO US A BIT ABOUT GENDER
IDENTITY AND HOW WE CAN BETTER
CONSIDER SEX AND GENDER
MINORITIES IN OUR RESEARCH AND
WITH THAT, I AM GOING TO TURN
THIS OVER TO DR. SPRINGER.
>> CAN YOU SEE MY SCREEN?
ALL GOOD.
OKAY, FIRST I WANT TO THANK YOU
FOR--THANK EVERYBODY FOR
INVITING ME, THANK YOU FOR THE
WONDERFUL INTRODUCTION AND IT'S
A PLEASURE TO BE HERE WITH YOU
ALL TODAY.
SO AS HEATHER SAID I WILL DO A
THEORETICAL INTRODUCTION AND WE
WILL MOVE MORE INTO THE
DATABASE, THIS WILL HOPEFULLY
GIVE US GROUNDING IN TERMS OF
THINKING ABOUT INCORPORATING SEX
AND GENDER INTO THIS RESEARCH.
I HAVE NO CONFLICTS OF INTEREST
TO REPORT, SO THE WAY THAT I
VERMEN INFECTED THIS IS I'M
LOOKING AT, AND NOT JUST THE WAY
I DO IT BUT THE WAY THAT CURRENT
FEMINISTS THEORY AND KIND OF
SOCIOLOGICAL LOGICAL RESEARCH,
VIEW SEX AND GENDER IS A COMPLEX
PHENOMENON THAT IS
SIMULTANEOUSLY BIOLOGICAL AND
SOCIAL, SO WE HEARD EARLIER
THINKING ABOUT
INTERSECTIONALITY, WHETHER WHERE
YOU CAN THINK ABOUT RACE, CLASS,
GENDER TOGETHER, RIGHT?
WE CAN'T TEASE APART WHAT PART
OF SOMEONE'S EXPERIENCE OR WHAT
PART OF THEIR LIVED EXPERIENCE
AFFECTS HEALTH OUTCOMES BECAUSE
OF RACE OR BECAUSE OF GENDER OR
BECAUSE OF CLASS.
WHILE WE CAN THINK OF THAT THE
SAME WAY WITH THIS COMPLEX
PHENOMENON OF SEX GENDER SO
HOPEFULLY THROUGH THIS TALK AND
THROUGH OUR CONVERSATIONS, WE
WILL REALLY GRAPPLE WITH AND
EMBRACE THE IDEA THAT WE CAN'T
THINK ABOUT BIOLOGICAL FACTORS
AFFECTING COVID-19 OUTCOMES
WITHOUT THINK BEING HOW GENDER
IS AN INTEGRAL PART OF ALL OF
THOSE BIOLOGICAL FACTORS.
AND I'M GOING TO BE USING
COVID-19 MORTALITY AS AN EXAMPLE
THROUGHOUT.
SO WHEN I TALK ABOUT SEX GENDER
I WANT US TO THINK ABOUT THEM,
THEY'RE ENTANGLED RIGHT SO IF
THEY'RE ENTANGLED WE KNOW
THEY'RE ENTANGLED WE SHOULD
REALLY THINK ABOUT MODELING,
THEY--THE RISING AND ASSUMING
THAT UNTIL PROVEN OTHERWISE.
SO, YOU KNOW I WOULD ARGUE AND
CURRENT RESEARCH SUGGESTS THAT
WE NEED TO BE THINKING ABOUT HOW
TO MODEL ALL OF THESE SOCIAL
STRUCTURAL INSTIEWGDZAL GENDERS
ALONG WITH THE BIOLOGICAL
FACTORS TOGETHER IN ORDER TO
PRODUCE THE BEST SCIENCE MUCH
KEY POINT OF THIS WORK AND THIS
TALK I'M GIVING IS ALSO THAT A
BIOLOGICAL DIFFERENCE DOES NOT
MEAN A BIOLOGICAL CAUSE.
SO SOMETHING THAT'S REALLY
IMPORTANT WHEN WE THINK ABOUT
HEGHT OUTCOMES THAT WE CAN
NOTICE THAT THERE ARE BIOLOGICAL
DIFFERENCES.
WE'VE HEARD OF A LOT OF MALE,
FEMALE DIFFERENCES THAT ARE
BIOLOGICALLY GROUND BUT THAT
DOESN'T NECESSARILY MEAN THAT
THOSE ARE CAUSED BY A BIOLOGICAL
FACTOR OR SOLELY BY A BIOLOGICAL
FACTOR SO THAT'S THE POINT WE'RE
GOING TO HANG ON TO WITH THIS
TALK AND ALSO THAT GENDERED
EFFECTS ARE PRESENT IN OUR WORK.
THEY REALLY ARE PRESENT IN
ALMOST ALL HEALTH WORK EVEN IF
WE CAN'T MEASURE IT.
AND SO I THINK IT'S IMPORTANT
FOR US TO THINK ABOUT WHAT'S
THERE, HOW THEY'RE THERE, AND
THINK ABOUT WHAT'S GOING ON IF
WE CAN'T MEASURE IT.
SO HAVE YOU SEEN THIS FIGURE A
COUPLE TIMES NOW AND SO AGAIN,
WE'RE TALKING ABOUT COVID-19
MORTALITY AND THAT MEN HAVE
HIGHER RATES OF COVID-19
MORTALITY THAN WOMEN DO, RIGHT?
WE'VE SEEN THIS, WE KNOW THIS,
WE'VE HEARD ABOUT THIS AND
THERE'S CERTAINLY ARE BIOLOGICAL
TBACTORS AT PLAY.
BUT THERE ARE ALSO GENDERED
SOCIAL FACTORS THAT PLAY THAT
INTERSECT WITH THE BIOLOGICAL
FACTORS AND I KIENT KIND OF WANT
TO WALK THROUGH SOME EXAMPLES OF
HOW THAT MIGHT BE AND MOW WE CAN
THINK ABOUT INCORPORATING GENDER
INTO OUR MORE BIOLOGICAL MODELS
WE GO THROUGH WITH THIS WORK.
SO, 3 AREAS THAT WE CAN THINK
ABOUT IN TERMS OF GENDERED
FACTORS THAT INTERSECT WITH OUR
BIOLOGICAL FACTORS IN THIS
RESEARCH, ARE HEALTH BEHAVIORS,
GENDER STRUCTURES AND GENDER
BIOLOGICAL MECHANISMS AND I WILL
TALK ABOUT EACH OF THOSE IN
TURN.
SO HEALTH BEHAVIORS, I THINK
THIS IS KIND OF THE EASIEST TO
GRASP, EASIEST TO UNDERSTAND
FACTOR, RIGHT?
SO WE KNOW THAT WOMEN ARE MORE
LIKELY TO WEAR MASKS, MORE
LIKELY TO WASH THEIR HANDS, MORE
LIKELY TO COMPLY WITH PUBLIC
HEALTH ADVICE, MORE LIKELY TO
GET ROUTINE TESTING, RIGHT?
SO THIS GENDERED FACTOR IN TERMS
OF HOW,--IN TERMS OF COVID-19
MORTALITY APPROXIMATE AND IN
TERMS OF FACT THAT MEN HAVE
HIGHER RATES OF COVID-19
MORTALITY IS PRETTY EASY TO
GRASP AND EASY TO UNDERSTAND SO
WE START WITH THAT IN EMERGINGS
OF THINK BEING HOW GENDER MAKES
AN IMPACT.
BUT GENDER IS NOT JUST INVOLVED
IN COVID-19 MORTALITY THROUGH
HEALTH BEHAVIORS, RIGHT?
WE CAN THINK ABOUT GENDER
IMPACTING COVID-19 MORTALITY
THROUGH WHAT I'M REFERRING TO
HERE AS GENDER LATE STRUCTURES
SO LET'S TAKE A MINUTE TO THINK
ABOUT IT.
SO WE KNOW THAT IN HEALTHCARE,
SUPPORTIVE OCCUPATIONS, WE KNOW
THOSE ARE HIGH RISK FOR
COVID-19.
BUT WHAT WE ALSO KNOW IS THAT
APART FROM HEALTHCARE SUPPORT
PHYSICIANINGS, MEN ARE THE
MAJORITY OF THE LABOR FORCE AND
PROFESSIONALS WITH HIGH RISK OF
COVID-19 MORTALITY.
RIGHT?
SO HERE WE HAVE A GENDERED
FACTOR, WE HAVE A GENDERED
FACTOR OF DIFFERENT YALE
WORKPLACE POSITIONS OF MEN BEING
IN HIGHER PERCENTAGES OF CERTAIN
JOBS THAT HAVE HIGHER RATES OF
COVID-19 MORTALITY RISK.
WE'VE ALL HEARD ABOUT THE
OUTBREAKS IN MEET PACKING
PLANTS, MAINTENANCE WORKERS THAT
ARE PREDOMINANTLY MAIL, HAD TO
GO INTO THEIR OCCUPATION AND
COULD NOT WORK REMOTELY.
WE THINK ABOUT GENDER AS A
STRUCTURE, WAY OF RGINIZINGING
OCCUPATIONS, GENDER VERVIDS
NONAPOPTOTIC THE JUST
INDIVIDUAL'S IDENTITY OR THEIR
EXPRESSION BUT IT'S RELATED TO
THESE OCCUPATIONS IN A WAY THAT
CAUSES OR THAT IS RELATED TO
COVID-19 MORTALITY.
ALSO ENCORSERATION AND
HOMELESSNESS, SO WE KNOW THAT
MORE MEN ARE INCARCERATED,
HOMELESSNESS AND GREATER AMONG
MEN AND THOSE AREAS HAVE HIGH
RISK COVID-19 AND COVID-19
MORTALITY, RIGHT?
SO THAT INTERSECTION OF THESE
GENDERED STRUCTURES,
INTERSECTING WITH THE BIOLOGICAL
FACTOR THAT LEAD TO MEN TO HAVE
A HIGH RATE OF COVID-19
MORTALITY.
SO WHAT ABOUT MORE OF THE
BIOLOGICAL MECHANISMS.
HOW MIGHT WE SEE THE SOCIAL
FACTORS THAT ARE UNDERLYING
THESE BIOLOGICAL MECHANISMS.
SO I'LL JUST TAKE 1 EXAMPLE HERE
TO WALK US THROUGH.
SO WE KNOW THAT MEN HAVE HIGHER
LEVELS OF HEALTH CONDITIONS THAT
ARE CO-MORBIDITIES FOR COVID-19
PORTALLITY SO FOR EXAMPLE
CARDIOVASCULAR DISEASE.
AND 1 ASPECT OF THAT AND YOU ALL
ARE MUCH MORE OF AN EXPERT ON
THE BIOMEDICINE OF THIS THAN I
AM.
SO YOU CERTAIN LE KNOW, THAT
THERE ARE CERTAIN MANY
BIOLOGICAL FACTORS THAT LEAD TO
CARDIOVASCULAR DISEASE AND THAT
ARE ASSOCIATE WIDE MEN HAVING
HIGHER RATES OF CARDIOVASCULAR
DISEASE.
ONE BEING HIGH CHOLESTEROL AND
CENTRAL ATAPPOSSITY, OF COURSE,
OF COURSE THERE ARE BIOLOGICAL
MECHANISMS AT PLAY IN THIS.
YOU WILL KNOW MORE THAN I WILL
BUT JUST FOR EXAMPLE, FAT AND
CHOLESTEROLLOR PROCESSED
DIFFERENTLY FOR MALES AND
FEMALES ARE ANOTHER EXAMPLE IS
THAT HIGHER LEVELS OF
TESTOSTERONE ARE ASSOCIATED WITH
HIGH LEVELS OF HLD CHOLESTEROL,
SO THERE ARE BIOLOGICAL FACTORS
AT PLAY THAT LEAD TO THIS, THAT
ARE ASSOCIATEDES WITH HIGHE
OF COVID MORTALITY WHICH LEADS
TO HIGHER RATES OF MORTALITY FOR
MEN.
ABOUT YOU WHAT WHAT ABOUT SOCIAL
FACTORS, LET'S TAKE A STEP BACK,
RIGHT?
SO THERE ARE SOCIAL FACTORS AT
PLAY THAT LEAD THORS THESE
DIFFERENT BIOLOGICAL MECHANISMS
ASSOCIATE WIDE HIGHER RATES OF
COVID-19 MORTALITY FOR MEN.
SO FOR EXAMPLE, THERE ARE THE
NORMATIVE IDEAS OF MEN AS STRONG
AND BIG VERSUS WOMEN AS SLENDER
AND DELICATE.
SO THESE NORMATIVE IDEAS OF MENS
AND WOMEN BODIES EAT MORE AND
EAT HIGHER FAT FOODS WHICH IS
ASSOCIATE WIDE HIGHER
CHOLESTEROL, MORE CENTRAL
ATAPPOSSITY, GREATER CVD,
GREATER MORTALITY RATES.
AND ALSO WHEN RESOURCES ARE
LIMITED MEN ARE MORE LIKELY TO
RECEIVE THE RICHEST AND MOST
UNHEALTHY MEET.
SO GENDERED STRUCTURES THAT LEAD
TO DIFFERENCES IN BIOLOGICAL
PROCESSES THAT ARE ASSOCIATE
WIDE COVID-19 MORTALITY RATES
THAT ARE HIGHER FOR MEN VERSUS
WOMEN.
SO WHERE DOES THIS LEAVE US?
IN IS A SYMPOSIUM ON SEX AND
GENDER, NOT JUST SEX OR GENDER,
BUT SEX GENDER TOGETHER.
SO RIGHT?
SO THERE ARE AT LEAST 3 WAYS
FORWARD.
A LOT OF WHAT IS DONE ON
RESEARCH LOOKING AT SEX GENDER
AND HEALTH OUTCOMES, JUST ANY
MALE/FEMALE DIFFERENCE AND YOU
ASSUME IT'S RELATED TO A
BIOLOGICAL CAUSE, IT'S NOT
INFORMATIVE, NOT THE BEST
SCIENCE AND DOESN'T HELP US WITH
INTERVENTIONS.
ANOTHER THING THAT IS OFTEN DONE
IS THAT PEOPLE WILL ONLY TEST
PARTICULAR BIOLOGICAL CAUSES AND
DON'T THINK ABOUT THE GENDERED
MECHANISMS, AGAIN THAT'S
INSUFFICIENT SCIENCE.
NOT THE WHOLE COMPREHENSIVE IDEA
OF WHAT'S GOING ON.
WHAT I WOULD CHALLENGE PEOPLE TO
DO, WHAT I REALLY THINK THAT WE
NEED TO WORK TOGETHER AS KIND OF
CROSS DISCIPLINARY TEAMS TO GET
THE BEST SCIENCE IS TO PRESUME,
EXPLORE ASSESS AND MODEL SEX
GENDER FACTORS TOGETHER THAT
MIGHT SHAPE HUMAN HEALTH
OUTCOMES.
THIS IS BEST PRACTICE, IT'S BEST
SCIENCE, IT LEADS THE MOST
OPPORTUNITIES FOR INTERVENTIONS,
IN TERMS OF BIOLOGICAL
MECHANISMS BUT ALSO IN TERMS OF
SOCIAL FACTORS THAT WILL SHAPE
THE HEALTH OUTCOMES THAT WE'RE
INTERESTED IN.
SO I WOULD REALLY HOPE WE CAN IN
THE DISCUSSION TALK ABOUT HOW TO
DO MORE OF THESE--THIS KIND OF
MORPHFUL AND ACCURATE STRATEGY.
I ALSO WANT TO SAY IN HERE 1
THING WHAT WE'VE BEEN THINKING
ABOUT ON THESE GREAT
PRESENTATION SYSTEM A REMINDER
THAT TO DO INTERESTING AND
IMPORTANT SEX JEBDER RESEARCH,
YOU DON'T HAVE TO COMPARE MEN
AND WOMEN, THERE'S SO MUCH
GENDER AND SO MUCH BIOLOGICAL
SECTION AND SEX GENDER THAT
HAPPENS WHEN YOU'RE LOOKING
WITHIN MEN OR WOMEN AND PEOPLE
IN THOSE WHO DON'T IDENTIFY IN
THOSE BINARYS, IT'S NOT ON HERE
BUT IT'S SOMETHING I WOULD PUSH
US TO THINK ABOUT.
THAT IS THE END OF MY TALK.
THANK YOU.
>> THANK YOU SO MUCH CHRISTEN.
AND THEN I HAVE THE NEXT TALK.
WERE WE DOING QUESTIONS RIGHT
AFTER THE TALKS, I CAN'T
REMEMBER RIGHT NOW.
>> WE WILL HAVE DISCUSSIONS
AFTER ALL OUR TALKS.
>> OKAY, THEN I WILL MOVE INTO
MY TALK.
OKAY SO YOU SHOULD BE ABLE TO
SEE JUST MY SLIDES AND THAT
WOULD BE 3, 1, AND HI,
EVERYBODY, THANKS SO MUCH TO
ORGANIZERS FOR INVITING MOOY AND
PREPARING THIS WORKSHOP, I'M
TRAINED AS A HUMAN BIOLOGIST BUT
I'M AN ASSISTANT PROFESSOR OF
WOMEN AND GENDER STUDIES AT THE
UNIVERSITY OF SOUTHERN MAIN AS
WELL AS CONFOUNDER AND ASSISTANT
DIRECTOR OF THE HARVARD LAB.
TODAY I WILL BE USING WORK IN MY
LAB, IN RELATION TO THE COVID-19
PANDEMIC TO ILLUSTRATE LARGER
POINTS ABOUT HUMAN HEALTH AND
BIOLOGY.
SO DR. SPRINGER INTRODUCED AND
WE HAD EARLIER SPEAKERS THAT
ALSO TALKED ABOUT PRETTY
FUNDAMENTAL CONCEPTS AROUND SEX
AND GENDER AND IN DOING SO,
THEY'RE DOING WORK FROM THE
GENDER SIDE LAB, SO HERE I WOULD
LIKE TO CONTINUE EXPANDING ON
THOSE CONCEPTS AND WALK THROUGH
SOME OF THE DATA THAT THE LAB
GATHERED CONCERNS SEX GENDER AND
COVID-19.
SO FIRST I WOULD LIKE TO TELL
YOU ABOUT THE LAB BECAUSE IT
HELPS TO FRAME OUR COVID-19
WORK, WE WERE FORM INDEED 2018
BASED OUT OF A 10 YEAR
COLLABORATIVE RELATIONSHIP
BETWEEN MYSELF AND 2 OTHER
PROFESSORS SPANNING DISCIPLINES
AND OUR LAB PRIMARILY FOCUSES ON
UNDERSTANDING HOW GENDER SEX IS
MODELED IN THE BIOSCIENCES.
FROM BOTH A METHLOGICAL
PERSPECTIVE AND OUR LAB IS ISHT
DISCIPLINARY, WE HAVE HISTORIANS
OF SCIENCE, EPIDEMIOLOGISTS,
PHILOSOPHERS, BIOLOGIST AND
OTHERS WORKING SIDE BY SIDE TO
UNDERSTAND THE CONCEPTUALIZATION
AND OPERATIONALIZATION OF JEBDER
SEX IN REALLY DIVERSE DOMAINS
FROM ALZHEIMERS TO COVID-19 AND
ADVERSE DRUG EVENTS.
EARLIER IN THE PANDEMIC THAT
HAVE BEEN WELL DISCUSSED HERE,
WE TRACKED IT IN THE STATES WE
AGGREGATED THE DATA AND BREAK
DOWN BY STATES IN THE U.S., WE
MADE THESE AVAILABLE AND
CONTEXTUALIZED WE OFFERED
FIGURES AND CHARTS IN RELATION
TO POPULATION SIZE AND AGE
STRUCTURE.
IN THE EARLY DAYS OF THE
PANDEMIC, IT WAS CLEAR THE SEX
DIFFERENCE WAS FAR FROM STRAIGHT
FORWARD.
THE MALE-FEMALE MORTALITY RATIO
VARIED WIDELY ACROSS STATES AND
TIME.
IN BECAME APPARENT THAT SOCIAL
GROUPS, AFRICAN AMERICANS,
LATINOS, NATIVE AMERICANS WERE
BEING HIT HARD BY THE PANDEMIC.
TO UNDERSTAND THESE DISPARITIES
OUR GROUP QUESTIONED HOW THE SEX
DIFFERENCE IN MORTALITY VARIED
ACROSS RACIAL GROUPINGS IN THE
U.S., WE LIAISON POGHTICIZE IF
THERE'S STRONG SEX DRIVEN, TO
THE APPARENT SEX DISPARITY, THEN
THERE SHOULD BE RELATIVELY
SIMILAR SEX DIFFERENCES ACROSS
SOCIAL GROUPS.
CONVERSELY IF THE REASON FOR THE
SEX DIFFERENCE IS LARGELY DUE TO
SOCIAL FACTORS WE WOULD EXPECT
TO SEE A LOT OF VARIATION IN THE
SEX DIFFERENCE BETWEEN SOCIAL
GROUPS.
BASED ON RESULTS OF OF OTHER
RESEARCHERS WE EXPECTED PLAQUE
AMERICANS WOULD HAVE HIGHER
MORTALITY THAN WHITE AMERICANS
BUT WE DID NOT KNOW WHAT
MORTALITY RATES WOULD SHOW.
SO I THINK YOU CAN SEE MY HOUSE
HERE, HERE'S ASIAN AND PI,
HERE'S BLACK, WHITE,
INDIVIDUALS, IN GEORGIA AND
MICHIGAN WHICH ARE THE ONLY
STATES THAT WERE OFFERING RACE
AND SEX AND AGE DATA AT THIS
TIME FOR COVID MORTALITY.
SO WE FIND THAT PLAQUE MEN HAD
MUCH HIGHER MORTALITY RATES THAN
OTHER RACE OR SEX GROUPS
REVELING A PARTICULARLY
VULNERABLE SUBGROUP, BUT
CONTRARY TO THE COMMON STORY OF
MEN AS UNIQUELY VULNERABLE,
BLACK WOMEN, SO THE DARKER BAR
HERE, AND HERE, COMPARED TO
WHITE AND ASIAN WOMEN, HAD 3 TO
4 TIMES THE MORTALITY RATE OF
WHITE MEN OR ASIAN PACIFIC
ISLANDER MEN.
WE ALSO FOUND THAT THE SEX
DISPARITY AND MORTALITY VARIED
WIDELY BETWEEN RACIAL GROUPS.
SO THE RELATIVE, THE MORTALITY
DIFFERENCE BETWEEN BLACK MEN AND
WOMEN WAS LARGE E-PRESCRIBING
THAN THE CORRESPONDING DISPARITY
BETWEEN WHITE MEN AND WOMEN, OR
AMONG ASIAN AND INTASK ISLANDER
MEN AND WOMEN.
ARK DITIONALLY AND THIS GOES TO
DR. SPRINGER'S POINT AROUND
VARIATION WITHIN 6, OUR ANALYSIS
REVEALED SIGNATURES NICHE CANT
RACIAL DISPARITIES WITHIN SEX,
SO FOR INSTANCE THE DIFFERENCE
IN PORTALLITY IN BLACK AND WHITE
WOMEN WAS ALMOST 4 TIMES GREATER
THAN THE SEX DISPARITY BETWEEN
WHITE MEN AND WHITE WOMEN.
--GAVE EVIDENCE THAT WHILE THERE
I MA BE INDEED LINK TO SEX IN
DIGS PARITY, SOCIAL AND
CONTEXTURAL FACTORS WILL DRIVING
THE MORTALITY DIFFERENCES.
THESE ARE A FEW PATTERNS TO HOW
SOCIAL FACTORS ASSOCIATED WITH
GENDER RACE AFFECT THE FACTORS
OF THE VIRUS.
s OVERREPRESENTED INDUSTRIES
SUCH AS HEALTHCARE WORKERS,
INDUSTRIES CONSIDERED EISN'TIAL
COULD NOD WORK FROM HOME AND HAD
HIGH EXPOSURE RATES TO COVID-19.
THIS IS OTHER SOCIAL FACTORS
SUCH AS NEIGHBORHOOD SEGREGATION
AND HOUSING DENSITY IS 1
INFLUENCE BY HISTORICAL AND
CONTEMPORARY RACISM AND SOCIETAL
SECTORS AND 2 AFFECT THE RISK OF
EXPOSE TOWER COVID-19 DURING THE
PANDEMIC.
OTHER FACTORS AFFECTED PEOPLE'S
SUSCEPTIBILITY TO COVID GISK AN
EXPOSURE FOR INSTANCE CHRONIC
DISEASES ARE AN ESTABLISHED RISK
FACTOR, CHRONIC DISEASE PATTERNS
IN THE U.S. AWNCH MIRROR THE
PATTERN OF DATA WE VAW FOR
COVID-19 OUTCOMES, NOW CHRONIC
DISEASEs AS DR. SPRINGER WAS
TALKING ABOUT AND MANY OF YOU
KNOW, ARE CLEARLY MULTIFACTORIAL
IN TERMS OF CAUSES BUT THERE'S
CLEAR LINKAGES LIKE SOCIAL
ACCESS, RACISM, SOCIETAL FACTORS
AFFECTING THE ABILITY TO
EXERCISE AND EAT HEALTHY FOODS
SUCH AS POVERTY EXPE
NEIGHBORHOOD FACTORS, AND
OUTCOMES LIKE CHRONIC DEC.
IN OUR ANALYSIS OF THE
INTERACTION BETWEEN RACE AND SEX
AND COVID-19 OUTCOMES WE
OUTLINED HOW FACTORS SUCH AS
THESE BEING INFLUENCE THE
PATTERNS WE OBSERVE, DRAWING ON
WELL ESTABLISHED BODIES OF
THEORETICAL AND ANALYTICAL WORK,
AND RACE OF CONSTRUCKS IMPACT
HEALTH AND EXPERIENCES IN THE
UNITED STATES.
IN PARTICULAR, IN WORKING TO
UNDERSTAND HOW SOCIAL VALID AND
RELIABLIA BELIEVES AND
ASSOCIATED POWER DYNAMICS
INFLUENCE HEALTH DISPARITIES WE
DREW FROM THE FRAMEWORK OF
INTERSECTIONALITY FOR
[INDISCERNIBLE], AND I HAD TO
STEP OUT FOR A SECOND DURING AN
EARLIER TALK BUT I SO I
APOLOGIZE IF THIS IS A REPEAT
BUT I WANT TO TALK ABOUT
INTERSECTIONALITY, AND DRAWING
ANN EXTENSIVE AND PRETTY DREEP
HISTORY OF SUCH ANALYSIS WITHIN
THE WRITINGS OF BLACK AND OTHER
WEMG OF COLOR FEMINIST SCHOLARS,
SO THE SOME A COMMITMENT OF
SOCIAL LINK TO CATEGORIES
DIFFERENTLY STRUCTURES
EXPERIENCES, SUCH THAT
CATEGORIES SUCH AS GENDER AND
RACE CANNOT BE CONSIDERED AS
DISCREET BUT ARE NECESSARILY CO
CONSITUTING EACH OTHER.
INCRETESINGLY THERE ARE CALLING
TO INCORPORATE AND UNDERSTANDING
OF INTERSECTIONALITY INTO THE
HEALTH SCIENCES AND SCHOLARS
SUCH AS [INDISCERNIBLE] ARE
DEMONSTRATING HOW THE HEALTH
SCIENCES CAN REALLY MOVE FORWARD
WITH SUCH ANALYSIS INTO A MORE
SOCIALLY ROUTED CONSIDERATION OF
EXPHELGT HEALTH EQUITY.
OUR ANALYSIS OF COVID-19
OUTCOMES AMONG RACE AND GENDERED
AND TD IEE, AUDIENCE PEERANCE OF
SEX DISPARITIES VARIED IN THE
SPRING OF 2021 WE ANALYZED MORE
THAN A YEAR OF WEEKLY DATA WE
ARE INTERESTED IN WHAT OUR DATA
COULD TELL US REGARDING HOW CASE
AND MORTALITY RATES VARIED OVER
PLACE AND TIME.
THIS IS FROM AN A VERY EXTENSIVE
DATA THAT UNPACKED A LOT MORE
AND JUST TRYING TO HIGHLIGHT
WHAT YOU CAN ABSORB IN 10
MINUTES.
SOPHISTICATEDY WOO FOUND
THROUGHOUT THE MAN DEMIC THE
CASE RATE VARIED DIFFERENTLY.
OFTEN WOMEN WERE RECEIVING
POSITIVE TESTS FOR CONIA VIRUS,
THIS COULD BE DO TO FREQUENTLY
TESTERRED INDUSTRIES SUCH AS
HELT WORKERS, COULD BE DUE TO
EXPOSURES OR THE TESTS, MANY
STATES RESEMBLE LA LAXER WITH
WOMEN HAVING HIGHER STATES
THROUGHOUT THE PANDEMIC.
AND EACH STATES WHERE THEY HAD
CASE RATES FROM THE BEGINNING
SUCH AS TEXAS.
THE SEX DISPARITY AND CASE
MORTALITY RATE HIGHER IN MANY
VARIED QUITE WIDELY.
IN MEN AND WOMEN HAD EQUAL
MORTALITY THROUGHOUT THE
PANDEMIC, IN OTHERS MEN HAD
HIGHER MORTALITY FROM THE
BEGINNING AND STILL IN OTHERS,
THE MORTALITY THAT EMERGE
THROUGHOUT THE PANDEMIC.
>> ONE MINUTE LEFT.
>> THE LAB DEMONSTRATED THAT THE
OOSKTS PREVIEWED AS EVIDENCE OF
SEX DIFFERENCES VARIES
EXTENSIVELY BETWEEN THE SOCIAL
CATEGORIES OF RATE AND TIME IN
PLACES.
WHAT DOES THIS INDICATE, THE SEX
DISPARITY IN MORTALITY IS LIKELY
LINKED TO GENDER IN CONJUNCTION
WITH RACE, SOCIAL CLASS AND
OTHER SOCIAL BIOFACTORS.
AND THESE ARE MY NEXT STEPS IN
QUESTIONS FROM MY OWN
PERSPECTIVE AND I DON'T KNOW IF
WE EVER RETURN TO THESE, I CAN'T
QUITE REMEMBER.
LATER BUT REALLY WHEN I'M THINK
BEING THE OTHER TALKS, 1 OF THE
THINGS I'M INTERESTED IN IS
UNDERSTANDING HOW WE CAN BETTER
ACCOUNT FOR GENDER AND LARGE
PREEXISTING DATA SETS AND THERE
ARE FOLKS THAT ARE OUTLINING HOW
TO DO SO IN SOME DRNT WAYS
WITHIN SOCIOLOGY.
THEY'RE NOT FOCUSED ON USUALLY
ON HEALTH OUTCOMES AND CERTAINLY
NOT GRANULAR HEALTH OUTCOMES
LIKE BIOMARKERS OR IMMUNE
FUNCTION.
YOU KNOW UNLESS THE DATA SET IS
TRULY CONTROLLING FOR FAST AVEY
OF CHRONIC DISEASES, THERE ARE
MANY, LIKE WHEN WE'RE MEASURING
IL6 AND CRP, I WORK A LOT WITH
CRP AND OTHER INFLAMMATORY
MARKERS AND WE LOOK AT
DIFFERENCES BETWEEN MEN AND
WOMEN, WE'RE ALSO OF COURSE
MEASURING THEIR DIFFERENCE IN
THEIR LIFESTYLE, DIFFERENCES IN
YEARS OF PAST EEIVETS AND TRAUMA
EXPOSURE AS OTHER PEOPLE HAVE
TOUCHED ON ET CETERA ESTROGEN
AND HOW DO WE TAKE INTO,A COUNT
THESE DIFFERENCES, THOSE
PREEXISTING SOCIALLY ROOTED BUT
BIOLOGICALLY VISIBLE DIFFERENCES
RELATED TO FOACIAL FACTORS WHEN
WE CONSIDER DISEASES LIKE
COVID-19.
THANK YOU.
ALL RIGHT AND NOW I WILL TURN
THIS OVER TO DR. LIU.
>> THANK YOU SO MUCH, LET'S SEE
IF THAT WORKS THERE.
OKAY, SO HI, EVERYONE, I'M CINDY
LIU AND I'M A CLINICAL
PSYCHOLOGIST AND RESEARCHERS IN
NEW BORN MEDICINE AND PSYCHIATRY
AND ALSO THE DIRECTOR OF SEEK O
SOCIAL STRESS AND HEALTH WITHIN
THE CONNOR CENTER FOR WOMEN'S
HEALTH AND GENDER BIOLOGY.
IT'S SUCH A PRIVILEGE TO BE PART
OF THIS WORKSHOP.
I AM MORE FAMILIAR WITH NIMH AND
NICHD AND HEARING THE
PRESENTATIONS, YOU KNOW THAT
HAVE TAKEN PLACE SO FAR TODAY, I
CAN REALLY SEE THIS
MULTIDISCIPLINARY EFFORT IN
UNDERSTANDING YOU KNOW SEX
GENDER AND HEALTH.
WHAT I'M GOING TO FOCUS ON ARE
THE SOCIAL SOCIAL STRESS
EXPERIENCES OF PEOPLE OF COLOR
AND WOMEN BASED ON OBSERVATIONS
PRACTICES THE PANDEMIC SO I'M
GRATEFUL FOR DR. SPRINGER AND
HEIDORN, AND I HOPE TO REINFORCE
THE MESSAGES THEY'RE SHARING SO
FAR.
I WANT TO FORM A FRAMEWORK FOR
SEX SPECIFIC COVID-19 OUTCOMES
AND MANAGEMENT.
REALLY TO PROVIDE A DOSE OF
REALITY THAT WE NEED TO CONSIDER
BOTH SEX, GENDER AND RACE IN
DISAGGREGATION, THIS DOES NOT
WITH DIRECT EFFECTS OF THE
COVID, BUT THE EXPERIENCE OF THE
PANDEMIC.
IMPORTANT CONSIDERATION GIIVE
UPON THE ACCUMULATED EVERY DAY
EXPERIENCES SO FAR IN THE 2 PLUS
YEARS.
THE FIRST THING I WANT TO DO IS
COVER THIS MYTH ABOUT THE
PANDEMIC AND REALLY HEARD A LOT
ABOUT THIS.
ESPECIALLY EARLY ON, I THINK
WITH THIS CROWD ASK WHAT HAS
BEEN SHOWED SO FARRED IN THE
WORKSHOP IS FOR THE MOST PART
THERE'S EVIDENT TO SUGGEST IT'S
NOT A GREAT EQUALIZER BUT THE
THING IS IT HAS BEEN A NARRATIVE
THAT TOOK HOLD, THROUGH THE
MEDIA, AND THROUGH POLITICIANS,
THE IDEA THAT THE PANDEMIC IS
TERRIBLE BUT IT'S MADE PEOPLE
EQUAL AND IN FACT, JUST THIS
PAST YEAR, THIS WAS EXPOSED BY
THE A RIVIEWER OF A PAPER THEY
SUBMITTED WHO TOLD ME I MISS THE
OPPORTUNITY TO REVIEW THE
PANDEMIC AS A EQUALIZER.
SO WHILE THERE'S .ARE ON HERE
TEMPTING THEM AND HEAD LINES
THAT DISPEL THE MYTH IT'S STILL
PART ABOUT HOW PEOPLE ARE
THINKING ABOUT RESEARCH AND EVEN
RESEARCHERS THEMSELVES.
BUT WHAT WE DO KNOW AND HAVE
HEARD SO FAR IS THAT BOTH SEX
AND GENDER AND RACE MATTERS.
SO AT THIS POINT IT'S LARGELY
ACCEPTED THAT PEOPLE OF COLOR
ARE AT GENERAL GREATER HEALTH
RISK FOR PROBLEMS DUE TO THE
PANDEMIC AND THE QUESTION IS,
WHY IS THAT?
SO IN GENERAL, ANY DISRUPTION TO
SOCIETY DISPROPORTIONATELY FACE
MORE INIQUITIES TO BEGIN WITH
AND SO I POINT OUT SOCIAL
DISTANCING ITSELF IS ACTUALLY A
PRIMATES LEDGE AS MANY PEOPLE OF
COLOR AREN'T ABLE IEBL TO SOCIAL
DISTANCE BASED ON WHERE THEY
LIVE AND WORK THIS IS A REMINDER
OF HOW WE MUST TAKE SERIOUSLY
THE SOCIAL DETERMINANTS OF
HEALTH IN OUR OUTCOMES.
OOSE NOT JUST ABOUT RACE BUT
JEBDER AS WELL.
RIGHT?
SO WE'VE SEEN THAT STRUCTURAL
GENDERED RACISM SHAPES INCREASED
RISK FOR COVID AMONG PEOPLE OF
COLOR BASED ON THEIR OCCUPATION,
HERE'S ANOTHER EXAMPLE, SO
AACCORDING TO THE NATIONAL
NURSES, UNION, FILIPINO WOMEN IN
THE U.S. WHO MAKE UP 4% OF THE
WORKFORCE, COMPRISED OF 31% OF
THE DEATHS AMONG REGISTERED
NURSE DEATHS.
DUE TO THE COVID AND SO, WHEN
CONSIDERING NURSES OF COLOR, YOU
KNOW 54 OF THOSE WHO HAVE DIED
TO DATE HAVE BEEN FILIPINO.
SO WHILE SOCIAL DISTANCING TO
MITIGATE TRANSMISSION, WOMEN ARE
DISPLACED WITH PSYCHOSOCIAL
STRESS FROM THE DEMIC OVERALL
WHEN WE CONSIDER THAT
PSYCHOSOCIAL STRESS IS
RACIALIZED AND ENGENDERED WITHIN
THE STRUCTURES AND THESE
EVERYDAY INTERPERSONAL
INTERACTIONS.
SO THIS ASSERTION MADE BY
DR. SPRINGER AND COLLEAGUES, I
PULL THIS OUT, I REALLY LIKE IT,
HERE, SHE AWRPGS THAT THE
BIOLOGICAL FACTORS OF GENDER ARE
INEXTRICABLILY BOUND WITH THE
SOCIAL WORLD OF GENDER AND THIS
POINT APPLIES TO HOW WE THINK
ABOUT RACE.
SO AS DEPICTED HERE STRUCTURAL
RACISM WHETHER IT'S HISTORICAL
CULTURAL, INSTITUTIONAL OR
INTERPERSONAL IN MIGHT BE
FUNDAMENTAL CAUSE TO VARIOUS
DISADVANTAGES AND EVERY DAYA
ADVERSE EXPERIENCES AND THESE
PROCESSES GET UNDER THE SKIN AS
HAS BEEN ALLUDED TO IN TALKS, SO
IN THE CONCEPTUAL MODELS,
APPRAISALS AND OTHER
PSYCHOSOCIAL STRESSORS FACED BY
PEOPLE OF COLOR AND WOMEN HAVE A
DOWN STREAM EFFECT ON HEALTH
RISK VIS A VIS HEALTH BEHAVIORS,
SEECIAL --PSYCHOSOCIAL FACTORS
AND NEUROLOGICAL PROCESSES.
SO HERE I SHOW A FEW OF THESE
POETIC TESHTIAL PATHWAYS
ILLUSTRATED SO IN SOME WORK
FUNDED BY ROBERT WOODS JOHNSON
AND THIS WAS CONDUCTED BEFORE
THE PANDEMIC, 1 OF 3 PLAQUE
AMERICANS WERE FOUND TO AVOID
CERTAIN SOCIAL SITUATIONS IN
PLACES COMPARED TO 1 OUT OF 12
WHITE AMERICANS.
AND AMONG THOSE WHO HAVE HAD THE
HIGHEST LEVEL OF HYPER VIGILANCE
MORE THAN HALF PLAQUE ACULTS
WERE FOUND TO HAVE HYPER TENSE 1
OUT OF 5 ADULTS SO THESE
PATHWAYS ANTICIPATEATORY
ANXIETY, AVOIDANCE THESE
BEHAVIORS THAT TAKE PLACE WITHIN
DISCRIMINATION, THEY'RE
HYPOTHESIZED TO EXPLAIN THE
LINKS BETWEEN DISCRIMINATION AND
HYPERTENSION AND PROBLEMS WITH
OTHER OUTCOMES AMONG BLACK
ACULTS AND THIS LITERATURE IS
GROWING WITH MORE EVIDENCE,
ESTABLISHING THESE ASSOCIATIONS.
ONE OF THE AREAS I'VE BEEN
FOCUSING ON IN MY RESEARCH
PROGRAM IS THE EXPERIENCE OF
DISCRIMINATION OF ASIAN
AMERICANS DURING COVID.
EXPERIENCES THAT TOGETHER WE
MIGHT EVEN CONSIDER AS A DUAL
PANDEMIC FOR THIS GROUP.
MY RESEARCH ON THE WORK OF
OTHERS DURANS COVID AT THIS TIME
THE HYPER VIM LANCE HAS BEEN
TAKING PLACE AMONG ASIANS.
IN 1 OF OUR LONGITUDINAL STUDIES
ON ASIAN AMERICANS WE ARE SEEING
HIGHERATES EVER DISCRIMINATION
RATES WITHIN THE GROUP.
WITHIN MONTHS OF THE PANDEMIC,
GROUPS WERE EXPERIENCING RACIAL
INCIDENT AND STRESS.
WE ALSO SHOW ASSOCIATION BETWEEN
DISCRIMINATION AND RACIAL TRAUMA
AND IT'S AN OPEN QUESTION, THE
EXTENT TO WHICH THIS
DISCRIMINATION WOULD ALSO HAVE
AN EFFECT ON HEALTH OUTCOMES OR
THE EXTENT TO WHICH IT
EXACERBATES ANY COVID RELATED
HEALTH RELATED ISSUES.
MY POST DOC AND GRADUATE
STUDENTS ARE TAKING A CLOSER
LOOK ON THE NEWER PAPERS TO GET
A SENSE OF THE EXTENT TO WHICH
DHEEZ EFFECTS ARE EXPERIENCING
ASIAN AMERICANSA THE THIS TIME
BUT TO MY KNOWLEDGE NOT VERY
MUCH FOCUSED ON THE FISCAL
HEALTH OF ASIAN AMERICANS.
SO COMING BACK TO THE EFFECTIVE
GENDER ON PANDEMIC OUTCOMES WE
NEED TO DISAGGREGATE GROUPS NOT
JUST BY RACE OR GENDER BUT HERE
THERE'S ACTUALLY MORE DATA WITH
THE NEED TO DISAGGREGATE WITH AS
AND ASIAN AMERICAN WOMEN HAVING
TAKEN ON MORE HOUSEHOLD
RESPONSIBILITIES SINCE THE BEP
BEGINNING OF THE PANDEMIC IN
2020 AND SO WITHOUT THAT DATA
DISAGGREGATION, POTENTIAL
PATHWAYS OF THE STRUCTURAL LEVEL
AND ASSOCIATED PSYCHOSOCIAL
STRESS EXPERIENCES MAY BE MISSED
THUS REALLY REDUCING OUR ABILITY
HOW BEST TO DESCREESES
SUBSEQUENT HEALTH OUTCOMES.
>> TWO MINUTES LEFT.
>> THANK YOU.
SO GIVEN THE TIME CONSTRAINTS
I'VE PROVIDED AN OVERVIEW OF
CONSIDERATIONS INVOLVING RACE
AND GENDER, THESE ARE
PARTICULARLY CRUCIAL
CONSIDERATIONS WHEN WE'RE TRYING
TO DETERMINE THE EFFECTS OF
COVID, THE VIRUS BUT ALSO THE
SIDEWALK O SOCIAL EFFECTS OF THE
PANDEMIC OVERALL, SO I'M LEAVING
WITH 3 PRIORITIES FOR MOVING IN
THE DIRECTION OF INVESTING IN
RACE AND GENDER VARIABLES IN
RESEARCH.
ONE IS TO PRIORITIZE STUDIES OF
FOCUS ON GROUPS OF COLOR AND
IT'S DIFFICULT TO DO THIS
WITHOUT INCREASED FUNDING GIVEN
THE NEED TO BUILD THE
INFRASTRUCTURE AND I KNOW FIRST
HAND IN RECRUITING THESE SAMPLES
WE HAVE TO INVEST THE TIME, HAVE
THE STAFF TO CONDUCT TRANSLATION
IF NECESSARY, BUT BUILDING
RELATIONSHIPS IN THE COMMUNITY
YOU KNOW JUST AS ANOTHER
EXAMPLE, IT'S MAY BE A REASON
WHY ASIAN AMERICANS ARE THE MOST
UNDERSTUDIED RACIAL GROUP.
THE FUNDING HAS BEEN POOR WITH,
YOU KNOW BETWEEN 2007-2017 PNL
.17% OF NIH GRANTS ONLY A
FRACTION OF A PENNY WAS
COMMITTED TO ASIAN HEALTH.
I RECEIVED SOME IN THIS PAST
SPRING, HOPING WE'RE GOING INTO
THE RIGHT DIRECTION BUT IF RACE
AND GENDER ARE PRIORITY THESE
THESE THINGS HAVE BE TAKEN INTO
CONSIDERATION.
THE OTHER POINT I WANT TO MAKE
IT THAT IN ORDER TO ASSESS KEY
FACTORS WE WANT TO CAPTURE
PSYCHOSOCIAL DISTRESS AND MOMENT
TO MOMENT EXPERIENCES AS I
MENTIONED HYPER VINL LANCE MAY
MATTER AND SO BEING ABLE TO
CAPTURE THAT, WILL BE KEY TO
DELINEATING PATHWAYS BETWEEN
RACE, GENDER AND HEALTH AND
FINALLY TO INVEST THE TIME IN
COLLABORATING WITH STAKEHOLDERS
INCLUDING RESEARCHERS FOR PEOPLE
OF COLOR WHOSE RESEARCH LENGTHS
FOCUS ON THESE SPECIFIC
VARIABLES AND TO WORK WITH
COMMUNITY MEMBERS AND BUILD
ADVISORY BOARDS TO INSURE THAT
WHAT WE'RE DOING IS ACTUALLY
MEANINGFUL TO THE COMMUNITY.
SO THIS IS THE NIH, ALL OF US
DATABASE.
THIS IS A PROMISING DIRECTION, I
KNOW THAT THERE HAVE BEEN
EFFORTS TO INSURE REPRESENTATION
OF ALL GROUPS INCLUDING ASIANS,
SO REALLY HOPEFUL THAT WORK OF
THIS SORT AND OTHER
COLLABORATIONS THAT GET
GENERATED FROM OUR WORKSHOP
TODAY WILL BE ABLE TO ADDRESS
SOME OF THESE NEEDS.
THANK YOU SO MUCH.
>> THANK YOU SO MUCH DR. LIU AND
NEXT UP WE HAVE DR. KHAN.
>> EXCELLENT THANK YOU SO MUCH
AND I WILL BE ABLE TO SHARE ONCE
DR. LIU HAS STOPPED SHARING.
>> HOPEFULLY THIS GIVES AUSAS
WELL AS CARDIOVASCULAR OUTCOMES
AND WHAT WE CAN LEARN FROM
CARDIOVASCULAR RESEARCH FOR
OUTCOMES IN COVID-19.
I HAVE 3 KEY POINTS I WANT TO
COVER OVER THE NEXT SEVERAL
MINUTES.
FIRST SOCIAL FACTORS ARE
IMPORTANT DETERMINANTS OF
OUTCOMES IN BOTH COVID-19 AND
CARDIOVASCULAR DISEASE AND THIS
BUILDS ON THE EXCELLENT TALKS
YOU HEARD SO FAR.
SECOND, PLACE BASED INIQUITIES
THAT INFORM SOWCIAL
VULNERABILITY REPRESENT
STRUCTURAL DETERMINANTS OF
HEALTH OUTCOMES AND WE WILL LOOK
AT THE DATA IN PLACE OF
COVID-19.
SEX ASSIGNED AT BIRTH AND GENDER
IDENTITY INTERACT WITH SOCIAL
DETERMINANTS AND INFLUENCE
HEALTH AND I KNOW DR. PHIL
EPIGENETICS WILL FOLLOW ME WITH
MORE INDEPTH DISCUSSION OF THIS
AS WELL.
THIS IS AN OVERSLEE SIMPLIFIED
FLOW DIAGRAM AND WE'VE HEARD
ABOUT MANY OF THE ABOUT
IOLOGICAL FACTORS EARLIER THIS
MORNING THAT INTERACT WITH
ENVIRONMENTAL FACTORS TO PROVIDE
A SPECIFIC PHENOTYPE AND IN THE
CASE OF OOSK 19, THE DIDY GREE
OF SEVERITY AND OUTCOME AS WELL
AS FAR CARDIOVASCULAR DISEASE.
FOR THE NEXT SEVERAL MINUTES WE
WILL FOCUS ON PLACE AS AN ASPECT
OF THE ENVIRONMENT AND
SPECIFICALLY ON SOCIAL
DETERMINANTS OF HEALTH WHICH ARE
DEFINED BY THE WORLD HEALTH
ORGANIZATION AND THE CONDITIONS
IN WHICH PEOPLE ARE GROWN, WORK
AND LIVE AND GROWN HERE ARE
THESE SPECIFIC FACTORS THAT
INTERSECT WITH WHERE SOMEONE
LIVES IN PARTICULARLY IN TERMS
OF PLACE WITH INCOME AND
ECONOMIC STABILITY AND
EDUCATION, FOOD INSECURITY,
STABLE HOUSING SOCIAL INCLUSION
AND DISCRIMINATION AS WELL AS
ACCESS TO HEALTHCARE.
PLACE BASED INIQUITIES ARE
PARENT AND HAVE BEEN SINCE THE
BEGINNING OF THE PANDEMIC.
DATA FROM THE EARLIEST SURGE IN
NEW YORK ARE SHOWN HERE.
FOR HOSPITAL IEGZS AND THOSE
WITH HOPPULATION.
PARTICULARLY, ACROSS THE
NEW YORK CITY BURROS THOSE
LIVING IN THE FRONKS WERE MORE
LIKELY TO GET HOSPITALIZED AND
MORE LIKELY TO DIE FROM
COVID-19.
THIS SHOULDN'T BE SURPRISING AND
IS VERY CONSIST WENT GEOGRAPHIC
PATTERNING THAT'S BEEN OBSERVED
FOR CARDIOVASCULAR DISEASE AS
WELL.
SHOWN HERE ARE NEIGHBORHOOD
LEVEL DATA FOR 3 LARGE
METROPOLITAN AREAS IN THE UNITED
STATES, CHICAGO, WASHINGTON D.
C. AND NEW ORLEANS.
IN THE TOP 3 PANELS ARE AGE
ADJUSTED PREVALENCE OF CORONARY
HEART DISEASE AND THE LOWER 3
PANELS ARE THE SOARNL
VULNERABILITY INDEX IN NEEZ 3
AREAS IN 1 CITY.
THE DARKER PLURIBU AND THE
DARKER RED OVERHAY, AND
REPRESENT HIGHER RATES OF
CORONARY HEART DISEASE IN AREAS
OF HIGHER SOCIAL VULNERABILITY.
THIS TYPE OF JAIRGZ AND ALSO
SEEN AT THE LARGER NATIONAL
LEVEL AND SHOWN HERE ARE DATA
FROM THE U.S. SMALL AREAS LIFE
EXPECTANCY ESTIMATES PROJECT
THAT SHOWS SIGNIFICANT VARIATION
ACROSS THE UNITED STATES OR LIFE
EXPECTANCY AT FIRST AND HAD IS
PRIOR TO THE BEGENERATED
BEGINNING OF THE COVID-19
PANDEMIC WHERE WE'VE SEEN
SIGNIFICANTLY DISCUSSED CHANGES
IN LIFE EXPECTANCY AS A RESULT
OF PREMATURE MORTALITY RELATED
TO COVID-19 THAT HAS BEEN
PROPORTIONATELY DRIEWBTED.
AS CAN YOU SEE, AREAS IN THE RED
IN THE SOUTH AND SOUTHEAST THAT
ARE CLUSTERED HAVE A LIFE
EXPECTANCY LESS THAN 75.
COMPARED WITH OTHER AREAS
RANGING AS HIGH AS 80-98.
IF WE THINK ABOUT THE UPSTREAM
ROOT CAUSES OF THESE DISPARITIES
IN LIFE EXPECTANCY WE CAN GO
BACK TO RESIDENTIAL SEGREGATION
AND SHOB IN THE GREEN AREA ARE
AREAS WITH HIGHEST SEGREGATION
THAT OVERLAP WITH AREAS WITH
LOWEST LIFE EXPECTANCY THIS, IS
RELATED TO DISCRIMINATORY
POLICIES AND PRACTICES THAT LEAD
TO DISADVANTAGEOUS COMMUNITIES
WHERE THEY HAVE FEWER
OPPORTUNITIES AND LESS
SOCIOECONOMIC INVESTMENT AND
INFLUENCES OF CLIMATE CHANGE IN
HEGHT OUTCOMES, THIS RECENT
ANALYSIS LOOKED AT EXTREME HEAT
DAYS IN THE SUMMER TIME BETWEEN
2008 AND 20 SNEAN IN THE UNITED
STATES AND YOU CAN SEE
CLUSTERING AGAIN AND AGAIN IF
THE SOUTHEAST, HIGHER TOTAL
NUMBER OF EXTREME HEAT DAYS,
THAT WAS ASSOCIATED WITH THE
GREATER INCREASE IN ALL CAUSE
MORTALITY THAT WAS
DISPROPORTIONATELY DISTRIBUTED
AMONG NONHISPANIC BLACK
INDIVIDUALS IN THESE AREAS.
SO IF WE GO PAST THE FIRST WAVE
AND LOOK AT THE INTERSECTION
BETWEEN SEX, INCAS AND RACE
ETHNICITY DATA THAT'S AVAILABLE
FOR COVID-19, WE SEE 3 DIFFERENT
PATTERNS ACROSS THE COVID-19
PERIODS.
FOR BLACK WOMEN, WHITE WOMEN,
AND IN THE LIGHT BLUE IS THE
WORRIED BETWEEN JULY AND
OCTOBER 2021 WHEN VACCINES WERE
AVAILABLE AND YOU CAN SEE THERE
WAS A SIGNIFICANT DECLINE IN
COVID-19 DEATH RATES AND EACH OF
THESE 3 RACE GROUPS FOR OALTDER
ADULTS 80 AND OLDER.
BUT IN FACT, THE DEATH RATE FOR
YOUNGER ADULTS INCREASED AND
PARTICULARLY AMONG BLACK AND
HISPANIC WOMEN IT WAS MUCH
HIGHER THAN THAT FOR WHITE
WOMEN, UNDER 50.
--UPTHROUGH APRIL 21, AND ON THE
ACCESS PERCENT OF THAT
NEIGHBORHOOD VACCINATED AND
COUNTER INTUITIVE, THOSE AREAS
THAT HAD A HIGHER HISTORICAL
RATE HAD A LOWER RATE.
ONE THING THAT WAS APPARENT IS
THE AREAS WITH THE LOWEST
VACCINATION RATE HAD THE HIGHEST
PROPORTION OF NONHISPANIC BLACK
ADULTS.
IN AN IMPORTANT AREA WHERE
MISINFORMATION WITH BE IMPORTANT
STRUCTURAL FACTOR THAT THEY BE
CONTRIBUTING TO INIQUITIES AND
PREVENTIBLE DEATHS IF WE DIG
DEEPER ON THESE AND VACCINATION,
CHICAGO FROM MY HOME TOWN SHOWN
IN THE BLUE MAP ARE VACCINATION
LEVELS AS OF AUGUST 1, 2021.
CAN YOU SEE VARIATION ACROSS THE
CITY OF CHICAGO.
SECOND PANEL SHOWS COVID DEATHS
FROM AUGUST 1 TO NOVEMBER 6 AND
WEPT TO HAVE MORE DEATH RATES IN
AREAS THAT WERE DISADVANTAGESSED
AND IF WE LOOK AT THE
CHARACTERISTICS OF THE CODES
THAT HAD THE TORTILE, WE SEE A
GREATER PROPORTION OF WOMEN, AND
A SIGNIFICANTLY PROPORTION OF
NONHISPANIC BLACK INDIVIDUALS AT
80% COMPARED TO WIT% IN THE MOST
VACCINATED CORTILE.
NOW WE'VE HAD GREAT DISCUSSIONS
ALREADY ABOUT THE
INTERSECTIONALITY LENS WHEN
WE'RE ASSIGNING SEX AT BIRTH,
GENDER IDENTITY AND OVERLAYING
THAT WE PLACE RACE, ETHNICITY,
NATIVITY, DISABILITY, RPGHT
FACTORS THAT 1 MY IDENTIFY AS AS
WELL AS STRUCTURAL AND SOCIAL
FORCES THAT CONTRIBUTE TO
ADVANTAGE AND DISADVANTAGE.
PARTICULARLY, DURING THE
PANDEMIC, ASIDE FROM THE VIRUS,
THE IMPORTANCE OF THE PANDEMIC
ITSELF IN SOCIAL AND
PSYCHOSOCIAL STRESS HAS BEEN
REALLY RELEVANT AS DR. LIU
POINTED OUT.
SHOWN HERE ARE UNEMPLOYMENT
RATES BY SEX, RACE ETHNICITY AND
DISABILITY.
AND YOU CAN SEE THAT OVERALL,
WOMEN HAVE MUCH HIGHER
UNEMPLOYMENT RATES SINCE THE
BEGIN OF THE PANDEMIC AND IN
FACT 1 POPULATION HAS THE
HIGHEST RATE, WOMEN WITH
DISABILITIES HAVE AN 8%
UNEMPLOYMENT RATE.
THIS HAS SIGNIFICANT IMPACT ON
FINANCIAL STRESS AS WELL AS
PSYCHOSOCIAL STRESS AND
PARTICULARLY BECAUSE 2 OUT OF 3
CAREGIVERS IN THE UNITED STATES
ARE WOMEN THIS MAY LEAD TO
AVOIDANCE OF OWN HEALTHCARE AND
WORSE OUTCOMES.
IN FACT A KAISER FAMILY
FOUNDATION SURVEY IN NOVEMBER OF
2020 SHOWN HERE DEMONSTRATE THAD
A LARGER SHARE OF WOMEN HAVE
GONE WITHOUT HEALTHCARE SERVICES
DURING THE PANDEMIC PARTICULARLY
WOMEN IN FAIR OR POOR HEALTH
WHICH INCLUDED PREVENTIVE
SERVICES AS WELL AS SKIPPED A
RECOMMENDED MEDICAL TEST OR
TREATMENT.
>> TWO MIN UTRS LEFT.
>> WHAT DO WE KNOW ABOUT THE
INTERSECTION OF DISPARITIES AND
CARDIOVASCULAR DISEASE AND SEX
DIFFERENCES.
SHOWN HERE ARE DATA FROM THE
CORONARY ARTERY RISK DEVELOPMENT
IN YOUNG ADULTS STUDY OR THE
CARDIO STUDY, YOU CAN SEE IN THE
FIRST PANEL INDIVIDUALS WHO ARE
BLACK HAD HIGHER RATE OF
CARDIOVASCULAR DISEASE THAN
INDIVIDUAL WHO IS ARE WHITE AND
NO 1'S SURPRISED BY THAT.
THAT'S WELL ESTABLISHED BUT WHAT
I WOULD LIKE TO POINT OUT IS
THAT IN THIS SAMPLE BLACK WOMEN
HAD A SIMILAR INCIDENT RATE OF
CARDIOVASCULAR DISEASE AS WHITE
MEN AND PARTICULARLY FOR
PREMATURE CARDIOVASCULAR DISEASE
UNDER THE AGE OF 65 THIS IS
STRIKING WHEN WE THINK OF MEN
HAVING MUCH HIGHER RATES OF
CARDIOVASCULAR DEC IN THIS AGE
GROUP.
IF WE LOOK AT FACTORS THAT
EXPLAIN RACIAL DIFFERENCES IN
THESE 2 GROUPS, 1 THING THAT
COMES OUT AS BEING DIFFERENT
BETWEEN THE 2 IS NEIGHBORHOOD
FACTORS LIKE SEGREGATION AND
NEIGHBORHOOD POVERTY
PARTICULARLY AMONG WOMEN AND
IECIAL INDENSES AND INCIDENT OF
CVD WERE EXPLAINED BY
NEIGHBORHOOD FACTORS FOR
OPPORTUNITIES FOR INTERVENTION.
OTHER STRUCTURAL FACTORS THAT
NEED BE ACCOUNTED FOR INCLUDE
NEIGHBORHOOD EXPERIENCES AND 1
UNIQUE FACTOR MAY BE
NEIGHBORHOOD POLICE VIOLENCE.
IN THIS STUDY FROM AN ELECTRONIC
HEALTH RECORD OF AN INTEGRATED
HEALTH SYSTEM BETWEEN 2018,
NEIGHBORHOODS WITH HIGHER
ETIONZ'RE EXCESSIVE FORCE
COMPLAINTS WERE ASSOCIATE WIDE
HIGHER RATES OF PRETERM BIRTH
AND CARDIOVASCULAR DISEASE WHICH
IS REEL KEEPSAKES HAVEN'T FOR
THE BIRTHING INDIVIDUAL AND
OFFSPRING AND ACROSS GENERATIONS
WHEN YOU THINK ABOUT THE ENTIRE
LIFE COURSE.
SHOWN HERE AS A CONCEPTUAL
FRAMEWORK OF HOW WE CONSIDER
HELT PROMOTING AND HEALTH
FACTORS FROM DR. KERSHAW.
WHAT I LIKE IN THIS DIAGRAM IS
THERE'S OPPORTUNITIES FOR
INTERVENTION AS WE THINK ABOUT
WHERE WE NEED TO GO NEXT.
PARTICULARLY THE IMPORTANCE OF
HIGH QUALITY STABLE AFFORDABLE
HOUSING, EDUCATIONAL
OPPORTUNITIES AND INVESTMENT,
WEALTH ACCUMULATION, AFFORDABLE
HEALTHCARE, HEALTH PROMOTING
BUILD AND PHYSICAL ENVIRONMENT
TO IRPT VENE ON WEATHERING AND
POOR REPAIFERSS AND RISK OF CVD
AND WE COMPLETED WITH 3 KEY
POINTS IN TERMS OF KNOWLEDGE
GAPS AND FUTURE RESEARCH.
FIRST SUBPOPULATIONS OF SEX AND
GENDER MINORITY INDIVIDUALS
REMAIN UNDERSTUDIED,
UNDERREPORTED AND UNDER
REPRESENTED PARTICULARLY WITH
HIGH SOCIAL VULNERABILITY, THIS
INCLUDES POPULATIONS LIKE WOMEN
WITH DISABILITIES.
SECOND, ENGAGEMENT OF
COMMUNITIES AND KEY STAKEHOLDER
SYSTEM CRITICAL PARTICULARLY IN
IRBIAS WITH POOR COVID-19 AND
CVD OUTCOMES.
CONSIDERING NEIGHBORHOODS THAT
HAVE HAWAII RATES OF BOTH OF
THESE ADVERSE OUT COMES AS KEY
AREAS TO TARGET.
AND THIRD, FOCUSING ON
INTERVENTIONS TO TARGET
STRUCTURAL RACISM AND
DISCRIMINATION, WHICH ARE THE
ROOT CAUSES OF THESE HEALTH
DISPARITIES AND UNDERSTANDING
WHAT IS NEEDED TO FURTHER THE
EVIDENCE SPACE TO BEGIN TO
CREATE THESE INTERVENTIONS.
THANK YOU SO MUCH TO YOUR TIME
AND ATTENTION.
LOOK FORWARD TO THE DISCUSSION
WITH THE PANEL.
>> THANK YOU SO MUCH DR. KAHN.
AND NOW I AM DELIGHTED TO TURN
IT OVER TO DR. PHIL EPIGENETICS.
>> THANKS SO MUCH FOR HAVING US,
I THINK YOU WILL HEAR A LOT OF
SIMILAR THINGS IN MY TALK AS YOU
HEARD FROM DR. KHAN, EVEN THOAR
WE'RE TALKING ABOUT DIFFERENT
TOPICS, I WILL TALK TO BUT
SOCIAL AND STRUCTURAL COVID-19
DISPARITIES IN TRANSGENDER AND
GENDER MINORITY COMMUNITIES.
SO NO CONFLICTS OF INTEREST TO
REPORT.
WANT TO START OFF WITH QUICK
DEFINITIONS SINCE I KNOW WE
TALKED A LITTLE BIT ABOUT SEX
AND GENDER DIFFERENCES BUT NOT
AS MUCH INDEPTH AS I WILL GET
INTO AT THIS TALK.
SO SEX ASSIGNED AT BIRTH OR SAB
IS A SEX RECORD OFFICE OF
DIVERSITY 1'S BIRTH SERIES
POINTS TAIFICATE.
GENDER IDENTITY HOW THEY
INTERPRETS THEIR GENDER, YOU MAY
SEE THIS MALE, FEMALE, GENDER
NONCONFORMING OR NONBINARY,
GENDER MODALITY IS WHETHER
SOMEONE'S CURRENT GENDER
IDENTITY CORRESPONDS WITH THEIR
SAAB, SO THIS IS CISGENDER OR
TRANSGENDER, TRANSGENDER IS
SOMEONE WHOSE GENDER IDENTITY
DOES NOT CORRESPOND WITH SAAB,
AND GENDER NONCONFORMING IS
SOMEONE WHOSE GENDER IESHES
DENTITY DOES NOT FIT NEATLY INTO
THE SOCIAL BINARY CATEGORS.
THERE ARE MORE DEFINITIONS, I
WON'T GO INTO THEM BECAUSE
THAT'S A LONG TALK ON THEIR OWN,
BUT I WANTED TO ESTABLISH THOSE
BEFORE I TALK ABOUT THESE
IMPACTS OF COVID-19 ON THESE
POPULATIONS.
SO PRIOR TO EARLY 2201 THERE WAS
NOT VERY MUCH DAT ON COVID-19
IMPACTS ON SEXUAL OR GENDER
MOOINORRITY POPULATIONS.
THIS WAS DUE TO A NUMBER OF
REASONS.
WE KNOW COVID-19 SURVEILLANCE
DATA WAS COLLECTED FROM THE
BEGINNING SEXUAL ORIENT AND
GENDER IDENTITY WERE NOT
COLLECTED IN THESE, WITH THE FEW
EXCEPTIONS CROSS LINKING BENS
PENS PENINSULA EACH MUCH THESE
JURISDICTIONS HAD THEIR OWN
LIMITATIONS IN HOW THEY
COLLECTED THE DATA AND HOW THEY
SHARED SO THERE WAS LITTLE
EVERYDAY IMPACT OF COVID-19,
ADDITIONALLY THERE WAS LACK OF
EVIDENT ON COVID-19 OUTCOMES
AMONG THESE POPULATIONS, SO AS
MUCH AS NIH AND OTHER FUNDING
BODIES SUPPORTED COVID-19
STUDIES AND TRIALS, NONE OF THEM
COLLECTED SOGI, SO WE DIDN'T SEE
ANY SOCIAL OR GENDER IDENTITY
INFORMATION RECORDED SO WE WERE
UNABLE TO SEE WHETHER THERE WERE
ANY DIFFERENCES BASED ON GENDER
IDENTITY, GENDER MODALITY, ANY
OF THESE THINGS.
SO, AT THE BEGINNING AT LEAST AT
THE END OF 2020, SOME NEW
FINDINGS WERE PUBLISHED.
SO 2 OF THESE CAME OUT IN
FEBRUARY TWEBT 21, 1 MUCH IN,
MWR THAT USED DATA FROM THE
BEHAVIORIAL RISK FACTOR
SURVEILLANCE SYSTEM.
THIS ONLY REPORT OFFICE OF
DIVERSITY SEXUAL ORIENTATION,
THEY DID NOT DISCUSS GENDER
IDENTITY.
AND THE WILLIAMS INSTITUTE THAT
CAME OUT AT THE SAME TIME PROVED
ALL LESBIAN GAY, BISEXUAL AND
TRANSINDIVIDUALS TOGETHER, AGAIN
SOME INDICATION THERE WOULD BE
DIFFERENCES BUT UNABLE TO
DISARTICULATE THE GENDER
MINORITY POPULATIONS FROM THE
SEXUAL MINORITY POPULATIONS.
SO YOU MIGHT BE ASKING WHY WOULD
TRANSPOPPULATIONS BE IMPACTED?
I HAVE A FIGURE NEAR FROM MY
TEAM WHO PUBLISHED A PAPER ABOUT
THE IPT GREATER'RE IMPACT OF
COVID-19 ON TRANSPOPPULATIONINGS
P
OPPULATION--TRANSPOPPULATI
ONS AND THIS GIVES INFORMATION
AS TO ACCESSING CARE AMONG
TRANSPOPPULATIONS.
AS WE HEARD ABOUT WITH RACISM,
TRANSPHOBIA, AND TRANSPHOBIC
STIGMA ARE HUGE BARRIERS TO ALL
OF THESE THINGS, WE CAN SEE
HEALTHCARE DISCRIMINATION,
HOUSING DISCRIMINATION, AND
EMPLOYMENT DISCRIMINATION, ALL
OF THESE ARE STRUCTURAL FACTORS
THAT LEAD TO POOR ACCESS TO
HEALTHCARE AND POOR ACCESS TO
VACCINATION TESTING, WHATEVER
YOU MIGHT HAVE THAT WOULD HELP
EITHER GET SOMEONE TESTED EARLY
FOR COVID-19 EARLY OR GET THEM
VACCINATED AND BOOSTED EARLY, SO
OUR TEAM WERE THE LEADER WHO IS
WERE PROMOTING THE NEED FOR
ACTION FOR LGBTQ HEALTH EQUITY
SO WE PUBLISHED THIS PAPER BACK
AT THE END OF 2020, OUTLINING
SOME RECOMMENDATIONS FOR WHAT TO
DO, TO INSURE THAT LGBTQ
POPULATIONS WERE BETTER
REPRESENTED IN THE RESPONSE TO
COVID-19.
WE'VE SEEN SOME SUCCESS IN
RESPONSE TO THIS, BUT THERE'S
STILL A LONG WAY TO GO TO MAKE
SURE THAT TRANSAND IMENDER
MINORITY POPULATIONS, REP
FLECTED AND INCLUDED IN COVID-19
RESEARCH.
SO WE'LL TALK ABOUT 1 OF THE
STUDIES I HAVE ONGOING, SO THE
COVID-19 STUDY IS AN ONLINE
LONGITUDINAL SURVEY WITH
MINORITIZED INDIVIDUALS BETWEEN
THE AGES OF 14-24 THAT STARTED
IN FEBRUARY OF 2021.
SO THIS IS 1 OF MANY PROJECTS
THAT WAS FUNDED THROUGH THE RAD
X-UP INITIATIVE THROUGH THE NIH.
WE FINISHED BASE LINE DATA
EZEKIEL ELLIOTT CLRKS WE ARE
DOING A LOT OF CLEANING BUT
WANTED TO AT LEAST PRESENT IN OF
THE QUALITATIVE AND QUANTITATIVE
FINDINGS.
WE LOOK AT A NUMBER OF
HEALTHCARE OUTCOMES, WE SAW HUGE
DIFFERENCES IN DEPRESSION AND
TRAUMA, SO COMPARED TO CISMEN,
TRANSMEN, NONBINARY AND
INDIVIDUALS ARE SIGNIFICANTLY
LIKEEE TO REPORT DEPRESSION AND
SYMPTOMATOLOGY AND USE THE
EVENTS SCALE TO ROCK AT TRAUMA
STRNSS AND WE SAW THAT NONBIENAR
INDIVIDUALS ARE SIGNIFICANTLY
MORE LIKELY TO REPORT TRAUMATIC
EXPERIENCES, WE HAVE A LOT MORE
EXPLORATION TO DO TO LOOK AT THE
NUMBER OF COVID-19 INCOMES AND
IMPACTS WE COLLECTED OVERSEEING
SOME EVIDENCE THAT COVID-19 HAS
HAD CLEAR IMPACTS ON GENDER
MINORITY POPULATIONS.
I THINK SOME OF THESE QUOTES
THAT WE COLLECTED FROM OUR
PARTICIPANTS ARE ALSO VERY
TELLING ABOUT THE IMPACTS OF
COVID-19 ON GENDER MINORITY
POPULATIONS, THE FIRST LINE OF
BARRIERS TO CARE, SOMEONE
REPORTED THEIR GENDER
REASSIGNMENT SURGERY WAS
DELAYED, BECAUSE THEY WEREN'T
ABLE TO GET THE SURGERY, THEY
HAD MENTAL AND PHYSICAL HEALTH
ISSUE THAT REALLY MADE THEIR
TIME DURING THE PANDEMIC WORSE.
ANOTHER 1 REPORTED MOVING BACK
IN WITH THEIR FAMILY, THEY HAD A
ROOF OVER THEIR HEAD WHICH
THEY'RE HAPPY BUT BUT THEIR
FAMILY WAS TRANSPHOBIC SO IT WAS
NOT A POSITIVE EXPERIENCE FOR
THEM.
EVEN WORGS WE CAN SEE IN THE
THIRD 1 THAT THIS PARTICIPANT
WAS UNABLE TO AFFORD THERAPY
BECAUSE OF LOSING THEIR JOB DUE
TO THE PANDEMIC.
AND WAS HAVING SUICIDAL THOUGHTS
BECAUSE THEY DIDN'T WANT TO BE A
DEPRESSED TRANSGENDER PERSON OF
COLOR THAT HAD TO NAVIGATE THE
WORLD WITHOUT HAVING ACCESS TO
CARE AND SUPPORT.
I DON'T WANT TO END ON A SAD
NOTE SO I INCLUDED THIS LAST 1,
WE SAW A FEW PARTIC PLAN TO
ANALYZE BY AGES WHO SAID THAT
THEY DID HAVE SOME POSITIVE FROM
THE PANDEMIC AND THIS PERSON WAS
1 OF THE FEW WHO TALKED ABOUT
HAVING TIME TO THINK ABOUT THEIR
GENDER IDENTITY DURING THE
QUARANTINE AND COME TO TERMS AND
IDENT FIELD FUNCTIONS WHAT THEIR
REAL GENDER IDENTITY IS RATHER
THAVEN HAVING IT BE DEFINED BY
INTERACS WITH THE WORLD.
SO AS I MENTIONED THERE'S BEEN A
BIT MORE ATTENTION PAID TO
EFFECTS OF COVID-19 ON MINORITY
POPULATIONS BUT THERE'S A CLEAR
NEED FOR MORE WORK.
WE HAVE BEEN DOING A NUMBER OF
OTHER PROGECS, I THINK 1 THAT I
WOULD LOVE TO HIGHLIGHT IS WORK
WITH HOWARD BROWN WHICH IS AN
LGBTQ HEALTH CENTER HERE IN
CHICAGO.
WE GOT FUNDING FROM NORTHESTERN
TO DO A PILOT STUDY ON--DATA
EVALUATED OR TO ACTUALLY ANALYZE
THE DAILY BASIS THEA THAT WAS
COLLECTED AND DEVELOP REPORTS
AND ALSO BE ABLE TO SAY THEY
HAVE SKILLS AND
QUALITATIVE--QUALITATIVE
RESEARCH WHICH WE THINK IS
IMPORTANT FOR COMMUNITY
BUILDING.
LATELY WE SAW A LOT OF
TRANSCOMMUNITIES REFOCUSING
PRIORITIES FROM HEALTHCARE
DELIVERY AND ADVOCACY WORK, TO
REALLY SUPPORT THEIR OWN, SO,
BRAVE SPACE ALLIANCE HERE IN
CHICAGO IS 1 OF OUR
COLLABORATORS AND PARTNERS, THEY
WERE A LEADER THAT WERE TURNING
THEIR FOCUS TO MUTUAL AID AND
USING A COMMUNITY DERIVED
APPROACHES TO SUPPORTING THE
TRANSAND GENDER MINORITY
COMMUNITIES WHO WERE
DISPROPORTIONATELY IMPACTED.
>> ONE MINUTE LEFT.
>> OKAY.
SO MAJOR GAPS.
RADX-UP IS 1 OF THE LARGEST
INITIATIVES TO STUDY COVID-19 IN
UNDERREPRESENTED GROUPS DOES NOT
SHOW IT AS A DISPROPORTIONATELY
IMPACTED GROUP.
I HAVE A FIGURE I DOWNLOADED
FROM THE WEBSITE.
THEY HIGHLIGHT ALL THESE OTHER
UNDERREPRESENTED GROUPS BUT
DON'T SO GENDER OR SEXUAL
MINORITY POPULATIONS AS BEING
IMPACTED.
ADIGDZALLY, MOST NIH FUNDED
RESEARCH RELATED TO COVID-19
STILL FOCUSES ON BI OPEN LOGICAL
IMPACTS AND INTERVENTIONS RATHER
THAN THE STRUCTURAL AND SOCIAL
IMPACTS OF COVID-19 WHICH WE
KNOW ARE LEADING TO LONG-TERM
IMPACTS IN ADDITION TO LONG
COVID, BUT ALSO SOCIAL AND
STRUCTURAL IMPACTS.
SO SOME QUICK FUTURE DIRECTIONS,
SURVEILLANCE SYSTEMS AND I ARGUE
ALL RESEARCH STUDIES NEED TO
MOVE AWAY FROM USING A BINARY
DEFINITION OF SEX AND TO
CONFLATING SEX IN GENDER AND
INSTEAD INCLUDE DATA THAT
ACCURATELY REFLECTS POETIC
DALLASCOWBOYS.COMITY OF THE
ENTIRE POPULATION, WE ALSO
RECOMMEND PRIORITIZING
STRUCTURAL INTERVENTIONS OVER
INDIVIDUAL LEVELED 1S BECAUSE WE
KNOW STRUCTURAL FACTORS ARE THE
1S DRIVING POOR HEGHT OUTCOMES
AND THESE NEED TO BE THE FOCUS
OF ATTENTION AND FUNDING.
WE ALSO THINK THE IMPACT AND
STUDY COMMUNITY SHOULD BE AT THE
TABLE AND ARE IN LEADERSHIP
POSITIONS, HAVING TRANSAND
GENDER MINORITY INDIVIDUAL WHO
IS ARE ABLE TO DICTATE THE WORK
FOR COVID-19 AND HIGHLIGHTED BY
OTHER PANELISTS OF IRPT
SECTIONALLITYS ARE IMPORTANT.
WE KNOW THAT MINORITY
POPULATIONS WERE
DISPROPORTIONATELY IMPACTED
RACIAL TRANSGENDER POPULATIONS
MORE OVERWHELMING LOAMACYY
IMPACTED BY COVID-19.
I WILL END THERE.
>> BRAD: THANK TO YOU ALL THE
PRESENTERS ARE WE NOW MOVING
INTO THE DISCUSSION SECTION
ENEMY 3:25.
>> GREAT.
SO PEOPLE WHO ARE LOOKING
INVOLVED TO QUESTION THE Q, ANDA
WHERE YOU CAN MESSAGE ME
DIRECTLY QUESTIONS IF YOU ARE 1
OF THE PANELISTS FOR THE OTHER
SECTIONS, AND CURRENTLY, I WAS
WONDERING IF I COULD GET FOLLOW
UP ON 1 OF THE POINTS THAT
SHARES IN THEIR DIRECTIONS SO 3
OF OUR SPEAKERS DR. KAHN AND
ARES IF THEY COULD SPEAK A
LITTLE BIT MORE ABOUT THEIR OWN
EXPERIENCES DOING THIS TYPE OF
WORK DURING COVID AND MAYBE YOU
KNOW TIPS OR STRATEGIES FOR
FOLKS WHO ARE INTERESTED IN THIS
AREA.
>> I CAN SAY A LITTLE BIT ABOUT
WORKING WITH COMMUNITY GROUPS
BEFORE COVID, I THINK THAT COVID
REALLY OPENED OUR EYES TO THE
EXTENT IN WHICH DIFFICULT TO
REACH POPULATIONS BECAME MUCH
MORE DIFFICULT TO REACH DURING
THE PANDEMIC.
YOU KNOW WE TALKED ABOUT THE
WIDENING OF DISPARITIES OR THE
EXACERBATION OF DISPARITIES AND
IT STARTS AT RECRUITMENT AND
ENGAGEMENT AND SO, I THINK A
LESSON LEARNED IS THAT WE NEED
TO REALLY INVEST AND I MENTIONED
THIS IN MY PRESENTATION, BUT
REALLY LAY OUT THE GROUND WORK
FOR BEING ABLE TO ENGAGE WITH
COMMUNITIES.
IT'S TOTALLY POSSIBLE, BUT IT
REALLY DOES REQUIRE A LOT OF
INVESTMENT AND RECOGNITION THAT
IT TAKES NOT JUST TIME BUT IT
TAKES PERSONNEL TO REALLY
DEVELOP THAT SUCH THAT WHEN
THERE IS A MAJOR DISRUPTION THAT
WE CAN CONTINUE TO COLLECT DATA
WITH THIS GROUP AND UNDERSTAND
THE EXTENT AT WHICH THEY'RE
AFFECTED AND THEREFORE BE ABLE
TO IDENTIFY PRIORITIES IN TERMS
OF TARGETS FOR INTERVENTION BUT
WITHOUT THAT INFRASTRUCTURE LAID
OUT WE'RE GOING TO CONTINUE TO
SEE ISSUES WITH INIQUITIES.
SO THAT'S MY TWO-CENTS.
>> THANKS DR. LIU, I WANT TO
FOLLOW UP ON THAT POINT TO ALSO
ADD AND EMPHASIZE THE KEY NOTE
WAS MAKING A POINT AS WELL WAS
THAT IN ORDER TO ENGAGE WITH
COMMUNITIES WE NEED INDIVIDUALS
THAT REPRESENT THE COMMUNITIES
AND LEADERSHIP POSITIONS IN OUR
STUDIES, IN OUR TEAMS AND BE
ABLE TO HAVE A MORE I THINK
DIVERSE LEADERSHIP RATHER THAN
MORE HIERARCHICAL STRUCTURE AS
WELL TO THESE TEAMS AND INSURING
THAT THEIR VOICE IS HEARD
REQUIRES HAVING INDIVIDUALS THAT
REPRESENT THEM IN LEADERSHIP
POSITIONS.
>> THE ONLY THING I WOULD ADD, I
AGREE WITH ALL THAT IS THAT ALSO
BUILDING THE RELATIONSHIP AHEAD
OF TIME, I KNOW COVID-19 WASN'T
NECESSARILY ANYTHING WE EXPECTED
BUT COMING TO PEOPLE AND SAYING
YOU WANT TO STUDY THEM VERSUS
BUILDING THE RELATIONSHIP AHEAD
OF TIME IS NOT THE BEST
APPROACH, SO I WAS LUCKY I
ALREADY HAD RELATIONSHIPS WITH A
NUMBER OF AGENCIES I'M CURRENTLY
WORKING WITH SO IT WAS EASY TO
FIND THE FIT.
BUT THAT'S REALLY A BAD WAY TO
GET COMMUNITY BUY-IN IS TO JUST
PULL THEM IN AT THE LAST MINUTE.
>> I THINK THAT'S A GREAT POINT
BECAUSE SOMETIMES COMMUNITY
ENGAGED RESEARCH CAN BE
BURDENSOME SO WE WANT TO MAKE
SURE WE BALANCE THAT WITH ALSO
WHAT QUESTIONS ARE OF INTEREST
TO COMMUNITIES AS WELL.
>> YEAH, THOSE ARE GREAT
THOUGHTS AND THAT'S BEEN A
CHALLENGE I'VE NOWND A LOT OF
COMMUNITY RESEARCH.
I USED TO BE THE MAINE STATE
HEALTH REFUGEE COORDINATOR AND I
AM GOING BACK TO THAT POSITION
SOON, AND I WORKED A LOT WITH
SIDE BY SIDE COMMUNITIES BUT
SOMETIMES THE QUESTION FIST
THEY'RE RELEVANT TO HEALTH
OUTCOMES THAT MAY BE WORTH EVEN
CONDITIONS THAT WERE PREVALENT
IN COMMUNITIES, THE QUESTION OF
THE ACADEMICS HAD MIGHT NOT FIT
VERY WELL WITH THE GOALS OF THE
COMMUNITIES THEMSELVES.
THERE'S A QUESTION IN THE CHAT
THAT I'M GOING TO RETIRN TO IN
2-SECONDS BUT I PULL UP THIS
LONGER PRESENTATION I HAVE SO I
CAN GED A GIVE REQUESTED TO THIS
ANSWER, BUT FIRST I WILL ASK
DR.
PHIL DR.
PHIL EPIGENETICS A QUESTION, I
HAD A OPPORTUNITY WHO DID A
PROJECT WHERE HE CALLED ALL THE
PUBLIC HEALTH STATE DEPARTMENTS
AND SHE HAD 22 DEPARTMENTS GET
BACK TO HER WHERE WE SORT OF
POKED A LITTLE BIT AT WHAT MAY
MEANT BY THAT.
AND WE'VE WRITTEN ABOUT HOW
IMPORTANT IT IS TO HAVE BETTER
NONBINARY IDEAS OF DATA MOVING
BEYOND CODING MALE OR FEMALE AND
A PROBLEM WE RUN INTO ESPECIALLY
IN VERY LARGE DATA SETS, IS THAT
FIRST POPULATIONS THAT ARE VERY,
VERY SMALL LIKE 1 OR 2% OF THE
POPULATION, IF A QUESTION IS
MISS UNDERSTOOD, LIKE IF ENOUGH
CIS PEOPLE READ A QUESTION AND
DON'T UNDERSTAND WHAT IT'S
ASKING AND ASSESSMENT TO ANSWER
WHAT THEY ATTEMPT TO ANSWER IT
COULD CREATE ENOUGH NOISE TO
DROWN OUT THE MINORITY
POPULATIONS AND I TOOK A PRETTY
COMPREHENSIVE LOOK AT THE NIH
GUIDELINES ON SEX AND JEKSUALITY
RESEARCH AND GENDER IDENTITY
RESEARCH THAT CAME OUT RECENTLY
BUT I WAS WONDERING IF YOU HAD
ANY SOLUTIONS TO THIS IN LIKE
LARGE DATA SETS OR IF YOU HAD
ANY BEST PRACTICES THAT YOU WERE
CURRENTLY USING?
RESPIRATORY
>> THANKS FOR THE QUESTION.
I ACTUALLY HAVE AN RO-1 THAT
STARTED LAST YEAR THAT'S REALLY
FOCUSED ON USING COMMUNITY
ENGAGED APPROACHES TO THE
MEASURE GENDER IDENTITY.
WE ARE WORKING ON IT.
I WOULD SAY THAT THE ARCH DATA
SETS ARE CHALLENGING.
I DO A LOT OF WORK IN THE YOUTH
RISK BEHAVIOR SURVEY AND THEY
ASK WHAT IS YOUR SEX AND THAT
PAIRED WITH THE GENDER MODALITY
QUESTION ARE REALLY HARD TO
INTERPRET BECAUSE WE DON'T KNOW
IF THEY SAY THEY'RE FEMALE AND
THEY'RE TRANS, IF THEY'RE FEMALE
AND TRANS, OR FEMALE ASSIGNED AT
BIRTH OR TRANSMALE IT MAKES IT
SO MUCH MORE CONFUSING BUT WE
LIKE TO SAY THAT DATA CAN BE
USED TO GET BETTER DATA SO AT
LEAST KNOWING THERE IS 1% WHO IS
TRANSOR FIEOF THE% THAT DIRKS
DENTIFYS AS BISEXUAL IS ENOUGH
TO HELP ADVOCATE FOR DATA
COLLECTION, ALSO IT REALLY IS
JUST MAKING SURE THAT THE
QUESTIONS ARE REFLECTIVE OF THE
COMMUNITY.
I MEAN, I HATE THAT WE HAVE TO
ALWAYS CATER EVERYTHING TO THE
CIS HEAD MAJORITY BUT THOSE ARE
THE 1S ANSWERING THE QUESTIONS
AND I KNOW THAT WAS A LOT OF
EARLY KRIST TECHS WITH THE RO-1
SUBMISSION IS HOW ARE THE CIS
RESPONDENTS GOING TO REACT TO
THESE.
I THINK IT WILL ALSO BE A
CHALLENGE BUT PROVIDING CLEAR
DEFINITIONS I THINK HELPS A LOT
IN MAKING SURE THAT PEOPLE ARE
ABLE TO GIVE AN ACCURATE
RESPONSE TO THEMSELVES AND THAT
THE PEOPLE WHO ARE WORKING AT
THE BACK END ARE ABLE TO
INTERPRET THEIR RESPONSES
BECAUSE I THINK BOTH OF THOSE
ARE IMPORTANT.
>> YES, THANK YOU VERY MUCH.
SO I WANT TO ANSWER, SARAH'S
QUESTION IN THE Q&A, AND SO THE
DAILY BASIS AT ARE INDIRECTLY
STANDARDIZED FOR AGE AND THEREYA
A COMPLICATED WAY IN WHICH THIS
WAS DONE BECAUSE YOU CAN'T
DIRECTLY, SO TRANSPARENTLY I'M A
MISDZ AUTHOR ON THAT PUBLICATION
AND WHILE I SET UP A LOT OF THE
PROJECT, I WAS ON MATERNITY
LEAVE WHEN THE ANALYSIS WERE RUN
AND THE MOST OF THE PAPER WAS
WRITTEN.
SO I STAYED OUT OF THE DIRECT
ANALYSIS BUT I HAVE A SLIDE CAN
TALK ABOUT THIS, IF SOMEBODY'S
REALLY CURIOUS, I CAN E-MAIL IT
TO, IT'S ALSO IN THE PAPER, THE
PAPER IS DANIELSEN 2022.
ESSENTIALLY YOU CAN'T DIRECTLY
STANDARDIZE FOR AGE BECAUSE THE
STATES HAVE DIFFERENT AGE
STRUCTURES WITHIN THEM SO
THIS--I'M TRYING TO TRANSFER A
GIANT SLIDE TO SPEECH AND IT'S
NOT WORKING.
SO YES, THEY'RE INDIRECTLY
STANDARDIZED.
I WILL--IF HAVE YOU MORE
QUESTIONS ABOUT THAT I CAN REFER
YOU TO THE PAPER OR SEND YOU THE
SLIDE.
WE HAVE A QUESTION COMING
THROUGH IN THE CHAT FOR ME AND
OTHER PANELISTS SO 1 OF THE
QUESTIONS IS HOW CAN THE
RESEARCH THAT'S BEEN CONDUCTED
ON ACUTE COVID-19 AND
COMMUNITIES WITH HIGH RATES OF
HEALTH DISPARITIES AND COVID-19
HARM PIVOT OR EXPAND TO SUPPORT
RESEARCH ON LONG COVID IN THESE
COMMUNITIES.
SO NONE OF OUR TALKS SPOKE ABOUT
LONG COVID REALLY AND I WILL
TURN THAT OVER TO THE OTHER
PANELISTS.
>> I WOULD BE DELIGHTED TO TALK
ABOUT THIS.
IT GOES TO WHAT DR. PHIL
EPIGENETICS IS TALKING ABOUT, WE
NEED MORE DATA IN THESE
COMMUNITIES, RIGHT?
AND WE NEED TO INVEST MORE FUND
NOTHING THE COMMUNITIES TO BE
ABLE TO FOLLOW, KIND OF
UNDERREPRESENTED GROUPS
LONGITUDINALLY TO TRACK LONG
COVID IN DIFFERENT GROUPS AND
SEE HOW IT VARIES.
>> YEAH, I AGREE, LIKE THE
LIMITATIONS OF THE RADX-UP WORK
WE WERE DO IS 2 YEARS SO THEY'RE
OLD PEOPLE AND IT'S DONE, SO
WE'VE BEEN TRYING TO GET FUNDING
TO FOLLOW THE PEOPLE WHO HAVE
HAD COVID AT LEAST ONCE IN OUR
COHORT.
BUT IT'S BEEN CHALLENGING
BECAUSE WE'RE VERY FOCUSED JUST
ON THE STRUCTURAL FACTORS RAGHT
E-PRESCRIBING THAN TESTING AND
VACCINATION AND EVERYTHING.
>> YEAH.
>> OKAY, ANOTHER QUESTION HAS
COME IN AND THIS IS--I'M
INTERESTED TO SEE WHAT YOU FOLKS
THINK ABOUT THIS.
I WAS APPROACHED ON THIS
QUESTION MAYBE A YEAR OR 2 AGO
TO POSSIBLY JOIN AN NIH GRANT
AND ENDED UP DECIDING IT WASN'T
A GOOD FIT, HOW DO YOU RECOMMEND
THE BASIC SCIENTIST MODEL,
TRANSGENDER AND THEIR BIOLOGICAL
STUDIES AND WHAT YOU THINK ABOUT
OVERECTOMY-IZED ANIMALS TREATED
WITH TESTOSTERONE OR ANIMALS
TREATED WITH ESTROGEN AND
PROGESTERONE?
>> WELL I KNOW NOTHING ABOUT THE
BIOG LOGIC SIDE AND HAVEN'T FOR
A LONG TIME.
MAYBE SOMEONE ELSE CAN COMMENT
ON THAT.
IF YOU ARE INTERESTED IN HORMONE
LEVELS YOU BASE IT BASED ON
HORMONES IF YOU'RE INTERESTED ON
THE WAY THEY APPEARED TO WORLD
LIKE HOW THEY'RE SOCIALIZED HOW
THEY'RE VIEWED BY THE WORLD AND
HOW THAT IMPACTS THEM, WE'VE
SEEN A LOOT OF HOW WOMEN AND HAD
MEN ARE SOCIALIZED DIFFERENTLY
AND HAVE DIFFERENT IMPACTS, I
THINK WE IF PEOPLE IDIDN'TIFY AS
CIS OR TRANS, IF THAT'S WHAT
YOU'RE INTERESTED IN, THAT'S HOW
YOU FOCUS ON IT, BUT AGAIN, IT
DEPENDS, ARE YOU FOCUSED ON BODY
PARTS OR HORMONES OR FOCUSED ON
THE WAY THEY APPEAR, ARE YOU
FOCUSED ON THEIR PAST?
I MEAN THERE'S A LOT OF THINGS
WE CAN GET INTO THAT INVOLVE
LIKE INTERSEX INDIVIDUALS WHICH
I THINK ALSO A COMPLETELY
UNDERSTUDIED POPULATION.
>> SO I WAS APPROACHED BY
SOMEBODY WHO'S NOT ON THIS CALL
AND NOT IN THIS REALM OF
RESEARCH WHO WANTED TO CREATE A
TRANSGENDER MOUSE AND THEN
ENROLL TRANSGENDER PEOPLE IN A
PROJECT I WAS SORT OF
UNCOMFORTABLE WITH THE IDEA THIS
YOU COULD GIVE A FEMALE MOUSE
TESTOSTERONE AND CALL IT A
TRANSGENDER MOUSE BECAUSE THE
BIOLOGICAL EFFECTS ISSUES THE
BIOLOGY OF IT BEING TRANSGENDER
AND SO I HAVE A CLOSE
COLLABORATOR WHO WORKS WITH
TRANSGENDER MEN AND HAS DONE
STUDIES ON LEVELS OF
INFLAMMATORY PROTEINS AND
PROTEIN RESPONSES SO TRANSGENDER
MEN GOING ABOUT THEIR WORLD AND
THEY FEEL LIKE THEY'RE PASSING
AND BEING GENDERED IN PUBLIC AND
USING PRONOUNS AND THEY HAVE
LOWER RESTING HEART RATES, THEY
HAVE LOWER CARDIOVASCULAR
RESPONSE TO A STRESS TEST, LOWER
RATES, AND TRANSGENDER MEN IN
THE PROCESS OF TRANSITIONING ON
WHO ARE NOT SOCIALLY PROCESSING
AND THEY'RE GOING AROUND THE
WORLD AND USING SHE/HER AND
USING THOSE SO THOSE ARE ALL
SOCIAL EVENTS THAT HAVE CLEAR
BIOLOGICAL OUGHT COMES AND THOSE
ARE NOT REPLICATED BY A MOUSE BY
REMOVING IT'S OVARIES AND GIVING
IT TESTOSTERONE AND THEY'RE PART
OF THE EXPERIENCER OF THE
TRANSGENDER, IF YOU'RE GOING TO
REDUCE A SET OF QUESTIONS,
TRANSGENDER PEOPLE'S RESPONSE TO
COVID WILL BE [INDISCERNIBLE]
WITH LEVELS OF EBPOSE AND YOU
ARE CESS SEPTORSIBILITY ON
CHRONIC CONDITIONS AND EXPOSURE
DO THROUGH DUE ON CLINICAL
DISCRIMINATION, WHO THEIR
PARTNERS ARE AND WHETHER THEY
CAN CONTROL EXPOSE THAT YOU ARE
ROUTE, ET CETERA BUT A MODEL,
THERE'S PROBABLY A LOT OF ROOM
FOR ANIMAL STUDIES INVOLVED LIKE
WHAT ARE THE LONG-TERM EFFECTS
OF TESTOSTERONE TREATMENT ON THE
ABILITY OF THIS ANIMAL TO BECOME
PREGNANT RIGHT AND THEN IMAWN
OVER [INDISCERNIBLE] ANIMAL
RETAINS ITS UTERUS, AND I
HAVEN'T THOUGHT DEEPLY ABOUT
THIS WHERE YOU COULD WORK
THROUGH BUT TRY TO REPLICATE THE
EXPERIENCE OF BEING TRANSGENDER
IN OUR SOCIETY BY SHIFTING MOUSE
HORMONES IS I THINK IS NOT SORT
OF A--IT'S A REALLY LIKE LIMITED
APPROACH IN MANY WAYS.
SO I DO MOUSE WORK SO WHAT I DO
KNOW NTHERE'S A QUESTION IN THE
CHAT THAT SAYS HAS THE IGF 95
CANT INCREASE IN THE TELEHEALTH
THROUGH THE PAN DEMIMPROVED
ACCESS THROUGH SOME
DISADVANTAGED COMMUNITIES.
>> I'M NOT SURE IF THERE ARE
GREAT DAT ON THAT, SO IF SOMEONE
HAS DATA THAT WOULD BE GREAT.
BUT I HAVE SEEN 2 DISTRIBUTIONS
WHERE THERE HAVE BEEN PEOPLE
PARTICULARLY THOSE WHO LIVE VERY
FAR AWAY THAT HAVE NOW GOTTEN
ACCESS TO ACCESS TO LARGER
MEDICAL CENTERS FOR
CONSULTATIONS, PARTICULARLY FOR
CARDIOLOGY WHERE THEY MAY NOT
HAVE, BUT THERE'S ALSO BEEN KIND
OF A DROP OFF FOR PEOPLE THAT
DON'T HAVE READY ACCESS TO BROAD
BAND, TO INTERNET, TO
WIFI, SO
I'VE SEEN IT BE HELPFUL AND NOT
HELPFUL.
>> OTHER THOUGHTS.
>> THAT'S BEEN MY VIEW AS WELL
THOUGH I DON'T HAVE THE DATA FOR
IT, EXACTLY JUST THAT, I ALSO
THINK IT'S AREA SPECIFIC.
SO IN PSYCHIATRY ACTUALLY IN
PSYCHIATRY, IT'S--THERE'S STILL
HAVE CONTINUED WITH THE
TELEHEALTH AND I'M NOT SURE AT
WHAT POINT THEY'RE GOING TO
SHIFT FROM THAT BECAUSE IT HAS
BEEN QUITE CONVENIENT DESPITE
SOME OF THE ISSUES RELATED TO
ACCESS AND I DO SEE IN THE DATA
THAT ARE--OUR HOSPITALS HAD
GERIATRIC POPULATIONS HAVE
DROPPED FROM TELEPSYCHIATRY SO
CERTAINLY THINKING ABOUT YOU
KNOW ACROSS THE LIFE SPAN, AS
WELL AS PRIVACY ISSUES, TOO,
ESPECIALLY IN PSYCHIATRY, IF
YOU'RE AT A HOUSE AND YOU'RE
TRYING TO DO TELEHEALTH, YOU
NEED PRIVACY TO HAVE THAT
CONVERSATION WITH YOUR
PSYCHIATRIST, THAT MIGHT NOT BE
AVAILABLE.
THAT COULD REALLY AFFECT
TELEHEALTH AS WELL.
>> THANK YOU SO MUCH AND I WANT
TO THANK EVERYBODY, ALL THE
SPEAKERS WHO PARTICIPATED IN
THIS AND THE REST OF THE
PANELISTS FOR YOUR PARTICIPATION
IN THIS FASCINATING WORKSHOP AND
I WILL WRAP THIS UP I KNOW WE
HAVE AT LEAST 1 OTHER QUESTION
AND WE WILL MOVE THAT TO--WE DID
TALK ABOUT IT PERHAPS IN 1 OF
THE MEETINGS AFTER THESE EVENTS.
BUT I WANT TO KEEP TO THE
SCHEDULE SO THAT WE CAN MOVE ON
TO OUR NEXT PIECE.
THANK YOU SO MUCH, EVERYBODY.
>> THANK YOU SO MUCH FOR THE
FANTASTIC SESSION ON THE SOCIAL
DETERMINANTS OF HEALTH AND COVID
OUTCOMES WITH THE EMPHASIS ON
GENDER.
IT WAS FANTASTIC, THANK YOU TO
ALL THE PANELISTS AND
DR. SHATTUCK-HEIDORN.
>> SO NEXT WE WILL MOVE TO
ANOTHER INDIVIDUAL'S PERSPECTIVE
FROM THEIR PERSONAL PERSPECTIVE
OF HAVING HAD COVID AND I'M
GOING TO INTRODUCE MISS HEATHER
YATES ISSUES SHE'S A GRADUATE OF
EDEN BURRO UNIVERSITY IN THIS
COUNTRY AND SHE WORKS FOR
UNIVERSITY OF WEST VIRGINIA FOR
CASE MANAGER FOR THE OFFICE OF
STUDENT CONDUCT AND ACADEMIC
INTEGRITY AND SHE'S WORKED IN
SOCIAL SERVICE FOR OVER 20
YEARS, 10 OF WHICH AS THE
EXECUTIVE DIRECTOR OF THE COURT
APPOINTED SPECIAL ADVOCATE
PROGRAM AND SHE HAS AND CAN YOU
SEE FROM EVERYTHING SHE'S GONE
DONE SHE HAS A DEFINITE PASSION
FOR ADVOCACY IS HELPING OTHERS.
SHE'S BEEN INVOLVED IN THE
RECOVER PROJECT WHICH IS A
COMMUNITY PROJECT THAT SUPPORTS
RECOVERY USING INDIVIDUAL'S
EXPERIENCES AS HAVING A SHARED
EXPERIENCE OF SOMETHING.
SO SHE'S VERY INVOLVED IN THAT.
SHE ON THE EXECUTIVE COMMITTEE
AND SERVES ON THE ADVISORY BOARD
AND TODAY SHE'S GOING TO TALK
ABOUT HER EXPERIENCE AS BEING A
POST ACUTE SEQUELA OF SARS-COV-2
INFECTION.
>> MISS YATES.
>> THANK YOU.
I APPRECIATE YOU ALL INVITING
MOOY TO BE A PART OF THIS.
AS YOU SAID, I AM HEATHER YATES,
I AM 50 YEARS OLD, I LIVE IN
MORGAN TOWN, WEST VIRGINIA.
I HAVE BEEN DIAGNOSED AS A PAST
PATIENT OTHERWISE KNOWN AS A
LONG HAULER AND I'VE WORKED,
LIKE I SAID AT WEST VIRGINIA IN
THE OFFICE OF ACADEMIC CONDUCT
AND INTEGRITY DURING THE
PANDEMIC AND WHEN WE ALL HAD TO
PIVOT IS CLASSES GO ONLINE, OUR
OFFICE IS DEALING WITH ALL THE
COVID VIOLATIONS, WITH WE WERE
BRINGING THE STUDENTS BACK AND
SO FORTH.
I SERVE AS A CO CHAIR ON THE
NATIONAL COMMITTEE ENGAGEMENT
GROUP OF THE NIH COVID RECOVER
STUDY AS WELL AS I AM A VOTING
MEMBER OF THE EXECUTIVE BOARD
FOR THAT STUDY AS WELL.
MY STORY STARTS BACK IN DECEMBER
OF 2019, JANUARY OF 2020.
AT THAT TIME I WAS WORKING WITH
THE UNIVERSITY BUT I WORKED IN
THE FINANCIAL AID OFFICE AND I
WAS WORKING ON A DAILY BASIS
WITH STUDENTS THAT WERE STUDYING
ABROAD AND INTERNATIONAL
STUDENTS.
AT THAT TOO MANY I HAD GOTTEN
BETTER AFTER SPEAKING TO
COWORKERS AND IT FELT LEAK A BAD
COLD AND FLU THAT I HAD BUT I
COULDN'T KICK IT SO I STARTED
HAVING--LIKE DEVELOPING OVER THE
NEXT FEW MONTHS LIKE I WOULD
HAVE TO TAKE A DAY OFF, I WAS
RELAPSING, UP AND DOWN, WORK WAS
NOT SUPPORTIVE AT ALL ABOUT
MISSING AND BEING OUT AND DURING
THIS TIME I WAS SUFFER FROM--I
STARTED HAVING LIKE CHILLS AND
HOT FLASHES, STRANGELY ENOUGH,
GI ISSUES, URNATION, I HAD BEEN
DNGED WITH ANXIETY BUT MY
ANXIETY HAD INCREASED
TREMENDOUSLY.
I COULD--IT FELT LIKE I COULD
NEVER GET OUT OF THE FIGHT OR
FLIGHT PHASE.
AT THAT TIME, MY--I HAD ALSO
BEEN DIAGNOSED WITH SVT, YEARS
AGO AND HAD BEEN TREATED FOR
THAT, BUT THAT TOO, STARTED TO
BE TRIGGERED AT THAT TIME.
I WAS SENT TO ER FOR THE
TACHYCARDIA AND YOU KNOW
SHORTNESS OF BREATH.
I THEN WAS SENT BY MY PC P TO
SEE EAR NOSE AND THROAT
SPECIALIST, THEY THOUGHT I HAD
ALLERGIES, I WAS SENT TO A
GYNECOLOGIST HERE THEY THOUGHT
SINCE I HAD A HYSTERECTOMY BACK
IN 2013, THAT MUST BE WHY I WAS
HAVING THESE SYMPTOMS, BECAUSE
AT THIS POINT COVID WAS JUST
REALLY COMING OUT EVERYWHERE BUT
THERE WAS NO TESTING IN WEST
VIRGINIA, I DON'T EVEN KNOW IF
THERE WAS ANY NEARBY SO THIS
WENT ON THROUGH MARCH OR APRIL
20.
WE SHIFTED TO WORKING FROM HOME,
AND I WAS STILL STRUGGLING WITH
THESE SYMPTOMS AND LIKE YOU SAID
GOING TO THE DOCTOR DIFFERENT
DOCTORS, MY DAUGHTER IS WVU
CHEERLEADER, AS THEY WERE
RETURNING TO GET ATHLETICS BACK
IN LINE IN AUGUST OF 2020 THEY
TESTED THE ATHLETES, SHE TESTED
NEGATIVE WE THOUGHT EVERYTHING
WAS GOOD.
ONE OF HER TEAMMATES AFTER BEING
TESTED NEGATIVE WENT OUT, HAD A
GOOD TIME, DIDN'T TELL ANYONE,
SHE WAS--SHE CAME DOWN WITH
COVID AND THEN HAD PASSED IT ON
TO OTHER TEAM MEMBERS HENCE HOW
I HAD GOTTEN IT BUT WE DIDN'T
KNOW UNTIL I GO REALLY, REALLY
SICK AND THE CONTACT TRACING
STARTED.
SO THAT WAS IN LIKE AROUND LABOR
DAY.
AT THAT TIME AND I REALLY, THIS
TIME I FELT LIKE I WAS ALMOST
ALLERGIC TO MYSELF I WAS LIKE
OFF THE CHARTS.
I NEVER HAD ALLERGIES, AND I WAS
SENT TO ENT AGAIN, THEY ORDERED
ALLERGY TESTING AND I LITERALLY,
MY ARM WAS SPOALEN UP, BOTH ARMS
FOR WEEKS AND I SUDDENLY
ALLERGIC IT SAID TO EVERYTHING.
I DID GET SENT TO--THEY WANTED
TO GET ME ON ALLERGY TESTING BUT
AGAIN, I GOT SICK AND THEY
PULLED BACK BECAUSE I WAS SO
SICK.
I WAS SENT TO ANOTHER LIKE
ALLERGIST THAT WAS ACTUALLY LIKE
CERTIFIED WHO DID ALL THE
TESTING ON MY BACK AND THAT CAME
BACK AS I WASN'T ALLERGIC TO
ANYTHING, THEY DID A BLOOD TEST,
WASN'T ALLERGIC TO ANYTHING BUT
I WAS HAVING THESE KIND OF
INFLAMMATORY RESPONSES THAT WERE
REALLY CRAZY.
SO IN OCTOBER, I SUDDENLY
DEVELOPED DEBILITATING HEADACHES
AND I HAD NEVER HAD A HEADACHE
BEFORE ISSUE MAYBE LIKE A MINOR
SINUS PRESSURE BUT NOTHING LIKE
THIS.
I WAS HAVING HEADACHES FOR 25
DAYS IN A ROW.
I COULDN'T GET TO A NEUROLOGIST
FAST ENOUGH, THERE WERE NO
OPENINGS.
IT WASN'T UNTIL MY PC P REFERRED
TO ME INFECTIOUS DISEASE, THAT
DR. LISTENED TO ME AND SHE TOLD
ME, THAT I WAS NOT ALONE, WE
NEEDED TO LEARN MORE AND SO
FORTH BUT SHE REALLY HELPED ME
THROUGH A LOT BECAUSE DURING
THIS TIME, I WAS SUFFERING A LOT
OF MEDICAL DEBT FROM ALL THE
TESTING AND SO FORTH, AND SHE
WENT TO BAT FOR ME WITH THE
HOSPITAL BECAUSE I COULDN'T LIKE
EVEN ATTEMPT TO RECOVER BECAUSE
I WAS SO STRESSED OUT AND IT WAS
JUST A VISUAL CYCLE OF THE
STRESS LIKE INFLAMING EVERYTHING
THAT WAS HAPPENING TO ME.
I STARTED HAVING THE HEADACHES,
BLURRY VISION, THAT'S WHEN THE
TERRIBLE MUSCLE PAIN TWASN'T IN
MY JOINTS AND IT WAS IN MY
MUSCLES AND IT WENT FROM THE
BASE OF THE SKULL DOWN MY SPINE
ON OTHER SIDE THAT WAS TERRIBLE,
THE FATIGUE AND THE INSOMNIA,
LIKE I--IT'S HARD TO IMAGINE
BEING SO TIRED YET COULD NOT
SLEEP TO SAVE YOUR LIFE.
I HAD THIS--I COULDN'T EXPLAIN
IT TO ANYONE THIS FEELING OF
CONGESTION THAT WAS SO DEEP IN
THE CENTER OF MY HEAD AS IF YOU
PUT A CROSS THROUGH THE MISS OF
MY HEAD, IT WAS IN THERE BUT I
WAS NOT CONGESTED, I KNEW MY
NAISAL PASSAGES WERE COMPLETELY
CLEAR, I COULD BREATHE FINE BUT
I HAD THIS HORRIBLE FEELING OF
CONGESTION AND PAIN.
I WAS FINALLY REFERRED TO
NEUROLOGY BUT IT WAS A VERY LONG
KIND OF TESTING, YOU HAVE TO TRY
THIS FIRST, THIS FIRST AND I WAS
VERY FRUSTRATED BECAUSE I WAS
NOT BEING LISTENED TO I'M
NOT--I'VE NEVER HAD HEADACHES
YOU'RE ASKING ME FOR A HISTORY
THEY DON'T HAVE, YOU KNOW, IN IS
WHERE MY HISTORY STARTS SO
DURING THAT TIME I WAS SO SICK
IN TRYING TO ADVOCATE FOR
MYSELF, I WROTE TO MY STATE
REPRESENTATIVES AND 1 RESPONDED,
AND SHE ACTUALLY HELPED ME GET
CONNECTED HERE IN WEST VIRGINIA
WITH SUPPLEMENTAL MEDICAID FOR
PEOPLE LIKE ME WHO HAVE A
LONG-TERM ILLNESS AND HAVE
COMMERCIAL INSURANCE AND THAT
LITERALLY, IT WAS LIFE SAVING
BECAUSE IT PICKED UP ALL OF THAT
THAT MEDICAL DEBT.
WHATEVER MY INSURANCE DIDN'T
COVER, THAT WAS PICKING UP AND
THAT WAS A HUGE, HUGE HELP.
>> THANK YOU SO MUCH MISS YATES,
THAT'S REALLY HELPFUL FOR YOU TO
OUTLINE THIS ORDEAL THAT YOU
WENT THROUGH AND YOU KNOW, LIKE
WE HEARD BEFORE, COMING UP WITHA
A NEW REALLY AND HAVING
PEOPLE SAY, WELL, NEVER SEEN IT
BEFORE SO DOIBTING WHAT YOU'RE
GOING THROUGH OR NOT REALLY
UNDERSTANDING HOW TO CLASSIFY
IT.
IT'S SO--IT'S SO VALUABLE THAT
YOU WOULD SHARE THIS PERSONAL
EXPERIENCE WITH US AND I'M GLAD
THAT SOMEWHERE ALONG THE WAY,
SOME INDIVIDUALS WERE ACTUALLY
LISTENING AND HELPING YOU MANAGE
BECAUSE YOU'RE TALKING ABOUT THE
STRESS OF THE MONEY SITUATION ON
TOP WHICH ALSO HAS A BIOLOGICAL
EFFECT OF COURSE.
BUT THANK YOU SO MUCH FOR
SHARING AND WE HOPE THAT YOU
WILL PARTICIPATE IN THE BREAK
OUT SESSIONS BECAUSE, I MEAN
THIS IS REALLY, REALLY HELPFUL
TO HEAR SO THAT WE CAN AS I SAY,
SO WE CAN MODEL THE BASIC
SCIENCE CAN MODEL THE PROBLEMS
AND THE CLINICAL VICTORYS CAN
ASK THE RIGHT QUESTIONS.
>> ABNORMALITIES VIEWTLY,
ABSOLUTELY THIS REAL PROBLEM.
I THINK WE HAVE TO MOVE ON.
SO THAT I DON'T GET IN TROUBLE
WITH THE JASMINA BECAUSE SHE HAS
THIS WHIP.
BUT THANK YOU SO MUCH, SO NOW
WE'RE GOING TO HEAR FROM MR. JD
DAVIDS.
HE'S A HEALTH JUSTICE AND
COMMUNICATIONS STRATEGIST AND
HE'S BEEN WORKING WITH THE
NETWORKS OF DISABLED AND
CHRONICALLY ILL PEOPLE AND HE
CONFOUNDED STRATEGIES FOR HIGH
IMPACT AND IT'S NETWORK FOR LONG
OOSK JUSTICE.
THANK YOU FOR THAT MR. DAVIDS.
AND HE'S A CONTRIBUTING MEMBER
OF THE PATIENT LED RESEARCH
COLLABORATIVE AND HE'S--I DON'T
HAVE TIME TO READ EVERYTHING
HE'S DONE BUT BEEN AN EXTERNAL
EXPERT OOZE'RE ADVISOR TO THE
NIH, THE CENTER FOR DISEASE
CONTROL AND ALSO THE LOCAL
HEALTH DEPARTMENTS AND HE'S A
SENIOR DIRECTOR OF
COMMUNICATIONSA THE BODY, BODY
PRO AND SERVED AS STRATEGIST AND
ORGANIZER WITH MANY GROUPS
INCLUDING THE TRANSGENDER
STRATEGY CENTER, IT WAS A
PLEASURE TO HEAR FROM YOU TODAY,
THANK YOU SO MUCH FOR SHARING
YOUR PERSONAL STORIES.
MR. DAVIDS?
>> THANKS FOR THIS OPPORTUNITY.
I'M A DISABLED AND CHRONICALLY
ILL TRANSGENDER AND QUEER PERSON
LIVING WITH MULTIPLE COMPLEX
CHRONIC CONDITIONS ENCLOUDING
MESS, AND NEUROLOGICAL DISORDER
AND LONG COVID AND BROOKLYN,
NEW YORK.
AS I RESPOND TO OPPORTUNITIES TO
BE A PART OF LONG COVID
RESEARCH, I BECAME AWARE OF A
VOICE INSIDE ME EVEN AS
PRIVILEGED AFFIRMED AS I AM,
SAYING THAT I AM AN INTERLOPER,
THAT I WILL CONFOUND THE DATA
THAT I WILL SOMEHOW BREAK THE
RESEARCH AND/OR THAT I CAN'T
TRUST THAT THE QUESTIONS AND
ANALYSIS WILL BE ABLE TO HANDLE
MY MULTIPLE ATYPICALITYS WHICH I
WILL DESCRIBE.
--I WANT TO REMIND US THAT THE
UNITED STATES NOW INCLUDES
REGIONS WHERE CARE FOR
TRANSGENDER IEWGHT FOR SUCH IS
EXPLICITLY ILLEGAL, TRANSGENDER
HAVE BEEN BANNED FROM COMPETENT
CARE IS THEIR CARE PROVIDERS
SUBJECT TO PROSECUTION, THERE
ARE NATIONS AROUND THE WORLD
WHERE LGBTQ PEOPLE ARE
MARGINALIZED.
IT'S A VICIOUS CYCLE, TRANSWOMEN
ARE WOMEN AND TRANSMEN ARE MEN,
BUT LIKE MANY PEOPLE, I AM
NEITHER, I WAS ASSIGNED FEMALE
AT BIRTH, BUT AM TRANSGENDER,
NOT MALE, NOT FEMALE, I'VE BEEN
CHRONICALLY ILL, LABELED ALLERGY
AS AS GROWING UP, FREQUENT
INFECTIONS AND ROUNDS OF ROUNDS
OF ASPECT BIOTICS I ALSO
EXPERIENCED FAMILIARIAL ABUSE
AND SOCIAL OTHERSING BUT START
NOTHING MID TO LATE 20S AFTER A
CYCLING, I WENT NUM FROM THE
NECK DOWN, I WAS DIAGNOSED WITH
TRANSVERSE MILE IDENTITYITEIS
WITH CLINICALLY ISOLATED
SYNDROME, MULTIPLE SCLEROSIS
WHEN IT HAPPENED A SECOND TIME
AND NEUROMILITEIS WHEN IT
HAPPENED TWICE MORE, I HAVE
ATYPICAL PRESENTATION AS
TRANSMILEITIS CAUSES RAPID
PARALYSIS AND [INDISCERNIBLE]
CAUSES MILD DAMAGE AND I HAVE
NUMBNESS AND WEAKNESS AND OTHER
SYMPTOMS I HAVE TAKEN
IMMUNOSUPPRESSIVE TREATMENT
BECAUSE I'M OFF BECAUSE I DIDN'T
WANT TO BE IMMUNE CYPRESSED
DURING THE PANDEMIC I HAVEN'T
HAD REOCCURRENCE BUT WAS
DIAGNOSED WITH M. E. AS WELL M.
THFR GENE MUTATION BY DR. SUSAN
LAVINE IN 2017 NOW WITH MANY
SYMPTOMS THE SAME IN LONG COVID.
I HAVE ALWAYS BEEN QUEER AND
TRANS, BUT I DIDN'T HAVE
LANGUAGE FOR IT.
AFTER GIVE--ADD ON ESTRO
GENERATED BLOCKER TO STOP
CYCLING AND TRANSFER MY HORMONE
AT MEDS TO THAT MOSTLY
ASSOCIATED WITH CISGENDER MEN
WHO HAVE LOWER RATES OF
AUTOIMMUNE CONDITIONS THAT I WAS
ACCUMULATING DIAGNOSIS OF.
I HAVE HIGH LEVELS OF
AFIRNLATION IN MY LIFE AS A
WHITE PRIVILEGED PERSON IN A
QUEER PERSON IN THE QUEER
COMMUNITY AND BEEN ABLE TO WORK
IN SITUATIONS WHERE I'M NOT
EXPERIENCING DISCRIMINATION OR
BIAS AND THE THIRD OR FOURTH
GENERATIONS THAT MAY BE MORE AND
DIRECT LINEAGE OF MY
[INDISCERNIBLE] JEWISH FAMILY
THAT'S QUEER OR TRANS,
NONETHELESS HAVE HAD TO BREAK
OFF CONTACT WITH POETIC MOST OF
MY FAMILY FOR ABUSE OF
TRANSPHOBIA INCLUDING THREATS TO
ME AS A PARENT.
SO I'VE HAD GOOD ACCESS TO CARE,
THOUGH IT'S HARD AND VERY HA
ORDER TOK SESES CARE, I'VE
ALMOST ALWAYS HAD PRIVATE
INSURANCE, I'VE BEEN MARRIED
TWICE TO RETAIN OR OBTAIN IT AND
I LIVE WHERE THERE'S SPECIALISTS
IN URBAN AREAS, I HAVE A LOT OF
EXPERIENCE WITH NEFF GATING
HEALTHCARE SYSTEMS BUT STILL
TROUBLING, EXHAUSTING TO LIVE
WITH THE COMPLEX CHRONIC
CONDITION THAT CAN BEING AMPLIFY
BIDE GENDER STUFF.
I WON'T GO INTO DETAILS BUT I
HAVE TO DEAL WITH 17 DIFFERENT
COURSES OF MEDICATION AND
TREATMENT PLUS MULTIPLE
PROVIDERS AND OTHER THINGS AND
I'VE HAD PROVIDERS WHO WERE
GENDER COMP TEBT WHO WOULDN'T
TREAT ME BECAUSE OF MY RARE
MEDICAL CONDITIONS AND I'VE HAD
SPECIALIST WHO IS COULDN'T TREAT
ME FOR MY GENDER BUT SAID MY
GUESS WAS AS GOOD AS THEREs IF
WHETHER CHANGING MY HORMONAL MIX
WOULD EFFECT MY CONDITIONS.
I GOT MARRIED IN 2020.
I HAD STANDARD SORT OF LIST OF
MILD, COVID SYMPTOMS AND
AFTERWARDS WASN'T SURE IF I
ONGOING SYMPTOMS WERE FROM MY
CHRONIC CONDITIONS OR FROM
COVID.
THOUGH I DID HAVE EPISODES OF
HEART FAST BEATING AT NIGHT AND
OTHER THINGS THAT WERE NEW.
I HAD BRAIN FOG AND I CAN'T TELL
WHAT WAS FROM THE HELLISH
CLIMATE OF FEAR INCLUDING
SHARING A CHILD BETWEEN
HOUSEHOLDS THAT COULD EXPOSE MY
TYPE 1 DIABETIC PARTNER WHOSE
ALSO TRANS.
I HAD SIDE EFFECTS THAT PASS THE
OUT AND BROKE MY ANKLE, 36 HOURS
LATER WHEN I WENT FOR PREE
SURGERY FOR MY ANKLE I TESTED
POSITIVE FOR COVID.
SO I COULDN'T THEN TELL
RECOVERING FROM ANKLE SURGERY 2
DAYS LATER IF I WAS HAVING
SYMPTOMS OR NOT BUT I KNEW IT
WASN'T SEVERE BUT I DO HAVE
DISTINCT LONG COVID SINCE THEN.
FORTUNATELY NONAPOPTOTIC THE A
DANGEROUS LEVEL, MASS CELL
ACTIVATION SYNDROME TYPE
SYMPTOMS BUT WHICH FORTUNATELY I
HAVE ACCESS TO TREATMENT THAT
I'VE LEARN BODY AT FIRST FROM
OTHER PEOPLE WITH LONG COVID
THAT I NEVER LEARNED ABOUT FROM
ANY OF MY CARE PROVIDERS THAT
HAVE HELPED ME LIFT MY BRAIN
FOG, BUT NOW I HAVE PREDIABETES
LAB MARKERS AND WEIGHT DISTINCT
ABDOMINAL FAT INCREASES WHICH
COULD BE TREATMENT FROM THE LONG
COVID BUT IN COMPARISON TO THE
PREPANDEMIC I DO LITTLE BESIDES
WORKING AT HOME, PARENTING AT
HOME, AND RESTING AT HOME.
SO AS WE CLOSE, THANK YOU FOR
YOUR DISCUSSIONS TODAY ABOUT
GENDER DIVERSITY, I HOPE YOU
WILL PROACTIVE FOR EXAMPLE, IN
PUB ILICATIONS AND REPORTING ON
RESEARCH, IF THERE'S NOT USE OF
A 2 STEP SYSTEM FOR VALIDATION
OF GENDER THAT SHOULD BE POINTED
OUT AS A STUDY LIMITATION, IF
IT'S NOT CLEAR THAT RANS PEOPLE
WERE IN YOUR STUDY, IT'S IT'S
NOT CLEAR AND POWER THEM IT
WHENEVER POSSIBLE TO CONTRIBUTE
TO KNOWLEDGE BASE BASED ON
TRANSABOUTS OF LIVES.
IF THAT CAN HAPPEN NOTICE THE
LACK OF ABILITY TO DISAGGREGATE
OR SEPARATELY ANALYZE DATA.
FINALLY THE BEST WAYS TO INCLUDE
TRANSPEOPLE IN RESEARCH AND
SOPHISTICATED HIRE TRANSPEOPLE
AT ALL LEVELS ENCLOUDING PRIMARY
INVESTIGATORS AND STAFF AND AS
MEANTORS TO 1 ANOTHER IN
RESEARCH EFFORTS.
WE NEED RESEARCH THAT INTEGRATES
AND LOOKSA THE REALITIES OF
TRANSLIVES AND HOW IT AFFECTS
OUR ABILITY TO ACCESS OR BENEFIT
FROM INTERVENTIONS AND TO DID
DEVOTE RESOURCES TO THE
RECRUITMENT AND RETENTION OF
RESEARCH, REMEMBERING THAT LIVES
ARE CRIMINALIZED AND SUBJECT TO
MUCH BUREAUCRATIC VIOLENCE OR
EVEN PUBLIC VIOLENCE ON
TRANSEDITOR TO A STUDY SITE AND
JUST AS WE DON'T CONSIDER BINARY
GENDER AS A MONOLILGT,
DISTINGUISH RCH AND CARE FOR
PREBIEW BESSENT WOMEN AND GIRLS
WHO ARE GENDER, MUST RECOGNIZE
THESE BODIES, FOR EXAMPLE YOUNG
TRANSPEOPLE IN MY FAMILY MODEL
CITIZEN TRANSITION BUYER
BIEWBERTY AND USING PUBERTY
BLOCKER WHO IS WILL NEVER
EXPERIENCE ADOLESCENCE IN WHAT'S
CONSIDERED THE SEX THEY WERE.
>> THANK YOU SO MUCH MR. DAVIDS.
THOSE ARE ALL FANTASTIC
SUGGESTIONS WE ARE WRITING THEM
DOWN, WE ARE WRITING ALL THOSE
DOWN.
THANK YOU SO MUCH FOR SHARING
YOUR STORY.
YOU MADE VERY, VERY IMPORTANT
POINTS AND WE REALLY APPRECIATE
IT.
SO NEXT WE ARE MOVING TO TO
SESSION 3.
AND THIS IS GOING TO BE
MODERATED BY VESNA, GAROVIC, IT
WILL BE ON PREGNANCY AND OTHER
CONDITIONS AFFECTING
SUSCEPTIBILITY.
SO DR. GA ROVICH CHIEF
NEPHROLOGY HYPERTENSION IN THE
DEPARTMENT OF MEDICINE AT THE
MAYO CLINIC IN ROUGH ATOM
CHESTER, MINNESOTA.
SHE ALSO HOLDS A JOINT
APPOINTMENT IN OBSTETRICS AND
GUIN COALING.
SHE'S VICE CHAIR FOR RESEARCH IN
THE DEPARTMENT OF MEDICINE AND
DIRECTOR OF THE CLINICAL
RESEARCH CAN TRIALS UNIT AT THE
MAYO CLINIC WHICH IS PART OF
WHAT I IMAGINE THE NCATS CENTER
FOR ADVANCING TRANSLATIONAL
SCIENCE CENTER, THAT'S A CUTE
CAT, I LOVE CATS THAT'S GREAT.
AT THE NATIONAL CENTER FOR
ADVANCING TRANSLATIONAL
SCIENCES.
I IMAGINE IT'S THE CTSI, THE
CENTER FOR TRANSLATIONAL AND
CLINICAL SCIENCE.
SHE'S BEEN NIH FUNDED FOR OVER
15 YEARS AND THAT'S IMPRESSIVE
IN TODAY'S VERY HIGHLY
COMPETITIVE WORLD, SERVES AS A
CHARTERED MEMBER OF THE NIH
PREGNANCYNYONATOLOGY STUDY
SECTION AND SHE'S PUBLISHED OVER
190 PAPERS AND HER CLINICAL
RESEARCH INTERESTS LIE WITHIN
HYPER TENSIVE PREGNANCY
DISORDERS AND PREECLAMPSIA AND
SHE'S INTERESTED IN THE
DIAGNOSIS AND TREATMENT AND
SHE'S--THE UNDERLYING MECHANISMS
AND THEN HER MOST RECENT FOCUS
IS ON SENESCENSEL, ENDEMIOLOGY
OF THE LONG-TERM CARDIOVASCULAR
AND RENAL EFFECTS AND
SHE'S--WE'LL LET HER TALK MORE
ABOUT HER WORK BUT SHE'S VERY
INTERESTED IN POTENTIAL NEW
THERAPEUTIC TARGETS, ALWAYS A
VALUABLE DIRECTION FOR MOVING
HEALTHCARE FORWARD TO IMPROVE
MAIDIA AND LONG-TERM
CONSEQUENCES OF THIS VERY
ENIGMATIC DISEASE.
SO PLEASE TAKE IT,A WAY.
>> THANK YOU VERY MUCH FOR TD
KIND INTRODUCTION.
I TRULY ENJOY THE MEETING SO
FAR.
IT WAS VERY INSPIRING AND
INFORMATIVE AND FURTHER
ENFORCING OUR CONFLICTS IN
INVOLVING THE THEMES OF MEN
BEING DISPROPORTIONATELY
DISPOSED TO THE RISK OF
INFECTION AND THE SEVERITY OF
OUTCOMES AND HIGHLIGHT THIS IS
IS LIKELY DUE TO GENDER SPECIFIC
BEHAVIORS, GENETIC AND HORMONAL
FACTORS AND SEX DIFFERENCES IN
BIOLOGICAL PATHWAYS.
IN ADDITION TO THESE DIFFERENCES
I THINK VERY EARLY IN THE
PANDEMIC IT BECAME APPARENT THAT
SOME SEX-SPECIFIC PHYSIOLOGICAL
CONDITIONS, AS WELL AS DISEASE
ENTITIES IN HUMAN MAY MODIFY
RECENT DIAGNOSIS, CLINICAL
PRESENTATION, PROGNOSIS AND RISK
FOR A LONG-TERM COMPLICATIONS.
SO IN THAT CONCEPTUAL FRAME, WE
DEVELOP THIS SHORT SYMPOSIUM OR
SECTION OR WHATEVER YOU CALL IT,
WITH GREAT ASSISTERRANCE FROM
AND THE ONLY PERSON WHO CAN
ACTUALLY PRONOUNCE HER NAME
CORRECTLY.
AND IN THOO CONTEXT WE HAVE
DEVELOPED THE FOLLOWING
LECTURES.
WE WILL START WITH DR. SHAH,
FROM DIVISION OF NEPHROLOGY AND
HYPERTENSION AT THE UNIVERSITY
OF CINCINNATI.
SHE IS A PHYSICIAN-SCIENTIST WHO
FOCUSES ON WOMEN'S HEALTH,
KIDNEY DISEASE, SEX DISPARITIES,
KIDNEY DISEASE, SHE'S HAD MANY
REPORTS.
THANK YOU FOR THE ORDER OF
PRESENTERS,
FRANCK MAUVAIS-JARVIS, FROM
TULANE UNIVERSITY SCHOOL OF
MEDICINE, HE'S WITH THE TULANE
EVIDENCE OF SEX BIOLOGY AND
MEDICINE, NIH FUNDED AND
RESEARCH OCOMPLISHS BASIC
TRANSLATION AND CLINICAL
RESEARCH ABOUT THE BIOLOGY OF
SEX DIFFERENCES IN DIABETES AND
OBESITY.
SO HE WILL BE OUR FIRST
PRESENTER THEN DR. SHAH,
SUBSEQUENT TO THAT IT WILL HEAR
FROM DR. BABBETTE, LAMARCA, FROM
THE DEPARTMENT OF PHARMACOLOGY
AND TOXICOLOGY AT UNIVERSITY OF
MISSISSIPPI MEDICAL CENTER.
SHE'S ACTUALLY CHAIR OF THAT
DEPARTMENT.
SHE'S ALSO CHAIRING SEVERAL
IMPORTANT ROLES IN HER
INTERACTIONS WITH OB/GYN
DEPARTMENT AND MATERNAL FETAL
MEDICINE AMONG OTHER POSITIONS
SHE IS IN THE STUDY OF
EXCELLENCE IN PERINATAL
RESEARCH.
HER PRIMARY INTEREST IS
INTERACTION BETWEEN LYMPHOCYTES
AND ALLEGORISTIC ANTIBODIES TO
THE ANCHLIO TENSEIN 2 TYPE 1
RECEPTOR AND AS CAN YOU IMAGINE
THIS IS VERY INTERESTING, COMES
IN WITH THAT INTERACTION BETWEEN
AND NORMAL TENSIVE PREGNANCY.
AND COVID WITH RESPECT TO ACE 2
RECEPTORS, SUBSIDIARY QUEBT TO
THAT, DO WOE HAVE ANOTHER PERSON
FROM UNIVERSITY OF MISSISSIPPI
MEDICAL CENTER, GOOD FRIEND AND
COLLEAGUE AND COLLABORATOR,
DR. LICY YANES CARDOZO,
PHYSICIAN SCIENTISTACKISTLY
ENGAGED IN BOTH BASIC AND
CLINICAL RESEARCH FOCUSING ON
WOMEN METABOLIC COMPLICATIONS
AND CARDIO METABOLIC
COMPUTATIONS AND ANDROGEN WITH
RESPECT TO PC OS, I ALREADY
PRESENTED DR. FRANK
MAUVAIS,-JARVIS, AND WE WILL
HEAR FROM DR. JOHN RANDOLPH, HE
WILL TALK TO US ABOUT GENDER
AFFIRMING HORMONE THERAPY AND
SUSCEPTIBILITY TO COVID, HE DID
A VERY INTERESTING CAREER, EVEN
MORE INTERESTING THAN MINE.
INTERNIST SECOND, HE STARTED
THIS--THIS SURGEON BECAME
ENDOCRINOLOGY IV THERAPY AND HIS
RESEARCH INTERESTS IN CLOSE
GENDER HORMONES AND REPRODUCTIVE
FUNCTION.
SO I WANT TO THANK ALL THE
PRESENTERS AND I WOULD LIKE TO
START WITH DR. FRANK.
THE STAINL IS YOURS.
>> CAN YOU SEE MY SCREEN.
>> YES NMANY THANK FIST ARE THIS
INTRODUCTION, THANK YOU ALL FOR
INVITING ME AND I APOLOGIZE FOR
TAKING THE FIRST PLACE BUT I
REALLY GOTTA GO AND WE RUN A
LITTLE BIT LATE.
SO I THANKED THE TITLE A LITTLE
BIT BECAUSE HORMONE REPLACEMENT
THERAPY IS NOT AN APPROPRIATE
TERM BECAUSE THERE'S NO
RELACEMENT.
MENOPAUSAL HORMONE THERAPY OR
ESTROGEN PROGESTERONE THERAPY OR
ESTROW ZYGOUS GEN BUT NOW
REPLACEMENT.
>> SO HERE'S MY DISCLOSURES,
WE'VE ALREADY SEEN DIFFERENT
CONFRUCTS FROM PATHOPHYSIOLOGY
RESPONSE TO TREATMENT OF A LOT
OF DISEASE AND SINCE THE
BEGINNING OF THE OUTBREAK WE
HAVE OBSERVED THAT MEN, MALES
HAD MERESOEVER EF EVOLUTION IN
TERMS OF ADMISSION TO ICU AND
DEATH.
SO OF COURSE THERE ARE MANY
CAUSES THAT HAVE BEEN DESCRIBED
THROUGHOUT THE SESSION THIS
MORNING, SOME ARE INTERESTING,
SOME ARE LESS.
I WOULD SAY THE MOST INTERESTING
HYPOTHESIS IS, 1 OF THE MOST IS
THE 1, THE FACT THAT TLR 7
ANTIVIRAL RESPONSE GENE IS IN
THE X-CHROMOSOMES IN WOMEN, AND
ALSO IT'S 1 OF THOSE GENES THAT
ESCAPES IN ACTIVATION.
AND OF COURSE, WE HAVE THE SEX
DIFFERENCE IN THE INNATE IMMUNE
RESPONSE AND THE ADAPTIVITY
IMMUNE RESPONSE AND WE WILL
SPEAK ABOUT THAT TODAY.
PROBABLY 1 OF THE--1 OF THE
CONSEQUENCE OF WOMEN HAVING A
MORE PRONOUNCED ANTIBODY
RESPONSE TO A LOT OF SIMALIZED
THAT MOST AUTOIMMUNE DECEASES
HERE, ARE VERY, VERY STRONGER
FEMALE PREDOMINANCE BUT IF WE
CAN HARNESS THESE FORCES AND
TRANSFORM THEM INTO A THERAPY,
THAT WOULD BE VERY INTERESTING.
SOA A LOT OF CLINICAL STUDIES
HAVE SHOWN THAT BECAUSE WE WANT
TO SPEAK ABOUT HORMONE THERAPY
TODAY THAT ESTROGEN AND
ESPECIALLY THE NATURAL EST
RADIOL DISP BENEFICIAL EFFECT ON
THE I IMMUNE SYSTEM, MOSTLY
ESTROGEN AND TO A LESSER EXTENT
PROGESTERONE HAVE FIRST OF ALL
ESTROGEN RECEPTORS AND
PROGESTERONE RECEPTORS
PRESENTING ALL IMMUNE CELLS AND
THEY HAVE ANTIINFLAMMATORY
MACROPAGES, PROINFLAMMATORY
MIGRATION AND CYTOKINE TISSUES,
THEY STIMULATE CD4 HELPER
PRODUCING ANTIINFLAMMATORY
CYTOKINE THAT INHIBITS THE
PATHWAY BUT ALSO THEY SIMULATED
THE VERSION OF REGULAR T-CELLS
PROMOTING IMMUNE TOLERANCE.
IN ADDITION, IT ALONE HAS NICE
EFFECTS ON B-CELLS, TO INCREASE
ANTIBODY PRODUCTION.
SO YOU SEE IN THEORY ALL THESE
ACTIONS WOULD SUGGEST THAT
FEMALE HORMONE WOULD BE
BENEFICIAL AGAINST THE INITIAL
CYTOKINE STORM TAKEN--THEY WE
SPOKE ABOUT AT THE BEGINNING OF
THE OUTBREAK.
SO SEVERAL EPIDEMIOLOGICAL
STUDIES HAVE LOOKEDDA THE
INTERACTION, AT THE RELATIONSHIP
BETWEEN THE USE OF HORMONE
THERAPY IN WOMEN AND COVID-19
OUTCOMES.
THERE ARE SEVERAL OF THEM, I
WILL SPEAK ONLY ON 3 THE BIGGEST
1, THIS 1 IN GERMANY LOOKING AT
A TRI NEXT DATABASE OF BOTH
SPANNING 17 COUNTRIES AND 37,000
COVID-19 INFECTED WOMEN.
THEY SPLIT THEM IN 2 AGE GROUP.
YOUNG BEFORE THE AGE OF MOAN O
PAUSE, OLDER AFTER THE AGE OF
MENOPAUSE AND YOU SEE THAT THERE
WAS A DECREASE AND OF COURSE THE
PRIMARY END POINT WAS MORTALITY.
AND THEY FOUND THE DECREASE IN
WOMEN TAKING ESTROGENS AND IN
HORMONE THERAPY, THE USERS IN
THE STUDIES IT'S NOT JUSTED
ESTRO DIOL SO THOSE BETWEEN
15-49, THERE IS A DECREASE RADIO
IN ESTROGEN USERS BUT IT WAS NOT
SIGNIFICANT.
IT WAS NOT INCREASED IN THE
NONUSERS, SORRY IN THE USERS
WHERE YOUNGER THAN 49 YEARS OF
RAGE WHICH THEY--YOU KNOW WE
JUST SPECULATE IN THE STUDY THAT
IT WAS BECAUSE THESE WOMEN ARE
STILL HIGHER ESTROW ZYGOUS GEN
LEVEL.
ANOTHER INTERESTING STUDY IN
SWEDEN, OUT OF OVER 16,000 WOMEN
ALSO LOOKED AT WOMEN TAKING
ESTROGENS, WHICH THEY CALL THE
AUGMENTED ESTROGEN GROUP
COMPARED TO WOMEN THAT THEY
CALLED THE DECREASED ESTROGEN
GROUP BECAUSE THEY WERE TAKING
ANTIESTROGEN FOR BREAST CANCER
AND YOU SEE MY MOUSE IS NOT
WORKING SO YOU WILL HAVE TO
LISTEN TO WHAT I SAY.
UNDERLINED IN RED, YOU CAN SEE
THAT IN THE AUGMENTED GROUP,
WHILE THE OTHER RATIO AGAIN OF
DEATH, THE PRIMARY END END POINT
WAS DEATH AND EVEN THE ADJUSTED
1.47.
I HAVE NO IDEA WHERE THE MOUSE
IS BUT GAY, WE DON'T NEED IT.
FINALLY, THIS STUDY THAT IS
STILL NOT PUBLISHED, SOME
[INDISCERNIBLE], OUT OF 400
GENERAL PRACTICES IN ENGLAND,
THEY LOOKED AT 1.8 MILLION WOMEN
AND THEY FOUND 5500 WITH COVID
CASES AND HERE AGAIN, WHEN THEY
LOOK AT HORMONE THERAPY USE,
WELL, AGAIN, AND THE PRIMARY
EPPED POINT AGAIN WAS DEATH, THE
OTHER RATIO WAS .22, SO,
[INDISCERNIBLE] YOU SEE IN ALL
THE STUDIES IT SEEMS LIKE THERE
ANN ASSOCIATION BETWEEN HORMONE
THERAPY USE IN WOMEN OVER THE
AGE OF 50 AND DECREASE IN DEATH
WHICH SUGGESTS THAT HORMONES,
PROTECT.
SO BASICALLY IT HAS BEEN A FEW
CLINICAL TRIAL THAT HAVE
ASSESSED THAT 1 OF THEM
USED--WAS A SMALL RANDOMIZED
CONTROL TRIAL AND ABOUT 50
PATIENTS AND THEY LOOKED AT THE
EFFECT OF PROGESTERONE
SUBCUTANEOUS PROGESTERONE,
NATURAL PROGESTERONE, 200
MILLIGRAM PER DAY AND
[INDISCERNIBLE] HOSPITALIZED
PATIENT.
AND YOU SEE THEY FOUND KIND OF
MODERATE IMPROVEMENT SIGNIFICANT
WITH 3 FEWER DAYS OF OXYGEN IN
THOSE PROGESTERONE AND .25 DAYS
OF HOSPITALIZATION, THESE ARE
MEN, I FORGOT TO SAY THEY LOOK
AT MEN.
>> TWO MINUTES LEFT.
>> THEY LOOK AT THE DETAIL OF
STUDY, THE POPULATION AT BASE
LINE WAS DIFFERENT.
THOSE ASSIGNED TO PLACEBO
ACTUALLY HAD LESS CO-MORBIDITIES
THAN THOSE ASSIGNED TO HORMONES
SO I DON'T KNOW IF THAT'S
RELEVANT.
FROM AN EARLY TO LATE 2020, TO
EARLY 2021, WE APPLIED FOR THE
FDA TO START PROGESTERONE IN
PATIENTS HOSPITALIZED, THE
PAPEROT PROTOCOL, NOT THE
PUBLISHED STUDY, WE WANTED TO DO
A RANDOMIZED CONTROL TRIAL OUT
OF A HUNDRED PATIENTS, ADDING
ESTRADIOL, INTRA MUSCULAR, LASTS
10 DAYS AND PROGESTERONE
200-MILLIGRAM ORALLY FOR 5 DAYS.
UNFORTUNATELY, WE'RE DELAYED BY
THE FDA FOR 10 MONTHS.
WHICH MADE THAT AT THE END WHEN
WE STARTED RECRUITING PATIENTS,
WE ASKED WHEN 50 PATIENT
RECRUITED ONLY 15 AND THEN COVID
BECAME OMICRON CHRKS IS A
DIFFERENT DISEASE SO I ASK ASKED
FOR THE STUDY TO BE CLOSED
BECAUSE IT WAS NOT SAME DISEASE,
OMICRON, ARE NOT HOSPITALIZED
FOR RESPIRATORY FAILURE BUT FOR
AG GRATES--GRATUEIGATION OF
ANOTHER DISEASE LIKE DIABETES,
ET CETERA.
BUT STILL, OUR PRIMARY OUTCOME
WAS A SHIFT FROM USING THE W. H.
O. SCALE, A SHIFT FROM MILD TO
SEVERE DISEASE SCALE 3-5, TO
WOJ-2, WE WANTED TO PREVENT THEM
FROM GOING TO 6, 7, 8.
I'M JUST SHOWING YOU THIS, WHICH
IS THE RESULT OF THIS VERY SMALL
NUMBER OF PATIENT, 12.
WE HAD 12.
THERE IS A SIGNIFICANT
IMPROVEMENT AT DAY 6 WHICH IS
DISCHARGE AND THE PATIENT
ASSIGNED TO KD--SALLY QUHA AND
ANOTHER SIGNIFICANT IMPROVEMENT
AT DAY 60.
BUT, YOU KNOW IT IS SO SMALL, SO
I DON'T THINK WE CAN REALLY DRAW
A CONCLUSION BUT IT'S STILL
INTERESTING.
>> TIME IS UP.
>> SO TO CONCLUDE, YOU KNOW I
WOULD SAY GAP IN KNOWLEDGE FOR
ME, FIRST OF ALL,
EPIDEMIOLOGICAL STUDIES SUGGEST
A PROTECT EVALUATION PROCESS
EFFECTIVE HT IN WOMEN WITH
COVID.
BUT REGARDING THE EFFECT OF
HORMONE THERAPY AND RANDOMIZED
CONTROL TRIAL WOULD NEED A
PROPERLY POWERED RANDOMIZED
CONTROL TRIAL WITH E2 AND P4,
MAYBE WITH OTHER ESTROGEN AND
PROGESTERONE COMBINATION TO
REALLY DRAW A CONCLUSION.
IN ADDITION TO THE EFFECT OF
HORMONE THERAPY AND IMMUNE
FUNCTION WITH COVID, I THINK IS
AN IMPORTANT DATA WHICH WILL
ASSESS ACTUALLY IN OUR PATIENTS.
--SO I THANK YOU FOR YOUR
ATTENTION.
THAT'S ALL I HAVE TO SAY.
>> THANK YOU VERY MUCH FRANK.
OUR NEXT SPEAKER IS SILVI SHAH.
ARE YOU WITH US?
>> I AM HERE.
>> PLEASE.
>> I WOULD LIKE TO THANK THE
ORGANIZING COMMITTEE FOR THE
OPPORTUNITY AND THANK YOU
DR. GAROVIC FOR THE INTRODUCTION
I WILL TALK ABOUT HORMONES AND
PREGNANCY AND SPECIFIED COVID-19
OUTCOMES.
I NO RELEVANT DISCLOSURES THIS A
BRIEF OUTLINE, WE WOULD BE
BRIEFLY TALKING ABOUT FEMALE
HORMONES AND PREGNANCY AND
COVID-19, INFLAMMATORY RESPONSE
IN COVID-19 AND PREGNANCY,
LESSENED RESPONSE AND MECHANISMS
OF WIDER TRANSMISSION, COVID-19
IMPACT ON PREGNANCY, LONG
COVID-19 AND PREGNANCY, FETAL
SAFETY AND FINALLY TALKING ABOUT
THE CURRENT KNOWLEDGE GAPS AND
FUTURE RESEARCH OPPORTUNITIES.
SO THIS IS A NICE INFO GRAPHIC
WHICH SHOWS FLUCTUATIONS OF 60
HORMONES, DURING PREGNANCY, AT
VARIOUS STAGES OF GUESTATION,
WHICH INCLUDES HUMAN
[INDISCERNIBLE],IOJESTERON,
ESTROGEN, PROLACTIC ACIDOSEISIN,
RELAXIN AND OXIS TOIN WHICH IS
NEED FOR GROWTH OF PLACENTA,
GROWTH OF BABY, CHILD BIRTH AND
LACTATION.
IS AND AS WE CAN SEE THE LEVELS
OF PROGESTERONE AND ESTROGEN
INCREASES WITH PREGNANCY.
INITIALLY IT IS PRODUCED BY THE
CORPUS LIEWT YEM AND THE CORPUS
TAKES OVER OF THE SO. SO WELL IS
INCREASED CIRCULATING LEVELS IN
PREGNANCY.
AND PROGESTERONE HAS
IMMUNOMODULATORY PROPERTIES AND
DR. XAVIER GAVE AN EXCELLENT
TALK ON THAT MAKING HIGH LEVELS
DURING PREGNANCY POTENTIALLY
BENEFIT FOR RECOVERY AFTER LONG
VIRAL INFECTIONS.
MOSTLY IT HAS BEEN STUDIED FOR
INFLUENZA, BUT WE DID SEE A FEW
STUDIES IN WHICH IT'S BEEN
STUDIED FOR COVID-19, HOWEVER
FOR THE STUDIES ARE NEEDED TO
UNDERSTAND THE ROLE OF FREG
MANCY RELATED CHANGES, IN
PROGESTERONE AND OTHER HORMONES
INCLUDING ESTON JOANS AND
ANDROGENS WHICH MAY CONTRIBUTE
TO REGULATION WITH COVID-19.
SO WHAT ARE THE INFLAMMATORY
RESPONSES WHICH OCCUR IN
PREGNANCY.
THERE IS SHIFT IN CD4 T-CELLS
TOWARDS TH2 PHENOTYPE OVER TH1.
THERE IS DECREASE IN CIRCULATING
NK CELLS, THERE IS DECREASE IN
CIRCULATING PLASMA SIGHTOID
DENDRITIC CELLS AND THERE IS
ALTERATION IN INNATE IMMUNE
SYSTEM AND TELOMERE SHORTENING
LIKE RECEPTORS.
NOW ALL THESE MECHANISMS HELP
CLEARANCE OF VIRAL INFECTED
CELLS BUT THEY DECLINE WITH
PREGNANCY HOWEVER, HOW IT
INTERACTING WITH COVID-19 IS
STILL NOT KNOWN AND NEEDS
FURTHER RESEARCH.
SO THERE HAVE BEEN CASE REPORTS
OF SARS DETECTION IN THE
PLACENTA AND HISTOLOGICAL SIGNS
OF PLACENTAL MILD PROFUSION
WHICH MOSTLY OCCURS WITH
CLOTTING, HOWEVER, IT IS UNCLEAR
WHETHER THE PRESENCE OF AND IT
IS DAMAGED BY OTHER PATHOLOGIES.
WE ALSO KNOW THAT ACE 2 AND
TMPRSS2 CO EXPRESSION HELPS IN
ENTRY OF VIRUS IN THE LUNG
TISSUE.
HOWEVER, THERE IS LACK OF ACE 2
AND TMPRSS, IN THE PLACENTA
SEBTA.
SO MOST LIKELY SARS ENTER THE
TISSUES VIA AN OLYMPIC TERNATIVE
MECHANISM HOWEVER, MECHANISM OF
VIRAL INVASION OF THE PLACENTA
HAS NOT BEEN CLEARLY
ESTABLISHED.
THIS IS A STUDY WHICH SHOWS THE
IMPACT OF COVID-19 ON PREGNANCY.
THE OTHERS LOOK AT 14,000 WOMEN
IN U.S. HOSPITALS AND THEY LOOK
AT VARIOUS MATERNAL AND FETAL
OUTCOMES FOR THE PRIMARY
OPPOSITE OUTCOME OF THAT, OR
SERIOUS MORBIDITY FROM HYPER
TENSIVE DISORDERS OF PREGNANCY,
POSTPARTUM HEMORRHAGE ON NONSARS
COV-2 INFECTION, THE RISK IS
HIGHER IN WOMEN WHO ARE SARS
COVERY-2 POSITIVE COMPARED TO
WOMEN WHO DID NOT HAVE
INFECTION, BY ABOUT 40%.
--THE RISK OF CONGENITAL
MALFORMATIONS DID NOT FORM
BETWEEN THE 2 GROUPS.
INTERESTINGLY IN SECONDARY
ANALYSIS, ADVERSE OUTCOMES ARE
ATTRIBUTED TO THOSE WITH
MODERATE OR HIGHER COVID-19
SEVERE MITRAL ERITY.
SO ASHING 19 AWLINGS INCREASES
THE RISK OF NEURODEVELOPMENT
DELAYS IN INFANTSA THE 12
MONTHS.
THIS IS A STUDY WHICH GOT
PUBLISHED EARLIER THIS MONTH
WHICH LOOKEDDA THE ABOUT 7700
LIVE BIRTHS TO SARS-COV-2
MOTHERS AND THE OUTCOME WAS
DEVELOPMENT DELAYS WHICH MOSTLY
INCLUDED MOTOR DELAYS, SPEECH
DELAYS AND LANGUAGE DELAYS AND
IF YOU LOOK, WHOM HAD SARS-COV-2
POVERTY HAD A HIGH RISK OF
DEVELOPING, DELAYS.
PRETERM BIRTHS INCREASE RISK OF
DELAYS AND ALSO THE THIRD
TRIMESTER INFECTIONS WERE
ASSOCIATED BY HIGHER EFFECTS OF
HIGHER MAGNITUDE.
SO TO SUMMARIZE COVID-19
INCREASES THE RISK OF MATERNAL
MORBIDITY AND MORTALITY.
COVID-19 INCREASES RISK OF
PREELAMPSIA AND HYPER TENSIVE
DISORDERS OF PREGNANCY.
COVID-19 INCREASES RISK OF
PRETERM BIRTHS DURING PREGNANCY
AND INCREASES THE RISK OF
NEONATAL INTENSIVE CARE
ADMISSIONS AND IT INCREASES THE
RISK OF DEVELOPMENT DELAYS IN
INFANTS.
SO LONG-TERM EFFECTS OF THIS
INCLUDES FATIGUE, SHORTNESS OF
BETH, SLEEP DISORDERS, ANXIETY
AND DEPRESSION.
HOWEVER THERE IS INSUFFICIENT
DATA ON LONG COVID-19 AND
PREGNANCY.
ALTHOUGH COVID-19 HAS SHOWN TO
INCREASE ADVERSE CARDIOVASCULAR
OUTCOMES IN 1 YEAR IN THE
GENTLEMEN POPULATION THERE,
CONTINUES TO BE INSUFFICIENT
DATA IN PREGNANCY.
REGARDING FETAL SAFETY AND
TREATMENT OF COVID-19 IN
PRACTICAL NANCY, SO PROPHYLAXIS
IS RECOMMENDED AND I WOULD LIKE
TO EMPHASIZE HERE THAT MOST OF
THE DATA COMES FROM THE TRIAL,
FROM THE TRIAL WHICH HAS
EXCLUDED PREGNANT WOMEN.
SO CURRENTLY STEROIDS AND
MONOCLONAL ANTIBODIES IS SAFELY
BEING USED DURING REG NANCY,
HOWEVER, THEIR SAFETY HAS BEEN
ESTABLISHED WITH THEIR USE IN
OTHER CONDITIONS, OR MOSTLY FROM
ANIMAL STUDIES.
THIS, 2 MIN ROUTES LEFT.
>> THESE ARE THE RESEARCH
OPPORTUNITIES.
SO THERE IS INSUFFICIENT DATA
REGARDING INFLAMMATORY RESPONSE,
LEVEL OF IMMUNITY AND HORMONAL
CHANGES DURING PREGNANCY, THE
MECHANISM OF VIRAL INFECTION,
NEEDS MORE RESEARCH.
LONG-TERM EFFECTS OF COVID-19
DURING PREGNANCY IS UNKNOWN,
CARDIOVASCULAR OUTCOMES
APPROXIMATE WITH OOSK 19 DURING
PREGINANCE SENOT KNOWN.
THERE NEEDS TO BE INCLUSION OF
REGNANT WOMEN WITH COVID-19
TREATMENT TRIALS AND PREAPPROVAL
DRUG DEVELOPMENT PROCESS, AND
THE EFFECT OF COVID-19 DURING
PREGNANCY AND INFANTS AND LATER
LIFE NEEDS MORE RESEARCH.
I WOULD LIKE TO THANK MY FAMILY,
MENTORS COLLABORATORS AND
RESEARCH TEAM FOR THEIR SUPPORT
AND FUNDING FROM NHLBI.
>> THANK YOU MUCH SILVI,
ORIGINAL NEXT PRECEPT BEER IS
BABBETTE LAMARCA, TALKING ABOUT
PREELAMPSIA LIKE PRESENTATION IN
PREGNANT COVID-19 PATIENTS.
CAN YOU HEAR ME?
NYES, --
>> YES.
>> IT'S TELLINGS ANOTHER PRESENT
SERIES POINTS SHARING.
>> SILVI, CAN YOU STOP SHARING.
>> YES.
>> OKAY.
>> GIVE IT A SHOT NOW.
>> OKAY.
THERE WE GO.
OKAY, CAN YOU SEE IT OKAY.
IT'S NOW 3:15 SO 3:35.
>> THANK YOU, FOR INVITING ME TO
SHARE THIS DATA TODAY.
AND DR. SHAH ARE FOR THE NICE
INTRODUCTION WHAT'RE SHOULD THE
MEMBERS OF MY LAB AND SOURCES OF
FUBDING FOR A LOT OF THE CONTROL
PATIENTS THAT I WILL SHOW TO YOU
TODAY.
>> SO FIRST WE WILL DEFINE
PREELAMPSIA WHICH IS NOW ONSET
HYPERTENSION DURING PREGNANCY
AND IT CAN OCCUR WITHOUT
PROTEINURIA, THESE ALSO DEVELOP
ENDOTHELIAM DYSFUNCTION AND
SERIES POINTS EASTBOUNDIAL
VASCULAR DYSFUNCTION WHICH LEADS
TO THE DEVELOPMENT OF SEIZURES
AND STROKES.
THESE WOMEN PRECEPT WITH A
CHRONIC INFLAMMATORY STATE, THE
IDEA OR THE HYPOTHESIS IS THAT
EARLY IN PREGNANCY THERE'S A
REDUCTION OF PLACENTAL BLOOD
FLOW WHICH LEADS TO THE
DEVELOPMENT OF PLACENTAL
ASCHEMIA AND HYPOXIA WHICH LEADS
TO SEVERAL FACTORS BEING
SECRETED SUCH ASOXIDATIVE
STRESS, INFLA AMATORY FACTORS
AND CYTOKINES AND AGANISTIC
AUTOBODIES TO THE RECEPTOR AS
WELL AS ANGIOGENIC FACTORS SUCH
AS [INDISCERNIBLE].
ALL OF THESE HAVE BEEN SHOWN TO
REDUCE RENAL FUNCTION AND CAUSE
AN INCREASE IN PREGNANT MODELS
OF PREELAMPSIA, MANY OF THESE
FACTORS HAVE BEEN SHOWN TO
INCREASE CEREBRAL BLOOD FLOW
WHICH LEADS TO DEVELOPMENT OF
SEIZURES AND STROKES IN HYPER
TENSIVE PATIENTS.
SO EARLY ON IN THE COVID
PANDEMIC OUR PHYSICIANS NOD
THERE WAS INCREASED INCIDENCE OF
AMONG WOMEN THAT TESTED POSITIVE
FOR OOSK DURING PRESCRIBING
NANCY, THIS WORSENED AS WE GO
INTO THE DELTA STRAIN IN WHICH
WE HAD I ABOUT A 50% DIAGNOSIS
RATE AMONG COVID POSITIVE
PATIENTS.
THIS WAS ACTUALLY NOTICED ALL
AROUND THE WORLD IN
SELF-REGULATORY ORGANIZATIONS
INSTITUTIONS THAT PUBLISHED
PAPERS INDICATING THAT WOMEN
WITH COVID DURING PREGNANCY
DEVELOPED A HYPER INFLAMMATORY
STATE WHICH IS ASSOCIATE WIDE
PLACENTAL HYPOXIA, PRETERM
LABOR, PRETERM BIRTH, FETAL AND
MATERNAL MORBIDITY AND
MORTALITY.
SO WE KNOW THAT PREELAMPSIC
WOMEN HAVE A CHRONIC T-CELL
RESPONSE WHICH LEDS TO
INFLAMMATORY CYTOKINES AND
TRIGGERS AT1 ANTIBODIES TO BE
PRODUCEDEE ALSO KNOW THAT COVID
PATIENTS HAVE A CHRONIC T-CELL
RESPONSE WITH INCREASE IN
INFLAMMATORY CYTOKINES AND I
WILL SHOW TODAY THAT THEY ALSO
PRODUCE THE AT1 ANTIBODY,
HOWEVER WHAT WE DON'T KNOW IS
WHAT ROLE DO THESE T-CELLS AND
INFLAMMATORY CYTOKINES AND THE
AUTOANTIBODY SAYS PLAY IN
CAUSING A LONG COVID SYNDROME OR
CAUSING POST THAT CAUSE DISEASE
AND NEUROVASCULAR FUNCTION.
SO WE KNOW THAT THE SYSTEM IS
HIGHLY REGULATED DURING
PREGNANCY AND INCREASE PLASMA IN
ANG 1, 2, AND 7 AND A DECREASE
IN ANGIO TENSEIN CONVERTING
ENZYME AND WE ALSO KNOW THAT ACE
2 IS ACTUALLY THE PORTAL OF
ENTRY FOR THE VIRUS FOR THE
COVID-19 VIRUS.
SO WE WANT TO COMPARE THE 2
ACTIVITY IN PLACENTAS IN WOMEN
WITH A HISTORY OF COVID DURING
PREGNANCY TO NONCOVID
PREELAMPSIA PATIENTS.
SO FIRST I WILL SHOW YOU THE
WOMEN IN THE FIRST OR SECOND
TRIMESTER HA HAD SOSK, AND THEY
ALL DELIVERED IN 34 WEEKS
GUESTATION, AND WE COMPARE THEM
TO THOSE WITHOUT COVID.
SO WE MEASURE ACE 2 AND WE FOUND
THAT WOMEN WITHOUT A HISTORY OF
COVID HAD SIGNIFICANTLY HIGHER
LEVELS OF ACE 2 ACTIVITY THAT
HAD PREELAMPSIA HAD
SIGNIFICANTLY HIGHER LEVELS OF
ACE 2 ACTIVITIES COMPARED TO
THOSE WITH A HISTORY OF COVID.
IT COULD INDICATE TO TIPPINGS
ISSUES ACE 2 IS NOW REGULATE
INDEED THE PLACENTA AND THE
ANGIO TENSEIN SYSTEM IS
NORMALIZED WELFARE WEEKS LATER
AND THAT THE INFLAMMATORY
PROCESS COULD ACTUALLY PLAY A
ROLE IN THE PREELAMPSIA
PHENOTYPE THAT WE SEE.
OR IT COULD INDICATE THAT
PREELAMPSIC WOMEN HAVE ENOUGH
REGULATION THAT WE DON'T KNOW
ABOUT THAT MAY LEAD THEM A
LITTLE MORE SENSITIVE TO
DEVELOPING OR CONTRACTING COVID
DURING PREGNANCY.
ONE OF THESE FACTORS THAT WE'RE
INTERESTED IN AND THAT COULD
PLAY A ROLE IN THE INCREASED
INCIDENCE OF PREELAMPSIA IN
COVID PATIENT SYSTEM THE AT1
AUTOANTIBODY WHICH IS ELEVATED
IN PREELAMPSIA WOMEN, AND OTHER
PEOPLE HAVE SHOWN IT'S PRODUCED
IN PATIENTS IN COVID POSITIVE
PATIENTS AS WELL, SO WE RETURN
TO OUR PATIENTS WITH THE HISTORY
OF COVID DURING PREGNANCY AND
MEASURED THE AT1 AUTOANTIBODY
AND WE FOUND ALL THOSE THAT
DEVELOPED HYPER TENSIVE
DISORDERS DURING PREGNANCY ALSO
PRODUCED THE AT1 AUTOENT BODY
AND WE'VE SHOWN THAT THE AT-1
AUTOANTIBODY INCREASES BLOOD
PRESSURE DURING PREGNANCY BUT TO
STUDY THE CENTER FOR EXCELLENCE
ON AGINGS POSTPARTUM WE ALLOW
THEM TO GIVE BIRTH AND MEASURE
BLOOD FLOW AT 10 AND 12 WEEKS.
THOSE THAT RECEIVE THE ANTIBODY
NO LONGER HAD HYPERTENSION WHEN
WE GAVE THEM A SECOND HIT OF THE
AUTOANTIBODY, THEY HAD A HYPER
TENSIVE STATE.
SO WHEN WE MEASURED BLOOD FLOW
WE FIRST LOOKED AT BLOOD FLOW,
WE HAD ELEVATED PRESSURES,
HOWEVER THOSE THORS RECEIVE THIS
DURING PREGNANCY AND AGAIN
POSTPARTUM HAD A SIGNIFICANT
INCREASE IN CEREBRAL BLOOD FLOW
DHS WOULD BE INDICATIVE THAT
WOMEN THAT STILL PRODUCE THE
AUTOANTIBODY, OR HAD IT DURING
PREGNANCY HAVE SIGNIFICANT
CHANGES IN THEIR SERIES
POINTSEBERAL BLOOD FLOW WHICH
COULD LEAD TO NEUR'S VASCULAR
DYSFUNCTION AND COGNITIVE
DECLINE.
SO WE BELIEVE THAT PLACENTA WILL
ESCHEMIA AND THE PRESENCE OR
ABSENCE OF A HISTORY OF COVID
LEADS TO A CHRONIC T-CELL
RESPONSE AND AT1 AUTOANTIBODIES
WHICH CAUSES HYPERTENSION AND
CEREBRAL DYSFUNCTION DURING
PREGINANCE CHE IS MAINTAINED
DURING POSTPARTUM.
ALL DATA I'M SHOWING WAS WOMEN
SHOWING THEIR INFECTION.
WE MEASURE BLOOD PRESSURE ON DAY
19 AND AGAIN AT 10 AND 12 WEEKS
POSTPARTUM, WE ALSO MEASURED
CEREBRAL FUNCTION AND COGNITIVE
DECLINE AT 12 WEEKS POSTPARTUM.
SO THE 50 THING WE DO IS PUT THE
RATS IN A BARN MAZE FOR 5 DAYS
ABILITY AND TIME THEIR ABILITY
TO NAVIGATE THROUGH THE MAZE.
WE SEE THOSE RATS WHO RECEIVED
NORMAL TENSIVES WERE ABLE ABLE
TO NAVIGATE THROUGH THE MAZE AD
GET THROUGH THE MAZE BETTER AND
QUICKER THAN THE T-CELLS THAT
EITHER WITH OR WITHOUT A HISTORY
OF COVID DURING PREGNANCY.
SO, WHEN WE LOOK AT BLOOD
PRESSURE DURING PREGNANCY WE SEE
THOSE THAT RECEIVE T-CELLS FROM
PREELA.IC PATES WITH OR WITHOUT
A EFTHIMIOSY OF COVID DURING
PREGNANCY HAD AN INCREASE IN
BLOOD PRESSURE AND A DECREASE IN
FETAL WEIGHT.
WOMEN DID NOT DEVELOP HYPER
ATTENTION BUT WE DID SEE A
DECREASE IN FETAL WEIGHT.
SO WE MEASURE THEIR BLOOD FLOW
AT 12 WEEKS POSTPARTUM.
THE BLACK LINE ARE THE
RECIPIENTS OF NORMAL T-CELLS
WITH WOMEN DURING A HISTORY OF
PREGNANCY AND WE SEE A NICE
PLATLINE IN RESPONSE TO
INCREASED BLOOD PRESSURE.
HOWEVER THOSE THAT RECEIVE
PREELA.IC T-CELLS WITH PATIENTS
WITH OR WITHOUT COVID DURING
NEGNANCY HAD INCREASES IN
CEREBRAL BLOOD HAWAIIER BLOOD
PRESSURES.
THIS WAS ASSOCIATE WIDE
SIGNIFICANTLY DESCREASED
RESPONSE TIME TO WHISKER BRUSHES
WHICH IS INDICATIVE OF A
DECREASE IN RESPONSES OR
COGNITIVE FUNCTION.
SO IN 1 CLIEWGZ, PATIENTS WITH
PREELAMPSIA AND PATIENTS WITH
COVID-19 PREGNANCY THAT DEVELOP
HYPER TENSIVE DISORDERS PRODUCE
THE AT1 ANTIBODY.
CD4 T-CELLS STIMULATED IN
RESPONSE TO ASEMIA OR IN THE
PRESENCE OR ABSENCE OF COVID
INFECTION DURING PREGNANCY
CAUSED BY HYPERTENSION AND
NEUROLOGICAL DYSFUNCTION
PREGNANCY COULD BE PRODUCTION OF
AUTOANTIBODY OR PRODUCTION OF
INFLAMMATORY CYTOKINE.
SOME THINGS WE DON'T KNOW IF WE
CLOCK THE CYTOKINES DURING
PREGNANCY COULD WE PREVENT THESE
WITH OR WITHOUT A HISTORY OF
COVID DURING PREGNANCY.
FURTHER MORE WOULD BLOCKING THE
AT1 AUTOANTIBODY OR INFLAMMATORY
CYTOKINES IMPROVE THE
NEUROLOGICAL DEFICITS THAT
DR. SHAH WAS TALKING ABOUT IN
HER PRESENTATION.
IMPORTANTLY WE DON'T KNOW HOW
LONG THESE COVID PATIENTS HAVE
THIS CHRONIC INFLAMMATORY
RESPONSE POSTPARTUM.
WE DON'T KNOW HOW LONG THEY
PRODUCE THE AT1 AUTOANTIBODY AND
MORE IMPORTANTLY, WE DON'T KNOW
HOW WE'RE GOING TO TREAT THEM OR
WHETHER WE'RE GOING TO TREAT
THEM DURING PREGINANCER OR IN
THEIR POSTPARTUM PERIOD.
>> THANK YOU VERY MUCH.
THANK YOU FOR IDENTIFYING THE
LARGE GAPS, I THINK ARE A COUPLE
OF QUESTIONS FOR YOU BUT WE WILL
DO THAT IN THE Q&A SESSION.
NOW I WOULD LIKE TO MOVE TO YOUR
COLLEAGUE FROM THE SAME UNC
TUITION, LICY YANES, CAR DOZA,
SHE WILL TALK ABOUT PC OS AND
OOSK 19 AND IT IS 3:26, WE HAVE
10 MINUTES.
I GIVE 3:36, ACTUALLY 4:36
EASTERN TIME.
>> THANK YOU SO MUCH FOR THE
INVITATION TO SHARE OUR RESEARCH
DATA TODAY, I'M REALLY EXCITED,
TO BE HERE TODAY.
I WILL TALK ABOUT POLYCYSTIC
OVARY SYNDROME WHICH IS THE MOST
ENDOKRIN DISORDER IN
REPRODUCTIVE AGE WOMEN.
FOR WOMEN TO HAVE THE DIAGNOSIS
OF PC OS, THEY HAVE TO HAVE 2 OF
THESE 3 CRITERIA, POLYCYSTIC
OVARIAN MORPHOLOGY, MENSES OR
HYPER ANDROGENNISM, THERE ARE
SEVERAL TYPES IN THE CLINIC AND
IN RESEARCH, 3 OF THEM, THE ABC
FENEE TYPE HAVE ELEVATED LEVEL
OFANDY ANDROGENS AND THE
PHENOTYPE THEY DO NOT HAVE.
THESE WOMEN'S ALSO HAVE A
CLUSTER OF
CARDIOVASCULAR--INFECTED WITH
SARS COV-2 THEY WILL GET SICKER
THAN CONTROL WOMEN.
SO THERE ARE 2 EPIDEMIOLOGICAL
STUDY THAT SUGGIEST THAT THAT IS
THE CASE TO THE LEFT, HAVE YOU A
CROSS CONTROL OF SCAIS STUDY
CONTROL PATIENTS WITH PC OS,
THIS RESEARCH IN SEPARATE
PATIENTS WITH PC OS WITH THOSE
THAT HAVE HIGH REFLECT OF
ANDROGENS DYNAMIC PC OS AND TOM
PAIRED TO THOSE THAT NORMAL
LEVEL OF ANDROGENS AND CONTROL
WOMEN'S AND AS CAN YOU SEE,
THOSE WOMEN HAVE HIGH LEVEL OF
ANDROGENS HAVE WORSE COVID
SYMPTOMS WHEN YOU COMPARE TO THE
CONTROL, SO THEY HAVE--THEY
COMPLAIN MORE ABOUT FEVER,
SMELL, SHORTNESS OF BREATH.
AND TO THE RIGHT YOU HAVE DATA
FROM A COHORT STUDY, FOR THE
DATA COMES FROM THE UK, WHERE
WOMEN'S WITH PC OS WERE COMPARED
TO MATCH CONTROL WOMEN AND WHAT
THIS RESEARCH SHOW IS THAT WOMEN
WHO HAVE THE DIAGNOSIS OF PC OS,
HAVE A 52 INCREASE RISK OF BEING
INFECTED WITH COVID-19.
SO THE DPA THEA, ALSO, THE RATIO
FOR INCREASE RISK OF COVID,
REMAIN ELEVATED DESPITE THE FACT
THAT THE DATA WAS
[INDISCERNIBLE] GLUCOSE AND ALSO
[INDISCERNIBLE] SUGGESTING THAT
WOMEN INDEPENDENT OF THOSE
CARDIOVASCULAR FACTOR THEY JUST
MENTIONED TO YOU HAVE A HIGH
PLACE POSITION TO GET INFECTED
WITH SARS-COV-2.
SO FOR THE ACE 2, ALSO NEED THE
HELP OF SEVERAL PROTEINS THAT
CLEAVAGE, THE PROTEIN TO BECOME
ACTIVE.
SO WHEY WILL SHOW YOU TODAY IS A
COUPLE OF DATA THAT WE
DEMONSTRATED KEY ROLE OF HYPER
ANDROGEN ROGANISM WITH THE ACE 2
RECEPTOR AS WELL AS PROTEINS.
IN OUR ANIMAL MODEL OF PC OS, SO
IN OUR LAB, WE MIMIC THE DYNAMIC
WOMENS WITH PC OS IN A FEMALE
MICE AND BY IMPLANTING THEM WITH
AN ANDROGEN WHICH IS THE
[INDISCERNIBLE].
AND BY DOING SO, THIS MODEL OF
PC OS EXHIBITS SEVERAL
CARDIOVASCULAR RISK FACTOR THAT
ARE VERY SIMILAR TO WOMEN'S WITH
PC OS, SO THE MICE THAT GET
IMPLANTED WITH DHT HAVE INCREASE
IN BODY WEIGHT, INSULIN
RESISTANCE AND THEY HAVE
EXPANSION OF THE ADIPOSE TISSUE.
SO WE LOOK AT SEVERAL PRACTICES
TEENS THAT ARE VITAL FOR
IMPORTANT ENTRY AND I WILL START
THE DAT WITH THE ACE 2, SO IN
THE TOP PANEL, YOU HAVE THE MRNA
OF THE ACE 2 AND IN TD BOTTOM
PART, YOU HAVE THE PROTEIN, SO
AS CAN YOU SEE THAT THE MRNA WAS
UPREGULATED IN THE
[INDISCERNIBLE] ACE 2 WAS RUP
REGULATED IN THE LEFT VENTRICLE,
KIDNEY AND LUNG, AND PROT TEEN
EXPRESSION OF THE ACE 2 WAS
UPREGULATED IN THE SITE OF THE
HYPODYNAMIC FEMALE MICE AS WELL
AS LEFT VENTRICLE IN THE IT
KIDNEY.
WE SAW CANNED WHAT OF THE ACE 2
IN THE LUNG IN THE MRNA, BUT WE
DID NOT SEE AN INCREASE OF THE
PROTEIN LEVEL, SUGGESTING THAT
THEY ARE CROSS TRANSLATIONAL
CHANGES THAT MAY OCCUR IN THE
LUNG IN PRESENCE OF HIGH LEVEL
ANDROGENS.
IN CONTRAST IN THE SMALL
INTESTINE, WE SAW UPREGULATION
OF THE PROTEIN BUT THE MRNA WAS
UNCHANGED.
SO THIS DATA SHOWINGS THE
CRITICAL ROLE OF HYPOANDROGEN
ROGGISM MODULATED THE EXPRESSION
OF ACE 2 IN OUR HYPER DYNAMIC
FEMALE MICE MODEL OF PC OS.
TMPRSS2 IS 1 OF THE MECHANISMS
TO HELP THE PROTEIN.
THESE ARE A COUPLE OF TISSUES
THAT WE LOOK AT FOR TAKE OF TIME
BUT FOR EXAMPLE, IN THE SMALL
INTESTINE, WE AWE SAY DOWN
REGULATION OF THE MRNA, HOWEVER
THE PROTEIN EXPRESSION OF THE
[INDISCERNIBLE] WAS
SIGNIFICANTLY UPREGULATED, SO
SUGGESTING ALSO THERE ARE POST
TRANSLATIONAL CHANGES THAT MAY
OCCUR AND HOW IMPORTANT IT IS TO
LOOK AT BOTH, RIGHT?
SO THE MRNA LEVEL AND THE
PROTEIN LEVEL TO HAVE A WHOLE
IDEA OF WHAT'S GOING ON, AND
THIS IS DIFFERENT IN EVERY
TISSUE.
LOOK AT WHAT HAPPENED IN THE
COLON, SO IN THE COLON WE SAW AN
UPREGULATION OF THE MRNA, TO A
PROTEIN HOWEVER THE PROTEIN HAVE
ATTENDANCY TO BE DOWN REGULATED
AND THE SAME THING HAPPENED IN
THE KIDNEY.
SO THE MRNA FTION UPREGULATED SO
WHEN WE LOOKED WE SAW A
SIGNIFICANT DOWN REGULATION AT
THE PROTEIN LEVEL AT THE KIDNEY
SUGGESTING THAT MAYBE RPGHT
PROTEINS ARE IMPORTANT IN THE
VITAL ENTRY IN PRESENCE OF HYPER
ANDROGENEMIA IN WOMENS WITH PC
OS.
OTHER PROTEINS [INDISCERNIBLE]
THIS IS NOT AN EFFECTIVE PROTEIN
[INDISCERNIBLE], BUT ALSO CAN
HELP TO IN THE ENDOCYTOSIS OF
THE VIAL.
PROTEIN IS EXPRESSED IN
CATHEPSIN, AND THIS MRNA AND WE
ARE WORKING ON THE PROTEINS TO
SEE SIMILAR OR DIFFERENT
CHANGES.
THIS IS ALSO UPREGGULE THE INNED
ANDROGEN SO THIS IS THE SUMMARY
OF THE CHANGES WE SAW IN
PRESENCE, THE LEVEL OF ANDROGENS
WE SEE UPREGULATION OF A LOT OF
GENES, ALSO WE SAW DOWN
REGULATION, THERE'S THE VIRAL
ENTRY SUGGESTING AGAIN THAT HIGH
LEVEL OF ANDROGENS PLAY A KEY
ROLE IN THESE IN SARS-COV-ENTER
TO THE SALE.
ALSO DIET CAN IMPACT THIS, SO
THIS IS THE DATA WE HAVE ON DIET
THAT CATHEPSIN IS WELL, SO IT
HAS A DIFFERENT EFFECT WITH A
HIGH LEVEL OF ANDROGENS.
SO TO SUMMARIZE OUR DATA, HIGH
DEVELOPED ANDROGENS, IN INCREASE
CARDIOVASCULAR RISK FACTOR TO
COVID-19 SEVERITY BUT ALSO REG
IEWLGT PROTEINS OF ENTRY OF THE
VITALS--THE DATA WAS NOT
DEDEGRADATION.
Q.IGATEED BY SEX AND
GENDER HOWEVER THE
REPORT SIGNIFICANT
IMPROVEMENT WITH THE
ANTIANDROGEN.
BUT MOST RECENT CLINICAL TRIAL,
THE HITCH TRIAL DOES NOT SO
IMPROVEMENT IN COVID OUTCOME.
THE COVIDENZA, BUT LOOK AT THE
FEMALE CONTROL IN ONLY 30 WOMEN
WITH COVIDENZA, SO WOMEN WERE
REPRESENTATIVE WHEN WE TALK
ABOUT AN ANTIANTIGEN SO ARE WE
BLOCKING DEVICES?
WE DON'T WANT TO MEASURE THIS
DOSE WHEN WE GET CALLED TO SEE
PATIENTS IN THE HOSPITAL BECAUSE
WE KNOW THE LEVEL OF ANDROGENS
WILL DECLINE WITH THE THIS AND
THAT'S WHAT HAPPENED BUT LOOK
WHAT HAPPENED WITH WOMEN SO
ACTUALLY IF YOU COMPARE WOMEN IN
THE ICU, THEY HAVE HIGH
DEVELOPED ANDROGENS COMPARED TO
WOMEN THAT HAVE NONCOVID BUT ARE
NOT IN THE ICU.
WE DON'T SEE THEY CLIN WE SEE
INCREASE IN ANDROGEN, WE DON'T
HAVE ANY DATA OF LONG COVID IN
PATIENTS WITH PC OS.
SO TO SUMMARIZE MY TALK, I WANT
TO SUMMARIZE BY SAYING THAT HIGH
LEVEL OF ANDROGENS, ARE A
CLUSTER OF CARDIOVASCULAR RISK
OCTETTORS, THAT WE HAVE, AND
ALSO I DIDN'T SHOW TODAY BUT WE
DO HAVE DATA THAT MODULATE
CYTOKINES, SPECIFICALLY ILC AND
ANDROGENS, NOT ONLY UPREGULATED
ACE 2 RECEPTOR, IN OUR MODEL OF
PC OS, BUT ALSO UPREGULATES
SEVERAL PROTEINS THAT ARE REALLY
KEY IN THE VIRAL ENTRY IN THIS
MODEL OF PC OS, SUGGESTING THAT
WOMEN WITH PC OS IF THEY GET
COVID, THEY MAY GET SEEKER WITH
COVID-19.
SO WHAT WE NEED TO GO FROM HERE,
WE DON'T HAVE ANY HIGHER END
POINT IN WOMEN'SS WITH PC OS SO
WE NEED DATA OF MORTALITY AND
SEVERITY OF THE COVID IN
PATIENTS WITH WOMENS, ALSO SHARE
WITH YOU THERE ARE A LOT OF
CLINICAL TRIALS THAT THEY DO
INCLUDE WOMENS BUT THEY DON'T
ANALYZE THE DATA
DEGRADATIONGREGATING THE DAILY
BASIS THEA BY SEX AND GENDER.
WE DON'T HAVE ANY DATA OF LONG
COVID IN PC OS AND WE REALLY
MOTIVATED FOR BASIC RESEARCH IN
ANIMAL MODEL OF COVID-19.
I WANT TO THANK ALL THE PEOPLE
WHO HELP ME TO BE HERE TODAY
WITH YOU TODAY, ESPECIALENTIALLY
WANT TO THANK THESE 2,
SCIENTISTS, HERE, THEY PERFORMED
THE DATA THAT I SHARE WITH YOU
THIS AFTERNOON.
AND THANK YOU SO MUCH AGAIN.
APPRECIATE IT.
>> THANK YOU VERY MUCH.
WE ARE A LITTLE BIT LATE, SO WE
ARE GOING TO MOVE RIGHT AWAY TO
THE LAST SPEAKER LECTURE, FROM
DR. JOHN RANDOM GENDER AFFIRMING
HORMONE THERAPY AND
SUSCEPTIBILITY TO COVID-19.
WE ARE CURRENTLY 3:38.
4:38 SO 10 MINUTES TO 4:48.
THANK YOU VERY MUCH.
>> WE SEE IT.
>> GREAT AFTERNOON EVERYBODY.
IT'S ALWAYS A PLEASURE TO BE THE
FINAL SPEAKER OF THE SESSION.
IESM A REPRODUCTIVE
ENDOCRINOLOGIST AND 1 OF OUR
PROGRAMS HERE WITH OVER 30 YEARS
EXPERIENCE IN TREATING PATIENTS
WITH GENDER AFFIRMING HORMONES,
PART OF SURNLICAL TEAM IN THE
BEGINNING.
AND TODAY, I'M GOING TO GIVE YOU
MUCH MORE OF A CLINICAL TALK
THAN--VERY DATA IS LIMITED
BECAUSE THERE ISN'T A LOT OF
DATA WITH RESPECT TO THIS
PARTICULAR TOPIC.
NO DISCLOSURES.
JUST TO SET THE STAGE SO WE'RE
COMING FROM THE SAME PLACE
PREVALENCE ESTIMATE VS INCREASED
DRAMATICALLY OVER THE 30 YEARS
FOR PEOPLE REQUESTING GENDER
AFFIRMING HORMONE THERAPIES AND
JUST HOT OFF THE PRESS FROM LAST
WEEK, THERE'S A SURVEY THAT
QUERIES OVER 11,000 U.S. AADULTS
AND .6 IDENTIFIED APS
TRANSGENDER, 1% IDENTIFIED AS
NONBINARY AND THE THEN THE
YOUNGER AGE GROUP, 18-292% OOH
DENTIFIED AS TRANSGEPPEDDER AND
3% AS NONBINARY.
AND SO, IF YOU JUST DO A LITTLE
BACK TO THE ENVELOPE
CALCULATION, IF YOU LOOK AT THE
POTENTIAL SCOPE OF WHAT WE'RE
TALKING WHO MIGHT BE USING
HORMONE THERAPY, OF THE U.S.
POPULATION OF .6% ABOUT
2 MILLION PEOPLE RIGHT NOW, AND
HALF OF THEM HAVE ACCESS TO
HORMONES AND CHOOSE TO TAKE THEM
WE'RE TALKING ABOUT A MILLION
INDIVIDUALS NOW WHO MIGHT BE
POTENTIALLY ON HORMONE THERAPY.
THE GOALS OF THIS TREATMENT TO
INDUCE THE DESIRED SECONDARY SEX
CHARACTERISTICS FOR TRANSGENDER
WOMEN THATY BREAST GROWTH, FAT
MASS AND DISTRIBUTION, FOR
TRANSGENDER MEN, VOICE CHANGING
MALE PATTERN TERMINAL HAIR
GROWTH, CHANGE IN MUSCLE AND FAT
MASS AND SOME PHALLIC GROWTH AND
IMPORTANTLY TO PREVENT
APPROXIMATE PIEWBITTAL OR
PREPIEWBITTAL TO REGRESS THE
CHARACTERISTICS THAT ARE HAVE
ALREADY OCCURRED AND FOR
TRANSGENDER MEN THAT MEANS
BECOMING AMENERRYIC AND SOME
TISSUE REGRESSION AND IN
TRANSGENDER WOMEN THAT INCLUDES
REGRESSION OF MALE PATTERN AND
TERMINAL CARE, MUSCLE MASS AND
THE ATROPHY IS LOSS OF
SPONTANEOUS EREKSS.
THE GOALS CLINICALLY ARE TO GET
TESTOSTERONE AND OAOF THE RADIOL
IN THE ADULT RANGE FOR
TRANSGENDER MANY.
IT'S IMPORTANT TO KNOW THAT
TESTOSTERONE IS 10-20 FOLD
HIGHER IN MEN MAN IN WOMEN.
THAT'S WHAT WE SHOOT FOR, THAT'S
THE SAFEST AND PRODUCES THE
DESIRED EFFECTS, THAT DIRECTLY
INDUCES THE SECONDARY SEX
CHARACTERISTICS AND IT
SUPPRESSES TROAPINS IN INDUCE
QUIESCENCE.
SIGNALING AS YOU HEARD HAS A
RECEPTOR AND IT REDUCES TMPRSS2,
AND AS SPEAKER VS MENTIONED
THAT'S IMPORTANT IF IN TERMS OF
PRESENTATION OF SPIKE PROTEINS
TO THE ACE 2 RECEPTOR, AND
CLEARLY, ANDROGENS HAVE
MODULATION EFFECTS ON THE IMMUNE
SYSTEM.
ADMINISTRATION'S USUALLY BY
TESTOSTERONE, AND SUBCUTANEOUS
INJECTIONS OR TRANSGERMAL
PATCHES OR GEL AND OCCASIONALLY
WITH SUBCUTANEOUS PELLETS AND IN
RISK FACTORS WITH ALL MEDS,
CONCERNS ABOUT THAT,
POLYCYTHEMIA, SLEEP
APPLICATIONSNIA AND
CARDIOVASCULAR DISEASE IN OLDER
MEN.
FOR TRANSGENDER WOMEN, THE GOAL
IS TO TRY TO MATCH PHYSIOLOGY IF
WE CAN SO ESTRADISCIPLINARY IOL
AND ADULT FEMALE PHYSIOLOGIC
RANGES.
IT'S TRICKIER WITH WOMEN BECAUSE
THEY CYCLE, SO WE TARGET IS DOWN
TO THE MIDPORTION OF NORMAL
CYCLIC EXCURSION, AGAIN THAT CAN
DIRECTLY INDUCE SECONDARY SEX
CHARACTERISTICS AND SUPPRESS
QUIESCENCE.
SIGNALING TO IS THE E. R. AND
ALPHA E. R. BETA RESOAPTORS AND
AGAIN AS WE HEARD, THERE'S
CERTAINLY MODULATION OF THE
IMMUNE SYSTEM WITH ESTROGEN
ADMINISTRATION, TYPICALLY MOST
COMMONLY ESTRADIOL BY ORAL,
INTRA VASCULAR, SUBDERNLAL
ROUTES, USUALLY TOGETHER WITH
ANTIANDROGEN TOASMLIFY THE
EFFECT OF THE SKIN, CLASSICALLY
CANNED WHAT OR 1 OF THE 5 REDUCT
ACE INHIBITORS OR ARAN TAGANIST
OR BREAST AUGMENTATION AND MOOD
EFFECTS.
RISKS, A BIG 1 IN THE ROOM IS
VENOUS THROMBOLLIC EVENTS AND
SOME HYPER TRIGLYCERIDE
CONCERNS.
THERAPY IS LIFE LONG BECAUSE
THIS PATIENT POPULATION WILL BE
EXPOSED FOR IT THEIR ENTIRE
LIFE, THEY WILL BE AT RISK WHEN
INFECTIOUS DISEASES COME UP ON
THE NEXT PANDEMIC COMES LOOK.
IT'S MODIFIED FOLLOWING
GONADECTOMY, AND CERTAINLY IN
TRANSWOMEN WE CAN LOWER ESTROGEN
DOSES AND STOP THE ANDROGENS.
TO PENTACLELY CAN LOWER
TESTOSTERONE BUT IT STILL HAS TO
BE MAINTAINED IN THE UPPER
RANGE, PHYSIO LODGE CAKE RANGE
THAT MEN HAVE, AND THE LONG-TERM
RISKS AND BENEFITS ARE
REMARKABLILY UNDERSTUDIED.
IF THERAPY IS DISCONTINUED, IN
TERMS OF PHYSIOLOGY, THERE'S
SOME, THE ANATOMIC CHANGES ARE
PERMANENT SO VOCAL CORD
LENGTHENING AND PHALLIC GROWTH
WILL NOT REGRESS DRAMATICALLY,
CERTAINLY VOCAL CORCORDS WON'T
CHANGE BUT THERE ARE REVERSIBLE
CHANGES AND REPRODUCTIVE BODY
CHANGES AND TERMINAL HAIR GROWTH
WILL REGRESS TO PRETREATMENT
LEVELS EVENT YULGLY, AND
CERTAINLY SUGGESTS THAT THE
EFFECTS OF THESE SEX STEROIDS
ARE MODIFIABLE.
THERE IS REMARKABLY FEW DATA.
I FOUND A SINGLE CLINICAL REPORT
REGUARDING SPECIFICALLY, GENDER
AFFIRMING HORMONE THERAPY AND
COVID-19 INCIDENTS AS A SINGLE
CROSS SECTIONAL WEB BASED SURVEY
IN ISTANBUL OF 238 SUBJECTS.
ALL HAD PC R CONFIRMED COVID-19,
MEAN AGE OF 27 AND 15% OF THE
3-QUARTERS THAT WERE TRANSGENDER
MEN, COVID VERSUS 5% OF THE
QUARTER THAT WAS TRANSGENDER
WOMEN, FOR AN AUDRATIO OF 3.46.
ANOTHER INTERESTING FIND FREE
RADICALS GENERATED THIS STUDY
WAS THE DURATION OF TESTOSTERONE
THERAPY IN THE MEN WHO WERE
POSITIVE WAS LONGER THAN IT WAS
WHEN THEY WERE NEGATIVES.
SO IT CERTAINLY RAISES THE
QUESTION AND SUPPORTS THAT
QUESTION, OUR TEST OFTWROAN AND
MEDIATED INFECTATIVITY, BUT THIS
IS WOEFULLY LACKING IN TERMS OF
GOOD HARD DATA.
I COULD FIND NO SPECIFIC DATA
SPECIFICALLY ABOUT GENDER
HORMONE THERAPIES AND
SUSCEPTIBILITY TO INFLUENZA OR
SPECIFICALLY SUSCEPTIBILITY TO
HIV, THERE'S A LARGE LITERATURE
ABOUT HIV IN THIS POPULATION BUT
NOT SPECIFICALLY WITH RESPECT TO
RISK FOR IT AND HORMONES.
SO, MORE QUESTIONS THAN ANSWERS
THERE'S A LOT OF THINGS WE NEED
TO ASK WITH RESPECT TO THIS
SPECIFIC APPLICATION.
SO DOES GAHT AFFECT RISK OF
INFECTION AND SERIES
POINTSERRITY AS WELL AS
COMPARISONS TO BOTH CISGENDER
MEN AND WOMEN ASETH POSITIVE AND
NEGATIVE CONTROLS.
SO WE HAVE WAYS TO MAKE
COMPARISONS TO TRY TO
DISENTANGLE THE SPECIFIC HORMONE
EFFECTS BOTH FROM THE NATAL
GENETIC EFFECTS AND POTENTIALLY
FROM SOME SOCIAL EFFECTS.
DOES THE DURATION AND TYPE OF
THERAPY RASKT THAT RISK IF IT'S
REAL.
>> DOES CESSATION AFFAIRS TEAM
LEADERRER THR ACTIVITIES AND
PROJECTSY OVER THE COURSE, SO
OPPOSE TO ACTUALLY ADDING
SOMETHING, CAN TAKING SOMETHING
AWAY MAKE A DIFFERENCE IN TERMS
OF OUTCOMES AND FINALLY, CAN WE
DEVELOP NOVEL THERAPIES BASED ON
THE POTENTIAL PATHWAYS.
AND YOU KNOW THE CLINICAL TRIAL
SO FAR HAVE LOOKED AT A COUPLE
OF DIFFERENT THINGS BUT ARE
THERE SELECTIVE ANDROGEN
MODULATORS OR ESTROGEN RECEPTOR
MODULATORS THAT CAN MODIFY THAT
RECEPTOR BASE SIGNALING AND
EFFECT BOTH THE INFECTATIVITY
AND THE POTENTIAL CLINICAL
COURSE OF COVID-19.
>> TWO MINUTES LEFT.
>> AND WHAT ARE THE NETEFFECTS
ON THE IMMUNE SYSTEM OF ANY OF
THESE THERAPIES OR OF
INSTITUTING OR WITHDRAWING
HORMONE THERAPY SPECIFICALLY.
SO WITH THAT, THE FINAL TAKE
HOME MESSAGE WITH THIS, AGAIN
VERY SHORT ON DATA IS CAN WE USE
THE APPLICATION OF GENDER
AFFIRMING HORMONE THERAPIES AND
THE HAVES WHO CHOOSE TO TAKE
THEM AS A TYPE OF NATURAL
EXPERIMENT WITH WHICH TO EXPLORE
GENDER BASED DIFFERENCES AND
DISEASE SUSCEPTIBILITY AND
OUTCOMES PEDEIATED THROUGH SEX
STEROIDS.
BECAUSE THERE'S A SUBSTANTIAL
POPULATION WHO CHOOSE TO BE ON
THESE THERAPIES AND WE HAVE A
LARGE BOTH POSITIVE AND NEGATIVE
CONTROL POPULATION.
AND WITH THAT I FINISHED WITHIN
MINUTE EARLY.
>> THERE ARE MULTIPLE QUESTIONS,
ACTUALLY, SO, I THINK THAT IT
WOULD BE IMPORTANT FOR THOSE WHO
WANT TO PARTICIPATE IN THESE
LAIFLY DISCUSSIONS TO JOIN US
DURING OUR BREAK OUT SESSIONS
TOMORROW.
SO LET ME JUST START FIRST WITH
A QUESTION FOR BABBETTE.
JUST SCROLL UP.
HOLD ON.
THERE YOU GO.
BABBETTE, A DIVERSE POOL IS
INCLUDING FOSTER NURSED FOCUSED
ON LIPIT ANTIBODIES CAN INCREASE
RISK OF PREELAMPSIA, AND WE KNOW
COVID TRIGGERS B-CELL MATURATION
TAKEN--THEY BYPASSES THE
GERMINAL CENTER AND AUTOANTIBODY
PRODUCTION.
THIS IS THE QUESTION FROM
[INDISCERNIBLE], WOULD YOU
COMMENT ON THE POTENTIAL
INTERACTIONS BETWEEN THESE 2
CONCEPTS IN THE CONTEXT OF
COVID?
>> OKAY, SO, WITH THE LACK OF
KNOWLEDGE THAT WE HAVE IN WHAT
MAY STIMULATE THE AUTOANTIBODIES
IN COVID, SO I THINK THAT YOU'RE
REFERRING TO THE PROCESS OF
B-CELL MATURATION BETWEEN B1 AND
B2 IN WHICH THE B1S DO NOT
MATURE IN THE GERMINAL CENTERS
SO I THINK IT'S A REALLY
INTERESTING QUESTION AND THERE
ARE--THERE IS 1 OR 2
PUBLICATIONS OUT THERE THAT HAS
SHOWN THAT B1 CELLS DO PRODUCE
OBVIOUSLY ANTIBODIES.
THEY ARE NOT THE 1S THAT ARE
MEMORY ASSOCIATED ANTIBODIES SO
THEY'RE NOT THE 1S THAT STAY
AROUND YOU KNOW FOR YEARS AT A
TIME.
THEY'RE NOT THE 1S THAT YOU
TRADITIONALLY THINK OF WHEN YOU
RAISE AN ANTIBODY TO SOMETHING,
THOSE ARE NOT B-1 CELLS, THOSE
COME FROM B2 CELLS SO THOSE ARE
MORE NATURALLY OCCURRING
ANTIBODIES, SO, I THINK IN THE
CASE, I THINK IT'S A REALLY
INTERESTING POINT, IN THE CASE
OF THE AUTOANTIBODY ITSELF
THOUGH BECAUSE WE KNOW THIS IS A
LONG-TERM MEMORY RESPONSE THAT
OCCURS IN WOMEN WITH REELAMPSIA
WITH PATIENTS THAT ARE
RECOVERING FROM COVID.
I BELIEVE THAT IT--IN BOTH
DISEASES ARE STRONGLY ASSOCIATED
WITH T-CELL ACTIVATION, I
BELIEVE THIS IS A T-CELL
MEDIATED RESPONSE.
AND I THINK THAT THAT'S A REALLY
IMPORTANT POINT.
PLUS THE EABT ANTIBODIES THAT
COME FROM B-1 CELLS ARE AROUND
2% OF WHAT UF FIND IN THE NORMAL
CIRCULATORY AMOUNT OF ANTIBODIES
THAT NORMAL PEOPLE PRODUCE, EVEN
DURING A--BITS INFLAMMATORY
RESPONSE, THEY'RE A SMALLER
FRACTION OF TOTAL IGGs
WHEREAS--WHEREAS THE 1S THAT ARE
PRODUCED FROM--AND THE
POPULATION OF THESE SEALS, IN
RESPONSE TO AN INFLAMMATORY
RESPONSE ARE REALLY AROUND 70%
B2s AND 70% B2 ANTIBODIES, --I
HOPE THAT ANSWERS YOUR QUESTION,
I THINK IT'S A REALLY IMPORTANT
POINT AND I THINK IT'S SOMETHING
THAT DESERVES FURTHER
INVESTIGATION.
AND YOU KNOW MAYBE HOPEFULLY WE
CAN--WE CAN ENTERTAIN SOME OF
THOSE QUESTIONS THAT YOU HAVE.
I THINK IT'S GOOD.
SPHWHRKS THERE'S ALSO ANOTHER
GOOD LECTURE QUESTION.
I THINK I KNOW THE ANSWER BUT I
THINK YOU ARE THE EXPERT IN THE
FIELD SO PLEASE IF YOU CAN
ADDRESS THIS.
HOW MIGHT WE BLOCK THE
[INDISCERNIBLE] ASPECT BODY?
>> YEAH, THAT'S A GOOD 1 YEAH,
THAT'S THE GREAT QUESTION.
ACTUALLY, SO, THE EAMENT
ANTIBODY BINDS TO THE ANGIO
TENSEIN 2 RECEPTOR AND WE CAN'T
INHIBIT ANY NORMAL READ OR
DURING THIS SYSTEM DURING
PREGNANCY BECAUSE IT'S SO
IMPORTANT FOR A NORMAL PREGNANCY
AS WELL FOR FETAL DEVELOPMENT SO
WHAT WE HAVE DONE IS LOWER THE
DRULGS IN THE AUTOIMMUNE
DESODERS BUT WAWE'VE DONE IN
JACKSON IS FORMULATED A PEPTIDE
THAT BINDS TO THE REGION OF THE
ANTIBODY AND WE USED IT IN
SEVERAL OF OUR ANIMAL MODELS AND
WE DO IT IN OUR INVITRO SYSTEM
IN WHICH WE TESTED AGAINST FREE
RADICALS ANTIBODY AND IT BINDS
TO THE EPITOPE BINDING REGION
AND IT INHIBITS THE ACTIVATION
OF THE ANTIBODY.
IT ACTUALLY SURVIVES WITHIN THE
CIRCULATION FOR ABOUT 7 DAYS AND
CAN KEEP THE ACTIVITY OF THE
ANTIBODY AT A MUCH LOWER LEVEL
FOR ABOUT 7 DAYS IN THE
CIRCULATION, SO WE'RE HOPING
THAT WE CAN PROGRESS WITH THAT
PEPTIDE AND HOPEFULLY MAKE IT
MORE CLINICALLY ATTRACTIVE.
RIGHT NOW WE HAVE TO USE IT AT A
CONSTANT RATE.
SO RIGHT NOW WE'RE DOING
MANIPULATIONS AND WE CAN MAKE IT
CLINICALLY ATTRACTIVE SO I THINK
IT GD COULD BE VERY BENEFICIAL
FOR PREVIOUSLY PREELA.IC WOMEN
AS WELL AS THESE PATIENTS THAT
ARE RECOVERING FROM COVID THAT
HAVE THAT ARE PRODUCING THE
ANTIBODY AS AS WELL.
>> THANK YOU VERY MUCH.
NEXT QUESTION IS FROM YOGEN FOR
LICY.
WHAT ARE IMAGES ARE IMPACT BIDE
ANDROGENS?
ARE THEY HARMONIZING FEATURES,
EG AND THE ENDOTHELIAL/SMOOTH
MUSCLE EPITHELIAL, THAT MIGHT
INFORM THE UNDER LYING BIOLOGY?
>> YES, VERY INTERESTING, WE
HAVEN'T SEPARATE THE WHOLE
TISSUE, KIDNEY AND SO ON SO
THAT'S VERY IMPORTANT QUESTION,
THAT NEED TO BE ANSWERED IN THE
FUTURE, AND WE CHARGE THE CELLS
THAT ARE RESPONSIBLE FOR THESE
CHANGES IN ACE 2 AND PROTEINS IN
EACH TISSUE THANK YOU VERY MUCH
AND NOW THE QUESTION FOR JOHN
RABD ORDER OF MICRONS, WHAT
CESSATION OF THERAPY DURING ANY
SEVERE ILLNESS AFFECT THROMBOSIS
RISK?
>> SO I'M ASSUMING ESTROGEN OR
ANDROGENS.
I DON'T KNOW IF SOMEBODY'S ON
ESTROGEN, YOU EXPECT WITHDRAWAL
WOULD AFFECT THROMBOTIC RISK.
BUT WITH ALL THE ESTROGEN
THERAPY YOU WOULD EXPECT WOULD
HAVE SIGNIFICANT EFFECT; OKAY.
SO THERE IS 1 INTERESTING
QUESTION ON QUESTION AND ANSWER,
PLATFORM WHICH I THINK IT GOES
AS FOLLOW OS, IS THERE REASON TO
BELIEVE THAT HEST ROUGH ATOM
GENS OR PROGESTERONES ARE MORE
BENEFICIAL THAN COVID-19 THAN
TREATMENT WITH CONVENTIONAL
ANTIINFLAMMATORY
IMMUNOMODULATORY STEROID
TREATMENTS IN OTHER WORDS ARE
THEY JUST SEEING THE GENERIC
ANTIINFLAMMATORY EFFECT THEY
TEND TO HAVE OR SPECIFIC
BENEFITS TO THE USE OF THESE
PARTICULAR STEROIDS?
INTERESTING QUESTION.
>> I THINK THIS QUESTION IS FOR
ME.
I THINK THE EFFECT OF ESTRADIOL
AND ROUGH ATOM JESTERON AND
IMMUNO REGULATOR WITHOUT
IMMUNOSUPPRESSION, THAT'S A BIG
FACTOR IF THEY WORK BECAUSE WE
DON'T KNOW YET.
BUT IF THEY WORK, IT WOULD BE AN
IMMUNO MODULATION, LIGHT
ANTIINFLAMMATORY SELECTION AND
WITHOUT THE IMMUNOSUPPRESSION OF
GLUCOCORD KOIDS.
>> I CAN--
>> YEAH, WITHOUT THE RISK OF
INFECTION IN THE LONG-TERM.
>> YEAH, I CAN ADD TO THAT IF
THAT'S OKAY, I KNOW THAT IN
PREGNANCY, WITH PROGESTERONE AS
DR. JARVIS WAS MENTIONING IT CAN
BEANIN FLAMMATORY BUT IT CAN BE
A DILLATTORY AGENT AND SO THEY
ADMINISTER PROGESTERONE
SOMETIMES TO WOMEN THAT ARE
UNDER GOING SUBSEQUENT PRETERM
LABOR TO STOP THE LABOR AND SO,
I THINK THAT IT HAS, I THINK
PROGESTERONE HAS ARK ADDITIONAL
BENEFITS, YOU KNOW OUTSIDE OF
WHAT WE JUST SEE WITH YOUR OTHER
COTTERRIC O STEROIDS AS WELL.
GO AHEAD DR. SHAH, I'M SORRY I
INTERRUPTED YOU.
>> SO JUST TO ADD TO THAT,
FOCUSED ON PROGESTERONE HAS
IMMUNO MODULATED PROPERTIES AND
IT HAS SHOWN INFLUENZ IN SECTION
THAT AGAIN PREVENT THE INFLUENZ
THAT'S PROTECTED FOR INFLUENZA
HOWEVER IN ANIMAL MODEL THERE IS
RESEARCH IN RAT MODELS AND IT
WASN'T SHOWN TO BE PROTECTIVE SO
IT WAS OPPOSITE RESULT.
SO, BUT I THINK RESEARCH NEEDS
TO BE DONE MORE WITH COVID-19
BUT IT'S POSSIBLE IT'S
BENEFICIAL.
JUST BECAUSE OF IMMUNOMODULATORY
PROPERTIES AND IT WAS ACTIONS
TOWARDS THE VIRUS.
>> THANK YOU VERY MUCH, I THINK
THERE IS ANOTHER QUESTION FOR
LICY, SHE'S TYPING THE ANSWER,
BUT YOU KNOW MAYBE SHE CAN
ADDRESS IT, YOU KNOW LIVE?
DO YOU KNOW IF YOUR CHANGES IN
ACE 2 PROTEIN RESULT IN
ALTERATIONS IN ANGIO DENSEIN 2
IN THE ORGANS INVESTIGATED MAYBE
ALSO BABBETTE CAN PROVIDE INPUT
ON THAT QUESTION AS WELL, SO
LICARE Y?
>> GREAT QUESTION.
SO THE SHORT ANSWER IS WE HAVE
NOT MEASURED LEVELS OF THE
PEPTIDES, AND WE ARE PLANNING TO
DO SO, SO WE DO BELIEVE THAT THE
UPREGULATION OF THE ACE 2 IS
PSYCHOCOMPENSATORY MECHANISM OF
THE CLASSICAL RAS, THAT WE SEE
IN OUR MODEL SO WE KNOW THAT IF
WE INHIBIT THE CLASSICAL
[INDISCERNIBLE] WE GET RID OF
THE INCREASES IN BLOOD PRESSURE
AND ACTUALLY IN THE OBESITY,
TOO, SO THE ACE 2 IS BECAUSE THE
CLASSICAL ARM IS--PLANNING TO
MEASURE THE PEPTIDE - AND SO FAR
WE HAVE NOT DONE IT YET.
>> YES, SO I AGREE WITH LICY,
BUT IN PREELAMPSIA IT'S
DIFFERENT, OUR OTHER COMPONENTS
OF THE SYSTEM ARE DOWN FOR THE
MOST PART COMPARED TO NORMAL
PREGNANT WOMEN.
EXCEPT FOR ACE 1 WHICH IS HIGHER
THAN WHAT YOU SEE IN NORMAL
PREGNANCY SO I AGREE A HUNDRED%,
THAT UPREGULATION OF THE
ACTIVITY OF ACE 2 THAT I SHOWED
FOR YOU TODAY, IS A COMP
PENSATORY RESPONSE AS WELL.
AND UNSUCCESSFUL COMPENSATORY
RESPONSE IN THE CASE OF
PREELAMPSIA.
I THINK THAT THE INTERACTION OF
AUTOANTIBODY THAT IS MADE, YOU
KNOW AROUND THE SECOND TRIMESTER
IN PREELAMPSIA WOMEN ACTIVATES
THE RECEPTOR AND CAUSES A LOT OF
CONFUSION IN REGULATORY
RESPONSES AND OTHER RESPONSES IN
THE ANGIO TENSEIN SYSTEMS DURING
PREGNANCY AND I THINK THAT THAT
JUST MUDDIES THE WATERS EVEN
MORE IN THE CASE OF THESE WOMEN.
THANK
>> THANK YOU VERY MUCH.
THERE IS ANOTHER QUESTION FOR
FRANK AND JOHN.
AS YOU THINK AHEAD, WHAT DO YOU
TO ENGAGE WITH PATIENTS
RECEIVING GAHT FOR CLINICAL AND
MECHANIST BEING STUDIES WE HOPE
TO DISCUSS THIS TOMORROW IN THE
BREAK OUT SESSIONS BUT YOU KNOW
MAYBE YOU CAN JUST SET THE STAGE
AND FRAMEWORK FOR OUR SESSION
FOR TOMORROW AFTERNOON?
>> DO YOU TOPTD START FRANK.
>> I THINK THE WEB CONNECTED
QUESTION IS FOR YOU BECAUSE I
DID NOT--I THINK IT WAS RELATED
TO CROSS HORMONE THERAPY, WASN'T
IT?
>> EITHER HORMONES OR ANDROGEN
BLOCKING HER THAPY?
>> CAN YOU REPEAT THE BEGINNING
OF THE QUESTION WHAT CAN YOU DO
BETTER TO DO WHAT?
>> TO BETTER ENGAGE THE PATIENTS
REPEATING HORMONES OR ANDROGEN
BLOCKING THERAPY FOR CLINICAL
AND MECHANIST BEING STUDIES.
>> WELL THE WAY I UNDERSTAND IT,
HOW CAN WE DO BETTER TO ENGAGE
PATIENTS DIFFICULT QUESTION.
LET ME GIVE YOU A PRECISE
EXAMPLE.
ONE OF THE REASONS WHY IN OUR
STUDY OF ESTROGEN AND
PROGESTERONE AND HOSPITALIZED
COVID-19 PATIENTS WHO WERE MEN
AND WOMEN, WE WERE RECRUITING
BOTH, VERY FEW PATIENTS IS THAT,
AT THE END I DIDN'T WANT TO GET
THIS HORMONE THERAPY.
WHEN WE PRONOUNCE THE WORD
HORMONE, A LOT OF PATIENTS SAID
NO.
SO I THINK THE WORD HORMONE IN
THE POPULATION ESPECIALLY
ESTROGENS WHEN YOU SAY THAT, YOU
CRY WOLF BECAUSE OF FALSE
INTERPRETATION OF PREVIOUS
TRIAL, POORLY DESIGNED IF YOU
EXCUSE ME MY FRENCH LIKE THE
WOMEN'S HEALTH INITIATIVE THAT
HAS LED TO MISGUIDING RESULT AND
FALSE BELIEF AND MYTH OF THE
POPULATION THAT ESTROGEN LEAD TO
BREAST CANCER.
SO HORMONES WHEN YOU SAY
HORMONES, PEOPLE ARE AFRAID SO I
DON'T KNOW HOW TO ENGAGE PEOPLE
BETTER.
MAYBE EDUCATE THEM BETTER BUT
EACH PHYSICIAN ARE POORLY
EDUCATED IN THESE MATTERS.
>> YEAH, FOR THE FOLKS SEEKING
GENDER HORMONE THERAPY, I THINK
THE KEY THERE IS INVOLVING THE
COMMUNITY.
I WAS SO--IT WAS SO WONDERFUL TO
HEAR FROM MR. DAVID ABOUT HIS
EXPERIENCE AND I THINK THAT
THAT'S GOING TO BE THE KEY.
PEOPLE HAVE TO FEEL COMFORTABLE
AND THE SETTING HAS TO BE
COMFORTABLE.
YOU KNOW THIS IS A--THIS HAS
BEEN A REALLY DISENFRANCHISED
POPULATION THAT FREQUENTLY
EITHER HAVE BEEN VERY, VERY
POORLY TREATED OR NOT TREATED AT
ALL.
AND SO IT HAS TO BE A SAFE AND
WELCOMING ENVIRONMENT BUT THAT
CAN BE DONE.
I THINK YOU HAVE TO INVOLVE
COMMUNITY MEMBERS AND I WOULD
TOTALLY AGREE, YOU NEED TO HAVE
MEMBERS OF THE COMMUNITYOT
RESEARCH TEAM.
AND I'M VERY MUCH ENGAGED WITH
THE SUBJECTS AND ANY KIND OF A
TRIAL.
>> WHETHER IT'S A CLINICAL TRIAL
OR OBSERVATIONAL STUDY, I THINK
EITHER WAY IT'S IMPERATIVE TO DO
THAT.
>> OKAY, WE ARE CLOSE TO THE
TIME THAT HAS BEEN ALLOTTED FOR
THIS SESSION.
WE ACTUALLY 4:05.
OR 5:04 EAST COAST TIME.
SO, JASMINA, YOU WANT TO TAKE
OVER FROM HERE.
>> YES, THANK YOU VERY MUCH.
WE ARE GOING TO HAVE THE
DR. AGARWALL, ANNOUNCING THE
PROGRAM FOR THE DAY.
RAJEEV, AND THANK YOU VERY MUCH
FOR YOUR PRESENTATION IT WAS
PRELLLY EXCITING.
>> THANK YOU.
CAN YOU HEAR ME PROPERLY.
>> THANK YOU.
GOOD AFTERNOON, EVERYONE, I'M
RAJEEV, AGARWALL, SENIOR PROGRAM
OFFICER ON OFFICE OF WOMEN'S
HEGHT AND I WANT TO THANK YOU
FOR ACTIVELY PARTICIPATE NOTHING
IN WONDERFUL MEETING.
WITHOUT YOUR PARTICIPATION WE
WOULD NONAPOPTOTIC THE HAVE
ACHIEVED THE LEVEL OF DISCUSSION
AND THE PRESENTATIONS FOR
WONDERFUL.
NEXT SLIDE, PLEASE.
SO I'M GOING TO SUMMARIZE OR
GIVER YOU THE OVERVIEW OF
TOMORROW'S SESSIONS VERY QUICKLY
BECAUSE I KNOW I AM STANDING
BETWEEN YOUR DAY OFF AND THIS
MEETING.
THE NEXT SESSION FOR TOMORROW
MORNING WE WILL HAVE THE FIRST
SESSION OF NOT REALLY A SESSION
IF YOU WANT TO CALL IT, JUST
HIGHLIGHT OF ALL THE SUMMARY OF
THE DAY EVENT BY DR. CATH LYNN
SANDBERG, THIS WILL BE FOLLOWED
BY SESSION NUMBER 4 WHICH IS ON
CARDIOVASCULAR AND METABOLIC
ASPECTS OF COVID-19, SEX AND
GENDER CONSIDERATIONS AND THE
MODERATOR FOR THIS PARTICULAR
SESSION IS DR. DELISSA FAIR
WEATHER MPLET THE SESSION WILL
HAVE PRESENTATIONS ISSUES THE
FIRST SESSION THE FIRST 1 IS SEX
DIFFERENCES IN CARDIOVASCULAR
OUTCOMES BY DR. BAIREY-MERZ,
SECOND TALK SEX DIFFERENCES IN
MITOCHONDRIA DURING VIRAL MY O
CARDITEDIS AND COVID-19 VACCINE
INDUCED MY O CARDITEIS, BY
DR. DELISA FAIRWEATHER, AND THE
NEXT TONG IS LONG COVID
ORTHOSTATIC INTOLERANCE AND
POSTURAL ORTHOSTATIC TACHYCARDIA
SYNDROME BY DR. SATISH, RAJ AND
THE LAST TALK IN SESSION 4 IS BY
DR. JAMES MOON ON CARDIOVASCULAR
IMAGING BIOMARKERS FOR COVID-19
NEXT SLIDE, PLEASE.
SESSION 5 IS ON SEX GENDER
RELATED MECHANISMS UNDERLYING
DISEASE IN COVID-19 AND THE
MODERATOR IN DR. YOGEN, KANTHI,
THIS WILL HAVE 4 DIFFERENT TALKS
PLUS MODULATION OF PLATELET
FUNCTION AND INTERACTION WITH
ESTROGENS BY DR. DALE ABEL.
AND THEN CONVALESCENT PLASMA IN
OUTPATES WITH COVID-19 BY
DR. ZUBAID RAFIQUE, AND THEN
COVID-19 THROMBOTIC
COMPLICATIONS IN ACTIV 4A BY
DR. MATTHEW NEIL AND THE LAST
TALK IN SESSION 5 IS ELECTRONIC
HEALTH RECORDS SKIN AND BLOOD
STUDIES IN COVID-19 INFECTION BY
DR. ALEX TSOI.
NEXT PLEASE.
SECTION 6 IS ON JEKS GENDER
GOVERNORSS ON COVID RELATED
SLEEP AND LUNG DISEASE AND THE
MODERATOR IS DR. PATRICIA
SILVEYRA, AND THIS WILL ALSO
HAVE 4 WONDERFUL TALKS COVID-19
LUNG INFECTION IMMUNE MEDIATORS.
BY DR. CHARLES DELA KRIEWZ.
THE NEXT IS COVID-19 RELATED
LUNG MICROVASCULAR AND PARAEN
CHIMAL SEQUELA BY DR. ELIZABETH
OELSENER, AND THE NEXT IS LUNG
FAGHTOLOGY IN MOUSE MODEL OF THE
POST ACUTE SEQUELA OF
SARS-CCROSS LINKING V-2 P A SV
BY DR. OKUDA, AND THE LAST TALK
IS SEX DIFFERENCES IN COVID P A
SC RELATED ISSUES TO SLEEP AND
CIRCADIAN BIOLOGY JANET MULLING
TON, AND SECTION 7 WHICH YOU
MIGHT HAVE HEARD TODAY TALKED
NUMBER OF TIMES IN THE BREAK OUT
SESSIONS SO WE HAVE CONCURRENT
BREAK OUT SESSIONS, THESE SEGS
WILL DISCUSS IMPLICATIONS FOR
FUTURE RESEARCH AND STIMULATION
OF COLLABORATIONS, THESE
SEGSESSIONS WILL THEN EXPLORE
NEXT TEPS?
FACILITATING SEX/GENDER CONTEXT
IN CLICKING, CHARACTERIZATION
AND COMOWNICATING WHICH WE CALL
4 Cs, COVID-19 HLBS DISORDERS
TO ADDRESS RESEARCH GAPS.
BREAK OUT ROOM 1 IS ON
WHEKANISTIC WHICH WHICH IS
PRECLINICAL AND CLINICAL,
TRANSLATIONAL SCIENCE AND THE
MODERATORS IS DR. KATHRYN
SANDBERG AND DR. CHAPPELL, AND
BREAK OUT ROOM NEAR 2 IS WITH
DR. KANTHI AND D
OERTELT-PRRIGIONE, AND IN THE
LAST REPORT WILL HAVE THE
MODERATORS SUMMARIZE THEIR
SESSIONS WHICH WILL BE FOLLOWED
BY SUMMARY OF 22 DIE DR. YOGEN
KANTHI AND LAST BUT NOT LEAST,
WE WILL HEAR FROM DR. JASMINA
VARAGIC ABOUT FUTURE DIRECTION
AND WE ADJOURN FOR TODAY AS WELL
AS THE MEETING WILL ADJOURN
TOMORROW AND JASMINA ANY LAST
WORDS?
>> I WOULD JUST LIKE TO SAY
THANK YOU VERY MUCH FOR THE
WONDERFUL DAY 1 EXCELLENT
PRESENTATIONS AND DISCUSSIONS SX
HEAT I JUST WANT TO POINT TO BE
AWARE OF THE BREAK OUT ROOM
SESSIONS THEY WILL HAVE
DIFFERENT WAREROOM LINKS AND
AUDIENCE WILL CHOOSE THE ROOM
THEY WOULD LIKE TO GO BUT THE
PANELISTS ARE ALREADY ASSIGNED
SO, LOOK FOR THE E-MAIL FROM THE
SYNERGY.
SO THANK YOU VERY MUCH FOR
EVERYTHING HAVE A GREAT EVENING