1 00:00:05,240 --> 00:00:08,280 WELCOME BACK TO THE WORKSHOP ON 2 00:00:08,280 --> 00:00:11,960 THE SEX GENDERS SPECIFIC 3 00:00:11,960 --> 00:00:13,760 COVID-19 OUTCOMES AND MANAGEMENT 4 00:00:13,760 --> 00:00:15,680 RELEVANT FOR HEART, LUNG, BLOOD 5 00:00:15,680 --> 00:00:17,280 AND SLEEP DISORDERS FROM BENCH 6 00:00:17,280 --> 00:00:17,760 TO BEDSIDE. 7 00:00:17,760 --> 00:00:22,200 SO BEFORE WE START WITH TODAY'S 8 00:00:22,200 --> 00:00:24,840 AGENDA, I WOULD LIKE TO REMIND 9 00:00:24,840 --> 00:00:26,320 BUT SEVERAL HOUSEKEEPING RULES. 10 00:00:26,320 --> 00:00:27,560 SO, PLEASE STAY OFF CAMERA AND 11 00:00:27,560 --> 00:00:30,640 MIKE IF YOU DO NOT SPEAK. 12 00:00:30,640 --> 00:00:31,800 FOR SPEAKERS, PLEASE TURN ON 13 00:00:31,800 --> 00:00:33,520 YOUR CAMERA AT THE END OF THE 14 00:00:33,520 --> 00:00:35,080 TALK BEFORE YOURS AND BE READSY 15 00:00:35,080 --> 00:00:38,120 TO IMMEDIATELY SHARE YOUR SLIDES 16 00:00:38,120 --> 00:00:40,120 WHEN THE PREVIOUS TALK ENDS. 17 00:00:40,120 --> 00:00:41,720 FOR EVERYONE, PLEASE POST YOUR 18 00:00:41,720 --> 00:00:44,120 QUESTION INTO THE Q&A POD AND 19 00:00:44,120 --> 00:00:46,120 USE CHAT FUNCTION FOR MESSAGING, 20 00:00:46,120 --> 00:00:48,920 SO, PLEASE USE THE OPTION TO 21 00:00:48,920 --> 00:00:49,800 SEND YOUR MESSAGES TO EVERYONE 22 00:00:49,800 --> 00:00:52,400 OR TO THE HOST AND PANELISTS 23 00:00:52,400 --> 00:00:54,600 EXCEPT IF YOU WOULD LIKE TO SEND 24 00:00:54,600 --> 00:00:55,840 A PRIVATE MESSAGE AND I WOULD 25 00:00:55,840 --> 00:00:57,720 ALSO LIKE TO ANNOUNCE A SLIGHT 26 00:00:57,720 --> 00:01:01,720 CHANGE IN THE AGENDA. 27 00:01:01,720 --> 00:01:02,680 AFTER SESSION 6, WE WILL GO 28 00:01:02,680 --> 00:01:05,000 FIRST TO THE SUMMARY OF DAY 2 29 00:01:05,000 --> 00:01:07,480 GIVEN BY DR. KANTHI AND THEN WE 30 00:01:07,480 --> 00:01:09,360 WILL GO TO BREAK OUT SESSIONS, 31 00:01:09,360 --> 00:01:11,960 SO THE BREAK OUTS WILL START 32 00:01:11,960 --> 00:01:13,240 AROUND 3:15 THIS AFTERNOON. 33 00:01:13,240 --> 00:01:14,600 THE ZOOM LINK FOR THE BREAK OUT 34 00:01:14,600 --> 00:01:17,160 ROOMS WILL BE FREQUENTLY POSTED 35 00:01:17,160 --> 00:01:17,760 IN THE CHAT. 36 00:01:17,760 --> 00:01:20,040 YOU SHOULD ALSO RECEIVED BY 37 00:01:20,040 --> 00:01:22,120 E-MAIL SENT YESTERDAY. 38 00:01:22,120 --> 00:01:23,600 PANELISTS HAVE THEIR ASSIGNMENTS 39 00:01:23,600 --> 00:01:25,120 ALREADY AND AFTER THESE WE CAN 40 00:01:25,120 --> 00:01:27,120 CHOOSE WHICH ROOM TO JOIN. 41 00:01:27,120 --> 00:01:29,520 AT THIS TIME, I WOULD LIKE TO 42 00:01:29,520 --> 00:01:32,360 TURNOVER THIS MEETING TO 43 00:01:32,360 --> 00:01:34,080 DR. SANDBERG TO GIVE A SUMMARY 44 00:01:34,080 --> 00:01:35,160 OF DAY 1. 45 00:01:35,160 --> 00:01:37,280 TAKE IT AWAY. 46 00:01:37,280 --> 00:01:39,480 >> THANK YOU JASMINA AND ALL OF 47 00:01:39,480 --> 00:01:41,680 US OWE A GREAT THINKS IT TO HER 48 00:01:41,680 --> 00:01:43,960 FOR PUTTING TOGETHER THIS 49 00:01:43,960 --> 00:01:45,280 INCREDIBLE WORKSHOP THAT WE 50 00:01:45,280 --> 00:01:46,920 ALREADY HAD A WONDERFUL DAY 51 00:01:46,920 --> 00:01:47,720 YESTERDAY EXPERIENCING AND IT IS 52 00:01:47,720 --> 00:01:51,360 MY JOB TO TRY TO SUMMARIZE THE 53 00:01:51,360 --> 00:01:53,360 RICHNESS OF ALL THE 54 00:01:53,360 --> 00:01:54,360 CONVERSATIONS AND PRESENTATIONS 55 00:01:54,360 --> 00:01:54,640 YESTERDAY. 56 00:01:54,640 --> 00:01:58,240 SO WITH THAT I WILL START WITH 57 00:01:58,240 --> 00:01:58,760 THE FIRST SLIDE. 58 00:01:58,760 --> 00:02:02,560 AND WE KICKED OFF THE WORKSHOP 59 00:02:02,560 --> 00:02:04,880 WITH DAVID GOFF WHO IS THE 60 00:02:04,880 --> 00:02:07,840 DIRECTOR OF CARDIOVASCULAR 61 00:02:07,840 --> 00:02:11,080 SCIENCES AT NHLBI AND HE WANTED 62 00:02:11,080 --> 00:02:12,760 TO EMPHASIZE THE COMMITMENT 63 00:02:12,760 --> 00:02:15,680 NHLBI HAS TO UNDERSTANDING THE 64 00:02:15,680 --> 00:02:18,560 IMPACT OF SEX AND GENDER IN 65 00:02:18,560 --> 00:02:19,960 CARDIOVASCULAR DISEASE, HEART, 66 00:02:19,960 --> 00:02:22,920 LUNG, AND BLOOD AND SLEEP 67 00:02:22,920 --> 00:02:23,160 DISORDERS. 68 00:02:23,160 --> 00:02:26,880 AND THEN WE HAD A PRESENTATION 69 00:02:26,880 --> 00:02:28,640 BY DR. JANINE AUSTIN CLAYTON WHO 70 00:02:28,640 --> 00:02:30,400 IS DIRECTOR OF THE OFFICE OF 71 00:02:30,400 --> 00:02:32,160 RESEARCH ON WOMEN'S HEALTH AND 72 00:02:32,160 --> 00:02:35,240 SHE EXPLAINED HOW NIH THINKS 73 00:02:35,240 --> 00:02:38,440 ABOUT DEFINED SEX AND GENDER AND 74 00:02:38,440 --> 00:02:40,400 THE IMPORTANCE IN BIOLOGICAL 75 00:02:40,400 --> 00:02:44,240 STUDIES AND CLINICAL TRIALS AND 76 00:02:44,240 --> 00:02:44,880 CLINICAL RESEARCH. 77 00:02:44,880 --> 00:02:47,120 NEXT SLIDE. 78 00:02:47,120 --> 00:02:49,160 SO THEN WE HAD--WE WERE REALLY, 79 00:02:49,160 --> 00:02:51,800 REALLY AND THIS WAS JUST A 80 00:02:51,800 --> 00:02:53,320 WONDERFUL ADDITION TO THIS 81 00:02:53,320 --> 00:02:53,560 WORKSHOP. 82 00:02:53,560 --> 00:02:58,240 WE HAD INDIVIDUALS WHO ARE 83 00:02:58,240 --> 00:03:01,280 HIGHLY DEDICATED TO THE 84 00:03:01,280 --> 00:03:02,560 UNDERSTANDING COVID AND THEY 85 00:03:02,560 --> 00:03:05,440 SHARED WITH US THEIR PERSONAL 86 00:03:05,440 --> 00:03:06,440 EXPERIENCE WITH COVID. 87 00:03:06,440 --> 00:03:08,760 AND IT WAS VERY BRAVE OF THEM 88 00:03:08,760 --> 00:03:09,960 AND EXTREMELY VALUABLE FOR THE 89 00:03:09,960 --> 00:03:14,360 BASIC SCIENTISTS AND THE 90 00:03:14,360 --> 00:03:15,600 CLINICAL INVESTIGATORS TO HEAR 91 00:03:15,600 --> 00:03:18,200 HOW THEY EXPERIENCE COVID AND 92 00:03:18,200 --> 00:03:21,920 LONG COVID AND IT REALLY PUT IN 93 00:03:21,920 --> 00:03:22,880 PERSPECTIVE WHAT ALL THE 94 00:03:22,880 --> 00:03:24,480 SYMPTOMS WERE AND ALL THEIR 95 00:03:24,480 --> 00:03:25,720 CHALLENGES AND CAN I HAVE THE 96 00:03:25,720 --> 00:03:26,040 NEXT SLIDE. 97 00:03:26,040 --> 00:03:30,200 SO WHAT I TOOK FROM THESE 98 00:03:30,200 --> 00:03:32,680 INDIVIDUALS GENEROUS SHARING OF 99 00:03:32,680 --> 00:03:34,400 THEIR EXPERIENCES IS THAT WE ALL 100 00:03:34,400 --> 00:03:36,240 SHOULD REALLY LISTEN TO THE 101 00:03:36,240 --> 00:03:37,120 PATIENT, WE SHOULD ALWAYS LISTEN 102 00:03:37,120 --> 00:03:38,880 TO THE PATIENT, THE SCIENTISTS, 103 00:03:38,880 --> 00:03:39,960 THE CLINICIAN, WE ALL NEED TO 104 00:03:39,960 --> 00:03:41,720 LISTEN TO THE PATIENT AND OUR 105 00:03:41,720 --> 00:03:45,240 JOB AS SCIENTISTS IS TRY TO MOVE 106 00:03:45,240 --> 00:03:46,760 FORWARD, TO FRONTIERS OF 107 00:03:46,760 --> 00:03:47,720 HEALTHCARE AND IF WE DON'T 108 00:03:47,720 --> 00:03:48,920 LISTEN TO THE PATIENT, THEN 109 00:03:48,920 --> 00:03:50,800 MAYBE WE'RE NOT STUDYING THE 110 00:03:50,800 --> 00:03:52,040 RIGHT MODEL. 111 00:03:52,040 --> 00:03:52,840 AND ANOTHER POINT THEY MADE IS 112 00:03:52,840 --> 00:03:56,520 THAT WE HAVE TO FOCUS ON THE 113 00:03:56,520 --> 00:04:00,520 CONSTELLATION OF SYMPTOMS AND 114 00:04:00,520 --> 00:04:04,160 NOT JUST TREAT 1 SYMPTOM 115 00:04:04,160 --> 00:04:06,360 INDIVIDUALLY BUT ABOUT IT AS THE 116 00:04:06,360 --> 00:04:07,320 WHOLE CONSTELLATION. 117 00:04:07,320 --> 00:04:08,360 AND THEN A THIRD POINT THAT WAS 118 00:04:08,360 --> 00:04:10,680 RAISED BY ALL OF THEM IS THAT 119 00:04:10,680 --> 00:04:13,200 THE AMOUNT OF STRESS THAT THEY 120 00:04:13,200 --> 00:04:15,480 ENDURED REALLY HAD AN IMPACT, A 121 00:04:15,480 --> 00:04:19,680 NEGATIVE IMPACT ON THE DISEASE 122 00:04:19,680 --> 00:04:22,240 AND THERE WAS THE STRESS FROM 123 00:04:22,240 --> 00:04:24,640 BEING 1'S OWN ADVOCATE, FROM THE 124 00:04:24,640 --> 00:04:26,400 HURDLES, INITIALLY THERE WERE NO 125 00:04:26,400 --> 00:04:28,800 ICD CODES SO THEY HAD A LOT OF 126 00:04:28,800 --> 00:04:30,440 TROUBLE GETTING THEIR TREATMENT 127 00:04:30,440 --> 00:04:33,440 COVERED AND IT WAS ALSO THE 128 00:04:33,440 --> 00:04:37,520 STRESS OF BEING A MEMBER FROM A 129 00:04:37,520 --> 00:04:38,560 MARGINALIZED COMMUNITY. 130 00:04:38,560 --> 00:04:40,160 AND THE MAJOR TAKE HOME THAT I 131 00:04:40,160 --> 00:04:42,760 THINK A LOT OF US GOT FROM 132 00:04:42,760 --> 00:04:43,600 LISTENING TO THESE INDIVIDUAL 133 00:04:43,600 --> 00:04:45,600 SYSTEM THAT WE REALLY, ALM OF 134 00:04:45,600 --> 00:04:47,400 US, THE CLINICIANS, THE BASIC 135 00:04:47,400 --> 00:04:48,800 SCIENTISTS, THE CLINICAL 136 00:04:48,800 --> 00:04:50,200 INVESTIGATORS, WE REALLY BENEFIT 137 00:04:50,200 --> 00:04:53,160 FROM ENGAGING THESE DEDICATED 138 00:04:53,160 --> 00:04:54,760 STAKEHOLDERS, STAKEHOLDER IN THE 139 00:04:54,760 --> 00:04:57,040 WHOLE SCIENTIFIC PROCESS FROM 140 00:04:57,040 --> 00:04:59,400 START TO FINISH. 141 00:04:59,400 --> 00:05:00,040 NEXT SLIDE. 142 00:05:00,040 --> 00:05:02,320 SO THEN WE BEGAN, WE KICKED OFF 143 00:05:02,320 --> 00:05:07,480 THE WORKSHOP WITH THE KEY NOTE 144 00:05:07,480 --> 00:05:11,360 SPEAKER BY DR. OERTELT-PRIGIONE, 145 00:05:11,360 --> 00:05:13,080 AND SHE GAVE SEVERAL EXAMPLES OF 146 00:05:13,080 --> 00:05:17,760 HOW SEX CAN REALLY IMPACT 147 00:05:17,760 --> 00:05:18,240 COVID-19 SUSCEPTIBILITY, 148 00:05:18,240 --> 00:05:21,800 PROGRESSION AND THE RESPONSE TO 149 00:05:21,800 --> 00:05:22,040 TREATMENT. 150 00:05:22,040 --> 00:05:24,040 BUT ALSO HOW GENDER RELATED 151 00:05:24,040 --> 00:05:25,920 FACTORS CAN IMPACT THESE VERY 152 00:05:25,920 --> 00:05:29,040 SAME ASPECTS OF COVID-19. 153 00:05:29,040 --> 00:05:33,320 AND THAT WE--THEY ARE SEPARATE 154 00:05:33,320 --> 00:05:34,680 BUT THEY'RE ALSO--THEY ALSO 155 00:05:34,680 --> 00:05:36,280 INTERSECT AND SO THAT WE NEED 156 00:05:36,280 --> 00:05:38,840 NEED TO BE AWARE OF THIS 157 00:05:38,840 --> 00:05:40,200 INTERSECTIONALITY BETWEEN SEX 158 00:05:40,200 --> 00:05:43,320 AND GENDER AND TO GIVER YOU AN 159 00:05:43,320 --> 00:05:44,840 EXAMPLE, OKAY, SO, SEX MIGHT 160 00:05:44,840 --> 00:05:48,160 AFFECT THE VIRUS REPRODUCTION OR 161 00:05:48,160 --> 00:05:49,480 THE DISTRIBUTION OF THE RECEPTOR 162 00:05:49,480 --> 00:05:52,480 FOR THE VIRUS OR THE ANTIBODY 163 00:05:52,480 --> 00:05:55,440 RESPONSE TO THE VIRUS BUT--AND 164 00:05:55,440 --> 00:05:56,880 GENDER COULD AFFECT THE EXPOSURE 165 00:05:56,880 --> 00:06:02,400 TO THE VIRUS, THE ACCESS TO 166 00:06:02,400 --> 00:06:04,120 POTENTIAL THERAPEUTICS AND 167 00:06:04,120 --> 00:06:09,960 PROTECTIVE EQUIPMENT AND ALSO IN 168 00:06:09,960 --> 00:06:10,400 COMPLIANCE, THERE'S 169 00:06:10,400 --> 00:06:11,040 SEX--DIFFERENCES BETWEEN MEN AND 170 00:06:11,040 --> 00:06:12,760 WOMEN IN TERMS OF COMPLIANCE, 171 00:06:12,760 --> 00:06:15,200 AND THEN THERE'S THE 172 00:06:15,200 --> 00:06:18,480 INTERSECTION, YOU KNOW, WHO 173 00:06:18,480 --> 00:06:19,480 MANAGES THE--WHO'S THE FIRST 174 00:06:19,480 --> 00:06:21,520 RESPONDER SO THEY HAVE AN 175 00:06:21,520 --> 00:06:23,000 INCREASED RISK BECAUSE OF THAT 176 00:06:23,000 --> 00:06:25,480 AND THEN THE DECISION MAKERS, 177 00:06:25,480 --> 00:06:30,080 THE DECISION MAKERS WHO ARE 178 00:06:30,080 --> 00:06:31,240 ACTUALLY IMPACTING WHAT RESEARCH 179 00:06:31,240 --> 00:06:35,080 GETS DONE AND WHAT GETS, YOU 180 00:06:35,080 --> 00:06:40,640 KNOW WHAT KIND OF FOCUS THERE 181 00:06:40,640 --> 00:06:42,280 SHOULD BE SO THE TAKE HOME IS WE 182 00:06:42,280 --> 00:06:45,920 SHOULD DO A BETTER JOB BY 183 00:06:45,920 --> 00:06:47,400 DISAGGREGATING OUR DATA BY SEX 184 00:06:47,400 --> 00:06:48,680 AND GENDER AND BY RACE AND 185 00:06:48,680 --> 00:06:50,920 ETHNICITY AND MARGINALIZED 186 00:06:50,920 --> 00:06:51,200 COMMUNITIES. 187 00:06:51,200 --> 00:06:53,080 WE HAVE ALL THIS DATA. 188 00:06:53,080 --> 00:06:54,720 WE REALLY NEED TO DISAGGREGATE 189 00:06:54,720 --> 00:06:59,000 IT SO THAT WE CAN ANALYZE IT TO 190 00:06:59,000 --> 00:07:01,960 SEE WHAT THESE--HOW THESE 191 00:07:01,960 --> 00:07:07,040 FACTORS IMPACT THE OUTCOMES. 192 00:07:07,040 --> 00:07:09,040 THE NEXT SLIDE SHOWS OUR SESSION 193 00:07:09,040 --> 00:07:11,120 1 SPEAKERS AND THIS SESSION WAS 194 00:07:11,120 --> 00:07:15,440 MODERATED BY MARK CHAPPELL, AND 195 00:07:15,440 --> 00:07:23,200 WE HAD STANLEY PERLMAN, DAN 196 00:07:23,200 --> 00:07:24,800 BAROUCH, EILEEN SCULLY, AND JOHN 197 00:07:24,800 --> 00:07:28,200 TSANG AND WHAT WE TOOK HOME FROM 198 00:07:28,200 --> 00:07:30,760 THIS SESSION WAS SEVERAL POINTS, 199 00:07:30,760 --> 00:07:33,600 FIRST OFLL THAT THE RENIN 200 00:07:33,600 --> 00:07:35,200 ANGIO TENSIN SYSTEM IS A 201 00:07:35,200 --> 00:07:37,440 CRITICAL COMPONENT OF COVID-19 202 00:07:37,440 --> 00:07:40,080 PATHOLOGY AND IT'S NOT JUST 203 00:07:40,080 --> 00:07:41,360 CONVERTS ENZYME 2, OTHERWISE 204 00:07:41,360 --> 00:07:43,960 KNOWN AS ACE 2 AND A MAJOR 205 00:07:43,960 --> 00:07:48,960 COMPONENT OF THE RENIN ANGIO 206 00:07:48,960 --> 00:07:50,240 TENSINSYSTEM, IT'S NOT JUST THAT 207 00:07:50,240 --> 00:07:51,920 IT'S THE VIRUS WHICH IS I 208 00:07:51,920 --> 00:07:53,200 CRITICAL COMPONENT FOR THE VIRUS 209 00:07:53,200 --> 00:07:56,280 TO GET INTO THE CELL AND INTO 210 00:07:56,280 --> 00:07:59,040 THE BODY BUT ALSO THAT THIS 211 00:07:59,040 --> 00:08:01,760 SYSTEM IS THEN REGULATED BY THE 212 00:08:01,760 --> 00:08:04,920 COVID-19 AND IT PLAYS A CRITICAL 213 00:08:04,920 --> 00:08:15,240 ROLE IN OUTCOMES AND RESPONSE TO 214 00:08:15,240 --> 00:08:20,080 TREATMENT THEY'RE NOT GOING TO 215 00:08:20,080 --> 00:08:21,360 HELP US WITH ALL THE QUESTIONS 216 00:08:21,360 --> 00:08:25,920 THAT ARE IMPORTANT FOR 217 00:08:25,920 --> 00:08:27,520 UNDERSTANDING HUMAN DISEASE BUT 218 00:08:27,520 --> 00:08:28,360 THEY'RE REALLY HELPFUL TO 219 00:08:28,360 --> 00:08:32,840 UNDERSTAND SOME OF THE 220 00:08:32,840 --> 00:08:33,920 MECHANISMS THAT SAID WE REALLY 221 00:08:33,920 --> 00:08:36,200 NEED TO KNOW MORE ABOUT HOW SEX 222 00:08:36,200 --> 00:08:37,680 HORMONES AND SEX CHROMOSOMES CAN 223 00:08:37,680 --> 00:08:39,760 IMPACT DISEASE AND USING THESE 224 00:08:39,760 --> 00:08:42,600 ANIMAL MODELS COULD HELP US GET 225 00:08:42,600 --> 00:08:45,000 SOME CLUES THAT COULD THEN 226 00:08:45,000 --> 00:08:45,880 INFORM CLINICAL STUDIES. 227 00:08:45,880 --> 00:08:48,720 BUT THESE ANIMAL MODELS NEED TO 228 00:08:48,720 --> 00:08:50,040 BE FURTHER REFINED. 229 00:08:50,040 --> 00:08:51,280 WE DON'T--MOST BASIC SCIENTISTS 230 00:08:51,280 --> 00:08:55,680 HAVE BEEN STUDYING MICE AND RATS 231 00:08:55,680 --> 00:08:58,120 AND YET THEY DON'T--UNLESS 232 00:08:58,120 --> 00:08:59,520 THEY'RE MODIFIED THEY DON'T GET 233 00:08:59,520 --> 00:09:01,720 COVID AND SO THERE ARE OTHER 234 00:09:01,720 --> 00:09:05,560 MODELS OUT THERE LIKE HASMSTERS 235 00:09:05,560 --> 00:09:07,240 AND FERRETS AND WE HAVE VERY 236 00:09:07,240 --> 00:09:09,560 LITTLE DATA ON THESE ANIMALS, 237 00:09:09,560 --> 00:09:11,920 ANIMALS THAT DO GET COVID. 238 00:09:11,920 --> 00:09:14,920 SO WE NEED TO SPEND MORE TIME ON 239 00:09:14,920 --> 00:09:16,640 OUR ANIMAL MODEL SO WE CAN ASK 240 00:09:16,640 --> 00:09:19,040 THESE QUESTIONS THAT WILL THEN 241 00:09:19,040 --> 00:09:19,720 INFORM CLINICAL STUDIES. 242 00:09:19,720 --> 00:09:23,560 AND THEN THERE ARE NO LONG COVID 243 00:09:23,560 --> 00:09:25,200 ANIMAL MODELS AND THESE NEED TO 244 00:09:25,200 --> 00:09:26,120 BE DEVELOPED BECAUSE LONG COVID 245 00:09:26,120 --> 00:09:32,800 IS TURNING OUT TO BE A REAL 246 00:09:32,800 --> 00:09:34,480 CONCERN AND IT'S A MAJOR CONCERN 247 00:09:34,480 --> 00:09:39,560 AND WE REALLY NEED WAYS TO STUDY 248 00:09:39,560 --> 00:09:40,000 IT. 249 00:09:40,000 --> 00:09:41,160 AND THEN ANOTHER KEY POINT FROM 250 00:09:41,160 --> 00:09:42,760 THIS SESSION IS THAT THERE ARE 251 00:09:42,760 --> 00:09:45,480 SOME DIFFERENCES IN IMMUNE 252 00:09:45,480 --> 00:09:46,400 RESPONSE BUT WE REALLY BUT WE 253 00:09:46,400 --> 00:09:48,560 SEE IN THE ANIMAL STUDIES BUT WE 254 00:09:48,560 --> 00:09:50,040 DON'T KNOW THE CLINICAL 255 00:09:50,040 --> 00:09:51,360 RELEVANCE AGAIN. 256 00:09:51,360 --> 00:09:53,040 AGAIN, THE ANIMAL STUDIES ARE 257 00:09:53,040 --> 00:09:53,720 HELPFUL AND INFORMING CLINICAL 258 00:09:53,720 --> 00:09:56,440 RESEARCH AND THEN THE CLINICAL 259 00:09:56,440 --> 00:09:59,480 RESEARCH ALSO IS VERY HELPFUL IN 260 00:09:59,480 --> 00:10:00,960 INFORMING HOW WE DESIGN OUR 261 00:10:00,960 --> 00:10:11,520 CLINICAL BASIC SCIENCE STUDIES. 262 00:10:22,880 --> 00:10:25,800 THIS WAS WAY PRIOR TO THE 263 00:10:25,800 --> 00:10:26,960 VARIANTS EMERGED SO IT'S ALMOST 264 00:10:26,960 --> 00:10:29,480 AS IF WE HAVE TO START OVER AND 265 00:10:29,480 --> 00:10:33,960 SEE HOW VACCINE EFFECTS EFFICACY 266 00:10:33,960 --> 00:10:36,440 WHEN WE'RE NOT AT PEEK IMMUNITY 267 00:10:36,440 --> 00:10:38,040 AND ALSO WHAT ABOUT THE DURATION 268 00:10:38,040 --> 00:10:43,040 OF THE ILLNESS AND HOW DO THESE 269 00:10:43,040 --> 00:10:45,560 VACCINES PROTECT US FROM EBE 270 00:10:45,560 --> 00:10:47,120 MERGING VARIANTS AND HOW THEY 271 00:10:47,120 --> 00:10:48,280 NEED TO BE DONE. 272 00:10:48,280 --> 00:10:49,960 NEXT SLIDE. 273 00:10:49,960 --> 00:10:51,920 SO SESSION 2 FOCUSED ON SECIAL 274 00:10:51,920 --> 00:10:53,600 DETERMINANTS OF HEALTH IMPACTS 275 00:10:53,600 --> 00:10:55,920 ON GENDER RELATED COVID-19 HEART 276 00:10:55,920 --> 00:10:58,280 LUNG AND BLOOD SLEEP DISORDER 277 00:10:58,280 --> 00:11:03,920 OUTCOMES AND WE--THIS SESSION 278 00:11:03,920 --> 00:11:07,800 WAS MODERATED BY 279 00:11:07,800 --> 00:11:09,200 DR. SHATTUCK-HEIDORN AND 1 OF 280 00:11:09,200 --> 00:11:11,920 THE KEY QUESTIONS IN THIS 281 00:11:11,920 --> 00:11:14,480 SESSION WAS HOW DO KEY 282 00:11:14,480 --> 00:11:15,120 DETERMINANTS IMPACT OUTCOMES. 283 00:11:15,120 --> 00:11:21,280 NEXT SLIDE. 284 00:11:21,280 --> 00:11:23,960 AND SO WHEN WE TALK ABOUT SOCIAL 285 00:11:23,960 --> 00:11:25,400 DETERMINANTS WE TALK ABOUT MANY, 286 00:11:25,400 --> 00:11:26,840 MANY FACTORS SO RESEARCHERS NEED 287 00:11:26,840 --> 00:11:30,800 TO CONSIDER HOW SEX AND GENDER 288 00:11:30,800 --> 00:11:32,360 IS GOING WAY BEYOND HORMONES, 289 00:11:32,360 --> 00:11:35,520 BUT LOOK AT GENDERED EFFECTS, 290 00:11:35,520 --> 00:11:36,320 FOR EXAMPLE, THE PSYCHOSOCIAL 291 00:11:36,320 --> 00:11:40,120 STRESS AND WE HEARD ABOUT THIS 292 00:11:40,120 --> 00:11:41,160 PSYCHOSOCIAL STRESS IN OUR 293 00:11:41,160 --> 00:11:43,040 INDIVIDUALS WHO CAME AND TALKED 294 00:11:43,040 --> 00:11:44,080 TO US ABOUT THEIR EXPERIENCE 295 00:11:44,080 --> 00:11:45,240 WITH COVID, WE HEARD ABOUT IT 296 00:11:45,240 --> 00:11:48,520 FROM EACH 1 OF THEM. 297 00:11:48,520 --> 00:11:49,120 TREMENDOUS, TREMENDOUS 298 00:11:49,120 --> 00:11:49,640 PSYCHOSOCIAL STRESS WITH 299 00:11:49,640 --> 00:11:50,960 DIFFERENT REASONS AND WE NEED TO 300 00:11:50,960 --> 00:11:56,240 CONSIDER THAT AS SCIENTISTS. 301 00:11:56,240 --> 00:11:57,480 BECAUSE SOCIAL DETERMINANTS OF 302 00:11:57,480 --> 00:11:59,320 HEALTH, A LOST IT IS ABOUT THE 303 00:11:59,320 --> 00:12:03,400 STRESS OF THESE SOCIAL 304 00:12:03,400 --> 00:12:06,200 DETERMINANTS, THE FINANCIAL 305 00:12:06,200 --> 00:12:08,600 STRESSORS AND OTHER STRESSORS. 306 00:12:08,600 --> 00:12:12,480 WE ALSO NEED TO IMPROVE OUR--THE 307 00:12:12,480 --> 00:12:14,520 WAY WE DEFINE AND OPERATIONALIZE 308 00:12:14,520 --> 00:12:16,720 THE TERMS OF GENDER, AND WE NEED 309 00:12:16,720 --> 00:12:18,720 TO INCLUDE SEXUAL ORIENTATION 310 00:12:18,720 --> 00:12:20,240 AND GENDER IDENTITY VARIABLES. 311 00:12:20,240 --> 00:12:22,680 IT'S NOT JUST MEN AND WOMEN. 312 00:12:22,680 --> 00:12:28,120 THERE'S SO MUCH MORE THERE. 313 00:12:28,120 --> 00:12:29,040 THERE'S TRANS--THE 314 00:12:29,040 --> 00:12:29,680 TRANSCOMMUNITY AND THE 315 00:12:29,680 --> 00:12:33,160 TRANSCOMMUNITY AND HAVE YOU THE 316 00:12:33,160 --> 00:12:37,800 INTERSEX COMMUNITY AND YOU HAVE 317 00:12:37,800 --> 00:12:40,440 INDIVIDUALS WHO HAVE DIFFERENT 318 00:12:40,440 --> 00:12:42,600 GENDER HORMONE AFFIRMING 319 00:12:42,600 --> 00:12:44,480 TREATMENTS AND YOU HAVE 320 00:12:44,480 --> 00:12:46,680 DIFFERENCES IN TIMING OF WHEN 321 00:12:46,680 --> 00:12:47,800 THESE TREATMENTS BEGAN AND 322 00:12:47,800 --> 00:12:51,400 THERE'S JUST MANY ASPECTS THAT 323 00:12:51,400 --> 00:12:52,480 WE REALLY--WE REALLY NEED TO 324 00:12:52,480 --> 00:12:55,640 CONSIDER WHEN WE'RE THINKING 325 00:12:55,640 --> 00:12:57,040 ABOUT SOCIAL DETERMINANTS OF 326 00:12:57,040 --> 00:13:01,720 HEALTH AND HOW--HOW WE THINK 327 00:13:01,720 --> 00:13:04,680 ABOUT GENDER AND BIOLOGICAL SEX 328 00:13:04,680 --> 00:13:06,480 AND THESE GENDER IDENTITY 329 00:13:06,480 --> 00:13:07,120 VARIABLES. 330 00:13:07,120 --> 00:13:09,920 WE ALSO NEED TO DO A BETTER JOB 331 00:13:09,920 --> 00:13:11,880 AT ENGAGING THE COMMUNITY IN OUR 332 00:13:11,880 --> 00:13:13,040 RESEARCH. 333 00:13:13,040 --> 00:13:13,880 WE NEED REPRESENTATIONOT STUDY 334 00:13:13,880 --> 00:13:16,760 TEAM AND DECISION MAKING. 335 00:13:16,760 --> 00:13:19,880 IT REALLY WELL HELP US, FIRST OF 336 00:13:19,880 --> 00:13:21,840 ALL INFORM THE DESIGN OF OUR 337 00:13:21,840 --> 00:13:23,800 RESEARCH TO UNDERSTAND THE 338 00:13:23,800 --> 00:13:25,320 IMPORTANT ASPECTS THAT WE REALLY 339 00:13:25,320 --> 00:13:28,160 NEED TO FOCUS ON AND WE NEED TO 340 00:13:28,160 --> 00:13:30,720 TRUST OF THESE INDIVIDUALS. 341 00:13:30,720 --> 00:13:32,160 AND SO THE ONLY WAY YOU CAN 342 00:13:32,160 --> 00:13:34,160 REALLY BUILD TRUST IS TO ENGAGE 343 00:13:34,160 --> 00:13:35,880 AT THE BEGINNING OF YOUR 344 00:13:35,880 --> 00:13:38,640 STUDIES, YOU NEED TO GAUGE THE 345 00:13:38,640 --> 00:13:41,240 COMMUNITY WITH YOUR RESEARCH AND 346 00:13:41,240 --> 00:13:44,120 THEN WE ABSOLUTELY HAVE TO HAVE 347 00:13:44,120 --> 00:13:45,880 LONGITUDINAL DATA, A SNAPSHOT IS 348 00:13:45,880 --> 00:13:48,800 JUST NOT SUFFICIENT TO REALLY 349 00:13:48,800 --> 00:13:49,560 UNDERSTAND THESE OUTCOMES. 350 00:13:49,560 --> 00:13:52,000 AND WHEN WE'RE TALKING ABOUT 351 00:13:52,000 --> 00:13:53,200 CARDIOVASCULAR AND LUNG AND 352 00:13:53,200 --> 00:13:55,400 BLOOD AND SLEEP DISORDERS, WE 353 00:13:55,400 --> 00:14:05,920 REALLY NEED TO THINK LONG-TERM 354 00:14:06,360 --> 00:14:08,320 AND SOCIAL DETERMINANTS OF 355 00:14:08,320 --> 00:14:09,520 HEALTH, PLACE, CONTEXTURAL 356 00:14:09,520 --> 00:14:11,440 FACTORS AND THE 357 00:14:11,440 --> 00:14:13,560 INTERSECTIONALITY REALLY HAVE A 358 00:14:13,560 --> 00:14:15,040 PROFOUND INFLUENCES ON OUTCOMES 359 00:14:15,040 --> 00:14:16,720 AND THEY MUST BE CONSIDERED. 360 00:14:16,720 --> 00:14:17,600 NEXT SLIDE. 361 00:14:17,600 --> 00:14:20,440 SO THAT LAST SESSION OF THE DAY, 362 00:14:20,440 --> 00:14:22,360 FOCUSED ON PREGNANCY AND OTHER 363 00:14:22,360 --> 00:14:24,120 CONDITIONS THAT AFFECT THE 364 00:14:24,120 --> 00:14:29,960 SUSCEPTIBILITY TO SARS COV 2, 365 00:14:29,960 --> 00:14:31,800 AND DR. GAROVIC WAS THE 366 00:14:31,800 --> 00:14:32,880 MODERATOR OF THIS OUTSTANDING 367 00:14:32,880 --> 00:14:33,120 SECTION. 368 00:14:33,120 --> 00:14:35,240 CAN I HAVE THE NEXT SLIDE AND 369 00:14:35,240 --> 00:14:36,360 SEVERAL, SEVERAL POINTS WERE 370 00:14:36,360 --> 00:14:37,320 MADE DURING THIS SESSION. 371 00:14:37,320 --> 00:14:39,640 ONE IS THAT THE EPIDEMIOLOGY 372 00:14:39,640 --> 00:14:42,280 THAT WE HAVE SO FAR AND WE DON'T 373 00:14:42,280 --> 00:14:45,960 HAVE A LOT YET IT SUGGESTS THAT 374 00:14:45,960 --> 00:14:46,800 ESTROGEN, ESTRADISCIPLINARY 375 00:14:46,800 --> 00:14:48,360 OLDER PEOPLE AND PROGESTERONE 376 00:14:48,360 --> 00:14:49,280 THERAPY COULD ACTUALLY HAVE A 377 00:14:49,280 --> 00:14:50,440 PROTECT EVALUATION PROCESS 378 00:14:50,440 --> 00:14:52,840 EFFECT IN COVID-19 WHICH HAS 379 00:14:52,840 --> 00:14:57,240 IMPLICATIONS FOR TO TENTIAL 380 00:14:57,240 --> 00:14:59,560 THERAPEUTIC STRATEGIES. 381 00:14:59,560 --> 00:15:00,280 POLYCYSTIC OVARY SYNDROME, THIS 382 00:15:00,280 --> 00:15:01,960 IS A CONDITION THAT AFFLICTS 383 00:15:01,960 --> 00:15:04,600 WOMEN AND IT'S A POTENTIAL RISK 384 00:15:04,600 --> 00:15:07,080 FACTOR FOR COVID-19 SEVERITY AND 385 00:15:07,080 --> 00:15:10,920 WE REALLY NEED TO UNDERSTAND WHY 386 00:15:10,920 --> 00:15:14,000 AND AND BY UNDERSTANDING WHY, WE 387 00:15:14,000 --> 00:15:15,880 MAY FIND CLUES FOR NEW 388 00:15:15,880 --> 00:15:18,400 THERAPEUTIC STRATEGIES FOR 389 00:15:18,400 --> 00:15:18,840 COVID. 390 00:15:18,840 --> 00:15:22,520 AND THIRD THAT COVID-19, IT 391 00:15:22,520 --> 00:15:25,240 INCREASES THE RISK OF MATERNAL 392 00:15:25,240 --> 00:15:27,200 MORBIDITY AND MORTALITY, THE 393 00:15:27,200 --> 00:15:29,280 RESK OF PREELAMPSIA AND OTHER 394 00:15:29,280 --> 00:15:30,480 HYPER TENSIVE DISORDERS OF 395 00:15:30,480 --> 00:15:37,200 PREGNANCY AND INCREASES THE RISK 396 00:15:37,200 --> 00:15:39,080 OF ADVERSE NEONATAL OUTCOMES. 397 00:15:39,080 --> 00:15:42,280 SO FINALLY THE TAKE HOME FROM 398 00:15:42,280 --> 00:15:43,880 SESSION 3 IS THAT WE REALLY 399 00:15:43,880 --> 00:15:44,600 DON'T KNOW MUCH. 400 00:15:44,600 --> 00:15:45,880 WE DON'T KNOW ENOUGH ABOUT THE 401 00:15:45,880 --> 00:15:48,000 IMPACT OF SEX HORMONES AND 402 00:15:48,000 --> 00:15:49,320 PREGNANCY IN COVID-19, THERE'S 403 00:15:49,320 --> 00:15:53,360 JUST NOT ENOUGH DATA ON YOU KNOW 404 00:15:53,360 --> 00:15:57,640 WHAT'S HAPPENING, HOW THESE SEX 405 00:15:57,640 --> 00:15:58,920 HORMONES, ESTROGEN, 406 00:15:58,920 --> 00:16:00,120 PROGESTERONE, HOW THE STATE OF 407 00:16:00,120 --> 00:16:00,840 PREGNANCY IMENT PACTS THE 408 00:16:00,840 --> 00:16:02,040 STABILITY OF THE DISEASE, 409 00:16:02,040 --> 00:16:03,480 PROGRESSION OF THE DEC, RESPONSE 410 00:16:03,480 --> 00:16:04,880 TO TREATMENT, THE LONG-TERM 411 00:16:04,880 --> 00:16:08,520 EFFECTS ON THE HEART LUNG BLOOD 412 00:16:08,520 --> 00:16:10,880 AND SLEEP SEQUELA AND THERE'S 413 00:16:10,880 --> 00:16:13,880 INSUFFICIENT DATA IN THIS REGARD 414 00:16:13,880 --> 00:16:14,520 WITH LONG COVID. 415 00:16:14,520 --> 00:16:16,280 AND WE REALLY DON'T KNOW MUCH 416 00:16:16,280 --> 00:16:19,720 ABOUT THE MATERNAL COVID-19 AND 417 00:16:19,720 --> 00:16:26,440 IT'S IMPACT ON OFFSPRING. 418 00:16:26,440 --> 00:16:30,440 GONADAL HORMONE THERAPY HAS SOME 419 00:16:30,440 --> 00:16:31,240 THERAPEUTIC POTENTIAL, IT'S 420 00:16:31,240 --> 00:16:32,800 HINTED AT BY STUDIES THAT ARE 421 00:16:32,800 --> 00:16:34,240 ONGOING AND WE NEED TO EXPLORE 422 00:16:34,240 --> 00:16:36,680 THAT FURTHER AND GENDER 423 00:16:36,680 --> 00:16:38,760 AFFIRMING HORMONAL THERAPY COULD 424 00:16:38,760 --> 00:16:41,560 ACTUALLY OFFER US A NATURAL 425 00:16:41,560 --> 00:16:43,280 EXPERIMENT TO GIVE US SOME 426 00:16:43,280 --> 00:16:45,560 INFORMATION ABOUT THE OUTCOMES 427 00:16:45,560 --> 00:16:49,720 AND ALSO AGAIN AS A POTENTIAL 428 00:16:49,720 --> 00:16:50,880 FOR THERAPEUTICS FOR COVID-19 429 00:16:50,880 --> 00:16:53,240 FOR THE GENERAL POPULATION. 430 00:16:53,240 --> 00:16:55,960 AND WITH THAT I WILL TURN IT 431 00:16:55,960 --> 00:16:58,720 OVER TO DR. KANTHI WHO WILL TAKE 432 00:16:58,720 --> 00:17:03,760 US TO THE NEXT SESSION, SECTION 433 00:17:03,760 --> 00:17:03,880 4. 434 00:17:03,880 --> 00:17:06,120 >> WONDERFUL, THANK YOU VERY 435 00:17:06,120 --> 00:17:06,520 MUCH DR. SANBBERG. 436 00:17:06,520 --> 00:17:08,840 I THINK THAT WAS REALLY AN 437 00:17:08,840 --> 00:17:09,640 EXCITING DAY YESTERDAY AND THANK 438 00:17:09,640 --> 00:17:13,360 YOU FOR THE GREAT SUMMARY OF DAY 439 00:17:13,360 --> 00:17:15,880 1 SESSIONS AND DISCUSSION. 440 00:17:15,880 --> 00:17:21,200 SO TODAY AS YOU HEARD EARLIER 441 00:17:21,200 --> 00:17:22,320 FROM OUR ORGANIZERS, WE ARE 442 00:17:22,320 --> 00:17:24,360 BREAKING THE DAY UP INTO 3 443 00:17:24,360 --> 00:17:27,760 SEPARATE SESSIONS, AND THAT WILL 444 00:17:27,760 --> 00:17:29,760 BE FOLLOWED BY A SUMMARY OF THE 445 00:17:29,760 --> 00:17:31,840 DAY AND THEN SOME BREAK OUT 446 00:17:31,840 --> 00:17:32,680 ROOMS, SO OUR FIRST SESSION FOR 447 00:17:32,680 --> 00:17:34,640 THE DAY HERE WHICH IS SESSION 448 00:17:34,640 --> 00:17:36,800 NUMBER 4 OF THE WORKSHOP IS 449 00:17:36,800 --> 00:17:39,560 CARDIOVASCULAR AND METABOLIC 450 00:17:39,560 --> 00:17:41,200 ASPECTS OF COVID-19 AND HOW SEX 451 00:17:41,200 --> 00:17:42,040 AND GENDER CONSIDERATIONS MAY 452 00:17:42,040 --> 00:17:43,040 PLAY A ROLE IN THIS. 453 00:17:43,040 --> 00:17:44,520 SO I WOULD LIKE TO INTRODUCE OUR 454 00:17:44,520 --> 00:17:49,680 MODERATOR FOR THE SESSION, 455 00:17:49,680 --> 00:17:51,080 DR. DELISSA FAIRWEATHER, SHE'S A 456 00:17:51,080 --> 00:17:52,160 DIRECTOR OF MEDICINE AND 457 00:17:52,160 --> 00:17:53,920 TRANSLATIONAL RESEARCH IN THE 458 00:17:53,920 --> 00:17:54,640 DEPARTMENT OF CARDIOVASCULAR 459 00:17:54,640 --> 00:17:57,760 MEDICINE AT THE MAYO CLINIC IN 460 00:17:57,760 --> 00:17:59,080 SUNNY JACKSONVILLE, FLORIDA. 461 00:17:59,080 --> 00:18:01,520 DR. FAIRWEATHER IS A BASIC AND 462 00:18:01,520 --> 00:18:02,160 TRANSLATIONAL RESEARCH FOCUSES 463 00:18:02,160 --> 00:18:04,320 ON SEX AND GENDER DIFFERENCES AS 464 00:18:04,320 --> 00:18:07,320 A TOOL TO DISCOVER NEW THERAPIES 465 00:18:07,320 --> 00:18:09,200 FOR BOTH CARDIOVASCULAR AND 466 00:18:09,200 --> 00:18:10,280 AUTOIMMUNE DISEASES LIKE MY O 467 00:18:10,280 --> 00:18:10,840 CARDITEIS. 468 00:18:10,840 --> 00:18:12,160 HER RESEARCH HAS BEEN FUNDED BY 469 00:18:12,160 --> 00:18:14,960 A VARIETY OF ORGANIZATIONS, NIH, 470 00:18:14,960 --> 00:18:16,400 AMERICAN HEART ASSOCIATION, 471 00:18:16,400 --> 00:18:20,720 BARTA AND OTHERS, SHE HAS A LONG 472 00:18:20,720 --> 00:18:23,080 HISTORY OF CHAIRING SECTIONS FOR 473 00:18:23,080 --> 00:18:25,840 THE NIH, EPA AND DEPARTMENT OF 474 00:18:25,840 --> 00:18:27,640 DEFENSE AND WAS WITH THE BOARD 475 00:18:27,640 --> 00:18:30,320 OF MY O CARDITIS AND MOST 476 00:18:30,320 --> 00:18:33,880 RECENTLY SHE SERVED ON A 477 00:18:33,880 --> 00:18:35,440 COMMITTEE FOR SCIENCE AND 478 00:18:35,440 --> 00:18:37,240 MEDICINE WHO WAS REVIEWING THE 479 00:18:37,240 --> 00:18:38,680 DISEASE PORTFOLIO OF THE NIH AND 480 00:18:38,680 --> 00:18:39,600 THIS WAS COMMISSIONED BY 481 00:18:39,600 --> 00:18:42,840 CONGRESS AND ALSO A LEADER OF 482 00:18:42,840 --> 00:18:45,080 THE USFDA MAYO EXPANDED ACCESS 483 00:18:45,080 --> 00:18:47,160 PROGRAM FOR THE USE OF 484 00:18:47,160 --> 00:18:48,840 CONVALESCENT PLASMA FOR PATIENTS 485 00:18:48,840 --> 00:18:50,520 WITH COVID-19 WHICH WE WILL 486 00:18:50,520 --> 00:18:52,400 HADDER MORE ABOUT LATER TODAY. 487 00:18:52,400 --> 00:18:54,360 SHE'S ALSO AN ACTIVE MEMBER OF 488 00:18:54,360 --> 00:18:57,480 THE STUDY OF SEX DIFFERENCES AND 489 00:18:57,480 --> 00:18:58,720 CHAIRED THEIR IMPORTANTANNUAL 490 00:18:58,720 --> 00:18:59,880 MEETING IN THE PAST REAR SO I 491 00:18:59,880 --> 00:19:02,320 WILL STOP HERE AND HAND THE MIC 492 00:19:02,320 --> 00:19:08,000 OVER TO DR. FAIRWEATHER TO 493 00:19:08,000 --> 00:19:08,640 INTRODUCE THE SESSION. 494 00:19:08,640 --> 00:19:11,120 >> THANK YOU DR. KANTHI. 495 00:19:11,120 --> 00:19:12,520 AND TODAY WELCOME EVERYBODY TO 496 00:19:12,520 --> 00:19:14,360 SESSION 4 WHERE WE'RE TALKING 497 00:19:14,360 --> 00:19:15,520 ABOUT CARDIOVASCULAR AND 498 00:19:15,520 --> 00:19:17,040 METABOLIC ASPECTS OF COVID-19, 499 00:19:17,040 --> 00:19:20,040 SEX AND GENDER CONSIDERATIONS. 500 00:19:20,040 --> 00:19:23,560 WE'RE GOING TO FOCUS NOW ON 501 00:19:23,560 --> 00:19:24,400 OUTCOMES FROM COVID-19 SO WE'RE 502 00:19:24,400 --> 00:19:33,240 GOING TO GET AN OVERVIEW FROM 503 00:19:33,240 --> 00:19:34,400 DR. NOEL BAIREY-MER0, I WILL 504 00:19:34,400 --> 00:19:37,160 TALK ABOUT MY O CARDITEIS AND WE 505 00:19:37,160 --> 00:19:40,760 WILL HEAR ABOUT LONG COVID, 506 00:19:40,760 --> 00:19:41,480 ORGTOSTATTIC INTOLERANCE AND 507 00:19:41,480 --> 00:19:45,480 POTS AND WE HEARD FROM MICHAEL 508 00:19:45,480 --> 00:19:47,600 SIEVERTS WHO SUFFERS FROM POTS 509 00:19:47,600 --> 00:19:48,840 AND THE SIMPLIFYS DESCRIPTION OF 510 00:19:48,840 --> 00:19:50,960 THAT IS WHEN YOU STAND UP YOU 511 00:19:50,960 --> 00:19:52,240 FEEL DIZZY, FAINT AND BLACK OUT 512 00:19:52,240 --> 00:19:53,760 AND IT CAUSES A LOT OF SYMPTOMS 513 00:19:53,760 --> 00:19:55,120 AND DIFFICULTY SAYS SO WE WILL 514 00:19:55,120 --> 00:19:58,160 HEAR THAT DESCRIPTION AND ALSO 515 00:19:58,160 --> 00:20:02,080 IMAGING BIOMARKERS WITH CARDIAC 516 00:20:02,080 --> 00:20:03,160 MRI. 517 00:20:03,160 --> 00:20:05,560 SO OUR MAIN DESCRIPTION OF THE 518 00:20:05,560 --> 00:20:12,360 OVERVIEW IS GOING TO HAPPEN WITH 519 00:20:12,360 --> 00:20:14,760 DR. BAIREY-MERZ SHE A LEADING 520 00:20:14,760 --> 00:20:15,960 DOCTOR ON CARDIOVASCULAR DISEASE 521 00:20:15,960 --> 00:20:16,880 AND SEX DIFFERENCES AND SHE'S 522 00:20:16,880 --> 00:20:17,960 BEEN DOING THAT FOR DECADES AND 523 00:20:17,960 --> 00:20:19,400 WE WILL HEAR THE BEST IN SCIENCE 524 00:20:19,400 --> 00:20:22,880 FROM HER, SHE HOLDS THE IRON AND 525 00:20:22,880 --> 00:20:25,040 SHEILA ALLEN CHAIR IN WOMEN'S 526 00:20:25,040 --> 00:20:27,400 HEART RESEARCH AT CEDAR SINAI AS 527 00:20:27,400 --> 00:20:30,040 WELL AS BEING A DIRECTOR OF MANY 528 00:20:30,040 --> 00:20:32,680 WOMEN'S HEART PROGRAMS. 529 00:20:32,680 --> 00:20:35,480 SHE HAS A LARGE RESEARCH 530 00:20:35,480 --> 00:20:36,440 PORTFOLIO WITH OVER 425 531 00:20:36,440 --> 00:20:37,360 SCIENTIFIC PAPERS PUBLISHED ON 532 00:20:37,360 --> 00:20:41,560 THIS TOPIC SO WE'RE VERY EXCITED 533 00:20:41,560 --> 00:20:43,000 TO HEAR HER OVERVIEW, I WILL 534 00:20:43,000 --> 00:20:45,120 TALK ABOUT SEX DIFFERENCES IN MY 535 00:20:45,120 --> 00:20:46,160 O CARDITEIS AND SEX DIFFERENCES 536 00:20:46,160 --> 00:20:49,480 IN THE VACCINE AS WELL AS SOME 537 00:20:49,480 --> 00:20:51,720 NEW AND UNPUBLISHED WORK ON 538 00:20:51,720 --> 00:20:52,400 MITOCHONDRIA AND SEX 539 00:20:52,400 --> 00:20:52,800 DIFFERENCES. 540 00:20:52,800 --> 00:20:56,000 WE WILL HEAR FROM DR. RAJ, HE IS 541 00:20:56,000 --> 00:21:03,560 THE SECTION CHIEF OF ADULT 542 00:21:03,560 --> 00:21:06,440 CARDIAC ARRHYTHMIC GROUP AT 543 00:21:06,440 --> 00:21:13,120 CALGARY WHERE HE'S LOOKED AT 544 00:21:13,120 --> 00:21:14,520 AUTONOMIC MEDICINE AND HE'S ALSO 545 00:21:14,520 --> 00:21:18,160 THE DIRECTOR OF EDUCATION AND AT 546 00:21:18,160 --> 00:21:19,320 THE LIBIN CARDIO VASCULARY 547 00:21:19,320 --> 00:21:20,920 INSTITUTE AND DIRECTOR OF 548 00:21:20,920 --> 00:21:22,720 KNOWLEDGE TRANSLATION AT WOMEN'S 549 00:21:22,720 --> 00:21:23,360 CARDIOVASCULAR INIT WHYATIVE SO 550 00:21:23,360 --> 00:21:24,960 WE WILL HEAR FROM THE WORLD 551 00:21:24,960 --> 00:21:27,240 AUTHORITY BOTH ON SEX 552 00:21:27,240 --> 00:21:28,520 DIFFERENCES AND WHAT IS KNOWN 553 00:21:28,520 --> 00:21:33,440 ABOUT POTS AND COVID. 554 00:21:33,440 --> 00:21:35,480 AND THEN FINALLY WE WILL HEAR 555 00:21:35,480 --> 00:21:38,560 FROM DR. MOON ON CARDIO MRI 556 00:21:38,560 --> 00:21:39,880 IMAGING BIOMARKERS FOR COVID SO 557 00:21:39,880 --> 00:21:42,080 HE'S A PROFESSOR OF CARDIOLOGY 558 00:21:42,080 --> 00:21:44,080 AND LEADS CARDIAC MRI AND HEART 559 00:21:44,080 --> 00:21:46,960 CENTER IN LONDON AND HE HAS A 560 00:21:46,960 --> 00:21:50,000 DISTINGUISHED RECORD OF OVER 450 561 00:21:50,000 --> 00:21:51,920 MANUSCRIPTS, HE'S VERY 562 00:21:51,920 --> 00:21:54,000 INNOVATIVE AND HE CAME UP IN 563 00:21:54,000 --> 00:21:57,920 MARCH, 2020 WITH SETTING UP THIS 564 00:21:57,920 --> 00:22:00,880 COVID-SORTIUM WHICH IS LOOKING 565 00:22:00,880 --> 00:22:02,560 AT IMMUNOLOGY OF MILD DISEASE IN 566 00:22:02,560 --> 00:22:04,400 COVID WHERE HE'S HAD MANY HIGH 567 00:22:04,400 --> 00:22:05,120 IMPACT IMPORTANT PAPERS COME OUT 568 00:22:05,120 --> 00:22:06,920 OF THAT STUDY AND HE'S ALSO 569 00:22:06,920 --> 00:22:10,000 LEADING ANALYSIS OF COVID HEART 570 00:22:10,000 --> 00:22:16,720 WHICH IS A 23 CENTER STUDY OF 571 00:22:16,720 --> 00:22:17,360 TROPONIN POSITIVE DISEASE. 572 00:22:17,360 --> 00:22:19,280 SO WE WILL HEAR FROM EXCITING 573 00:22:19,280 --> 00:22:20,680 SPEAKERS TODAY ON CARDIAC 574 00:22:20,680 --> 00:22:20,920 OUTCOMES. 575 00:22:20,920 --> 00:22:27,360 SO I WILL LIKE TO PASS THIS OVER 576 00:22:27,360 --> 00:22:29,160 TO DR. BAIREY-MERZ TO GIVE US 577 00:22:29,160 --> 00:22:29,560 OUR OVERVIEW. 578 00:22:29,560 --> 00:22:32,800 THANK YOU SO MUCH 579 00:22:32,800 --> 00:22:33,560 DR. FAIRWEATHER AND KANTHI. 580 00:22:33,560 --> 00:22:35,600 LET ME SCREEN SHARE. 581 00:22:35,600 --> 00:22:39,440 I'VE BEEN CHARGED WITH OVERVIEW 582 00:22:39,440 --> 00:22:45,480 AND SO, IN MY ALLOTTED TIME WHAT 583 00:22:45,480 --> 00:22:46,760 DO YOU SEE? 584 00:22:46,760 --> 00:22:49,480 DO YOU SEE MY SCREEN? 585 00:22:49,480 --> 00:22:49,760 >> YES. 586 00:22:49,760 --> 00:22:50,160 >> OKAY, GREAT. 587 00:22:50,160 --> 00:23:00,680 SO THIS WILL BE A BROAD BRUSH 588 00:23:02,760 --> 00:23:04,880 OVERVIEW OF CARDIOVASCULAR 589 00:23:04,880 --> 00:23:05,840 DOMINATED INFORMATION RELATED TO 590 00:23:05,840 --> 00:23:06,320 COVID RESEARCH. 591 00:23:06,320 --> 00:23:10,280 WE KNOW FOR A LONG TIME THAT 592 00:23:10,280 --> 00:23:11,440 COVID IS CARDIOVASCULAR DISEASE 593 00:23:11,440 --> 00:23:13,080 IS THE LEADING KILLER IN WOMEN 594 00:23:13,080 --> 00:23:14,720 AND MEN, BUT WE WILL BREAK THESE 595 00:23:14,720 --> 00:23:16,240 DOWN AND LOOK AT THEM 596 00:23:16,240 --> 00:23:17,440 SPECIFICALLY TO SET YOU UP FOR 597 00:23:17,440 --> 00:23:21,120 THE MORE SPECIFIC TALKS WE ALSO 598 00:23:21,120 --> 00:23:23,080 KNOW THAT CARDIOVASCULAR 599 00:23:23,080 --> 00:23:26,280 MORTALITY TRANSFER WOMEN AND MEN 600 00:23:26,280 --> 00:23:28,920 IN 1984 WOMEN BECAME THE 601 00:23:28,920 --> 00:23:31,280 MAJORITY OF VICTIMS. 602 00:23:31,280 --> 00:23:32,920 NHLBI, AMERICAN HEART, AMERICAN 603 00:23:32,920 --> 00:23:34,520 CARDIOLOGY ALL LAUNCHED 604 00:23:34,520 --> 00:23:35,760 INITIATIVES RESEARCH AS WELL AS 605 00:23:35,760 --> 00:23:37,640 PUBLIC AWARENESS AND IT RESULTED 606 00:23:37,640 --> 00:23:40,000 IN A PRETTY DARN GOOD DECLINE 607 00:23:40,000 --> 00:23:43,160 BUT AS WE SEE FROM THIS FINAL 608 00:23:43,160 --> 00:23:44,320 ARROW, THE MORTALITY FOR WOMEN 609 00:23:44,320 --> 00:23:53,680 AND MEN WAS GOING UP EVEN 610 00:23:53,680 --> 00:23:54,120 PREPANDEMIC. 611 00:23:54,120 --> 00:23:56,320 WHAT I WILL DO THEN IS DIVIDE 612 00:23:56,320 --> 00:23:59,680 THIS UP INTO 3 WAVES OF COVID 613 00:23:59,680 --> 00:23:59,960 PANDEMIC. 614 00:23:59,960 --> 00:24:05,360 I BROAD PRUSH THE FIRST WAVE, 615 00:24:05,360 --> 00:24:07,240 THE SECOND WAVE IS SOME SCIENCE 616 00:24:07,240 --> 00:24:08,880 AND THE THIRD WAVE, WE NEED 617 00:24:08,880 --> 00:24:14,000 SCIENCE, THIS IS GOING TO BE OUR 618 00:24:14,000 --> 00:24:16,160 INCREASED PANDEMIC WAVE OF 619 00:24:16,160 --> 00:24:18,280 INCREASED CBD AND I WILL SHOW 620 00:24:18,280 --> 00:24:19,360 YOU HOW COVID IS CONTRIBUTING TO 621 00:24:19,360 --> 00:24:29,840 THAT AND WILL NEED A LOT OF 622 00:24:31,880 --> 00:24:32,000 WORK. 623 00:24:32,000 --> 00:24:33,920 SO WHAT YOU SEE IS MEN LIKE 624 00:24:33,920 --> 00:24:37,080 COVID OVERALL ARE SUFFERING 625 00:24:37,080 --> 00:24:38,880 DISPROPORTIONATELY FOR 626 00:24:38,880 --> 00:24:40,120 COMPLICATIONS INCLUDING ICU'D 627 00:24:40,120 --> 00:24:40,560 MISSIONS AND DEATHS. 628 00:24:40,560 --> 00:24:41,600 CAN YOU SEE ON THE RIGHT HAND 629 00:24:41,600 --> 00:24:45,480 PANEL THAT IT'S NOT ALL ABOUT 630 00:24:45,480 --> 00:24:45,840 EXPOSURE. 631 00:24:45,840 --> 00:24:46,800 WE HEARD YESTERDAY ABOUT GENDER 632 00:24:46,800 --> 00:24:53,800 AND WOMEN ARE MORE LIKELY TO BE 633 00:24:53,800 --> 00:24:56,360 EXPOSED MEN WERE MORE AS 634 00:24:56,360 --> 00:24:59,360 ESSENTIAL WORKERRINGS OUT IN THE 635 00:24:59,360 --> 00:25:00,640 COMMUNITY MORE EXPOSED, MEN 636 00:25:00,640 --> 00:25:01,440 DON'T WASH THEIR HANDS AS 637 00:25:01,440 --> 00:25:02,880 RESEARCH BUT IF YOU LOOK AT 638 00:25:02,880 --> 00:25:03,920 FRANCE AND PRETTY GOOD DATA AM 639 00:25:03,920 --> 00:25:07,000 CANNING OUT OF FRANCE, EVEN 640 00:25:07,000 --> 00:25:08,320 THOUGH WOMEN WERE MORE EXPOSED 641 00:25:08,320 --> 00:25:10,880 AND HAD NOR CONFIRMED CASES, MEN 642 00:25:10,880 --> 00:25:12,560 STILL DIED MORE OF 643 00:25:12,560 --> 00:25:14,360 CARDIOVASCULAR DISEASE. 644 00:25:14,360 --> 00:25:17,960 SO WE STRATIFY ACUTE 645 00:25:17,960 --> 00:25:19,200 CARDIOVASCULAR DISEASE 646 00:25:19,200 --> 00:25:20,840 INVOLVEMENT IN COVID-19 INTO 4 647 00:25:20,840 --> 00:25:23,200 BROAD KACCT THE GORYS, 648 00:25:23,200 --> 00:25:26,000 ARRHYTHMIAS AND HEART BLOCK, 649 00:25:26,000 --> 00:25:29,320 THROMBOSIS, DVT AND PE, ARTERIAL 650 00:25:29,320 --> 00:25:30,960 AND STENT THROMBOSIS, WE HARDLY 651 00:25:30,960 --> 00:25:32,680 SEE ANY OF THIS IN CARDIOLOGY, 652 00:25:32,680 --> 00:25:34,600 WE SAW A LOT IN COVID. 653 00:25:34,600 --> 00:25:38,600 BIG BAD HEART ATTACKS CALL STEMI 654 00:25:38,600 --> 00:25:39,560 IN PEOPLE UNDER 30. 655 00:25:39,560 --> 00:25:41,200 THIS IS UNHEARD OF SO CLEARLY A 656 00:25:41,200 --> 00:25:43,200 COMPLICATION AND THEN WE SAW A 657 00:25:43,200 --> 00:25:44,640 LOT OF LATE PRESENTATIONS AND I 658 00:25:44,640 --> 00:25:46,600 WILL SHOW YOU SOME PREPRENTDATA 659 00:25:46,600 --> 00:25:48,680 ABOUT THAT FROM OUR GROUP. 660 00:25:48,680 --> 00:25:51,560 MY O CARDITEIS WHICH YOU WILL 661 00:25:51,560 --> 00:25:54,720 HEAR MORE ABOUT. 662 00:25:54,720 --> 00:25:55,640 TAKOTSUBO SYNDROME, SOMETIMES 663 00:25:55,640 --> 00:25:58,200 CALLED BROKEN HEART AND THEN 664 00:25:58,200 --> 00:25:59,040 CARDIOVASCULAR COLLAPSE, 665 00:25:59,040 --> 00:26:09,520 TRAGICALLY IN THE PEDIATRIC 666 00:26:10,440 --> 00:26:11,280 POPULATION. 667 00:26:11,280 --> 00:26:13,760 SO WE DIVIDE THOSE INTO 4 668 00:26:13,760 --> 00:26:14,120 CATEGORIES. 669 00:26:14,120 --> 00:26:16,120 OF COURSE, NOW THAT WOMEN AND 670 00:26:16,120 --> 00:26:17,760 WOMEN ARE AT PARITY MORE OR LESS 671 00:26:17,760 --> 00:26:21,080 IN THE UNITED STATES IN TERMS OF 672 00:26:21,080 --> 00:26:21,880 EXISTING UNDERLYING CVD, CAN YOU 673 00:26:21,880 --> 00:26:23,160 IMAGINE THEN THAT THOSE THAT 674 00:26:23,160 --> 00:26:25,400 HAVE THAT WOULD BE MORE AT RISK 675 00:26:25,400 --> 00:26:28,640 AND IN FACT, THAT'S WHAT THIS 676 00:26:28,640 --> 00:26:29,440 PUBLICATION DEMONSTRATES AND 677 00:26:29,440 --> 00:26:32,280 BECAUSE OF THE SEX, AGE 678 00:26:32,280 --> 00:26:37,160 DIFFERENCE, WOMEN ON AVERAGE GET 679 00:26:37,160 --> 00:26:38,680 THEIR CVD LATER THAN WOMEN ON 680 00:26:38,680 --> 00:26:41,680 MEN THIS IT IS ON AVERAGE THEN 681 00:26:41,680 --> 00:26:43,440 MORE MEN WERE DYING OF 682 00:26:43,440 --> 00:26:46,280 CARDIOVASCULAR DISEASE BECAUSE 683 00:26:46,280 --> 00:26:46,720 OF UNDERLYING CVD. 684 00:26:46,720 --> 00:26:48,560 THERE WAS ALSO A HIGHER BURDEN 685 00:26:48,560 --> 00:26:50,960 OF SMOKING AND OBESITY IN MEN. 686 00:26:50,960 --> 00:26:53,960 AND THEN WE'LL DIVE INTO SOME OF 687 00:26:53,960 --> 00:26:55,160 THE CARDIAC INFLAMMATION. 688 00:26:55,160 --> 00:26:57,120 NOW NOTABLY LOAMACY WERE NO SEX 689 00:26:57,120 --> 00:26:59,760 DIFFERENCES OBSERVED IN THE 690 00:26:59,760 --> 00:27:00,920 ARRHYTHMIAS AND THE THROMBOSIS 691 00:27:00,920 --> 00:27:04,720 AND THAT'S NOTE WORTHY BECAUSE 692 00:27:04,720 --> 00:27:06,560 WOMEN SUFFERED 693 00:27:06,560 --> 00:27:07,840 DISPROPORTIONATELY FROM 694 00:27:07,840 --> 00:27:10,120 THROMBOSIS DOMINANTLY RELATED TO 695 00:27:10,120 --> 00:27:11,200 EXOGENOUS AND ENDOGENOUS AS THAT 696 00:27:11,200 --> 00:27:12,360 MIGHT BE A CLUE AS WE WERE 697 00:27:12,360 --> 00:27:15,200 TALKING ABOUT IN THE SUMMARY. 698 00:27:15,200 --> 00:27:17,600 HIGHER MORTALITY OF CVD 19 IN 699 00:27:17,600 --> 00:27:18,080 MALES. 700 00:27:18,080 --> 00:27:20,640 THIS IS A BROAD BRUSH, I'M NOT 701 00:27:20,640 --> 00:27:22,240 AN IMMUNOLOGIST BUT WE DO 702 00:27:22,240 --> 00:27:24,320 RECOGNIZE THE ROLE OF THE IMMUNE 703 00:27:24,320 --> 00:27:26,360 SYSTEM AND THE CARDIOVASCULAR 704 00:27:26,360 --> 00:27:27,280 DISEASE AND VASCULAR 705 00:27:27,280 --> 00:27:29,040 INFLAMMATION SO OF COURSE A 706 00:27:29,040 --> 00:27:30,000 HIGHER ANTIVIRAL RESPONSE HAS 707 00:27:30,000 --> 00:27:34,120 BEEN NOTED IN FEMALES GREATER 708 00:27:34,120 --> 00:27:35,520 VIRAL CLEARANCE SO MEN DO WORSE 709 00:27:35,520 --> 00:27:37,800 IN THAT REGARD AND THEN A 710 00:27:37,800 --> 00:27:39,240 CYTOKINE RELEASE SYNDROME, MUCH 711 00:27:39,240 --> 00:27:41,520 HIGHER IN MALES AND THIS THEN 712 00:27:41,520 --> 00:27:45,240 LEADS TO THE 2 PATHS OF DEATH, 713 00:27:45,240 --> 00:27:46,320 ARDS AND CARDIOVASCULAR 714 00:27:46,320 --> 00:27:46,680 COMPLICATIONS. 715 00:27:46,680 --> 00:27:48,640 SO THIS IS AN IMPORTANT SEX 716 00:27:48,640 --> 00:27:50,160 DIFFERENCE THAT'S PROBABLY 717 00:27:50,160 --> 00:27:50,760 BIOLOGIC. 718 00:27:50,760 --> 00:27:52,360 SO THEN, HERE'S THE SIMPLE 719 00:27:52,360 --> 00:27:53,800 ANSWER TO THIS COMPLICATED 720 00:27:53,800 --> 00:27:56,000 QUESTION, SO LET'S JUST TARGET 721 00:27:56,000 --> 00:27:57,320 SEX DIFFERENCES IN IMMUNE 722 00:27:57,320 --> 00:27:57,720 FUNCTION, RIGHT? 723 00:27:57,720 --> 00:28:00,280 WELL, IF YOU GO TO OUR GOOD 724 00:28:00,280 --> 00:28:02,960 FRIEND AND COLLEAGUE DR. SABRE 725 00:28:02,960 --> 00:28:04,920 CLIEN'S LAB, YOU CAN SEE FROM 726 00:28:04,920 --> 00:28:07,840 THIS PUBLICATION THAT CHANGES IN 727 00:28:07,840 --> 00:28:09,200 IMMUNE RESPONSES, SEX 728 00:28:09,200 --> 00:28:10,160 DIFFERENCES BETWEEN WOMEN AND 729 00:28:10,160 --> 00:28:14,520 MEN, BOYS AND GIRLS, BABIES, 730 00:28:14,520 --> 00:28:17,520 VARY OVER TIME AND IMPORTANTLY 731 00:28:17,520 --> 00:28:18,680 WORSE FEMALE OUTCOMES HAVE BEEN 732 00:28:18,680 --> 00:28:26,720 OBSERVED IN OTHER VIRAL 733 00:28:26,720 --> 00:28:27,320 CONDITIONS, [INDISCERNIBLE], 734 00:28:27,320 --> 00:28:30,440 HSV2, AND THE MEASLES VIRUS, AND 735 00:28:30,440 --> 00:28:32,080 IAV, SO IT'S NOTTICISM THEY'LL 736 00:28:32,080 --> 00:28:33,840 WE WOULD TARGET SEX DIFFERENCES 737 00:28:33,840 --> 00:28:35,160 IN THE IMMUNE SYSTEM. 738 00:28:35,160 --> 00:28:36,280 WHAT ABOUT THE SECOND WAVE AND 739 00:28:36,280 --> 00:28:38,360 WHAT SCIENCE DO WE HAVE ABOUT 740 00:28:38,360 --> 00:28:40,120 THE IMPACT OF DELAY AND DEFERRED 741 00:28:40,120 --> 00:28:42,160 CARE RELATED TO THE PANDEMIC AND 742 00:28:42,160 --> 00:28:43,560 OBVIOUSLY A LOT OF PEOPLE WERE 743 00:28:43,560 --> 00:28:47,680 AFRAID TO COME IN. 744 00:28:47,680 --> 00:28:49,440 HERE'S A PREPRINT FROM OUR 745 00:28:49,440 --> 00:28:51,080 GROUP, THIS IS IMPRESS SECOND 746 00:28:51,080 --> 00:28:53,920 WAVE IMPACT OF DELAY SO WE TOOK 747 00:28:53,920 --> 00:28:56,280 SORT OF 1 OF THE MOST LETHAL 748 00:28:56,280 --> 00:28:58,680 FORMS OF CARDIOVASCULAR DISEASE 749 00:28:58,680 --> 00:29:00,400 THAT ST SEGMENT ELEVATION, MI, 750 00:29:00,400 --> 00:29:01,200 THAT'S WHAT WE TALKED ABOUT 751 00:29:01,200 --> 00:29:03,680 EARLIER AND IT WAS PRESENTING IN 752 00:29:03,680 --> 00:29:05,480 PATIENTS UNDER30 AS WELL AS 753 00:29:05,480 --> 00:29:06,880 DEFERRED AND DELAYED CARE 754 00:29:06,880 --> 00:29:08,240 MEANING PEOPLE DIDN'T COME IN, 755 00:29:08,240 --> 00:29:11,720 SO THIS IS A GOOD 1 TO LOOK AT 756 00:29:11,720 --> 00:29:13,040 BECAUSE CORONARY HEART DISEASE 757 00:29:13,040 --> 00:29:14,200 AND IS A LARGER CONTRIBUTOR AS 758 00:29:14,200 --> 00:29:16,640 WE SAW IN THAT PANEL 1 AND SO 759 00:29:16,640 --> 00:29:19,080 WHAT WE SEE IN THE SEX 760 00:29:19,080 --> 00:29:22,840 DIFFERENCES IN THIS REGISTRY 761 00:29:22,840 --> 00:29:25,320 STUDY, IS RELATIVELY MORE MEN, 762 00:29:25,320 --> 00:29:29,240 THEY HAVE THESE STEMI TYPE OF 763 00:29:29,240 --> 00:29:31,080 HEART ATTACKS,ET WOMEN ARE 764 00:29:31,080 --> 00:29:32,440 USUALLY OLDER, THEY'RE LIKELY TO 765 00:29:32,440 --> 00:29:34,400 BE DIABETIC OR HAVE A PRIOR 766 00:29:34,400 --> 00:29:36,520 HISTORY OF STROKE AND IMPORTANT 767 00:29:36,520 --> 00:29:38,480 SEX DIFFERENCES, THE EQUAL MORE 768 00:29:38,480 --> 00:29:40,400 OR LESS PRESENTING WITH CHEST 769 00:29:40,400 --> 00:29:41,960 PAIN THANKFULLY BUT MEN ARE MORE 770 00:29:41,960 --> 00:29:43,520 LIKELY TO HAVE WHAT'S CALLED A 771 00:29:43,520 --> 00:29:44,440 CORPORATE VESSEL WHICH THEN WE 772 00:29:44,440 --> 00:29:46,440 CAN OPEN UP WITH 1 OF THOSE 773 00:29:46,440 --> 00:29:49,200 STINTS AND THOSE ARE LIFE SAVING 774 00:29:49,200 --> 00:29:50,360 IN THAT REGARD APPROXIMATE SO 775 00:29:50,360 --> 00:29:51,880 WHAT YOU SEE IS AT THE END OF 776 00:29:51,880 --> 00:29:55,000 ALL THESE SEX DIFFERENCES, 777 00:29:55,000 --> 00:29:56,080 MORTALITY WAS ABOUT THE SAME. 778 00:29:56,080 --> 00:29:59,520 WHEN WE THEN ADJUST ALL OF THESE 779 00:29:59,520 --> 00:30:00,840 DATA, YOU CAN SEE THAT THE 780 00:30:00,840 --> 00:30:02,560 RELATIVE RISK IS ABOUT THE SAME 781 00:30:02,560 --> 00:30:05,440 BETWEEN WOMEN AND MEN. 782 00:30:05,440 --> 00:30:06,760 SO WOO CAN ANTICIPATE IN THE 783 00:30:06,760 --> 00:30:08,160 SECOND WAVE THAT WE'RE GOING TO 784 00:30:08,160 --> 00:30:11,080 SEE A LOT OF PATIENTS WITH 785 00:30:11,080 --> 00:30:12,360 DEFERRED AND DELAYED CARE AND WE 786 00:30:12,360 --> 00:30:14,760 HAVE A LOT OF CATCH UP TO DO. 787 00:30:14,760 --> 00:30:18,760 I SPENT A FULL DAY IN CLINIC 788 00:30:18,760 --> 00:30:20,000 THIS WEEK OVERBOOKING BECAUSE OF 789 00:30:20,000 --> 00:30:21,880 THIS DEFERRED AND DELAYED CARE. 790 00:30:21,880 --> 00:30:23,800 LET'S TALK BRIEFLY THEN ABOUT 791 00:30:23,800 --> 00:30:28,120 THE THIRD WAVE BECAUSE--OOPS 792 00:30:28,120 --> 00:30:30,240 THIS NEEDS--NEEDS SCIENCE, THERE 793 00:30:30,240 --> 00:30:31,840 IT IS. 794 00:30:31,840 --> 00:30:36,280 SO HERE'S AN UPTO DATE NATURE 795 00:30:36,280 --> 00:30:37,800 MEDICINE SUMMARY OF DATA 796 00:30:37,800 --> 00:30:41,960 REGARDING WHAT WE WOULD CALL 797 00:30:41,960 --> 00:30:46,120 MAYBE LONG HALL OR POST ACUTE 798 00:30:46,120 --> 00:30:46,800 COVID-19 COMPOSITE 799 00:30:46,800 --> 00:30:47,960 CARDIOVASCULAR OUTCOMES COMPARED 800 00:30:47,960 --> 00:30:50,160 TO A CONTEMPORARY CONTROL COHORT 801 00:30:50,160 --> 00:30:54,040 MEANING THEY DID NOT GET 802 00:30:54,040 --> 00:30:54,800 INFECTED WITH COVID-19. 803 00:30:54,800 --> 00:30:58,600 AND IT'S DIVIDED AGAIN INTO 804 00:30:58,600 --> 00:31:00,360 THESE CATEGORIES, CEREBRAL 805 00:31:00,360 --> 00:31:01,440 VASCULAR DISRYTH MIAS, INFLAMMA 806 00:31:01,440 --> 00:31:02,880 TOREVALUATION PROCESS HEART 807 00:31:02,880 --> 00:31:05,040 DISEASE, OUR MY O CARDITEIS, 808 00:31:05,040 --> 00:31:07,360 ESCHEMIC HEART DISEASE, THE BIG 809 00:31:07,360 --> 00:31:08,760 KILLER, OTHER CARDIAC DISORDERS, 810 00:31:08,760 --> 00:31:10,680 THE BLOOD CLOTS AND THEN THIS IS 811 00:31:10,680 --> 00:31:12,320 A SUMMARY OF ANY CARDIAC OUTCOME 812 00:31:12,320 --> 00:31:15,960 AND WHAT YOU CAN SEE IS THAT MEN 813 00:31:15,960 --> 00:31:18,600 AND WOMEN ARE PRETTY MUCH 814 00:31:18,600 --> 00:31:21,880 EQUALLY LIKELY AND IIS A 2 815 00:31:21,880 --> 00:31:24,840 FOLD INCREASE IN CARDIOVASCULAR 816 00:31:24,840 --> 00:31:28,800 DISEASE BECAUSE OF THE INFECTION 817 00:31:28,800 --> 00:31:31,680 OF COVID-19. 818 00:31:31,680 --> 00:31:32,440 THIS IS CRITICALLY IMPORTANT 819 00:31:32,440 --> 00:31:34,120 THIS IS DIFFERENT FROM OH MY 820 00:31:34,120 --> 00:31:36,200 GOODNESS I GAINED 10-POUNDS OR 821 00:31:36,200 --> 00:31:37,680 OH MY GOODNESS I SMOKED MORE 822 00:31:37,680 --> 00:31:40,400 BECAUSE I WAS STRESSED. 823 00:31:40,400 --> 00:31:43,040 THIS IS CRITICALLY IMPORTANT. 824 00:31:43,040 --> 00:31:44,400 NEW PUTATIVE MECHANISMS, THESE 825 00:31:44,400 --> 00:31:46,120 INVESTIGATORS WENT FORD WITH 826 00:31:46,120 --> 00:31:49,080 THEIR MECHANISMS, HOW ABOUT 827 00:31:49,080 --> 00:31:50,120 ENDOTHELLITEIS, THAT'S 828 00:31:50,120 --> 00:31:52,080 ENDOTHELIAL DYSFUNCTION, HOW 829 00:31:52,080 --> 00:31:53,160 ABOUT COAGULATION AND CO AG 830 00:31:53,160 --> 00:31:56,680 LOPATHY, WE HAVE DRUGS FOR THIS, 831 00:31:56,680 --> 00:31:57,880 WHAT ABOUT ANTIINFLAMMATORY 832 00:31:57,880 --> 00:31:59,000 INTERVENTIONS, WE HAVE DRUGS 833 00:31:59,000 --> 00:32:00,880 THAT HAVE BEEN TESTED FOR 834 00:32:00,880 --> 00:32:01,920 CARDIOVASCULAR DISEASE, WE COULD 835 00:32:01,920 --> 00:32:04,960 TRY THESE FOR COVID-19. 836 00:32:04,960 --> 00:32:07,000 WHAT ABOUT ANTICO AGULATE 837 00:32:07,000 --> 00:32:07,440 INTERVENTIONS? 838 00:32:07,440 --> 00:32:08,800 SO THAT WILL BE IMPORTANT AS WE 839 00:32:08,800 --> 00:32:09,400 GO FORWARD. 840 00:32:09,400 --> 00:32:11,080 OF COURSE, A LOT OF PEOPLE DID 841 00:32:11,080 --> 00:32:13,960 GAIN WEIGHT AND IN FACT, THE 842 00:32:13,960 --> 00:32:17,480 AVERAGE AMERICAN GAINED 843 00:32:17,480 --> 00:32:17,760 10-POUNDS. 844 00:32:17,760 --> 00:32:19,720 I DIDN'T GAIN ANYONE, SO 845 00:32:19,720 --> 00:32:20,760 SOMEBODY GAINED 20 FOR ME, THIS 846 00:32:20,760 --> 00:32:24,040 WILL BE A HUGE BURDEN, WE ALSO 847 00:32:24,040 --> 00:32:25,600 KNOW THIS PROPORTIONATELY 848 00:32:25,600 --> 00:32:26,360 IMPACTED WOMEN. 849 00:32:26,360 --> 00:32:28,560 WOMEN WERE MORE LIKELY TO DEFER 850 00:32:28,560 --> 00:32:30,680 CARE, SO I WILL LEAVE YOU WITH 851 00:32:30,680 --> 00:32:33,080 THESE 3 QUESTIONS: WHAT IMMUNE 852 00:32:33,080 --> 00:32:35,400 SPECIFIC THERAPIES CAN ADDRESS 853 00:32:35,400 --> 00:32:37,480 ACUTE COVID RELATED CVD, WE 854 00:32:37,480 --> 00:32:39,480 SHOULD LOOK AT CROSS-TALK 855 00:32:39,480 --> 00:32:40,640 BETWEEN IMMUNE MEDIATED AND 856 00:32:40,640 --> 00:32:41,520 VASCULAR INFLAMMATION AND WE 857 00:32:41,520 --> 00:32:43,200 HAVE DRUGS, WE HAVE DRUGS FOR 858 00:32:43,200 --> 00:32:45,880 THAT ALREADY STOABED IN 859 00:32:45,880 --> 00:32:48,080 CARDIOVASCULAR DEC. 860 00:32:48,080 --> 00:32:49,680 WHAT EXISTING CARDIOVASCULAR, 861 00:32:49,680 --> 00:32:50,600 METABOLIC AND IMMUNOLOGIC 862 00:32:50,600 --> 00:32:51,880 THERAPIES ARE EFFECTIVE, WE HAVE 863 00:32:51,880 --> 00:32:54,520 A LOT OF CROSS TALK WITH LUPUS 864 00:32:54,520 --> 00:32:57,200 AND RA DRUGS AND EFFECTIVE 865 00:32:57,200 --> 00:32:59,120 STRATEGIES ARE CVD AND THEN WHAT 866 00:32:59,120 --> 00:33:02,200 SCORES CAN IDENTIFY THESE COVID 867 00:33:02,200 --> 00:33:03,680 RELATED INCREASED CVD, IT'S A 2 868 00:33:03,680 --> 00:33:05,960 FOLD INCREASE, WE FLEED TO FIND 869 00:33:05,960 --> 00:33:07,360 THOSE PEOPLE, NOT EVERYBODY IS 870 00:33:07,360 --> 00:33:10,000 AT RISK AND TREAT THEM 871 00:33:10,000 --> 00:33:10,640 APPROPRIATELY WITH PREVENTIVE 872 00:33:10,640 --> 00:33:11,680 STRATEGIES THAT WE KNOW WORK. 873 00:33:11,680 --> 00:33:15,280 SO I WILL CLOSE WITH THAT AND 874 00:33:15,280 --> 00:33:18,680 THANK YOU FOR THIS IMPORTANT 875 00:33:18,680 --> 00:33:18,960 SYMPOSIUM. 876 00:33:18,960 --> 00:33:19,320 >> THANK YOU. 877 00:33:19,320 --> 00:33:27,280 THAT WAS A WONDERFUL OVERVIEW 878 00:33:27,280 --> 00:33:37,800 AND I WILL NOW GET MY SLIDES UP. 879 00:33:41,000 --> 00:33:43,440 >> SO WE HAVE A LONG HISTORY OF 880 00:33:43,440 --> 00:33:45,400 STUDYING SEX DIFFERENCES, IN THE 881 00:33:45,400 --> 00:33:47,280 1980S IT STARTED WITH SALLY 882 00:33:47,280 --> 00:33:48,480 HUBER AND I'VE BEEN STUDYING 883 00:33:48,480 --> 00:33:50,240 THEM FOR THE LAST 20 YEARS AND 884 00:33:50,240 --> 00:33:52,360 THIS STUDY BY DENNIS 885 00:33:52,360 --> 00:33:53,840 Mc NAMARRA THIS 2011 DIDN'T 886 00:33:53,840 --> 00:33:55,400 INTEND TO LOOK AT SEX 887 00:33:55,400 --> 00:33:56,440 DIFFERENCES BUT ACTUALLY FOUND 888 00:33:56,440 --> 00:33:59,320 THAT MEN PROGRESSED FROM MY O 889 00:33:59,320 --> 00:34:01,480 CARDITEIS TO DILATED 890 00:34:01,480 --> 00:34:02,600 CARDIOMYOPATHY WHILE WOMEN 891 00:34:02,600 --> 00:34:03,320 TYPICALLY RECOVER. 892 00:34:03,320 --> 00:34:05,160 AND THIS HIGHLIGHTS A REALLY 893 00:34:05,160 --> 00:34:05,880 IMPORTANT ISSUE ABOUT MY O 894 00:34:05,880 --> 00:34:07,320 CARDITEIS AND THAT IS 895 00:34:07,320 --> 00:34:09,000 CLINICALLY, WE USUALLY DO NOT 896 00:34:09,000 --> 00:34:13,200 CATCH ACUTE MY O CARDITEIS AND 897 00:34:13,200 --> 00:34:14,720 IT--ACUTE MY O CARDITEIS LASTS 898 00:34:14,720 --> 00:34:17,200 FOR ONLY A FEW DAYS AND MY O 899 00:34:17,200 --> 00:34:19,040 CARDITEIS IS A DIAGNOSIS OF 900 00:34:19,040 --> 00:34:20,840 EXCLUSION, IT'S USUALLY THE LAST 901 00:34:20,840 --> 00:34:21,760 THING THAT'S CONSIDERED IN 902 00:34:21,760 --> 00:34:23,280 EVERYTHING ELSE IS CONSIDERED 903 00:34:23,280 --> 00:34:25,440 FIRST, SO IT'S OFTEN CALLED 904 00:34:25,440 --> 00:34:26,000 ACUTE CARDIO MIRROR IMAGE 905 00:34:26,000 --> 00:34:26,680 OPERATING GLOBALLYATHY THAT 906 00:34:26,680 --> 00:34:28,680 WE'RE LOOKING AT AND WE'VE GONE 907 00:34:28,680 --> 00:34:30,600 PAST THE WAXER CUTE PHASE GOING 908 00:34:30,600 --> 00:34:32,600 INTO A CHRONIC PHASE WHERE WE 909 00:34:32,600 --> 00:34:35,320 REALLY PICK UP--START TO PICK UP 910 00:34:35,320 --> 00:34:36,840 NECROSIS AND FIBROSIS AS IT 911 00:34:36,840 --> 00:34:38,040 PROGRESSES TO THAT PHASE WHICH 912 00:34:38,040 --> 00:34:41,960 IS MORE EASILY PICKED UP ON 913 00:34:41,960 --> 00:34:45,240 IMAGES AND CARDIAC MRI AND WE 914 00:34:45,240 --> 00:34:46,800 SEE THIS REALLY IN OUR ANIMAL 915 00:34:46,800 --> 00:34:50,600 MODEL THAT I DEVELOPED AS A POST 916 00:34:50,600 --> 00:34:53,560 DOC BACK IN 2000 AND WITH THIS 917 00:34:53,560 --> 00:34:57,640 ANIMAL MODEL WE USE HUMAN 918 00:34:57,640 --> 00:34:58,680 [INDISCERNIBLE] VIRUS, WHAT I 919 00:34:58,680 --> 00:35:00,160 DIDN'T REALIZE AT THE TIME WHEN 920 00:35:00,160 --> 00:35:02,160 I DEVELOPED IT, I DEVELOPED IT 921 00:35:02,160 --> 00:35:04,800 AS AN AUTOIMMUNE MODEL AND IT 922 00:35:04,800 --> 00:35:06,320 ACTUALLY REALLY REQUIRES VIRUS 923 00:35:06,320 --> 00:35:08,000 AND MITOCHONDRIA TO INDUCE THE 924 00:35:08,000 --> 00:35:08,480 DISEASE. 925 00:35:08,480 --> 00:35:10,240 WE GET ACUTE INFLAMMATION THAT'S 926 00:35:10,240 --> 00:35:12,680 MUCH HIGHER IN MALES DURING 927 00:35:12,680 --> 00:35:15,600 ACUTE MY O CARDITE EXPIS ALSO IN 928 00:35:15,600 --> 00:35:16,440 THE DILATED CARDIOMYOPATHY PHASE 929 00:35:16,440 --> 00:35:17,560 AND EVERYTHING WE EXAMINED IN 930 00:35:17,560 --> 00:35:19,400 THIS MODEL AND LOOKED AT IN 931 00:35:19,400 --> 00:35:20,480 PATIENTS FOLLOWS THE SAME TIME 932 00:35:20,480 --> 00:35:22,360 COURSE AND THE SAME SEX 933 00:35:22,360 --> 00:35:24,400 DIFFERENCES IN THE IMMUNE 934 00:35:24,400 --> 00:35:24,760 RESPONSE. 935 00:35:24,760 --> 00:35:27,040 WE ALSO SEE THIS PROGRESSION TO 936 00:35:27,040 --> 00:35:29,280 DCM MAINLY IN MAILS AND MUCH 937 00:35:29,280 --> 00:35:32,720 LESS IN FEMALES, AND WE ALSO SEE 938 00:35:32,720 --> 00:35:36,760 THAT THERE IS NO NECROSIS OR 939 00:35:36,760 --> 00:35:37,600 FIBROSIS DURING THE ACUTE PHASE 940 00:35:37,600 --> 00:35:39,120 AND ACTUALLY THE TYPE OF IMMUNE 941 00:35:39,120 --> 00:35:45,160 RESPONSE IS WHAT DRIVES 942 00:35:45,160 --> 00:35:47,000 FIBROSEIS WHICH HAPPENS LATER 943 00:35:47,000 --> 00:35:51,760 AND SO TO SUMMARIZE LOTS OF DATA 944 00:35:51,760 --> 00:36:01,840 CLINICALLY IS WHAT'S CALLED 945 00:36:01,840 --> 00:36:03,040 LYMPHOCYTIC CARDITEIS AND THE 946 00:36:03,040 --> 00:36:05,560 MICE AND HUMANS HAVE A 947 00:36:05,560 --> 00:36:10,920 DIFFICULTY SURVIVING THAT, BUT 948 00:36:10,920 --> 00:36:13,040 DON'T IT'S A WHITE DISEASE IN 949 00:36:13,040 --> 00:36:19,560 PATIENTS AND MAINLY MALES AND 950 00:36:19,560 --> 00:36:20,920 PROGRESSES TO CARDIO MYOP APGHT 951 00:36:20,920 --> 00:36:25,760 EXPE THAT'S DRIVEN BY 952 00:36:25,760 --> 00:36:29,760 TESTOSTERONE AND ACUTE PHASES 953 00:36:29,760 --> 00:36:32,000 THAT ARE TOLL-LIKE RECEPTOR 4 954 00:36:32,000 --> 00:36:32,840 AND DRIVE THIS MACROFAJ TYPE 955 00:36:32,840 --> 00:36:34,800 RESPONSE THAT IS PRO 956 00:36:34,800 --> 00:36:36,440 INFLAMMATORY AND THIS IS IN 957 00:36:36,440 --> 00:36:37,840 CONTRAST TO E-MAILS WHERE 958 00:36:37,840 --> 00:36:39,360 ESTROGEN IS PROTECT EVALUATION 959 00:36:39,360 --> 00:36:40,640 PROCESS AND THEY PRODUCE EVERY 960 00:36:40,640 --> 00:36:44,280 IMMUNE FACTOR THAT CAN BE 961 00:36:44,280 --> 00:36:46,720 PROTECTIVE INCLUDING IL10, 962 00:36:46,720 --> 00:36:50,960 TREGULATORY CELLS AND REALLY 963 00:36:50,960 --> 00:36:51,960 ANTIINFLAMMATORY MACROPHAGES. 964 00:36:51,960 --> 00:36:53,840 SO WE LOOKED AT SOLIEWNL ST2, 965 00:36:53,840 --> 00:36:56,760 THIS IS PART OF THE TLR 4 IL1 966 00:36:56,760 --> 00:36:59,120 RECEPTOR COMPLEX AND WHEN IT'S 967 00:36:59,120 --> 00:37:00,320 CLEAVED TO SOLUBLE ST2 HAS BEEN 968 00:37:00,320 --> 00:37:02,880 FOUND TO BE A GOOD BIOMARKER OF 969 00:37:02,880 --> 00:37:04,200 HEART FAILURE IN NO MATTER WHO 970 00:37:04,200 --> 00:37:05,760 TYPE OF HEART DISEASE YOU LOOK 971 00:37:05,760 --> 00:37:06,240 AT. 972 00:37:06,240 --> 00:37:07,400 WE LOOKEDDA THE MY O CARDITEIS 973 00:37:07,400 --> 00:37:11,440 PATIENTS AND SEE THAT IT IS 974 00:37:11,440 --> 00:37:14,000 INCREASED IN MALES AND NOT 975 00:37:14,000 --> 00:37:15,640 FEMALES BUT ONLY IN MALES UNDER 976 00:37:15,640 --> 00:37:17,160 THE AGE OF 50 AND THIS 977 00:37:17,160 --> 00:37:20,080 HIGHLIGHTS THE IMPORTANCE OF 978 00:37:20,080 --> 00:37:23,640 LOOKING AT BIOMARKERS, AND OTHER 979 00:37:23,640 --> 00:37:25,240 FACTORS IN MY O CARDITEIS BY SEX 980 00:37:25,240 --> 00:37:26,560 AND AGE BECAUSE IT REALLY IS A 981 00:37:26,560 --> 00:37:28,680 DISEASE OF THE YOUNG AND 982 00:37:28,680 --> 00:37:30,520 PRIMARILY IN MEN AND SO WHAT 983 00:37:30,520 --> 00:37:33,800 ABOUT COVID MY O CARDITEIS AND 984 00:37:33,800 --> 00:37:34,320 VACCINES? 985 00:37:34,320 --> 00:37:36,360 WELL, THERE'S MANY PUBLICATIONS 986 00:37:36,360 --> 00:37:39,240 THAT HAVE SHOWN THAT SARS-COV-2 987 00:37:39,240 --> 00:37:40,600 THE IMMUNE RESPONSE THAT IT 988 00:37:40,600 --> 00:37:42,920 LEADS TO IS ELEVATED WITH THESE 989 00:37:42,920 --> 00:37:43,760 TYPES OF IMMUNE RESPONSES AND 990 00:37:43,760 --> 00:37:46,360 THAT THESE ARE ALL INCREASED IN 991 00:37:46,360 --> 00:37:49,960 MALES, CRP WHICH IS NOT IN MICE, 992 00:37:49,960 --> 00:37:53,120 TNF IL1, IL18 AND IL6 AND THE 993 00:37:53,120 --> 00:37:54,680 TH17 MONOCYTES AND MACROPHAGES 994 00:37:54,680 --> 00:37:56,680 AND THAT FEMALES HAVE MORE OF A 995 00:37:56,680 --> 00:37:59,480 T-CELL RESPONSE AND B-CELLS AND 996 00:37:59,480 --> 00:38:01,320 ANTIBODIES OR AUTOANTIBODIES 997 00:38:01,320 --> 00:38:03,160 WITH A LOT OF AUTOIMMUNE 998 00:38:03,160 --> 00:38:04,960 RESPONSES OR NUMBER OF 999 00:38:04,960 --> 00:38:08,480 AUTOIMMUNE DISEASES COMING OUT 1000 00:38:08,480 --> 00:38:09,040 OF COVID. 1001 00:38:09,040 --> 00:38:11,400 AND THIS IS EXACTLY THE RESPONSE 1002 00:38:11,400 --> 00:38:14,200 THAT WE HAVE BEEN PUBLISHING 1003 00:38:14,200 --> 00:38:16,160 MYSELF AND OTHER INVESTIGATORS 1004 00:38:16,160 --> 00:38:19,200 WITH MY O CARDITEIS BOTH IN OUR 1005 00:38:19,200 --> 00:38:21,080 ANIMAL MODELS AND IN PATIENTS 1006 00:38:21,080 --> 00:38:24,960 FOR MANYIERS NOW SO IT'S 1007 00:38:24,960 --> 00:38:25,880 REMARKABLE HOW SIMILAR IT IS AND 1008 00:38:25,880 --> 00:38:27,760 I ACTUALLY HAVE A REASON I THINK 1009 00:38:27,760 --> 00:38:28,600 IT'S SO SIMILAR THAT DOESN'T 1010 00:38:28,600 --> 00:38:30,320 HAVE DO SO MUCH WITH THE 1011 00:38:30,320 --> 00:38:31,120 VIRUS ITSELF. 1012 00:38:31,120 --> 00:38:32,520 SO 1 THING I WILL LIKE TO POINT 1013 00:38:32,520 --> 00:38:36,400 OUT IS WHEN WE LOOK AT ALL OF 1014 00:38:36,400 --> 00:38:37,560 THESE OUTCOMES, CARDIOVASCULAR 1015 00:38:37,560 --> 00:38:38,920 OUTCOMES FROM COVID AND WE THINK 1016 00:38:38,920 --> 00:38:41,000 OF MY O CARDITEIS, WELL THE 1017 00:38:41,000 --> 00:38:45,080 CYTOKINE STORM IS ACTUALLY THE 1018 00:38:45,080 --> 00:38:46,240 CLASSIC CYTOKINE PROFILE THAT'S 1019 00:38:46,240 --> 00:38:47,560 ALWAYS BEEN ASSOCIATE WIDE MY O 1020 00:38:47,560 --> 00:38:49,480 CARDITEIS AND IT JUST DEPENDS ON 1021 00:38:49,480 --> 00:38:52,440 HOW SEVERE IT IS, AND SO IT'S 1022 00:38:52,440 --> 00:38:55,440 EXACTLY THE SAME, ALSO 1023 00:38:55,440 --> 00:38:56,240 THROMBOSIS IS SOMETHING THAT 1024 00:38:56,240 --> 00:38:58,480 THIS KIND OF PROFILE IS KNOWN 1025 00:38:58,480 --> 00:39:01,760 WITH MY O CARDITEIS AND WE DO 1026 00:39:01,760 --> 00:39:07,920 SEE ON SOME SECTIONS THROMBI AND 1027 00:39:07,920 --> 00:39:11,680 WE ALSO SEE IT IN MURAL THROMBI. 1028 00:39:11,680 --> 00:39:16,520 SO IT'S QUITE SIMILAR TO COVID. 1029 00:39:16,520 --> 00:39:19,160 SO LOOKING AT VACCINES WE SEE 1030 00:39:19,160 --> 00:39:24,560 RNA VACCINES ARE CAUSING MY O 1031 00:39:24,560 --> 00:39:28,520 CARDITEIS, IT'S UNDER 30 YEARS 1032 00:39:28,520 --> 00:39:30,280 OF AGE, TYPICALLY NOT LASTING 1033 00:39:30,280 --> 00:39:31,080 LONG AFTER THE SECOND 1034 00:39:31,080 --> 00:39:32,040 VACCINATION BUT OF COURSE 1035 00:39:32,040 --> 00:39:33,120 COMPARED TO WHAT WAS HAPPENING 1036 00:39:33,120 --> 00:39:36,160 WITH COVID DURING THE PEAK OF 1037 00:39:36,160 --> 00:39:37,720 THE FIRST 2 YEARS WITH THOASES 1038 00:39:37,720 --> 00:39:42,640 STRAINS, THIS TYPE OF 1039 00:39:42,640 --> 00:39:45,160 VACCINATION, MWHY, OCARDITIS, IS 1040 00:39:45,160 --> 00:39:46,080 VERY DIFFERENT COMPARED TO WHAT 1041 00:39:46,080 --> 00:39:46,920 YOU SEE WITH COVID. 1042 00:39:46,920 --> 00:39:51,760 SOPHISTICATEDY WE KNOW THAT 1043 00:39:51,760 --> 00:39:53,640 MYOCARDITIS, WHICH IS MAINLY 1044 00:39:53,640 --> 00:39:56,040 LYMPHOCYTIC IN THE U.S., WE 1045 00:39:56,040 --> 00:39:57,200 SURVIVE AND MOST PEOPLE DON'T 1046 00:39:57,200 --> 00:40:00,320 DIE AND IT REALLY IS QUITE 1047 00:40:00,320 --> 00:40:01,480 SURVIVABLE BUT WITH COVID-19 WE 1048 00:40:01,480 --> 00:40:02,920 WERE SEEING MORE DEATHS AND 1049 00:40:02,920 --> 00:40:03,680 PROBABLY FOR MULTIPLE REASONS 1050 00:40:03,680 --> 00:40:06,400 BECAUSE THERE WAS A LOT OF OTHER 1051 00:40:06,400 --> 00:40:09,360 THINGS GOING ON AS WELL. 1052 00:40:09,360 --> 00:40:12,160 AND THAT THIS ARTICLE HAD REALLY 1053 00:40:12,160 --> 00:40:13,360 LOOKED AT POTENTIAL INCIDENTS OF 1054 00:40:13,360 --> 00:40:15,960 DISEASE WHICH IS NOT VERY HIGH 1055 00:40:15,960 --> 00:40:18,160 BUT WAS MUCH HIGHER WITH 1056 00:40:18,160 --> 00:40:20,640 COVID-19 AND THE VACCINATION 1057 00:40:20,640 --> 00:40:23,200 GROUP IS MUCH LOWER THAN THE 1058 00:40:23,200 --> 00:40:24,760 NORMAL INCIDENTS BUT THERE IS A 1059 00:40:24,760 --> 00:40:26,640 STUDY IN ISRAEL THAT LOOKED AT 2 1060 00:40:26,640 --> 00:40:29,360 AND HAEVERL MILLION 1061 00:40:29,360 --> 00:40:30,960 VACCINATED--HALF MILLION 1062 00:40:30,960 --> 00:40:33,360 VACCINATED PATIENTS AND GAVE AN 1063 00:40:33,360 --> 00:40:35,080 INCIDENCE AND ACTUALLY LOOKED AT 1064 00:40:35,080 --> 00:40:36,160 SEX DIFFERENCES SO THEY 1065 00:40:36,160 --> 00:40:39,160 ESTIMATED 2 OUT OF A HUNDRED 1066 00:40:39,160 --> 00:40:40,720 THOUSAND CASES BUT IN MALES IT 1067 00:40:40,720 --> 00:40:45,040 WAS 4 OUT OF A HUNDRED THOUSAND 1068 00:40:45,040 --> 00:40:47,560 WITH ONLY .23 IN FEMALES IN SEX 1069 00:40:47,560 --> 00:40:49,000 DIFFERENCES AND IF THEY LOOK AT 1070 00:40:49,000 --> 00:40:50,440 THOSE UNDER 30, IT WAS QUITE A 1071 00:40:50,440 --> 00:40:51,560 BIT HIGHER, SO THIS IS ACTUALLY 1072 00:40:51,560 --> 00:40:58,920 GETTING TO THE NUMBER THAT YOU 1073 00:40:58,920 --> 00:41:02,120 SEE WITH REGULAR MYOCARDITIS, 1074 00:41:02,120 --> 00:41:08,200 AND IT MIGHT BE CAUSING IT IN 1075 00:41:08,200 --> 00:41:09,680 MALES WITH MYOCARDITIS IN WHAT 1076 00:41:09,680 --> 00:41:11,360 WE SEE, SO SEX DIFFERENCES IN 1077 00:41:11,360 --> 00:41:12,880 METABOLISM, SO THIS IS A NEW 1078 00:41:12,880 --> 00:41:15,200 AREA THAT MY LAB IS STARTING TO 1079 00:41:15,200 --> 00:41:16,840 RESEARCH AND THIS IS UNPUBLISHED 1080 00:41:16,840 --> 00:41:19,560 WORK BUT WE ARE GETTING CLOSED 1081 00:41:19,560 --> 00:41:21,680 TO PUBLISHING, SO THIS IS AN 1082 00:41:21,680 --> 00:41:24,880 RNASEQ WHERE WE LOOK AT 1083 00:41:24,880 --> 00:41:26,360 MYOCARDITIS VERSUS CONTROL, MALE 1084 00:41:26,360 --> 00:41:28,320 AND FEMALE. 1085 00:41:28,320 --> 00:41:29,960 AND THE TAKE HOME MESSAGE FROM 1086 00:41:29,960 --> 00:41:32,880 THIS STUDY IS THAT WE SEE THAT 1087 00:41:32,880 --> 00:41:35,840 FEMALES REALLY HAVE 1088 00:41:35,840 --> 00:41:36,760 MITOCHONDRIAL HOMEOSTASIS DURING 1089 00:41:36,760 --> 00:41:39,080 ACUTE MYOCARDITIS AND MALES 1090 00:41:39,080 --> 00:41:42,600 UPREGULATE VIRAL INFECTION GENES 1091 00:41:42,600 --> 00:41:43,160 AND INFLAMMATORY GENES. 1092 00:41:43,160 --> 00:41:44,680 THAT SEEMS LIKE A GOOD THING TO 1093 00:41:44,680 --> 00:41:46,960 DO EXCEPT WHAT WE HAVE SHOWN AND 1094 00:41:46,960 --> 00:41:49,880 FOUND WITH THIS IS THEY 1095 00:41:49,880 --> 00:41:52,600 UPREGULATE COMPLEMENTSES AND 1096 00:41:52,600 --> 00:41:54,160 THEY UPREGULATE STORMS AND 1097 00:41:54,160 --> 00:41:55,680 CYTOKINES AND EVERYTHING THAT 1098 00:41:55,680 --> 00:41:58,160 LEADS TO REMODELING, A BAD 1099 00:41:58,160 --> 00:41:58,880 OUTCOME FOR MALES. 1100 00:41:58,880 --> 00:42:02,000 AND SO, WE WERE ABLE TO LOOK 1101 00:42:02,000 --> 00:42:04,480 THEN AND SEE, JUST WHAT COULD BE 1102 00:42:04,480 --> 00:42:06,440 HELPING FEMALES, AND WE FOUND 2 1103 00:42:06,440 --> 00:42:09,640 GENES THAT ARE KNOWN TO BE 1104 00:42:09,640 --> 00:42:10,200 REGULATORS OF MITOCHONDRIAL 1105 00:42:10,200 --> 00:42:11,880 HOMEOSTASIS THAT ARE HIGHER IN 1106 00:42:11,880 --> 00:42:14,280 FEMALES AND 1 IS ESTROGEN 1107 00:42:14,280 --> 00:42:17,080 RELATED RECEPTOR AND THE OTHER 1108 00:42:17,080 --> 00:42:19,280 IS PGC-1 ALPHA SO THAT CAN 1109 00:42:19,280 --> 00:42:20,120 EXPLAIN THIS GLOBAL CHANGE 1110 00:42:20,120 --> 00:42:26,360 THAT'S GOING ON IN MALES VERSUS 1111 00:42:26,360 --> 00:42:27,560 FEMALES WITH THE MITOCHONDRIA. 1112 00:42:27,560 --> 00:42:29,560 SO WHY DO ALL OF THESE VIRUSES 1113 00:42:29,560 --> 00:42:31,080 WHICH REALLY HAVE NO VIRAL 1114 00:42:31,080 --> 00:42:32,720 TROAPISM FOR THE HEART ARE ABLE 1115 00:42:32,720 --> 00:42:34,840 TO CAUSE MY O CARDITEIS, AND SO, 1116 00:42:34,840 --> 00:42:36,800 1 THING THAT ALL THESE VIRUSES 1117 00:42:36,800 --> 00:42:40,120 SHARE IS THE ABILITY THAT THEY 1118 00:42:40,120 --> 00:42:42,600 GO IN AND THEY TARGET 1119 00:42:42,600 --> 00:42:42,920 MITOCHONDRIA. 1120 00:42:42,920 --> 00:42:45,680 AND SO I'LL JUST HIGHLIGHT THE 1121 00:42:45,680 --> 00:42:50,640 SPIKE PROTEIN HAS BEEN FOUND 1122 00:42:50,640 --> 00:42:52,440 TO--SARS-COV-2 TO INTERACT WITH 1123 00:42:52,440 --> 00:42:53,640 MITOCHONDRIA, THERE'S A COUPLE 1124 00:42:53,640 --> 00:42:54,400 PAPERS HERE SHOWING THAT. 1125 00:42:54,400 --> 00:42:56,480 THE HEART IS THE HIGHEST LEVEL 1126 00:42:56,480 --> 00:42:59,240 OF MITOCHONDRIA OUTSIDE OF THE 1127 00:42:59,240 --> 00:43:00,880 BRAIN AND OF COURSE VIRUSES 1128 00:43:00,880 --> 00:43:03,960 TYPICALLY CAN'T GET TO THE BRAIN 1129 00:43:03,960 --> 00:43:07,840 AND SO CVD3 HAS BEEN SHOWN TO 1130 00:43:07,840 --> 00:43:11,080 ACQUIRE MITOCHONDRIA AND TO REP 1131 00:43:11,080 --> 00:43:11,360 LAYICATE. 1132 00:43:11,360 --> 00:43:14,440 AND WE FOUND DURING MYOCARDITIS 1133 00:43:14,440 --> 00:43:17,840 THAT EVs THAT CONTAIN THE 1134 00:43:17,840 --> 00:43:19,080 MITOCHONDRIA IN AND OUT OF THE 1135 00:43:19,080 --> 00:43:22,400 BRAIN ARE RELEASED DURING ACUTE 1136 00:43:22,400 --> 00:43:24,880 MYOCARDITIS AND THESE EVs 1137 00:43:24,880 --> 00:43:26,440 CONTAIN INFECTIOUS VIRUS AND THE 1138 00:43:26,440 --> 00:43:28,760 VIRUS COMING FROM THE HEART ARE 1139 00:43:28,760 --> 00:43:31,280 IN THESE EVs AND THERE'S THIS 1140 00:43:31,280 --> 00:43:34,400 SEX DIFFERENCES IN DRP 1 WHICH 1141 00:43:34,400 --> 00:43:37,160 IS THE FISSION, SO WE SEE MORE 1142 00:43:37,160 --> 00:43:41,000 MALE VS DRP1 AND THIS ALLOWS THE 1143 00:43:41,000 --> 00:43:43,840 VIRUS TO ESCAPE AND MORE 1144 00:43:43,840 --> 00:43:45,680 AUTOPHAGY SEEN THROUGH PARKIN 1145 00:43:45,680 --> 00:43:48,040 WHICH CAUSES THESE EVs TO 1146 00:43:48,040 --> 00:43:49,360 RELEASE AND IT TURNS OUT THAT 1147 00:43:49,360 --> 00:43:50,560 THIS IS REALLY WHAT WE WERE 1148 00:43:50,560 --> 00:43:52,440 USING TO INFECT IN OUR ANIMAL 1149 00:43:52,440 --> 00:43:54,800 MODEL TO INDUCE THIS DISEASE. 1150 00:43:54,800 --> 00:43:59,120 SO IN SUMMARY, WE SEE THAT MALES 1151 00:43:59,120 --> 00:44:00,120 HAVE MORE MYOCARDITIS, IT'S MORE 1152 00:44:00,120 --> 00:44:02,320 SEVERE, THAT AGE IS REALLY 1153 00:44:02,320 --> 00:44:03,320 IMPORTANT BOTH CLINICALLY AND WE 1154 00:44:03,320 --> 00:44:06,080 SEE IT IN THE ANIMAL MODEL AS 1155 00:44:06,080 --> 00:44:08,200 WELL UNDER 50 YEARS OF AGE AND 1156 00:44:08,200 --> 00:44:13,600 IT'S WORSE, THE YOUNGER YOU ARE. 1157 00:44:13,600 --> 00:44:15,200 THERE'S AN INCREASED RISK OF 1158 00:44:15,200 --> 00:44:16,560 DEATH IF YOU EXERCISE, SPECIALLY 1159 00:44:16,560 --> 00:44:17,800 IF YOU ARE YOUNGER. 1160 00:44:17,800 --> 00:44:21,040 SEX DIFFERENCES IN THE RA 1161 00:44:21,040 --> 00:44:24,760 VACCINE ARE SAME AS MYOCARDITIS, 1162 00:44:24,760 --> 00:44:26,680 THE CVB3 IN HUMAN AND MOUSE 1163 00:44:26,680 --> 00:44:27,720 MODELS IS REMARKABLY THE SAME AS 1164 00:44:27,720 --> 00:44:30,000 WHAT WE SEE IN SARS-COV-2 AND 1165 00:44:30,000 --> 00:44:32,080 WHAT I THINK COULD BE HAPPENING 1166 00:44:32,080 --> 00:44:38,240 IS IF WE HAVE VIRUS AND THE 1167 00:44:38,240 --> 00:44:39,760 MIGHT O MORE IMPORTANT THAN 1168 00:44:39,760 --> 00:44:42,080 VIRUS PER SE AND I ALSO 1169 00:44:42,080 --> 00:44:44,960 DEVELOPED A MODEL OF CYTOMEGALOW 1170 00:44:44,960 --> 00:44:46,520 VIRUS WHICH IS COMPLETELY 1171 00:44:46,520 --> 00:44:48,320 DIFFERENT AND IT PRODUCES THE 1172 00:44:48,320 --> 00:44:50,520 SAME TIME COURSE AS 1173 00:44:50,520 --> 00:44:51,400 [INDISCERNIBLE] ILLUSTRATING THE 1174 00:44:51,400 --> 00:44:53,440 STAIMA THIS POINT AND EVs 1175 00:44:53,440 --> 00:44:55,880 CONTAINING VIRUS AND HAD MIGHT O 1176 00:44:55,880 --> 00:44:57,600 CAN BE A POSSIBLE EXPLANATION 1177 00:44:57,600 --> 00:45:00,840 FOR MYOCARDITIS AND HOW VACCINES 1178 00:45:00,840 --> 00:45:01,640 COULD CAUSE MILD MYOCARDITIS. 1179 00:45:01,640 --> 00:45:03,640 THEY DON'T HAVE ANY INFECTIOUS 1180 00:45:03,640 --> 00:45:03,840 VIRUS. 1181 00:45:03,840 --> 00:45:06,880 SO WHAT ABOUT GAPS AND FUTURE 1182 00:45:06,880 --> 00:45:07,520 DIRECTIONS? 1183 00:45:07,520 --> 00:45:09,920 WELL, WE NEED BIOPSY SAMPLES OF 1184 00:45:09,920 --> 00:45:10,240 MYOCARDITIS. 1185 00:45:10,240 --> 00:45:11,960 IN THE U.S. WE ARE NOT PROVIDING 1186 00:45:11,960 --> 00:45:16,520 THOSE AND WE NEED TO REVISE THE 1187 00:45:16,520 --> 00:45:19,160 DALLAS CRITERIA THAT REQUIRES 1188 00:45:19,160 --> 00:45:20,680 THAT NECROSIS IS PRESENT AND 1189 00:45:20,680 --> 00:45:22,640 ACTUALLY NECROSIS IS NOT THERE 1190 00:45:22,640 --> 00:45:23,800 DURING ACUTE MYOCARDITIS AND 1191 00:45:23,800 --> 00:45:24,800 WE'RE MISSING THOSE SAMPLES AND 1192 00:45:24,800 --> 00:45:27,640 IT REALLY IS WHAT WE SEE WITH 1193 00:45:27,640 --> 00:45:28,400 CHRONIC MYOCARDITIS. 1194 00:45:28,400 --> 00:45:30,680 WE NEED FUNDING, TO LOOK AT 1195 00:45:30,680 --> 00:45:32,880 TISSUE, BLOOD, AND DATA IN 1196 00:45:32,880 --> 00:45:34,720 SUFFICIENT NUMBERS FROM MULTIPLE 1197 00:45:34,720 --> 00:45:37,280 SITES SO WE CAN ANALYZE BY SEX 1198 00:45:37,280 --> 00:45:39,480 AND AGE TO DEVELOP HIGH THROUGH 1199 00:45:39,480 --> 00:45:40,920 PUT MULTIPARAMETER METHODS TO 1200 00:45:40,920 --> 00:45:43,480 DETECT VIRUSES IN PLASMA AND 1201 00:45:43,480 --> 00:45:45,400 EVs ACCORDING TO SEX AND AGE. 1202 00:45:45,400 --> 00:45:47,680 WE WERE INVOLVED IN A PAPER IN 1203 00:45:47,680 --> 00:45:49,120 NEW ENGLAND JOURNAL OF MEDICINE 1204 00:45:49,120 --> 00:45:50,800 LOOKING AT A MIRROR THAT COULD 1205 00:45:50,800 --> 00:45:52,520 DETECT MY O CARDITEIS FROM MI 1206 00:45:52,520 --> 00:45:53,920 AND THOSE KINDS OF THINGS WILL 1207 00:45:53,920 --> 00:45:55,360 BE IMPORTANT GOING FORWARD AND 1208 00:45:55,360 --> 00:46:00,840 UNDERSTAND HOW THE VIRUS AND 1209 00:46:00,840 --> 00:46:05,640 MITO INTERACT TO 1210 00:46:05,640 --> 00:46:06,120 PROAUTOANTIBODIES AND 1211 00:46:06,120 --> 00:46:07,200 INFLAMMATION AND AND HEART 1212 00:46:07,200 --> 00:46:09,080 FAILURE ACCORDING TO SEX, AND 1213 00:46:09,080 --> 00:46:11,280 ENSURE PARTNERSHIP OF 1214 00:46:11,280 --> 00:46:13,480 INVESTIGATORS NEW TO SEX 1215 00:46:13,480 --> 00:46:15,560 DIFFERENCES SO WE CANY PROPEL 1216 00:46:15,560 --> 00:46:16,320 THIS RESEARCH IN THIS AREA. 1217 00:46:16,320 --> 00:46:17,840 SO THANK YOU AND I WILL STOP 1218 00:46:17,840 --> 00:46:28,320 SHARING SO THAT WE CAN GO TO 1219 00:46:35,760 --> 00:46:36,640 DR. RAJ'S PRESENTATION. 1220 00:46:36,640 --> 00:46:36,960 >> HELLO. 1221 00:46:36,960 --> 00:46:38,200 THANK YOU VERY HAVING ME. 1222 00:46:38,200 --> 00:46:40,840 SO MY BRIEF TALK WILL DEAL WITH 1223 00:46:40,840 --> 00:46:42,800 THE SUBTYPE OR SUBGROUP OF LONG 1224 00:46:42,800 --> 00:46:45,640 COVID PEASHTS THAT HAVE 1225 00:46:45,640 --> 00:46:46,720 ORTHOSTATIC INTOLERANCE AND 1226 00:46:46,720 --> 00:46:47,760 THESE WAS INITIALLY LONG COVID 1227 00:46:47,760 --> 00:46:49,560 POTS AND I BRANCHED OUT AND 1228 00:46:49,560 --> 00:46:51,200 HOPEFULLY YOU WILL SEE WHY, BOTH 1229 00:46:51,200 --> 00:46:54,360 OVERALL AND WILL LOOK AT SEX AND 1230 00:46:54,360 --> 00:46:59,760 I'LL DISCUSS GENDER IF YOU WISH. 1231 00:46:59,760 --> 00:47:01,160 SO VARIOUS DISCLOSURES ARE HERE, 1232 00:47:01,160 --> 00:47:04,400 NONE OF THIS HAS ANYTHING TO DO 1233 00:47:04,400 --> 00:47:07,120 WITH DATA OR STUFF I'M 1234 00:47:07,120 --> 00:47:09,560 PRESENTING WITH THE EXCEPTION 1235 00:47:09,560 --> 00:47:10,480 FOR PRELIMINARY RESEARCH DATA I 1236 00:47:10,480 --> 00:47:13,680 WILL SHARE WITH THE COMMUNITY 1237 00:47:13,680 --> 00:47:14,160 HEALTH RESEARCH. 1238 00:47:14,160 --> 00:47:17,520 SO POTS HAS BECOME MORE VENUS IN 1239 00:47:17,520 --> 00:47:22,120 THE LAST COUPLE YEARS WITH LONG 1240 00:47:22,120 --> 00:47:22,760 COVID UNFORTUNATELY PRODUCING 1241 00:47:22,760 --> 00:47:24,800 MORE PATIENTS BUT BY WAY OF 1242 00:47:24,800 --> 00:47:26,680 BACKGROUND THESE ARE THE 1243 00:47:26,680 --> 00:47:29,760 TRADITIONAL COMMON CRITERIA FOR 1244 00:47:29,760 --> 00:47:32,040 POTS. 1245 00:47:32,040 --> 00:47:34,000 THEY'VE BEEN MODIFIED A LITTLE 1246 00:47:34,000 --> 00:47:35,240 BUT BASICALLY THEY'VE BEEN 1247 00:47:35,240 --> 00:47:36,440 STATIC FOR 30 YEARS NOW. 1248 00:47:36,440 --> 00:47:40,240 IT REQUIRES 2 THINGS, PHYSIOLOGY 1249 00:47:40,240 --> 00:47:42,920 THAT'S ABNORMAL, ECSETIONZIVE 1250 00:47:42,920 --> 00:47:44,640 HEART IT'S WORTH REMEMBERING 1251 00:47:44,640 --> 00:47:46,800 THAT INCREASE IN HEART RATE IS 1252 00:47:46,800 --> 00:47:47,880 NORMAL, IT'S NORMAL PHYSIOLOGY, 1253 00:47:47,880 --> 00:47:50,200 BUT THESE PATIENTS ARE ORE 1254 00:47:50,200 --> 00:47:52,120 ACHIEVERS AND THAT DEFINED AS AT 1255 00:47:52,120 --> 00:47:53,920 LEAST 30 BEATS PER MINUTE. 1256 00:47:53,920 --> 00:47:55,880 THE INCREASE IN HEART RATE IS 1257 00:47:55,880 --> 00:47:57,520 PHYSIOLOGIC AND GOES DOWN AS WE 1258 00:47:57,520 --> 00:48:02,240 GET OLDER, SO IN KIDS, A 30 BEAT 1259 00:48:02,240 --> 00:48:05,000 INCREASE IS QUITE NORMAL AND 1260 00:48:05,000 --> 00:48:08,960 INVESTIGATORS LOOK INTO THIS AND 1261 00:48:08,960 --> 00:48:10,680 REDEDPIENED THE CRITERIA YEARS 1262 00:48:10,680 --> 00:48:14,680 AGO UPPING IT TO 40 BEATS PER 1263 00:48:14,680 --> 00:48:14,920 MINUTE. 1264 00:48:14,920 --> 00:48:18,440 SO THAT'S JUST THE PHYSIOLOGY, 1265 00:48:18,440 --> 00:48:20,240 THE S-IN POTS SYNDROME BASICALLY 1266 00:48:20,240 --> 00:48:22,000 MEANS THAT THESE PATIENTS HAVE 1267 00:48:22,000 --> 00:48:23,640 TO QUITE SYMPTOMATIC AND THE KEY 1268 00:48:23,640 --> 00:48:24,800 TO THE SYMPTOMS ALTHOUGH THEY 1269 00:48:24,800 --> 00:48:27,280 CAN VARY IN SPECIFICS ARE THAT 1270 00:48:27,280 --> 00:48:29,080 THEY'RE WORSE WITH UPRIGHT 1271 00:48:29,080 --> 00:48:30,720 POSTURE AND BETTER RESILIENCE 1272 00:48:30,720 --> 00:48:31,640 CUMBENCE AND THERE'S THOUGHTS 1273 00:48:31,640 --> 00:48:32,920 HERE AS TO THINGS THAT COULD 1274 00:48:32,920 --> 00:48:37,480 CAUSE IT BUT NOT AS RELEVANT AS 1275 00:48:37,480 --> 00:48:38,440 THAT DRINICAL FEATURE. 1276 00:48:38,440 --> 00:48:41,600 EVERYTHING I DESCRIBE NOW WILL 1277 00:48:41,600 --> 00:48:43,120 PROBABLY HAPPEN TO ANY 1 OF US 1278 00:48:43,120 --> 00:48:46,600 IF WE GOT ACUTELY ILL WITH A 1279 00:48:46,600 --> 00:48:49,280 VIRUS, COVID OR NOT COVID IN THE 1280 00:48:49,280 --> 00:48:50,160 ACUTE PHASE. 1281 00:48:50,160 --> 00:48:51,120 THAT SYMPTOM SPECIFIC DETAILS ON 1282 00:48:51,120 --> 00:48:52,840 NOT GO AWAY. 1283 00:48:52,840 --> 00:48:54,400 IT'S A CHRONIC DISORDER, 1284 00:48:54,400 --> 00:48:55,480 DIFFERENT CRITERIA HAVE USED 1285 00:48:55,480 --> 00:48:58,440 THESE 6 MONTHS AND 3 MONTHS IN 1286 00:48:58,440 --> 00:48:59,480 THE CANADIAN CARDIOVASCULAR SEAT 1287 00:48:59,480 --> 00:49:00,920 STATEMENT, WE SETTLED ON 3 1288 00:49:00,920 --> 00:49:02,640 MONTHS BECAUSE AFTER 3 MONTHS WE 1289 00:49:02,640 --> 00:49:04,520 HAVEN'T NOTICED A LOT OF 1290 00:49:04,520 --> 00:49:05,200 IMPROVEMENT OR CHANGE AND 1291 00:49:05,200 --> 00:49:07,560 IMPORTANT THIS IS IN THE ABSENCE 1292 00:49:07,560 --> 00:49:09,280 OF ANOTHER CAUSE IDEALLY 1293 00:49:09,280 --> 00:49:13,520 REVERSIBLE BUT ANOTHER CAUSE FOR 1294 00:49:13,520 --> 00:49:13,960 THE TACHYCARDIA. 1295 00:49:13,960 --> 00:49:15,760 IT'S BEEN HARD TO DETERMINE 1296 00:49:15,760 --> 00:49:17,520 EXACTLY HOW MUCH, WHAT THE 1297 00:49:17,520 --> 00:49:19,000 PREVALENCE IS, WHAT'S ESTIMATED 1298 00:49:19,000 --> 00:49:20,920 BEE HALF A MILLION AND 3 MILLION 1299 00:49:20,920 --> 00:49:21,960 PATIENTS IN THE U.S. IS THE 1300 00:49:21,960 --> 00:49:24,040 REASON IS BECAUSE THERE HASN'T 1301 00:49:24,040 --> 00:49:25,240 BEEN ADMEN ADMINISTRATIVE CODING 1302 00:49:25,240 --> 00:49:26,880 FOR IT, ALTHOUGH JUST TODAY, 1303 00:49:26,880 --> 00:49:30,680 I'VE HEARD THAT THE CDC HAS 1304 00:49:30,680 --> 00:49:32,440 APPROVED AN ICD10 CODE FOR POTS 1305 00:49:32,440 --> 00:49:33,880 THAT WILL KICK IN IN THE PAUL 1306 00:49:33,880 --> 00:49:34,960 AND THAT WILL HELP US GOING 1307 00:49:34,960 --> 00:49:37,800 FORWARD AND THERE IS AN ICD11 1308 00:49:37,800 --> 00:49:39,120 CODE WHEN THAT KICKS IN. 1309 00:49:39,120 --> 00:49:40,640 SO THESE ARE BASED ON BACK OF 1310 00:49:40,640 --> 00:49:43,400 THE MAP AND THERE'S A HUGE 1311 00:49:43,400 --> 00:49:44,280 FEMALE PREDOMINANCE AND I PUT 1312 00:49:44,280 --> 00:49:46,520 THIS HERE IN A LOT OF STUDIES 1313 00:49:46,520 --> 00:49:48,160 OVER 90% AND THE PATIENTS ARE 1314 00:49:48,160 --> 00:49:49,600 TYPICALLY WOMEN OF CHILD BEARING 1315 00:49:49,600 --> 00:49:51,520 AGE, THE MOST COMMON AGES 1316 00:49:51,520 --> 00:49:56,120 BETWEEN SAY 13 AND 50, IT CAN 1317 00:49:56,120 --> 00:49:57,680 OCCUR IN OLDER PEOPLE, IT 1318 00:49:57,680 --> 00:49:59,840 DOESN'T STOP AT 50 BUT LESS 1319 00:49:59,840 --> 00:50:00,360 COMMON, AND IMPORTANTLY 1320 00:50:00,360 --> 00:50:01,680 ASSOCIATE WIDE A LOT OF 1321 00:50:01,680 --> 00:50:02,160 FUNCTIONAL DISABILITY. 1322 00:50:02,160 --> 00:50:03,880 SO THESE ARE NOT MY DATA, THESE 1323 00:50:03,880 --> 00:50:08,240 ARE PUBLISHED DATA USING SF-36 A 1324 00:50:08,240 --> 00:50:10,440 UBIQUITOUS HEALTH RELATED 1325 00:50:10,440 --> 00:50:14,680 QUALITY OF LIFE SCALE FOR 2 1326 00:50:14,680 --> 00:50:16,960 DISORDERS RECOGNIZED AS HAVING A 1327 00:50:16,960 --> 00:50:18,720 PRETTY CRAPY QUALITY OF LIFE, 1328 00:50:18,720 --> 00:50:20,800 PATIENTS WITH BACK PAIN OR 1329 00:50:20,800 --> 00:50:22,680 PATIENTS ON DIALYSIS DUE TO END 1330 00:50:22,680 --> 00:50:23,760 STAGE RENAL DISEASE. 1331 00:50:23,760 --> 00:50:25,280 AND WE ADDED DATA FOR POTS 1332 00:50:25,280 --> 00:50:28,840 PATIENTS THIS WAS COLLECTED BY 1333 00:50:28,840 --> 00:50:29,160 VANDERBILT. 1334 00:50:29,160 --> 00:50:30,200 SO THIS DOESN'T SPEAK TO WHY THE 1335 00:50:30,200 --> 00:50:31,880 QUALITY OF LIFE IS HORRIBLE, BUT 1336 00:50:31,880 --> 00:50:32,800 IT IS, RIGHT? 1337 00:50:32,800 --> 00:50:35,160 SO WORTH RECOGNIZING THAT BUT 1338 00:50:35,160 --> 00:50:35,800 THERE'S THIS DISORDER, WHATEVER 1339 00:50:35,800 --> 00:50:37,240 IT IS AND WE'RE STILL HAVING 1340 00:50:37,240 --> 00:50:38,640 TROUBLE GETTING OUR ARMS AROUND 1341 00:50:38,640 --> 00:50:40,640 IT HAS A HUGE IMPACT ON THE 1342 00:50:40,640 --> 00:50:43,720 LIVES OF OUR PATIENTS. 1343 00:50:43,720 --> 00:50:47,160 WE CONDUCTED IN COLLABORATION 1344 00:50:47,160 --> 00:50:47,960 WITH [INDISCERNIBLE] ADVOCACY 1345 00:50:47,960 --> 00:50:49,760 GROUP, A LARGE PATIENT BASED 1346 00:50:49,760 --> 00:50:52,480 SURVEY SEVERAL THOUSANDS OF 1347 00:50:52,480 --> 00:50:54,240 PATIENTS AND JUST A COUPLE OF 1348 00:50:54,240 --> 00:50:56,560 SLIDES FROM THAT, JUST 1349 00:50:56,560 --> 00:50:58,080 DESCRIBING AGAIN, 93% THAT 1350 00:50:58,080 --> 00:51:00,800 COMPLETED THIS ONLINE SURVEY, 1351 00:51:00,800 --> 00:51:03,160 WERE FEMALE AND ALMOST ALL 1352 00:51:03,160 --> 00:51:03,360 WHITE. 1353 00:51:03,360 --> 00:51:06,440 AND WE HAD A LAUNDRY LIST OF 1354 00:51:06,440 --> 00:51:07,720 SYMPTOMS THAT THEY COULD 1355 00:51:07,720 --> 00:51:09,360 INDICATE THEY HAD OR DIDN'T AND 1356 00:51:09,360 --> 00:51:11,080 THE COMMON 1S ARE SHOWN HERE, 1357 00:51:11,080 --> 00:51:14,600 YOU KNOW THE TOP FEW, LIGHT 1358 00:51:14,600 --> 00:51:16,320 HEADEDNESS, TACHYCARDIA, ARE 1S 1359 00:51:16,320 --> 00:51:19,080 YOU WOULD EXPECT WITH 1360 00:51:19,080 --> 00:51:21,240 TACHYCARDIA IN THE NAME BUT THE 1361 00:51:21,240 --> 00:51:24,240 NEXT FEW SEEN IN 90% GIVE OR 1362 00:51:24,240 --> 00:51:26,360 TAKE OF PARTICIPANTS WERE 1363 00:51:26,360 --> 00:51:27,280 HEADACHE, DIFFICULTY 1364 00:51:27,280 --> 00:51:29,360 CONCENTRATING, NAUSEA AND MEMORY 1365 00:51:29,360 --> 00:51:30,640 PROBLEMS, SO WHAT THIS SPEAKS TO 1366 00:51:30,640 --> 00:51:32,720 IS THAT THE POTS IS NOT JUST A 1367 00:51:32,720 --> 00:51:34,440 CARDIAC OR CARDIO VASCULARY 1368 00:51:34,440 --> 00:51:36,080 DISORDER, IT'S ACTUALLY A 1369 00:51:36,080 --> 00:51:38,640 SYSTEMIC ILLNESS WITH OBVIOUS 1370 00:51:38,640 --> 00:51:39,280 AN IMPORTANT CARDIOVASCULAR 1371 00:51:39,280 --> 00:51:41,600 PHENOTYPE AND THAT'S PART OF THE 1372 00:51:41,600 --> 00:51:42,280 CHALLENGE IN UNDERSTANDING 1373 00:51:42,280 --> 00:51:43,800 WHAT'S DRIVING IT AND HOW TO 1374 00:51:43,800 --> 00:51:48,520 TREAT THESE DIFFERENT TENTACLES 1375 00:51:48,520 --> 00:51:49,120 OF DISABILITY. 1376 00:51:49,120 --> 00:51:51,640 O JUST A COUPLE WORDS ON OTHER 1377 00:51:51,640 --> 00:51:52,840 DISORDERS, SO INAPPROPRIATE 1378 00:51:52,840 --> 00:51:53,960 SINUS TACKY DISORDER, A COULD 1379 00:51:53,960 --> 00:51:56,520 YOU SAYIN OF POTS ISN'T THAT THE 1380 00:51:56,520 --> 00:51:57,800 ISSUE IS A HEART RATE THAT GOES 1381 00:51:57,800 --> 00:51:59,640 UP ON STANDING BUT THE HEART 1382 00:51:59,640 --> 00:52:01,920 RATE CAN BE UP ALL THE TIME AND 1383 00:52:01,920 --> 00:52:04,120 OFTEN A RESTING HEART RATE OF A 1384 00:52:04,120 --> 00:52:05,080 HUNDRED PETES PERMINUTE IF THEY 1385 00:52:05,080 --> 00:52:08,840 WERE LYING DOWN ON YOUR CLINIC 1386 00:52:08,840 --> 00:52:09,040 TABLE. 1387 00:52:09,040 --> 00:52:11,640 OR AT 24 HOUR ULTRA HEART RATE 1388 00:52:11,640 --> 00:52:13,880 OF GREATER THAN 90 BEATS OF THE 1389 00:52:13,880 --> 00:52:15,280 CRITERIA, AGAIN, THIS IS IN THE 1390 00:52:15,280 --> 00:52:16,920 ABSENCE OF ANOTHER CAUSE OF 1391 00:52:16,920 --> 00:52:18,000 TACHYCARDIA YOU CAN FIND AND 1392 00:52:18,000 --> 00:52:20,600 THIS IS ALSO VERY SYMPTOMATIC. 1393 00:52:20,600 --> 00:52:22,680 THERE ARE ORTHOSTATIC HYPE OR 1394 00:52:22,680 --> 00:52:23,640 TENSION DISORDERS AND SOME ARE 1395 00:52:23,640 --> 00:52:27,520 LISTED HERE AND THERE'S 1396 00:52:27,520 --> 00:52:29,040 CLASSICAL HYPOTENSION OR 1397 00:52:29,040 --> 00:52:29,760 ORTHOSTATIC HYPOTENSION, I WILL 1398 00:52:29,760 --> 00:52:32,240 TOUCH ON THE FIRST AND THE 1399 00:52:32,240 --> 00:52:33,480 THIRD. 1400 00:52:33,480 --> 00:52:34,400 SO CLASSICAL ORTHOSTATIC 1401 00:52:34,400 --> 00:52:35,840 HYPOTENSION TYPICALLY AFFECTS 1402 00:52:35,840 --> 00:52:37,920 OLDER PATES, TYPICALLY IS DUE 1403 00:52:37,920 --> 00:52:41,080 SOME FORM OF AUTONOMIC 1404 00:52:41,080 --> 00:52:41,600 NEUROPATHY OR NEUROLOGIC 1405 00:52:41,600 --> 00:52:43,400 DISORDER AND ASSOCIATED WITH A 1406 00:52:43,400 --> 00:52:45,840 SUSTAINED DROP IN BLOOD PRESSURE 1407 00:52:45,840 --> 00:52:47,480 OF MERCURY AND DIASTOLIC 1408 00:52:47,480 --> 00:52:49,080 PRESSURE WITHIN 3 MINUTES. 1409 00:52:49,080 --> 00:52:49,280 RIGHT? 1410 00:52:49,280 --> 00:52:52,120 THE BLOOD PRESSURE GOES DOWN AND 1411 00:52:52,120 --> 00:52:55,280 IT STAYS DOWN AND HAS LOTS OF 1412 00:52:55,280 --> 00:52:58,080 SYMPTOMS UNDERSTANDABLY. 1413 00:52:58,080 --> 00:52:58,720 INITIAL ORTHOSTATIC HYPOTENSION 1414 00:52:58,720 --> 00:52:59,400 IS AT THE BOTTOM. 1415 00:52:59,400 --> 00:53:01,320 THIS IS ASSOCIATE WIDE A 1416 00:53:01,320 --> 00:53:02,360 TRANSIENT BUT LARGER DROP IN 1417 00:53:02,360 --> 00:53:03,600 BLOOD PRESSURE THAT RECOVERS 1418 00:53:03,600 --> 00:53:05,280 WITHIN THE FIRST MINUTE. 1419 00:53:05,280 --> 00:53:06,680 THAT INITIAL DROP OCCURS IN 1420 00:53:06,680 --> 00:53:08,080 UNDER 152ndS AND THIS CAN 1421 00:53:08,080 --> 00:53:10,960 OCCUR IN ALL AGES, YOUNG PEOPLE 1422 00:53:10,960 --> 00:53:12,160 AS WELL, THIS IS ACTUALLY THE 1423 00:53:12,160 --> 00:53:14,040 CAUSE OF THE LIGHT HEADEDNESS 1424 00:53:14,040 --> 00:53:15,440 BUT EVERYONE FELT AT LEAST ONCE 1425 00:53:15,440 --> 00:53:16,840 OR TWICE IN THEIR WHEN THEY GET 1426 00:53:16,840 --> 00:53:18,640 UP QUICKLY AND HAVE TO HOLD ON 1427 00:53:18,640 --> 00:53:20,480 FOR A FEW SECONDS BUT IN SOME 1428 00:53:20,480 --> 00:53:23,200 PEOPLE THIS CAN BE DAILY AND 1429 00:53:23,200 --> 00:53:24,360 MULTIPLE TIMES DEBILITATING, SO 1430 00:53:24,360 --> 00:53:27,200 JUST SHIFTING GEARS WE'VE BEEN 1431 00:53:27,200 --> 00:53:29,120 CONDUCTING A STUDY USING 1432 00:53:29,120 --> 00:53:30,480 AUTONOMIC TESTING TO UNDERSTAND 1433 00:53:30,480 --> 00:53:32,360 THE FREQUENCY AND PREVALENCE OF 1434 00:53:32,360 --> 00:53:33,640 AUTONOMIC DISORDERS IN IN LONG 1435 00:53:33,640 --> 00:53:35,440 COVID OR PAST POPULATION, IN OUR 1436 00:53:35,440 --> 00:53:37,680 STUDY THE PATIENTS HAVE TO BE 1437 00:53:37,680 --> 00:53:42,600 BETWEEN 18-80 YEARS OF AGE, HAD 1438 00:53:42,600 --> 00:53:44,280 SYMPTOMS FOR AT LEAST 3 MONTHS 1439 00:53:44,280 --> 00:53:48,600 HAVE A PC R MOVEN TEST AND AN 1440 00:53:48,600 --> 00:53:49,440 ONLINE QUESTIONNAIRE, AUTONOMIC 1441 00:53:49,440 --> 00:53:52,080 TESTING BATTERY SO WE STUDIED, 1442 00:53:52,080 --> 00:53:54,480 IT'S AN ONGOING STUDY, WE 1443 00:53:54,480 --> 00:53:56,520 STUDIED 78 PATIENTS SO FAR 1444 00:53:56,520 --> 00:53:57,840 ADDRESSIVELY ENROLLING SINCE 1445 00:53:57,840 --> 00:53:58,480 JANUARY AND FUNDAMENTALLY DNCH 1446 00:53:58,480 --> 00:54:01,560 THAN WHAT A LOT OF OTHER 1447 00:54:01,560 --> 00:54:02,840 AUTONOMIC PAPERS THAT HAVE COME 1448 00:54:02,840 --> 00:54:05,080 UP SO FAR IS INSTEAD OF USING A 1449 00:54:05,080 --> 00:54:06,840 TILT TEST, WE USE AN ACTIVE 1450 00:54:06,840 --> 00:54:08,800 STAND TEST, WE HAD PEOPLE LYING 1451 00:54:08,800 --> 00:54:10,800 DOWN FOR 10 MINUTES WHILE 1452 00:54:10,800 --> 00:54:12,160 INSTRUMENTED WITH CONTINUOUS 1453 00:54:12,160 --> 00:54:15,200 HEART RATE AND TILTS THEM 1454 00:54:15,200 --> 00:54:16,520 UP,--NO STOOD THEM UP AND 1455 00:54:16,520 --> 00:54:17,360 WATCHED THEM FOR 10 MINUTES AND 1456 00:54:17,360 --> 00:54:19,200 WITH THIS WE COULD DETERMINE THE 1457 00:54:19,200 --> 00:54:20,800 CRITERIA FOR 4 DIFFERENT 1458 00:54:20,800 --> 00:54:23,360 DISORDERS AT LEAST THE 1459 00:54:23,360 --> 00:54:23,880 HEMODYNAMIC CRITERIA AND 1460 00:54:23,880 --> 00:54:26,440 NONAPOPTOTIC THE ALL THE SYMPTOM 1461 00:54:26,440 --> 00:54:28,840 CRITERIA ALONE, HEART RATE 1462 00:54:28,840 --> 00:54:32,200 INCREASE OF 30 BPM, A IST WITH 1463 00:54:32,200 --> 00:54:34,800 GREAT THEY'RE AN 100, A DROP OF 1464 00:54:34,800 --> 00:54:37,120 20 IN SIS TOLL-LIKE RECEPTORIC 1465 00:54:37,120 --> 00:54:39,120 BLOOD PRESSURE AND IOH WAS THE 1466 00:54:39,120 --> 00:54:46,480 RAPID DROP WITH RECOVERY IN 1467 00:54:46,480 --> 00:54:48,280 BLOOD PRESSURE JUST A BIT OF 1468 00:54:48,280 --> 00:54:50,040 DATA SHOWING SYMPTOMS WE 1469 00:54:50,040 --> 00:54:52,000 REPORTED IN PATIENTS WITH LONG 1470 00:54:52,000 --> 00:54:54,640 COVID, IN SOME CASES WITH OTHER 1471 00:54:54,640 --> 00:54:56,000 AUTONOMIC DISORDERS AND YOU WILL 1472 00:54:56,000 --> 00:54:59,360 SEE THAT LOSS OF TASTE PERSISTED 1473 00:54:59,360 --> 00:55:01,880 IN A THIRD OF POPULATION, 1474 00:55:01,880 --> 00:55:03,560 FATIGUE WAS ALMOST UBIQUITOUS, 1475 00:55:03,560 --> 00:55:07,320 SLEEP PROBLEMS IN 3-QUARTERS, 1476 00:55:07,320 --> 00:55:07,960 LIGHT HEADEDNESS, PALPITATION, 1477 00:55:07,960 --> 00:55:09,280 AGAIN WHAT YOU WOULD EXPECT, I 1478 00:55:09,280 --> 00:55:13,120 THINK, BUT WHEN WE BROKE IT DOWN 1479 00:55:13,120 --> 00:55:14,760 BY SEX, SOME SYMPTOMS WERE 1480 00:55:14,760 --> 00:55:17,680 PRETTY COMMON AND EVEN IN BOTH 1481 00:55:17,680 --> 00:55:19,440 GROUPS, SHORTNESS OF BREATH, 1482 00:55:19,440 --> 00:55:20,800 LIGHT HEADEDNESS, SLEEP 1483 00:55:20,800 --> 00:55:22,440 PROBLEMS, SEEN IN BOTH GROUPS 1484 00:55:22,440 --> 00:55:24,120 EQUALLY BUT OTHERS WEREN'T. 1485 00:55:24,120 --> 00:55:26,440 HEADACHES, MUCH MORE COMMON IN 1486 00:55:26,440 --> 00:55:28,440 FEMALES, TASTE ISSUES, MUCH MORE 1487 00:55:28,440 --> 00:55:31,200 COMMON IN FEMALES, HARDLY 1488 00:55:31,200 --> 00:55:36,800 PRESENT IN MALES, CONSIPATION 1489 00:55:36,800 --> 00:55:40,360 ALMOST PRESENT IN MALES, 1490 00:55:40,360 --> 00:55:44,120 PALPITATIONS MORE COMMON IN 1491 00:55:44,120 --> 00:55:44,920 FEMALES THAN MALES. 1492 00:55:44,920 --> 00:55:46,040 SO AGAIN, IT'S 1 OF THOSE THINGS 1493 00:55:46,040 --> 00:55:47,360 THAT IF YOU DIDN'T LOOK FOR 1494 00:55:47,360 --> 00:55:50,240 THIS, WE WOULDN'T HAVE REALIZED 1495 00:55:50,240 --> 00:55:50,520 IT. 1496 00:55:50,520 --> 00:55:51,760 WE'RE HAPPY SAYING WE HAVE A 1497 00:55:51,760 --> 00:55:53,520 SENSE OF A SYMPTOM BURDEN IN THE 1498 00:55:53,520 --> 00:55:55,400 POPULATION BUT THE SYMPTOM 1499 00:55:55,400 --> 00:55:57,040 POPULATION IS DIFFERENT BASED ON 1500 00:55:57,040 --> 00:55:58,000 SEX. 1501 00:55:58,000 --> 00:56:00,800 IN TERMS OF AUTONOMIC DISORDERS 1502 00:56:00,800 --> 00:56:03,640 WE LOOKED AT OVERALL, 72% MET 1503 00:56:03,640 --> 00:56:05,920 CRITERIA FOR 1 OR MORE THOSE 1504 00:56:05,920 --> 00:56:07,440 DISORDERS, THE AGE IS SHOWNOT 1505 00:56:07,440 --> 00:56:09,480 BOTTOM RIGHT BROKEN DOWN BY SEX, 1506 00:56:09,480 --> 00:56:12,520 PRETTY COMPARABLE, IF YOU LOOK 1507 00:56:12,520 --> 00:56:14,520 VERSUS THE TACHYCARDIA 1508 00:56:14,520 --> 00:56:16,280 DISORDERS, THE HEART RATE 1509 00:56:16,280 --> 00:56:17,680 CRITERIA FOR PLOTS ONLY 1 1510 00:56:17,680 --> 00:56:19,520 PATIENT, SO VERY FEW MET 1511 00:56:19,520 --> 00:56:22,520 CRITERIA FOR THE SINUS 1512 00:56:22,520 --> 00:56:22,800 TACHYCARDIA. 1513 00:56:22,800 --> 00:56:25,320 WE LOOK AT THE HYPOTENSION 1514 00:56:25,320 --> 00:56:27,800 DISORDERS, AGAIN COUPLE MET 1515 00:56:27,800 --> 00:56:28,600 CRITERIA FOR HYPERTENSION, NOT 1516 00:56:28,600 --> 00:56:32,000 AT ALL, BUT LOOK AT ORTHOSTATIC 1517 00:56:32,000 --> 00:56:33,640 HYPOTENSION, 2/3RDS MET CRITERIA 1518 00:56:33,640 --> 00:56:35,400 FOR THIS AND THIS IS RELEVANT 1519 00:56:35,400 --> 00:56:37,360 BECAUSE THIS IS ALMOST 1520 00:56:37,360 --> 00:56:38,400 UNDIAGNOSABLE WITH A TILT TEST. 1521 00:56:38,400 --> 00:56:40,080 YOU HAVE TO STAND PEOPLE UP 1522 00:56:40,080 --> 00:56:41,880 BECAUSE THE PHYSIOLOGY INVOLVES 1523 00:56:41,880 --> 00:56:44,080 THAT ACTIVE MUSCLE CONTRACTION 1524 00:56:44,080 --> 00:56:44,480 ON STANDING. 1525 00:56:44,480 --> 00:56:45,880 SO THIS IS SOMETHING THAT HAS 1526 00:56:45,880 --> 00:56:47,160 BEEN MISS INDEED ALMOST EVERY 1527 00:56:47,160 --> 00:56:48,440 STUDY THAT'S BEEN PUBLISHED TO 1528 00:56:48,440 --> 00:56:53,000 DATE IN THIS LONG COVID 1529 00:56:53,000 --> 00:56:53,320 POPULATION. 1530 00:56:53,320 --> 00:56:56,200 AGAIN, BROKEN DOWN BY SEX. 1531 00:56:56,200 --> 00:56:58,360 WHAT I WOULD SAY IS IF YOU FOCUS 1532 00:56:58,360 --> 00:57:00,040 ON THE INITIAL ORTHOSTATIC 1533 00:57:00,040 --> 00:57:02,120 HYPOTENSION ON THE BOTTOM, NOT 1534 00:57:02,120 --> 00:57:02,880 MUCH DIFFERENCE, RIGHT? 1535 00:57:02,880 --> 00:57:05,000 BOTH MALES AND FEMALES GET THIS. 1536 00:57:05,000 --> 00:57:06,400 RATES HIGHER IN FEMALES BUT 1537 00:57:06,400 --> 00:57:07,760 PRETTY CLOSE BUT IF YOU LOOK AT 1538 00:57:07,760 --> 00:57:10,360 THE POTS GROUP IN THE TOP 1539 00:57:10,360 --> 00:57:12,280 MIDDLE, IT'S ALL FEMALES. 1540 00:57:12,280 --> 00:57:14,800 NONE OF THE MALES ACTUALLY MET 1541 00:57:14,800 --> 00:57:15,200 CRITERIA FOR POTS. 1542 00:57:15,200 --> 00:57:16,520 IF YOU LOOK AT THE OVERALL 1543 00:57:16,520 --> 00:57:18,880 GROUP, THERE'S MORE FEMALES THAN 1544 00:57:18,880 --> 00:57:20,200 MALES, NOT QUITE STATISTICALLY 1545 00:57:20,200 --> 00:57:21,640 SIGNIFICANT AS I MENTIONED THE 1546 00:57:21,640 --> 00:57:23,080 STUDIES NOT DONE, WE'RE STILL 1547 00:57:23,080 --> 00:57:24,240 ENROLLING, BUT THE POINT IS 1548 00:57:24,240 --> 00:57:26,000 THERE'S ACTUALLY A MARKED 1549 00:57:26,000 --> 00:57:27,880 DIFFERENCE NOT ONLY JUST SAYING 1550 00:57:27,880 --> 00:57:29,920 THAT FEMALES GET MORE ISSUES 1551 00:57:29,920 --> 00:57:31,440 WITH AUTONOMIC DISORDERS BUT IT 1552 00:57:31,440 --> 00:57:34,120 VARIES DEPENDING ON THE TYPE OF 1553 00:57:34,120 --> 00:57:35,880 DISORDER AND AGAIN SOMETHING WE 1554 00:57:35,880 --> 00:57:37,040 WOULDN'T HAVE PICKED UP WITHOUT 1555 00:57:37,040 --> 00:57:39,600 SPECIFICALLY LOOKING FOR IT. 1556 00:57:39,600 --> 00:57:44,880 >> YOUR TIME IS UP. 1557 00:57:44,880 --> 00:57:45,400 >> OKAY. 1558 00:57:45,400 --> 00:57:48,200 DO YOU WANT ME TO STOP OR-- 1559 00:57:48,200 --> 00:57:49,480 >> YOU CAN JUST WRAP IT UP, 1560 00:57:49,480 --> 00:57:49,920 THANK YOU. 1561 00:57:49,920 --> 00:57:51,480 YOU CAN FINISH THE SLIDE. 1562 00:57:51,480 --> 00:57:53,440 >> OKAY, SO THE POINT IS 1563 00:57:53,440 --> 00:57:55,240 AUTONOMIC DISORDERS ARE COMMON, 1564 00:57:55,240 --> 00:57:56,800 POTS GETS ALL THE ATTENTION BUT 1565 00:57:56,800 --> 00:57:57,880 OTHER STUFF IS COMMON TOO IS THE 1566 00:57:57,880 --> 00:57:59,320 REALITY IS YOU FIND WHAT YOU 1567 00:57:59,320 --> 00:58:01,840 LOOK FOR SO IOH WASN'T DIAGNOSED 1568 00:58:01,840 --> 00:58:03,760 BECAUSE NO 1 IS LOOKING FOR IT, 1569 00:58:03,760 --> 00:58:05,120 SEX DIFFERENCES EXIST IN THE 1570 00:58:05,120 --> 00:58:06,200 SYMPTOMSAs WELL AS FREQUENCY 1571 00:58:06,200 --> 00:58:06,920 OF THESEOT NATIONAL LIBRARY OF 1572 00:58:06,920 --> 00:58:17,080 MEDICINIC DISORDERS AND I WILL 1573 00:58:17,080 --> 00:58:19,360 STOP, THANK YOU FOR LETTING ME 1574 00:58:19,360 --> 00:58:20,680 KICK THIS OFF. 1575 00:58:20,680 --> 00:58:22,840 >> THANK YOU DR. RAJ, WE WILL 1576 00:58:22,840 --> 00:58:31,920 GET THE NEXT SPEAKER WHICH IS 1577 00:58:31,920 --> 00:58:32,200 DR. MOON. 1578 00:58:32,200 --> 00:58:33,160 >> THANK YOU VERY MUCH, CAN YOU 1579 00:58:33,160 --> 00:58:36,120 HEAR ME AND SEE MY SLIDES IN 1580 00:58:36,120 --> 00:58:36,600 PRESENTATION MODE? 1581 00:58:36,600 --> 00:58:37,000 >> YES. 1582 00:58:37,000 --> 00:58:39,600 >> I WILL TALK ABOUT 1583 00:58:39,600 --> 00:58:41,000 CARDIOVASCULAR IMAGES AND 1584 00:58:41,000 --> 00:58:43,000 COVID-19 ESPECIALLY THE USE OF 1585 00:58:43,000 --> 00:58:46,560 BIOMARKERS TO ATTRACT DISEASE. 1586 00:58:46,560 --> 00:58:47,040 --TRACK DISEASE. 1587 00:58:47,040 --> 00:58:49,120 SO I'M A UK PROFESSOR OF 1588 00:58:49,120 --> 00:58:51,800 CARDIOLOGY AND I DID CARDIAC MRI 1589 00:58:51,800 --> 00:58:53,560 IT WASN'T USEFUL IN THE HEAT OF 1590 00:58:53,560 --> 00:58:55,400 THE HOT WAVES SO I SET UP A 1591 00:58:55,400 --> 00:58:57,480 STUDY OF MILD DISEASE USING A 1592 00:58:57,480 --> 00:58:58,840 HEALTHCARE WORKERS WHICH WAS 1593 00:58:58,840 --> 00:59:00,240 SUCCESSFUL, YOU MAY HAVE SEEN A 1594 00:59:00,240 --> 00:59:04,160 PAPER THIS WEEK ON WHAT OMICRON 1595 00:59:04,160 --> 00:59:06,920 SYSTEM, BUT I HAD TO WORK AS AN 1596 00:59:06,920 --> 00:59:09,360 ITU NURSE AS WE TRIED NOT TO BE 1597 00:59:09,360 --> 00:59:12,040 SWAMPED DURING 2 OF THE WAVES. 1598 00:59:12,040 --> 00:59:13,920 SO IMAGE SUGGEST ALL ABOUT 1599 00:59:13,920 --> 00:59:14,760 PRETEST PROBABILITY AND WHAT 1600 00:59:14,760 --> 00:59:15,760 YOU'RE LOOKING FOR AND WHAT YOU 1601 00:59:15,760 --> 00:59:18,280 WILL DO WITH THAT IMAGES BECAUSE 1602 00:59:18,280 --> 00:59:19,920 NO 1 GETS BETTER FROM IMAGING IT 1603 00:59:19,920 --> 00:59:22,040 HAS TO BE LINKED TO THERAPY. 1604 00:59:22,040 --> 00:59:23,960 AND THE EXPOSE OHM IF YOU LIKE 1605 00:59:23,960 --> 00:59:27,200 IS THESE MULTIPLE WEIGHS OF 1606 00:59:27,200 --> 00:59:28,680 SARS-COV-2 AS THEY GO THROUGH, 1607 00:59:28,680 --> 00:59:30,680 THOSE VARIANTS ARE CURRENTLY 1608 00:59:30,680 --> 00:59:31,560 LESS PATHOGENIC AND OF COURSE 1609 00:59:31,560 --> 00:59:35,440 HAVE YOU MANY PEOPLE WITH 3 1610 00:59:35,440 --> 00:59:36,040 VACCINES BY NOW. 1611 00:59:36,040 --> 00:59:37,960 YOU HAVE TO THINK IF YOU COMPARE 1612 00:59:37,960 --> 00:59:39,160 IMAGING RESULTS ABOUT WHO THE 1613 00:59:39,160 --> 00:59:41,080 PEOPLE ARE AND ESPECIALLY WHAT 1614 00:59:41,080 --> 00:59:42,120 PREDISPOSING RISK FACTORS THEY 1615 00:59:42,120 --> 00:59:47,680 HAVE AND OF COURSE IT'S NOT JUT 1616 00:59:47,680 --> 00:59:49,600 COVID AS CORONA VIRUS DISEASE, 1617 00:59:49,600 --> 00:59:52,200 IT'S WHETHER YOU'RE A 1618 00:59:52,200 --> 00:59:53,080 SYMPTOMATIC MILD OR ACUTE 1619 00:59:53,080 --> 00:59:54,640 INFECTION AND IF YOU WERE 1620 00:59:54,640 --> 00:59:57,000 HOSPITALIZED AND HOW LONG WERE 1621 00:59:57,000 --> 00:59:57,560 YOU HOSPITALIZED FOR. 1622 00:59:57,560 --> 00:59:58,720 AND ALL THAT GOES INTO THE 1623 00:59:58,720 --> 00:59:58,960 RESULTS. 1624 00:59:58,960 --> 01:00:00,320 AND WHAT WE FIND IN THE FIRST 1625 01:00:00,320 --> 01:00:03,480 WAVE MAY BE DIFFERENT THAN ANY 1626 01:00:03,480 --> 01:00:04,440 SUBSEQUENT WAVES BECAUSE THERAPY 1627 01:00:04,440 --> 01:00:06,600 HAS CHANGED AND THEN YOU HAVE TO 1628 01:00:06,600 --> 01:00:08,480 THINK OF MORE THAN JUST THE 1629 01:00:08,480 --> 01:00:09,400 HEART ALTHOUGH I VERY OFTEN JUST 1630 01:00:09,400 --> 01:00:11,120 THINK OF THE HEART IN IMAGING, 1631 01:00:11,120 --> 01:00:19,320 THERE IS THAT INTERACKING ACROSS 1632 01:00:19,320 --> 01:00:25,720 SCALES AND OF COURSE SOCIETAL 1633 01:00:25,720 --> 01:00:26,160 AND SCALABLE WORK. 1634 01:00:26,160 --> 01:00:28,360 IT IS REALLY UNLIKELY I THINK 1635 01:00:28,360 --> 01:00:31,720 NOW THAT FUTURE WAVES WILL HAVE 1636 01:00:31,720 --> 01:00:33,240 WILL HAVE SEVERE CARDIOVASCULAR 1637 01:00:33,240 --> 01:00:36,640 IMPACT. 1638 01:00:36,640 --> 01:00:41,080 SO IMAGING IS REALLY ESSENTIAL 1639 01:00:41,080 --> 01:00:43,200 SO IN CARDIOVASCULAR DISEASE, WE 1640 01:00:43,200 --> 01:00:44,120 DEFINE OUR DISEASES ESPECIALLY 1641 01:00:44,120 --> 01:00:45,720 HEARTS BY THE IMAGING 1642 01:00:45,720 --> 01:00:46,520 APPEARANCE, STRUCTURE AND 1643 01:00:46,520 --> 01:00:46,920 FUNCTION. 1644 01:00:46,920 --> 01:00:50,320 SO OUR DISEASES MIGHT BE CALLED 1645 01:00:50,320 --> 01:00:52,480 DILATED CARDIOMYOPATHY AND 1646 01:00:52,480 --> 01:00:53,400 HYPOTROPIC CARDIOMYOPATHY SO 1647 01:00:53,400 --> 01:00:55,360 WE'RE NOT VERY MOLECULAR, WE 1648 01:00:55,360 --> 01:00:56,960 LOOK AT APPEARANCE OF THE HEART, 1649 01:00:56,960 --> 01:00:59,840 SO WE ONLY HAVE 2 BLOOD 1650 01:00:59,840 --> 01:01:01,720 BIOMARKERS WE USE SO THOSE 1651 01:01:01,720 --> 01:01:04,240 APPEARANCES ARE VERY IMPORTANT. 1652 01:01:04,240 --> 01:01:05,840 NOW WE'VE OVERLAID THOSE WITH 1653 01:01:05,840 --> 01:01:07,080 SOME CHARACTERISTICS OF 1654 01:01:07,080 --> 01:01:08,280 PROCESSES USING TISSUE 1655 01:01:08,280 --> 01:01:10,760 CHARACTERIZATION SO WE CAN NOW 1656 01:01:10,760 --> 01:01:12,520 SEE ESCHEMIA AND FIBROSIS AND 1657 01:01:12,520 --> 01:01:13,480 SOME INFLAMMATION, ALTHOUGH OF 1658 01:01:13,480 --> 01:01:16,160 COURSE WE CAN'T TELL IF THE 1659 01:01:16,160 --> 01:01:17,040 INFLAMMATION IS CLEARS UP 1660 01:01:17,040 --> 01:01:20,320 DISEASE OR ACTUALLY THE 1661 01:01:20,320 --> 01:01:20,920 PATHOLOGICAL PROCESS. 1662 01:01:20,920 --> 01:01:22,240 SO WHEN WE THINK ABOUT IMAGING, 1663 01:01:22,240 --> 01:01:24,640 YOU NEED TO THINK ABOUT THE 1664 01:01:24,640 --> 01:01:25,920 DISEASE CHARACTERISTICS AND THEN 1665 01:01:25,920 --> 01:01:31,640 ALSO THE TEST CHARACTERISTICS, 1666 01:01:31,640 --> 01:01:32,080 SPECIFICITY, PRETEST 1667 01:01:32,080 --> 01:01:33,280 PROBABILITY, WE NEED TO KNOW 1668 01:01:33,280 --> 01:01:34,960 WHAT'S NORMAL AND YOU WILL SEE 1669 01:01:34,960 --> 01:01:37,240 MISTAKES ABOUT WHAT IS 1670 01:01:37,240 --> 01:01:38,440 INTERPRETING MISTAKES ABOUT WHAT 1671 01:01:38,440 --> 01:01:39,640 IS NORMAL FOR SOME PEOPLE DURING 1672 01:01:39,640 --> 01:01:41,000 THIS AND THEN OF COURSE YOU HAVE 1673 01:01:41,000 --> 01:01:42,480 TO HAVE IT AVAILABLE AND 1674 01:01:42,480 --> 01:01:42,960 EFFECTIVELY DELIVERED. 1675 01:01:42,960 --> 01:01:44,680 SO THE PROBLEM IS THAT WE HAVE 1676 01:01:44,680 --> 01:01:46,240 ASSOCIATION AND CAUSATION, SO 1677 01:01:46,240 --> 01:01:47,720 CARDIOVASCULAR DISEASE AS WAS 1678 01:01:47,720 --> 01:01:49,720 PREVIOUSLY SAID IS A RISK FACTOR 1679 01:01:49,720 --> 01:01:52,560 FOR SEVERE COVID, BUT COVID 1680 01:01:52,560 --> 01:01:53,200 CAUSES CARDIOVASCULAR DISEASE. 1681 01:01:53,200 --> 01:02:00,560 SO CAN YOU SEE THIS TWITTER 1682 01:02:00,560 --> 01:02:03,760 IMAGE MAKING LITTLE PAN ON CAUSE 1683 01:02:03,760 --> 01:02:05,920 THE VISITOR CENTER NEXT TO THE 1684 01:02:05,920 --> 01:02:07,120 ASTEROID SITE, HOW LUCK THAT'S 1685 01:02:07,120 --> 01:02:08,440 IS, BUT THERE'S MORE TO IT THAN 1686 01:02:08,440 --> 01:02:10,840 THAT BECAUSE IT SEEMS THAT COVID 1687 01:02:10,840 --> 01:02:14,240 IS ALSO A STRESS TEST FOR THE 1688 01:02:14,240 --> 01:02:14,680 CARDIOVASCULAR SYSTEM. 1689 01:02:14,680 --> 01:02:16,800 SO IF YOU FIND ABNORMALITIES BY 1690 01:02:16,800 --> 01:02:21,920 IMAGES FOR EXAMPLE, SOME OF IT 1691 01:02:21,920 --> 01:02:23,120 WAS PREEXISTING DISEASE THAT IS 1692 01:02:23,120 --> 01:02:27,760 REVEALED BY THE SEVERE--HAVING 1693 01:02:27,760 --> 01:02:28,080 SEVERE COVID. 1694 01:02:28,080 --> 01:02:31,560 SO YOU HAVE TO BE MORE COARSE 1695 01:02:31,560 --> 01:02:33,920 ABOUT DESCRIBING THINGS TO THE 1696 01:02:33,920 --> 01:02:35,080 SAR-COV-2 INFECTION AND HOW WE 1697 01:02:35,080 --> 01:02:38,560 CREATE CONTROLS FOR THIS IS HARD 1698 01:02:38,560 --> 01:02:42,120 BECAUSE WE KNOW HOW TO CONTROL 1699 01:02:42,120 --> 01:02:45,040 ALL THIS FOR CVD, BUT IT IS A 1700 01:02:45,040 --> 01:02:47,280 MORE COMPLEX PHENOTYPE AND IT 1701 01:02:47,280 --> 01:02:49,240 ALSO MEANS THAT WHILE THAT'S 1702 01:02:49,240 --> 01:02:50,520 MEASURED RISK FACTORS YOU HAVE 1703 01:02:50,520 --> 01:02:51,480 THE UNMEASURED RISK FACTORS AS 1704 01:02:51,480 --> 01:02:53,800 WELL AND WE KNOW THAT THOSE ARE 1705 01:02:53,800 --> 01:02:58,400 SIGNIFICANT IN HEART DISEASE. 1706 01:02:58,400 --> 01:03:03,000 SO EARLY IN THE PANDEMIC, THINGS 1707 01:03:03,000 --> 01:03:03,400 WERE OPEN ENDED. 1708 01:03:03,400 --> 01:03:06,160 PEOPLE SAW THAT THERE WAS 1709 01:03:06,160 --> 01:03:07,000 CARDIOVASCULAR DISEASE AND 1710 01:03:07,000 --> 01:03:07,960 MYOCARDIAL DISEASE AND THEY 1711 01:03:07,960 --> 01:03:09,400 CALLED IT SIMILAR TO MY O 1712 01:03:09,400 --> 01:03:12,400 CARDITEIS AND THERE WAS A LOT 1713 01:03:12,400 --> 01:03:13,920 TRIP OWNIN ELEVATION ESPECIALLY 1714 01:03:13,920 --> 01:03:17,080 IN SEVERE DISEASE AND ITU. 1715 01:03:17,080 --> 01:03:19,200 AND PEOPLE KEPT A BIG MIND AND 1716 01:03:19,200 --> 01:03:21,280 LATER A GERMAN PAPER CAME OUT 1717 01:03:21,280 --> 01:03:23,600 USING THE TECHNIQUE I'M SEEING 1718 01:03:23,600 --> 01:03:25,040 MOI AND SUGGESTED THAT MILD 1719 01:03:25,040 --> 01:03:25,960 DISEASE PEOPLE HAD ENORM USE 1720 01:03:25,960 --> 01:03:27,960 RATES OF WHAT THEY WERE THINKING 1721 01:03:27,960 --> 01:03:30,640 WAS MY O CARDITEIS WITH 78% OF 1722 01:03:30,640 --> 01:03:34,800 PEOPLE HAVING ONGOING 1723 01:03:34,800 --> 01:03:40,480 INFLAMMATION. 1724 01:03:40,480 --> 01:03:42,000 THIS CAUSED CONSIDERABLE CONCERN 1725 01:03:42,000 --> 01:03:44,080 AND AFFECTED LIVES IN MANY WAYS. 1726 01:03:44,080 --> 01:03:46,080 AND YOU WOULD NOT BE SURPRISED 1727 01:03:46,080 --> 01:03:47,600 TO FIND OUT THERE WERE LOTS OF 1728 01:03:47,600 --> 01:03:50,480 PROBLEMS WITH THIS PAPER, IT GOT 1729 01:03:50,480 --> 01:03:53,680 COMPLETELY REVISED A GROUP OF 1730 01:03:53,680 --> 01:03:56,520 SCIENTISTS INCLUDE MYSELF HAD 1731 01:03:56,520 --> 01:03:57,480 CONCERNS ABOUT METHODS AND 1732 01:03:57,480 --> 01:03:59,080 TECHNOLOGY AND THEY WERE NOT 1733 01:03:59,080 --> 01:04:00,440 REPLIED AND LITTLERS HAD TO COME 1734 01:04:00,440 --> 01:04:02,720 IN AND SUGGEST THAT THIS WAS A 1735 01:04:02,720 --> 01:04:05,320 PROBLEM, THIS PAPER AND IT 1736 01:04:05,320 --> 01:04:08,240 CAUSED UNNECESSARY HYSTERIA AND 1737 01:04:08,240 --> 01:04:09,600 CEMENTED THE WARD MYOCARDITIS 1738 01:04:09,600 --> 01:04:20,160 INTO THE COVID SORT OF MIND SET. 1739 01:04:23,120 --> 01:04:24,640 THIS WAS PRETTY MUCH AS GOOD AS 1740 01:04:24,640 --> 01:04:26,320 CAN YOU GET FOR CONTROLS BECAUSE 1741 01:04:26,320 --> 01:04:28,480 WE RECRUITED PEOPLE BEFORE THEY 1742 01:04:28,480 --> 01:04:30,000 HAD COVID AND WE PRODUCED THIS 1743 01:04:30,000 --> 01:04:32,280 IN A MATCH LIKE THIS AND WE 1744 01:04:32,280 --> 01:04:33,880 MEASURED 10 PARAMETERS USING 1745 01:04:33,880 --> 01:04:34,960 MAINLY MRI AND THESE WERE 1746 01:04:34,960 --> 01:04:38,800 CONTROLLED AS WELL AS WE COULD 1747 01:04:38,800 --> 01:04:41,640 BLIEPPEDDING AI ANALYSTICS ET 1748 01:04:41,640 --> 01:04:47,040 CETERA INDEPENDENT DATA 1749 01:04:47,040 --> 01:04:48,560 ANALYSIS, BLINDED BY 1750 01:04:48,560 --> 01:04:48,920 [INDISCERNIBLE]. 1751 01:04:48,920 --> 01:04:51,800 WE FOUND THAT NORMAL PEOPLE 1752 01:04:51,800 --> 01:04:54,800 QUITE OFTEN HAVE ABNORMALITIES, 1753 01:04:54,800 --> 01:04:56,520 70% FEMALE HEALTHCARE WORKERS 1754 01:04:56,520 --> 01:04:57,520 AND ABOUT 5% WERE ABNORMAL BUT 1755 01:04:57,520 --> 01:04:59,360 THE DEC THERE WAS NO SIGNAL OF 1756 01:04:59,360 --> 01:05:00,960 DIFFERENCE BETWEEN THOSE WHO HAD 1757 01:05:00,960 --> 01:05:02,920 COVID AND THOSE WHO HADN'T. AND 1758 01:05:02,920 --> 01:05:05,920 THAT CONSTRAINED THE MAXIMUM 1759 01:05:05,920 --> 01:05:07,280 INCREMENTAL WEIGHT IN MILD 1760 01:05:07,280 --> 01:05:09,080 DISEASE TO 4% AND IT'S VERY HARD 1761 01:05:09,080 --> 01:05:10,520 TO PROVE THE NEGATIVE. 1762 01:05:10,520 --> 01:05:13,080 AND THAT THAT SORT OF CHIMED 1763 01:05:13,080 --> 01:05:15,000 WITH SUBSEQUENT DATA ON ATHLETES 1764 01:05:15,000 --> 01:05:16,240 WHERE INFLAMMATORY DISEASE WAS 1765 01:05:16,240 --> 01:05:19,520 LOOKING VERY LOW IN THE 1766 01:05:19,520 --> 01:05:19,920 COMMUNITY. 1767 01:05:19,920 --> 01:05:22,480 .6.7% BUT SEVERE DISEASE IN HERE 1768 01:05:22,480 --> 01:05:23,640 WE'RE USING IMAGING AGAIN WAS A 1769 01:05:23,640 --> 01:05:25,200 DIFFERENT MATTER, IF YOU TAKE 1770 01:05:25,200 --> 01:05:27,400 PEOPLE WHO GET A TRIP OWNIN 1771 01:05:27,400 --> 01:05:28,240 ELEVATION IN THE HOSPITAL AND 1772 01:05:28,240 --> 01:05:32,160 MANY OF THOSE ARE IN ITU, YOU 1773 01:05:32,160 --> 01:05:34,240 FIND THAT WHILST THE HEALTHY 1774 01:05:34,240 --> 01:05:35,920 IMPAIRMENT IS MUCH MORE, 1775 01:05:35,920 --> 01:05:37,240 FUNCTION ISN'T MUCH WORSE IF 1776 01:05:37,240 --> 01:05:39,800 THEY SURVIVE AND YOU SCAN THEM 1777 01:05:39,800 --> 01:05:40,240 AS OUTPATIENTS. 1778 01:05:40,240 --> 01:05:43,120 THEY HAVE A LOT OF SCAR. 1779 01:05:43,120 --> 01:05:45,200 AND IT'S NOT JUSTA A PATTERN 1780 01:05:45,200 --> 01:05:46,520 THAT MIGHT BE MYOCARDITIS BUT IT 1781 01:05:46,520 --> 01:05:49,480 ALSO APPEARS TO BE AN INFARCT 1782 01:05:49,480 --> 01:05:52,160 PATTERN SO IT LOOKED LIKE IT 1783 01:05:52,160 --> 01:05:53,400 THERE FTIONA COMPLEX PICTURE 1784 01:05:53,400 --> 01:05:54,840 GOING ON. 1785 01:05:54,840 --> 01:05:58,360 PATHOTBOJICALLY AGAIN IN SEVERE 1786 01:05:58,360 --> 01:06:00,440 DISEASE, FOUND THAT INI RECALLLY 1787 01:06:00,440 --> 01:06:03,120 SUGGESTED LOTS OF REPORTS OF 1788 01:06:03,120 --> 01:06:04,280 MYOCARDITIS, BUT SUBSEQUENTLY 1789 01:06:04,280 --> 01:06:07,160 MORE LIKE 1.4% OF THOSE WHO DIED 1790 01:06:07,160 --> 01:06:09,080 FOR MOST AT RISK FOR COVID. 1791 01:06:09,080 --> 01:06:10,360 THE LATEST DATA PUBLISHED IN 1792 01:06:10,360 --> 01:06:14,520 ABSTRACT FORM IS THAT WE TOOK 23 1793 01:06:14,520 --> 01:06:16,640 SEN ILLEGALSENUS OF PATIENTS AND 1794 01:06:16,640 --> 01:06:19,240 LOOKED AT THOSE WITH TROPONIN 1795 01:06:19,240 --> 01:06:21,840 POSITIVITY AND THEN WE TOOK 1796 01:06:21,840 --> 01:06:23,160 CO-MORBIDITY POSITIVE PATIENTS, 1797 01:06:23,160 --> 01:06:24,960 THESE PEOPLE WITH LOTS OF 1798 01:06:24,960 --> 01:06:26,000 DIABETES AND HYPERTENSION LIKE 1799 01:06:26,000 --> 01:06:28,200 OUR SEVERE DISEASE POPULATIONS 1800 01:06:28,200 --> 01:06:31,480 AND THEN COVID POSITIVE TROPONIN 1801 01:06:31,480 --> 01:06:32,880 NEGATIVE SUBJECT WHO IS HAD BEEN 1802 01:06:32,880 --> 01:06:35,280 HOSPITALIZED AND WHAT WE FOUND 1803 01:06:35,280 --> 01:06:38,040 WAS FIRSTLY THAT THE TROPONIN 1804 01:06:38,040 --> 01:06:40,240 POSITIVE PEOPLE WERE MUCH MORE 1805 01:06:40,240 --> 01:06:40,560 MALE. 1806 01:06:40,560 --> 01:06:44,120 THERE WASN'T MUCH OF THE 1807 01:06:44,120 --> 01:06:45,560 IMPAIRMENT BUT THERE WERE 1808 01:06:45,560 --> 01:06:45,840 OUTLINES. 1809 01:06:45,840 --> 01:06:47,720 THERE WASN'T MUCH INFLAMMATION 1810 01:06:47,720 --> 01:06:50,320 AT 28 DAYS LATER BUT THERE WAS 1811 01:06:50,320 --> 01:06:52,880 AT LEAST TWICE AS MUCH SCAR IN 1812 01:06:52,880 --> 01:06:57,160 THOSE WHO HAD TROPONIN ELEVATION 1813 01:06:57,160 --> 01:06:57,480 AND HOSPITAL. 1814 01:06:57,480 --> 01:06:59,960 BUT THE EXCESS SCAR WAS 1815 01:06:59,960 --> 01:07:00,840 INFARCTION AND MICROINFARCTION, 1816 01:07:00,840 --> 01:07:02,440 WHAT WE FOUND WAS THAT THE 1817 01:07:02,440 --> 01:07:06,200 CONTROLS HAD LOTS OF MYOCARDITIS 1818 01:07:06,200 --> 01:07:06,600 LIKE SCAR. 1819 01:07:06,600 --> 01:07:09,800 SO THERE WAS A 13% AND 14% 1820 01:07:09,800 --> 01:07:11,000 RATING IN COMORBID CONTROLS AND 1821 01:07:11,000 --> 01:07:12,840 IF YOU DIDN'T HAVE ALL THOSE 1822 01:07:12,840 --> 01:07:14,400 CONTROLS YOU WOULD CALL ALL OF 1823 01:07:14,400 --> 01:07:15,960 THESE COVID RELATED MARKERS SO I 1824 01:07:15,960 --> 01:07:18,840 THINK WE ARE REALLY MOVING 1825 01:07:18,840 --> 01:07:21,720 TOWARDS THROMBOTIC AS THE 1826 01:07:21,720 --> 01:07:24,240 PRIMARY CAUSE OF MYOCARDIAL 1827 01:07:24,240 --> 01:07:25,640 JUDGE IN THE FIRST AND SECOND 1828 01:07:25,640 --> 01:07:26,720 WAVE OF INFECTION. 1829 01:07:26,720 --> 01:07:27,720 >> ONE MINUTE LEFT. 1830 01:07:27,720 --> 01:07:29,640 >> TO SUMMARIZE, WE'RE IN A 1831 01:07:29,640 --> 01:07:31,320 COMPLEX LANDSCAPE IF YOU WANT TO 1832 01:07:31,320 --> 01:07:32,360 DO IMAGING, YOU NEED TO 1833 01:07:32,360 --> 01:07:34,280 UNDERSTAND THE DISEASE BUT NOT 1834 01:07:34,280 --> 01:07:36,520 GET TOO HUNG UP ON WHAT SOME OF 1835 01:07:36,520 --> 01:07:43,200 THE EARLY LITERATURES TOLD YOU. 1836 01:07:43,200 --> 01:07:45,160 THE FUTURES ARE MUCH MORE LIKE 1837 01:07:45,160 --> 01:07:46,200 TO HAVE THIS. 1838 01:07:46,200 --> 01:07:48,280 WE HAVE THIS CAUSE TO THE ISSUE 1839 01:07:48,280 --> 01:07:49,480 ISSUES AND ASHING STZ IS A 1840 01:07:49,480 --> 01:07:50,760 STRESS TEST FOR THE HEART SO YOU 1841 01:07:50,760 --> 01:07:52,520 HAVE TO BE CAREFUL SELECTING 1842 01:07:52,520 --> 01:07:53,480 CONTROLS AND THINKING ABOUT 1843 01:07:53,480 --> 01:07:58,840 WHETHER THERE ARE UNMEASURED 1844 01:07:58,840 --> 01:08:01,240 RISK FACTORS. 1845 01:08:01,240 --> 01:08:02,760 >> THE SCENARIO MATTERS WITH 1846 01:08:02,760 --> 01:08:04,760 YOUR IMAGING AND YOU MAY THINK 1847 01:08:04,760 --> 01:08:07,120 OF THESE SCENARIOS, AND MILD 1848 01:08:07,120 --> 01:08:08,000 DISEASE REALLY--I WOULDN'T THINK 1849 01:08:08,000 --> 01:08:10,840 OF IT FOR STRUCTURAL OR 1850 01:08:10,840 --> 01:08:12,640 FUNCTIONAL PHENOTYPE AND 1851 01:08:12,640 --> 01:08:15,760 OBVIOUSLY IMAGES DOESN'T MEASURE 1852 01:08:15,760 --> 01:08:17,480 THE AUTONOMIC SIZE, SEVERE 1853 01:08:17,480 --> 01:08:18,920 DISEASE HOWEVER CAUSES THESE 1854 01:08:18,920 --> 01:08:29,480 WHICH MAY WELL HAVE DOWN STREAM 1855 01:08:31,360 --> 01:08:32,360 CONSEQUENCES AND THERE ARE 1856 01:08:32,360 --> 01:08:34,960 BETTER STUDIES NEED TO BE DONE. 1857 01:08:34,960 --> 01:08:36,760 SO TO SUMMARIZE, WE TRY TO 1858 01:08:36,760 --> 01:08:38,840 UNDERSTAND THE DISEASE AND I 1859 01:08:38,840 --> 01:08:41,480 FOCUSED ON CARDIAC MRI AS THE 1860 01:08:41,480 --> 01:08:42,800 BEST BIOLOGICAL IMAGING 1861 01:08:42,800 --> 01:08:43,360 DISCOVERY TECHNIQUE HERE. 1862 01:08:43,360 --> 01:08:43,880 THANK YOU VERY MUCH. 1863 01:08:43,880 --> 01:08:45,800 >> THANK YOU DR. MOON, SO WE'RE 1864 01:08:45,800 --> 01:08:47,600 GOING IT GO NOW TO OUR 1865 01:08:47,600 --> 01:08:48,920 DISCUSSION TIME SO IF YOU WANT 1866 01:08:48,920 --> 01:08:51,000 TO PUT ANY QUESTIONS INTO THE 1867 01:08:51,000 --> 01:08:59,280 QUESTION AND SW, WE WILL GET TO 1868 01:08:59,280 --> 01:09:00,960 THAT AND AND I AM GOING TO PULL 1869 01:09:00,960 --> 01:09:02,800 UP THE SUMMARY AND WHAT SOME OF 1870 01:09:02,800 --> 01:09:04,000 THE DIFFERENT END SLIDES THAT 1871 01:09:04,000 --> 01:09:05,640 WERE PRESENTED THAT WE CAN LOOK 1872 01:09:05,640 --> 01:09:07,320 AT TO JOG OUR THINKING. 1873 01:09:07,320 --> 01:09:10,040 BUT I HAVE A QUESTION FOR 1874 01:09:10,040 --> 01:09:12,240 DR. MOON RIGHT AWAY AND ACTUALLY 1875 01:09:12,240 --> 01:09:19,640 EVERYONE FROM OUR PANEL, YOU CAN 1876 01:09:19,640 --> 01:09:30,120 TURN YOUR CAMERA ON, DID YOU 1877 01:09:32,400 --> 01:09:34,280 LOOK AT DATA SETS AND FOR THE 1878 01:09:34,280 --> 01:09:35,920 ANALYSIS YOU WERE DOING WERE 1879 01:09:35,920 --> 01:09:41,120 THEY ANALYZING BY SEX? 1880 01:09:41,120 --> 01:09:42,280 AND REGARDING THE TYPE OF 1881 01:09:42,280 --> 01:09:43,360 RESULTS THAT YOU FOUND WHAT DO 1882 01:09:43,360 --> 01:09:45,360 YOU THINK SORT OF THE SEX 1883 01:09:45,360 --> 01:09:46,760 DIFFERENCES WOULD BE OR THE 1884 01:09:46,760 --> 01:09:52,760 IMPLICATIONS OF THAT FOR YOUR 1885 01:09:52,760 --> 01:09:53,120 METHOD? 1886 01:09:53,120 --> 01:09:54,640 >> SO FIRSTLY THANK YOU FOR 1887 01:09:54,640 --> 01:09:56,040 SETTING UP THIS SYMPOSIUM 1888 01:09:56,040 --> 01:09:58,960 BECAUSE I'VE BEEN CALLING BACK 1889 01:09:58,960 --> 01:10:01,680 AND POOLING MY TEAM TO DO 1890 01:10:01,680 --> 01:10:02,840 SUBGROUP ANALYSIS AND LOOK AT 1891 01:10:02,840 --> 01:10:05,400 THIS AND WE'VE BEEN LOOKINGA THE 1892 01:10:05,400 --> 01:10:06,920 TRANSCRIPT OHM AND PROTEOME OF 1893 01:10:06,920 --> 01:10:10,840 MILD DISEASE CASES WHERE WE HAD 1894 01:10:10,840 --> 01:10:15,160 BEFORE, DURING AND AFTER 1895 01:10:15,160 --> 01:10:15,560 SAMPLES. 1896 01:10:15,560 --> 01:10:17,320 FOR THE PROTEOME THERE WERE NO 1897 01:10:17,320 --> 01:10:21,640 SEX DIFFERENCES. 1898 01:10:21,640 --> 01:10:23,000 THERE WERE RESPONSE AND SYMPTOMS 1899 01:10:23,000 --> 01:10:26,120 BUT NOT WITH SEX. 1900 01:10:26,120 --> 01:10:28,520 FOR MANY OF THE STUDIES IN THE 1901 01:10:28,520 --> 01:10:33,040 LITERATURE THAT THE--THE BREAK 1902 01:10:33,040 --> 01:10:34,280 DOWNS ARE ARE BY SEX BUT YOU 1903 01:10:34,280 --> 01:10:40,720 DON'T GET THE IMPRESSION THAT 1904 01:10:40,720 --> 01:10:42,720 IT'S SEX IMPACT ON THE INFECTION 1905 01:10:42,720 --> 01:10:46,280 RATHER THAN THE UNDERLYING 1906 01:10:46,280 --> 01:10:48,640 CARDIOVASCULAR RISK FACTORS FOR 1907 01:10:48,640 --> 01:10:49,720 EXAMPLE. 1908 01:10:49,720 --> 01:10:52,200 SO I THINK THERE IS AS YOU SAY 1909 01:10:52,200 --> 01:10:53,960 MUCH MORE WORK TO DO, WITH 1910 01:10:53,960 --> 01:10:55,040 REGARDS TO LITERATURE, I TRY AND 1911 01:10:55,040 --> 01:10:56,680 KEEP UP BUT THERE HAVE BEEN 1912 01:10:56,680 --> 01:10:57,880 QUARTER OF A MILLION PAPERS SO 1913 01:10:57,880 --> 01:11:00,480 FAR SO I NEED TO READ SLIGHTLY 1914 01:11:00,480 --> 01:11:02,280 MORE THAN 1 PAPER PER SECOND TO 1915 01:11:02,280 --> 01:11:04,520 HAVE A CAP OFF I WANT TO IN THE 1916 01:11:04,520 --> 01:11:05,600 NEXT [INDISCERNIBLE]. 1917 01:11:05,600 --> 01:11:07,800 THE COVID LITERATURE IS DAUNTING 1918 01:11:07,800 --> 01:11:09,000 FOR SURE. 1919 01:11:09,000 --> 01:11:12,000 I WILL THEN MOVE TO A QUESTION 1920 01:11:12,000 --> 01:11:18,000 THAT CAME UP IN THE--FOR DR. RAJ 1921 01:11:18,000 --> 01:11:19,920 AND IT'S WHY DO YOUNG CHILDREN 1922 01:11:19,920 --> 01:11:23,760 LESS THAN 10 YEARS OF AGE 1923 01:11:23,760 --> 01:11:24,360 DEVELOP POTS? 1924 01:11:24,360 --> 01:11:26,240 >> THE BROADER QUESTION IS WHY 1925 01:11:26,240 --> 01:11:27,880 DOES ANYONE DEVELOP POTS, I'M 1926 01:11:27,880 --> 01:11:29,640 NOT SURE WE FULLY UNDERSTAND 1927 01:11:29,640 --> 01:11:29,920 THAT? 1928 01:11:29,920 --> 01:11:31,320 YEAH, THIS IS BASED ON THE HEART 1929 01:11:31,320 --> 01:11:32,400 RATE THING THEY WAS MENTIONING. 1930 01:11:32,400 --> 01:11:35,440 WHAT I WOULD SAY IS THAT IT'S 1931 01:11:35,440 --> 01:11:39,640 NOT SO MUCH POTS BUT ACTUALLY 1932 01:11:39,640 --> 01:11:42,680 YOUNG KIDS HAVE AN ORTHOSTATIC 1933 01:11:42,680 --> 01:11:43,480 TACHYCARDIA THAT'S PHYSIOLOGIC 1934 01:11:43,480 --> 01:11:44,480 AND NORMAL THAT'S JUST HIGHER 1935 01:11:44,480 --> 01:11:47,320 THAN WE DO IN ADULTS AND THAT 1936 01:11:47,320 --> 01:11:50,560 GOES DOWN AS WE GET OLDER. 1937 01:11:50,560 --> 01:11:52,280 WE DICHOTOMIZE AND COME UP WITH 1938 01:11:52,280 --> 01:11:54,320 A CUT POINT FOR ADULTS FOR 1939 01:11:54,320 --> 01:11:55,880 SIMPLICITY BUT THE REALITY IS AN 1940 01:11:55,880 --> 01:11:57,600 INCREASE OF 30 FOR A 20 YEAR-OLD 1941 01:11:57,600 --> 01:12:01,120 AND AN INCREASE OF 30 FOR A 50 1942 01:12:01,120 --> 01:12:01,800 YEAR-OLD, PROBABLY HAVE 1943 01:12:01,800 --> 01:12:04,800 DIFFERENT MEANINGS AND LET'S SAY 1944 01:12:04,800 --> 01:12:07,400 AT 12 OR 13, IT'S WELL WITHIN 1945 01:12:07,400 --> 01:12:07,840 THE NORMAL RANGE. 1946 01:12:07,840 --> 01:12:09,560 THAT'S WHAT I WAS TRYING TO GET 1947 01:12:09,560 --> 01:12:09,960 ACROSS. 1948 01:12:09,960 --> 01:12:11,840 ONE OF THE CHALLENGES WITH KIDS 1949 01:12:11,840 --> 01:12:15,360 IS THAT MOST KRIST TERIS WITH A 1950 01:12:15,360 --> 01:12:18,240 POSSIBLE EXCEPTION OF GUIDELINES 1951 01:12:18,240 --> 01:12:19,440 FROM CHINA DON'T ACTUALLY DEFINE 1952 01:12:19,440 --> 01:12:21,360 WHAT THE RIGHT HEART RATE CUT 1953 01:12:21,360 --> 01:12:22,840 POINT SHOULD BE FOR KIDS UNDER 1954 01:12:22,840 --> 01:12:25,120 THE AGE OF 12 SO THE WHOLE 1955 01:12:25,120 --> 01:12:27,880 DIAGNOSIS OF POTS BECOMES MORE 1956 01:12:27,880 --> 01:12:31,080 PROBLEMATIC IN THAT AGE GROUP. 1957 01:12:31,080 --> 01:12:33,040 >> SO I HAVE A QUESTION RELATED 1958 01:12:33,040 --> 01:12:35,720 ALSO TO THIS, SO WE SEE THAT A 1959 01:12:35,720 --> 01:12:38,960 LOT OF THE RESPONSE, 1960 01:12:38,960 --> 01:12:41,320 INFLAMMATORY RESPONSE TO COVID, 1961 01:12:41,320 --> 01:12:43,960 A LOT OF THE OUTCOMES RELATED TO 1962 01:12:43,960 --> 01:12:45,560 INFLAMMATION AND I WONDER IF YOU 1963 01:12:45,560 --> 01:12:46,760 SEE ANY CONNECTION TO 1964 01:12:46,760 --> 01:12:48,560 INFLAMMATION IN OUR POTS 1965 01:12:48,560 --> 01:12:50,880 PATIENTS WHETHER THEY HAVE MORE 1966 01:12:50,880 --> 01:12:54,160 MASS CELL ACTIVATION OR OTHER 1967 01:12:54,160 --> 01:12:55,560 THINGS THAT WOULD INDICATE AN 1968 01:12:55,560 --> 01:13:00,760 INFLAMMA ATORY MECHANISM. 1969 01:13:00,760 --> 01:13:02,760 >> YEAH, SO PRECOVID IN THAT BIG 1970 01:13:02,760 --> 01:13:04,960 POT SURVEY I ALLUDED TO 1 OF THE 1971 01:13:04,960 --> 01:13:06,320 QUESTIONS WAS ABOUT POSSIBLE 1972 01:13:06,320 --> 01:13:07,360 TRIGGERS THAT PATIENTS NOTICED 1973 01:13:07,360 --> 01:13:09,360 IN THE 3 MONTHS PRIOR TO ILLNESS 1974 01:13:09,360 --> 01:13:10,600 AND THE MAJORITY DIDN'T BUT THE 1975 01:13:10,600 --> 01:13:13,000 1S THAT DID, THE MOST COMMON WAS 1976 01:13:13,000 --> 01:13:14,160 POST VIRAL, RIGHT? 1977 01:13:14,160 --> 01:13:15,480 THERE'S A VIRAL ILLNESS, 1978 01:13:15,480 --> 01:13:16,840 PRECOVID MOST OF THE VIRUSES 1979 01:13:16,840 --> 01:13:18,720 DIDN'T HAVE A NAME BECAUSE WE 1980 01:13:18,720 --> 01:13:20,000 WEREN'T AGGRESSIVELY TESTING AND 1981 01:13:20,000 --> 01:13:21,320 THERE WASN'T WOB DOMINANT VIRUS 1982 01:13:21,320 --> 01:13:22,480 SO THERE'S BEEN A LOT OF 1983 01:13:22,480 --> 01:13:24,480 INTEREST IN SORT OF 1984 01:13:24,480 --> 01:13:26,480 AUTOIMMUNITY, AS A TRIGGER FOR 1985 01:13:26,480 --> 01:13:27,880 POTS FAIRLY BROADLY AND 1986 01:13:27,880 --> 01:13:28,600 AUTOANTIBODIES IN PARTICULAR, 1987 01:13:28,600 --> 01:13:30,040 THERE'S A LOT OF SMOKE AROUND 1988 01:13:30,040 --> 01:13:33,520 THAT BUT I'M NOT SURE A KACCT 1989 01:13:33,520 --> 01:13:34,120 UNITED STATESSAATIVE 1990 01:13:34,120 --> 01:13:34,920 AUTOANTIBODY HAS BEEN FOUND 1991 01:13:34,920 --> 01:13:36,120 THERE. IS SOME INTEREST IN THE 1992 01:13:36,120 --> 01:13:38,200 POTS WORLD NOW AND NOW IN LONG 1993 01:13:38,200 --> 01:13:40,000 COVID ABOUT TRYING IMMUNE 1994 01:13:40,000 --> 01:13:40,720 SUPPRESSIVE THERAPIES. 1995 01:13:40,720 --> 01:13:46,520 AS YOU ALOUDED TO THERE IS A 1996 01:13:46,520 --> 01:13:48,320 SIGNIFICANT SET OF POTS PATIENTS 1997 01:13:48,320 --> 01:13:51,680 THAT SEEM TO HAVE A STRONG 1998 01:13:51,680 --> 01:13:52,600 ALLERGIC IMMUNE PRESENTATION SO 1999 01:13:52,600 --> 01:13:53,840 THE MASS CELL ACTIVATION 2000 01:13:53,840 --> 01:13:56,000 SUBGROUP THAT YOU'RE ALOUDING TO 2001 01:13:56,000 --> 01:13:57,320 SEE I DON'T THINK IT ACCOUNTS 2002 01:13:57,320 --> 01:13:59,000 FOR ALL OF POTS BUT IT ACCOUNTS 2003 01:13:59,000 --> 01:14:00,880 FOR A GOOD PORTION AND A HIGHER 2004 01:14:00,880 --> 01:14:02,080 PROPORTION OF LONG COVID POTS 2005 01:14:02,080 --> 01:14:04,520 POPULATION THAT WE SEE. 2006 01:14:04,520 --> 01:14:06,320 >> OKAY, AND THEN I WANTED TO 2007 01:14:06,320 --> 01:14:10,520 ASK A QUESTION TO DR. BARRY MERZ 2008 01:14:10,520 --> 01:14:12,800 AND WE SEE THERE'S SEX 2009 01:14:12,800 --> 01:14:15,560 DIFFERENCES IN INFLAMMATION AND 2010 01:14:15,560 --> 01:14:16,720 IN CO-MORBIDITIES WITH 2011 01:14:16,720 --> 01:14:17,920 CARDIOVASCULAR DISEASE HAVE BEEN 2012 01:14:17,920 --> 01:14:19,360 PRETTY WELL DEFINED AND I'M 2013 01:14:19,360 --> 01:14:20,720 WONDERING, YOU KNOW OVER THE 2014 01:14:20,720 --> 01:14:22,120 YEARS WHETHER WITH COVID, IF YOU 2015 01:14:22,120 --> 01:14:25,240 THINK THAT WHAT WE SEE IS REALLY 2016 01:14:25,240 --> 01:14:27,520 SIMILAR TO WHAT WE'VE SEEN IN 2017 01:14:27,520 --> 01:14:29,880 THE PAST WITH COVID OR ARE WE 2018 01:14:29,880 --> 01:14:31,960 SEEING NEW THINGS EMERGE AS 2019 01:14:31,960 --> 01:14:33,480 CO-MORBIDITIES OR THINGS THAT 2020 01:14:33,480 --> 01:14:35,200 REALLY STAND OUT DISTINCTLY 2021 01:14:35,200 --> 01:14:38,720 BECAUSE OF COVID IN THIS EITHER 2022 01:14:38,720 --> 01:14:40,720 JUST CAUSING DISEASE OR IN A 2023 01:14:40,720 --> 01:14:41,440 SEX-SPECIFIC MANNER? 2024 01:14:41,440 --> 01:14:45,120 >> I THINK THAT'S A REALLY GOOD 2025 01:14:45,120 --> 01:14:45,360 QUESTION. 2026 01:14:45,360 --> 01:14:47,920 MY REVIEW, I WOULD SAY OVERALL 2027 01:14:47,920 --> 01:14:50,760 DEMONSTRATED THAT IT'S JUST AN 2028 01:14:50,760 --> 01:14:54,280 EXACERBATER OF SEX DIFFERENCES 2029 01:14:54,280 --> 01:14:57,840 AND AGAIN, UNDERSCORED BY REALLY 2030 01:14:57,840 --> 01:14:59,000 EXPANDING OUR KNOWLEDGE ABOUT 2031 01:14:59,000 --> 01:15:01,520 SEX DIFFERENCES IN THE IMMUNE 2032 01:15:01,520 --> 01:15:01,760 SYSTEM. 2033 01:15:01,760 --> 01:15:03,600 WE'VE KNOWN FOR A LONG TIME FOR 2034 01:15:03,600 --> 01:15:05,840 EXAMPLE THAT WOMEN WHO 2035 01:15:05,840 --> 01:15:07,720 DISPROPORTIONATELY SUFFER FROM 2036 01:15:07,720 --> 01:15:12,600 LUPUS AND LUPUS HAS A TREMENDOUS 2037 01:15:12,600 --> 01:15:14,800 AMOUNT OF VASCULAR INFLAMMATION 2038 01:15:14,800 --> 01:15:15,920 WHICH CAUSES THE HEART AND 2039 01:15:15,920 --> 01:15:18,040 KIDNEY AND BRAIN PROBLEMS 2040 01:15:18,040 --> 01:15:19,720 IMPORTANT SEX DIFFERENCE AND 2041 01:15:19,720 --> 01:15:25,800 MOST LIKELY RELATED TO THAT 2042 01:15:25,800 --> 01:15:26,760 XX THAT THEY HAVE 2 COPIES OF 2043 01:15:26,760 --> 01:15:30,280 EVERYTHING AND NOT ALL OF THE 2044 01:15:30,280 --> 01:15:31,520 Xs ARE SILENCED. 2045 01:15:31,520 --> 01:15:33,920 SO WOMEN SUFFER 2046 01:15:33,920 --> 01:15:34,840 DISPROPORTIONATELY FROM 2047 01:15:34,840 --> 01:15:36,600 AUTOIMMUNE DISEASE. 2048 01:15:36,600 --> 01:15:47,120 WOMEN SUFFER DISPROPORTIONATELY 2049 01:15:52,400 --> 01:15:56,440 FROM AUTOIMMUNE DISEASE-RELATE C 2050 01:15:56,440 --> 01:15:56,600 VD. 2051 01:15:56,600 --> 01:15:58,880 THE INFORMATION I SHARED IN THE 2052 01:15:58,880 --> 01:16:00,640 PAPER SUGGEST THAT THEY HAVE A 2053 01:16:00,640 --> 01:16:02,080 INCREASE AND THEY WERE NOT 2054 01:16:02,080 --> 01:16:02,720 DISPROPORTIONATE AT THAT TIME 2055 01:16:02,720 --> 01:16:05,520 BUT I THINK WE WILL SEE SLIGHT 2056 01:16:05,520 --> 01:16:06,040 SEX DIFFERENCES, RIGHT? 2057 01:16:06,040 --> 01:16:09,160 WOMEN WILL HAVE MORE OF THE 2058 01:16:09,160 --> 01:16:10,560 VASCULAR ISSUES, MEN WILL HAVE 2059 01:16:10,560 --> 01:16:13,280 MORE OF THE STEMI OBLIGATIONS 2060 01:16:13,280 --> 01:16:14,600 VECT IT STRUCTURALLYIVE CORONARY 2061 01:16:14,600 --> 01:16:15,680 DISEASE ISSUES, I DON'T KNOW IF 2062 01:16:15,680 --> 01:16:18,120 I ANSWERED THE QUESTION, BUT I 2063 01:16:18,120 --> 01:16:20,920 THINK HOPEFULLY I DID. 2064 01:16:20,920 --> 01:16:21,240 >> YEAH. 2065 01:16:21,240 --> 01:16:21,760 >> YEAH, GO AHEAD. 2066 01:16:21,760 --> 01:16:25,160 >> I THINK SO I THINK THAT'S 2067 01:16:25,160 --> 01:16:25,360 GREAT. 2068 01:16:25,360 --> 01:16:27,160 I SEE 1 QUESTION AIMED AT ME, 2069 01:16:27,160 --> 01:16:31,280 ARE THERE INCREASES IN IMMUNE 2070 01:16:31,280 --> 01:16:32,560 CELLS, NUTRIFILLS AND 2071 01:16:32,560 --> 01:16:34,920 MACROPHAGES IN HEARTS OF COVID, 2072 01:16:34,920 --> 01:16:37,680 SO MY ANIMAL MODEL IS NOT A 2073 01:16:37,680 --> 01:16:39,080 DIRECT MODEL OF COVID BUT WE 2074 01:16:39,080 --> 01:16:41,080 KNOW WHAT'S BEEN PUBLISHED IN 2075 01:16:41,080 --> 01:16:43,480 THE LITERATURE FOR COVID THAT 2076 01:16:43,480 --> 01:16:49,720 THERE ARE INCREASE IN NUTRIFILLS 2077 01:16:49,720 --> 01:16:52,040 AND MACROPHAGES IN MALES AND 2078 01:16:52,040 --> 01:16:55,280 THAT'S THE DOMINANT EFFECT IN MY 2079 01:16:55,280 --> 01:16:56,400 [INDISCERNIBLE] MODEL NUTRIFILLS 2080 01:16:56,400 --> 01:16:57,960 COME BEFORE THE PEAK AND ARE 2081 01:16:57,960 --> 01:17:00,480 ELEVATED IN MALES AND THEN WE 2082 01:17:00,480 --> 01:17:01,000 SEE PEAK MACROPHAGES. 2083 01:17:01,000 --> 01:17:04,160 SO IN THAT WAY, THAT IS SIMILAR. 2084 01:17:04,160 --> 01:17:05,520 SOPHISTICATEDY WE HAVE ANOTHER 2085 01:17:05,520 --> 01:17:07,240 QUESTION FOR DR. MOON. 2086 01:17:07,240 --> 01:17:09,520 DO YOU NOTE DIFFERENCES IN THE 2087 01:17:09,520 --> 01:17:11,240 SEVERITY OF MY O CARDITEIS 2088 01:17:11,240 --> 01:17:15,160 DEPENDENT ON THE TYPE OF 2089 01:17:15,160 --> 01:17:16,000 SARS-COV-2 VARIANT. 2090 01:17:16,000 --> 01:17:17,360 >> YEAH, IT'S A REALLY DIFFICULT 2091 01:17:17,360 --> 01:17:19,200 QUESTION TO ASK BECAUSE FIRSTLY 2092 01:17:19,200 --> 01:17:24,160 WE DIDN'T SEE MUCH MY O 2093 01:17:24,160 --> 01:17:24,440 CARDITEIS. 2094 01:17:24,440 --> 01:17:26,480 >> WE SEE MY O CARDITE LIKE LATE 2095 01:17:26,480 --> 01:17:28,920 ENHANCEMENT BUT WE KNOW THAT 2096 01:17:28,920 --> 01:17:31,320 THAT ACTUALLY AND HISTOLOGICALLY 2097 01:17:31,320 --> 01:17:35,560 CAN BE MICROTHROMBI RATHER THAN 2098 01:17:35,560 --> 01:17:38,400 A PRIMARY [INDISCERNIBLE] OF 2099 01:17:38,400 --> 01:17:39,600 MYOCARDITIS, AND SECONDLY THE 80 2100 01:17:39,600 --> 01:17:41,840 TO DO SCANS DURING THE WUHAN 2101 01:17:41,840 --> 01:17:44,160 WAVE IS WAS VERY POOR AND OUR 2102 01:17:44,160 --> 01:17:46,240 EFFORT WAS NOT VERY GOOD EITHER, 2103 01:17:46,240 --> 01:17:47,640 SO ONLY BY DELTA COULD WE SEE IT 2104 01:17:47,640 --> 01:17:49,680 SO I DON'T THINK I CAN COMPARE 2105 01:17:49,680 --> 01:17:52,320 BUT THE PRIMARY THING IS THAT WE 2106 01:17:52,320 --> 01:17:54,640 DON'T SEE MUCH MYOCARDITIS 2107 01:17:54,640 --> 01:17:57,120 COMPARED WITH THROMBOTIC AND 2108 01:17:57,120 --> 01:17:57,520 MICROINFARCT EVENTS. 2109 01:17:57,520 --> 01:17:59,520 >> AND I GUESS TO FOLLOW UP ON 2110 01:17:59,520 --> 01:18:01,760 THAT, I HAD ANOTHER QUESTION, 2111 01:18:01,760 --> 01:18:04,280 THEY WERE ASKING ABOUT THE 2112 01:18:04,280 --> 01:18:07,160 MICRO--IF I SEE MICROTHROMBY IN 2113 01:18:07,160 --> 01:18:10,480 MY HEART--IN THE HEARTS AND THIS 2114 01:18:10,480 --> 01:18:12,000 DEPENDING ON SEX DIFFERENCES, 2115 01:18:12,000 --> 01:18:15,920 SO, I SHOWED A PICTURE OF 2116 01:18:15,920 --> 01:18:17,560 THROMBI, MURAL THROMBI IN OUR 2117 01:18:17,560 --> 01:18:18,760 ANIMAL MODEL BUT WHERE WE REALLY 2118 01:18:18,760 --> 01:18:22,000 SEE THAT IS WHETHER WE AMPLIFY, 2119 01:18:22,000 --> 01:18:25,000 WE'VE SHOWN THAT IF YOU GIVE 2120 01:18:25,000 --> 01:18:26,200 RECOMBIN ANT IL33 TO MICE WITH 2121 01:18:26,200 --> 01:18:29,800 THIS MODEL, THAT YOU CAN GET USE 2122 01:18:29,800 --> 01:18:31,280 AN AFFILLIC MY O CARDITEIS WHICH 2123 01:18:31,280 --> 01:18:33,520 IS A MORE RARE TEEP OF MY O 2124 01:18:33,520 --> 01:18:35,720 CARDITEIS THAT HAS I THINK A LOT 2125 01:18:35,720 --> 01:18:39,600 OF NUTRIFILLS AND A LOT OF 2126 01:18:39,600 --> 01:18:40,560 EOCENOFILLS AND WHEN THEY 2127 01:18:40,560 --> 01:18:42,120 RELEASE THEIR GRANULES THAT IS 2128 01:18:42,120 --> 01:18:43,040 PRO THROMBOTIC AND THAT'S WHERE 2129 01:18:43,040 --> 01:18:45,640 WE SEE A LOT OF LARGE MURAL 2130 01:18:45,640 --> 01:18:48,080 THROMBI AND IT LOOKS LIKE 2131 01:18:48,080 --> 01:18:50,080 MICROTHROMBI AS WELL, SO WE SEE 2132 01:18:50,080 --> 01:18:52,760 THIS RESPONSE IN THE MODEL BUT 2133 01:18:52,760 --> 01:18:53,480 IT'S REALLY AMPLIFIED. 2134 01:18:53,480 --> 01:18:55,160 IF YOU INCREASE THAT IL33 2135 01:18:55,160 --> 01:18:57,960 RESPONSE WHICH IS 1 OF THE TLR 4 2136 01:18:57,960 --> 01:19:03,960 ST-2 RESPONSES THAT WE SEE 2137 01:19:03,960 --> 01:19:04,960 UPREGULATED IN MALES. 2138 01:19:04,960 --> 01:19:05,920 TELL BE INTERESTING TO SEE. 2139 01:19:05,920 --> 01:19:08,160 I DON'T THINK THAT I'VE SEEN 2140 01:19:08,160 --> 01:19:11,360 ANYTHING REPORTED ON ST2 OR IL3 2141 01:19:11,360 --> 01:19:11,800 RELATED WITH COVID. 2142 01:19:11,800 --> 01:19:14,120 BUT THAT IS A TYPE OF RESPONSE. 2143 01:19:14,120 --> 01:19:16,600 WE HAVE A QUESTION HERE THAT IS 2144 01:19:16,600 --> 01:19:19,960 ANOTHER POTS 1 WHEN ASTRONAUTS 2145 01:19:19,960 --> 01:19:22,160 RETURN PRACTICES MICROGRAPHITY, 2146 01:19:22,160 --> 01:19:24,440 FEMALES EXPERIENCE TACKY CARDIO 2147 01:19:24,440 --> 01:19:29,520 MORE THAN MALE ASTRONAUTS, THEY 2148 01:19:29,520 --> 01:19:30,360 DO EXPERIENCE [INDISCERNIBLE], 2149 01:19:30,360 --> 01:19:33,200 SO NOT QUITE POTS CAN COULD YOU 2150 01:19:33,200 --> 01:19:34,840 WANTER MEASURES BEING MANAGED 2151 01:19:34,840 --> 01:19:36,840 FOR THIS WITH LIEWNOR 2152 01:19:36,840 --> 01:19:37,720 EXPLORATION, PERHAPS WORKING 2153 01:19:37,720 --> 01:19:42,760 WITH THE SPACE EXPLORATION MAY 2154 01:19:42,760 --> 01:19:44,560 ACCELERATE THERAPIES HERE ON 2155 01:19:44,560 --> 01:19:44,840 EARTH. 2156 01:19:44,840 --> 01:19:46,920 NOT REALLY A QUESTION BUT 2157 01:19:46,920 --> 01:19:48,080 INTERESTING HAVE YOU HEARD OF 2158 01:19:48,080 --> 01:19:49,000 THAT BEFORE? 2159 01:19:49,000 --> 01:19:50,200 >> YEAH THE NASA MICROGRAPHITY 2160 01:19:50,200 --> 01:19:54,080 EXPERIMENTS ARE VERY MUCH A 2161 01:19:54,080 --> 01:19:55,800 MODEL OF POTS AND THEY HAVE 2162 01:19:55,800 --> 01:19:56,040 CAUSED IT. 2163 01:19:56,040 --> 01:19:58,120 IT'S 1 OF THE REASONS WE TALK 2164 01:19:58,120 --> 01:19:59,520 ABOUT REVERSIBLE CAUSES, PEOPLE 2165 01:19:59,520 --> 01:20:01,840 ON PROLONGED BED REST, I DON'T 2166 01:20:01,840 --> 01:20:03,920 MEAN PEOPLE THAT ARE TIRED BUT 2167 01:20:03,920 --> 01:20:05,680 SOME PATIENTS THAT ARE IN BED 20 2168 01:20:05,680 --> 01:20:08,080 HOURS A DAY BECAUSE THEY FEEL 2169 01:20:08,080 --> 01:20:12,960 BETTER AND ACTUALLY DOES PROMOTE 2170 01:20:12,960 --> 01:20:14,320 ORTHOSTATIC TOLERANCE AND 2171 01:20:14,320 --> 01:20:15,760 PROMOTES A DROP IN BLOOD VOLUME 2172 01:20:15,760 --> 01:20:18,360 AND THESE COME OUT OF EXCELLENT 2173 01:20:18,360 --> 01:20:19,720 NASES NASA PREPARING FOR SPACE 2174 01:20:19,720 --> 01:20:25,440 STATION STUFF, THEY HAVE SOME 2175 01:20:25,440 --> 01:20:27,560 WORK THAT CERTAIN THAT ONGOING 2176 01:20:27,560 --> 01:20:30,440 TRAINING HELPS SO IN THE 2177 01:20:30,440 --> 01:20:31,000 MICROGRAPHITY ENVIRONMENT, 2178 01:20:31,000 --> 01:20:32,240 THAT'S AN IMPLEMENT ON THE SPACE 2179 01:20:32,240 --> 01:20:40,800 STATION FOR EXAMPLE TO HELP BACK 2180 01:20:40,800 --> 01:20:41,480 ON EARTH. 2181 01:20:41,480 --> 01:20:42,680 SO THEY'VE IDENTIFIED THIS TO 2182 01:20:42,680 --> 01:20:45,240 TRY TO ENGAGE IN PROGRAM THAT'S 2183 01:20:45,240 --> 01:20:47,920 NOT TOO AGGRESSIVE SO SOMETHING 2184 01:20:47,920 --> 01:20:49,400 THAT'S DOABLE, SUSTAINABLE AND 2185 01:20:49,400 --> 01:20:51,120 COMPRESSION TO STROKE VOLUME AND 2186 01:20:51,120 --> 01:20:54,960 THIS IN SOME FORM COMES OUT OF 2187 01:20:54,960 --> 01:20:55,720 OF NASA WORK,. 2188 01:20:55,720 --> 01:21:02,880 >> SO INTERESTING I'M ON AN EDS 2189 01:21:02,880 --> 01:21:04,440 CLINIC HERE AND THOSE PATIENTS 2190 01:21:04,440 --> 01:21:06,840 DEVELOP POTS AND IT IS 95% WHITE 2191 01:21:06,840 --> 01:21:09,040 WOMEN UNDER 50 EXACTLY LIKE 2192 01:21:09,040 --> 01:21:11,240 YOU'RE SEEING BUT IT ALSO 2193 01:21:11,240 --> 01:21:13,120 HEARING THE PATIENT STORYINGS, 2194 01:21:13,120 --> 01:21:15,120 ALL OF THEM EVEN IF THEY DIDN'T 2195 01:21:15,120 --> 01:21:17,320 HAVE POTS SOUND LIKE THE MORE 2196 01:21:17,320 --> 01:21:21,360 SEVERE CASES OF HYPER MOBILE 2197 01:21:21,360 --> 01:21:24,240 EEDS WITH THIS OVERLAP OF 2198 01:21:24,240 --> 01:21:25,560 CHRONIC FATIGUE SYNDROME SO 2199 01:21:25,560 --> 01:21:26,360 THERE'S OVERLAPS IN THINGS WE 2200 01:21:26,360 --> 01:21:27,560 DIDN'T UPON UNDERSTAND THAT 2201 01:21:27,560 --> 01:21:28,640 VIRUSES MIGHT ACTUALLY HAVE A 2202 01:21:28,640 --> 01:21:30,720 ROLE IN SOME OF THESE DISEASES 2203 01:21:30,720 --> 01:21:32,360 MORE THAN WE UNDERSTOOD BEFORE 2204 01:21:32,360 --> 01:21:42,880 AND TO TRY TO UNDERSTAND WELL I 2205 01:21:43,200 --> 01:21:45,520 WANT TO THANK EVERYONE FOR THE 2206 01:21:45,520 --> 01:21:47,240 TIME WE'VE HAD BUT HOW ARE WE 2207 01:21:47,240 --> 01:21:47,800 DOING ON TIME? 2208 01:21:47,800 --> 01:21:53,440 DO WE HAVE MORE TIME? 2209 01:21:53,440 --> 01:21:56,000 ANY OTHER QUESTIONS? 2210 01:21:56,000 --> 01:21:56,840 >> DR. FAIRWEATHER THERE WAS A 2211 01:21:56,840 --> 01:21:59,160 QUESTION IS THERE CONVINCING 2212 01:21:59,160 --> 01:22:00,080 EVIDENCE FOR ENDOTHELIUM 2213 01:22:00,080 --> 01:22:03,200 INFECTION BY THE VIRUS, I THINK 2214 01:22:03,200 --> 01:22:05,000 THAT'S PRETTY CLEAR, YES AND I 2215 01:22:05,000 --> 01:22:10,280 JUST GOOGLED PULLED UP A 2216 01:22:10,280 --> 01:22:12,240 FRONTIER IN MEDICINE 2021 2217 01:22:12,240 --> 01:22:12,960 ARTICLE MULTICENTER PATHOLOGY 2218 01:22:12,960 --> 01:22:14,960 REPORT AND YEAH, IT'S IN THE 2219 01:22:14,960 --> 01:22:15,880 ENDOTHELIUM AND YOU PROBABLY CAN 2220 01:22:15,880 --> 01:22:19,960 ANSWER THAT AS WELL. 2221 01:22:19,960 --> 01:22:20,280 >> GREAT. 2222 01:22:20,280 --> 01:22:21,640 THANK YOU SO MUCH SO DO WE HAVE 2223 01:22:21,640 --> 01:22:24,720 MORE TIME FOR QUESTIONS ARE WE 2224 01:22:24,720 --> 01:22:27,280 ALMOST OUT DR. KANTHI. 2225 01:22:27,280 --> 01:22:28,120 >> DR. FAIRWEATHER WE DO NEED TO 2226 01:22:28,120 --> 01:22:30,600 MOVE ON TO THE NEXT SESSION, BUT 2227 01:22:30,600 --> 01:22:31,280 THANK YOU VERY MUCH. 2228 01:22:31,280 --> 01:22:35,920 THIS WAS AN INTERESTING 2229 01:22:35,920 --> 01:22:36,200 DISCUSSION. 2230 01:22:36,200 --> 01:22:38,000 >> SO I'M DELIGHTED TO INTRODUCE 2231 01:22:38,000 --> 01:22:40,160 THE NEXT SESSION, GIVE ME JUST A 2232 01:22:40,160 --> 01:22:42,400 MOMENT HERE AND THIS IS ON SEX 2233 01:22:42,400 --> 01:22:44,840 AND GENDER RELATED MECHANISMS 2234 01:22:44,840 --> 01:22:46,000 THAT UNDERLIE BLOOD, DISEASES 2235 01:22:46,000 --> 01:22:48,240 AND COVID. 2236 01:22:48,240 --> 01:22:50,880 I WILL FIRST JUST PRESENT TO YOU 2237 01:22:50,880 --> 01:22:55,080 MY DISCLOSURES FOR FULL 2238 01:22:55,080 --> 01:22:57,040 TRANSPARENCY AND THEN AND THEN 2239 01:22:57,040 --> 01:22:57,960 INTRODUCE OUR SPEAKERS. 2240 01:22:57,960 --> 01:23:00,040 SO THE FIRST SPEAKER IS--SO WE 2241 01:23:00,040 --> 01:23:03,040 HAVE A VERY EXCITING SLATE OF 2242 01:23:03,040 --> 01:23:06,120 SPEAKERS HERE, OUR FIRST SPEAKER 2243 01:23:06,120 --> 01:23:10,040 IS DR. DALE ABEL, HE IS THE 2244 01:23:10,040 --> 01:23:12,080 WILLIAM S. ADAMS DISTINGUISHED 2245 01:23:12,080 --> 01:23:13,480 PRACTICES FESSOR OF MEDICINE, 2246 01:23:13,480 --> 01:23:14,680 CHAIR AND DEPARTMENT OF MEDICINE 2247 01:23:14,680 --> 01:23:18,280 AT THE DAVE I GEF, EN SCHOOL OF 2248 01:23:18,280 --> 01:23:19,000 MEDICINE AND HEALTH. 2249 01:23:19,000 --> 01:23:20,160 HE FORMERLY THE CHAIR OF 2250 01:23:20,160 --> 01:23:22,120 DEPARTMENT OF MEDICINE AND 2251 01:23:22,120 --> 01:23:23,160 DREBTOR THE DIABETES RESEARCH 2252 01:23:23,160 --> 01:23:26,120 CENTER AT THE UNIVERSITY OF IOWA 2253 01:23:26,120 --> 01:23:29,280 WHICH GREW CONSIDERABLY WITH HIS 2254 01:23:29,280 --> 01:23:30,720 LEADERSHIP. 2255 01:23:30,720 --> 01:23:32,480 HE'S A QUINTESSENTIAL SCIENTIST, 2256 01:23:32,480 --> 01:23:36,040 LONG DISTINGUISHED CAREER IN 2257 01:23:36,040 --> 01:23:37,120 ENDOCRINE AND METABOLISM 2258 01:23:37,120 --> 01:23:37,440 RESEARCH. 2259 01:23:37,440 --> 01:23:39,400 I LEARNED ABOUT HOW HIS RESEARCH 2260 01:23:39,400 --> 01:23:42,200 ON GLUCOSE TRANSPORT AND HOW 2261 01:23:42,200 --> 01:23:43,840 MITOCHONDRIAL METABOLISM HAS LED 2262 01:23:43,840 --> 01:23:47,720 TO A RELATED FIELD TO STUDY 2263 01:23:47,720 --> 01:23:50,800 MOLECULAR MECHANISMS THAT ARE 2264 01:23:50,800 --> 01:23:52,440 RESPONSIBLE FOR CARDIOVASCULAR 2265 01:23:52,440 --> 01:23:54,000 COMPLICATIONS, SO THIS INCLUDES 2266 01:23:54,000 --> 01:23:56,000 THINGS LIKE HEART FAILURE AND 2267 01:23:56,000 --> 01:23:59,680 WORK, HE WILL SHARE MORE DETAIL 2268 01:23:59,680 --> 01:24:01,080 TODAY EXPLORES MITOCHONDRIAL 2269 01:24:01,080 --> 01:24:03,160 ECANISMS THAT CROSS TALK AND 2270 01:24:03,160 --> 01:24:04,200 LINK METABOLISM WITH THROMBOSIS, 2271 01:24:04,200 --> 01:24:05,520 I WILL INTRODUCE OUR SPEAKERS AS 2272 01:24:05,520 --> 01:24:13,400 WE GET TO TIME. 2273 01:24:13,400 --> 01:24:13,720 DR. ABEL? 2274 01:24:13,720 --> 01:24:15,680 >> LET ME UNMUTE AND PUT MY 2275 01:24:15,680 --> 01:24:17,880 CAMERA ON, THANK YOU VERY MUCH 2276 01:24:17,880 --> 01:24:25,200 AND LET ME ALSO SHARE MY SCREEN 2277 01:24:25,200 --> 01:24:25,760 SO LET'S SEA. 2278 01:24:25,760 --> 01:24:28,360 I START TO SHARE, OKAY. 2279 01:24:28,360 --> 01:24:38,840 LET ME GO TO MY SLIDE SHOW. 2280 01:24:44,480 --> 01:24:44,600 OOPS. 2281 01:24:44,600 --> 01:24:45,840 OKAY, SO FIRST SLIDE. 2282 01:24:45,840 --> 01:24:46,400 THANK YOU VERY MUCH. 2283 01:24:46,400 --> 01:24:50,120 CAN YOU SEE MY SLIDE SHOW OKAY? 2284 01:24:50,120 --> 01:24:51,720 >> YES, IT'S VERY CLEAR. 2285 01:24:51,720 --> 01:24:52,880 SPHRKS PERFECT OKAY, SO TALKING 2286 01:24:52,880 --> 01:24:57,240 ABOUT RECENT WORK LOOKING AT THE 2287 01:24:57,240 --> 01:24:57,840 RELATIONSHIP BETWEEN ESTROGEN 2288 01:24:57,840 --> 01:25:00,120 AND MITOCHONDRIAL AND MY MAJOR 2289 01:25:00,120 --> 01:25:01,200 DISCLOSURE IS THAT THIS IS A 2290 01:25:01,200 --> 01:25:03,200 STUDY THAT WAS FUNDED IN 2291 01:25:03,200 --> 01:25:07,120 RESPONSE TO AN NHLBI RFA 18003 2292 01:25:07,120 --> 01:25:12,120 ON SEX HORMONE INDUCED THROMBOW 2293 01:25:12,120 --> 01:25:13,120 EMBOLISM IN PREMENOPAUSAL WOMEN 2294 01:25:13,120 --> 01:25:17,560 AND OUR FUNDING WORK IS ON OP A 2295 01:25:17,560 --> 01:25:19,880 1 AND ESTROGEN TYPE OF 2296 01:25:19,880 --> 01:25:20,680 ACTIVATION. 2297 01:25:20,680 --> 01:25:21,360 SO HERE'S BACKGROUND SO 2298 01:25:21,360 --> 01:25:26,880 MITOCHONDRIAL IS A PROCESS OF 2299 01:25:26,880 --> 01:25:30,000 REPEATED FISSION THAT ARE 2300 01:25:30,000 --> 01:25:33,600 REGULATED BY PROTEINS, DRP1 AND 2301 01:25:33,600 --> 01:25:38,960 FIS1 FOR FISSION, AND OP A 1 AND 2302 01:25:38,960 --> 01:25:41,680 MITOFUSEIN IN FUSION, ALSO 2303 01:25:41,680 --> 01:25:42,400 MAINTAINS MORPHOLOGY. 2304 01:25:42,400 --> 01:25:45,920 THE PROJECT BEGAN WITH AN 2305 01:25:45,920 --> 01:25:47,320 OBSERVATION WAS MADE BY JANE 2306 01:25:47,320 --> 01:25:49,400 FREED MAN WHERE HE DID 2307 01:25:49,400 --> 01:25:50,960 TRANSCRIPTOMIC ANALYSIS FROM THE 2308 01:25:50,960 --> 01:25:54,840 FRAMINGHAM COHORT AND THESE ARE 2309 01:25:54,840 --> 01:25:56,600 CT VALUES IN THE COHORT AND YOU 2310 01:25:56,600 --> 01:25:58,600 CAN SEE THAT THE CT VALUES ARE 2311 01:25:58,600 --> 01:26:00,480 LOWER MEAN THAT THE LEVELS ARE 2312 01:26:00,480 --> 01:26:01,880 HIGHER IN FEMALES AND MENTIONING 2313 01:26:01,880 --> 01:26:03,920 THE ANALYSIS OF MULTIPLE 2314 01:26:03,920 --> 01:26:06,600 TRANSCRIPTS, IT TURNED UP THAT 2315 01:26:06,600 --> 01:26:08,840 OPA 1 [INDISCERNIBLE] WAS HIGHLY 2316 01:26:08,840 --> 01:26:10,360 PREDICTIVE OF FEMALE SEX WITH 2317 01:26:10,360 --> 01:26:12,280 THE P-VALUE OF 10 TO THE MINUS 2318 01:26:12,280 --> 01:26:14,240 12 SO THAT GOT US CURIOUS ABOUT 2319 01:26:14,240 --> 01:26:15,920 THEN REGULAT OF OPA 1 BY 2320 01:26:15,920 --> 01:26:18,720 ESTROGEN AND SO, THIS IS JUST 2321 01:26:18,720 --> 01:26:19,520 ESTROGEN LEVELS IN PREGNANCY AND 2322 01:26:19,520 --> 01:26:21,960 YOU CAN SEE THAT FROM 2323 01:26:21,960 --> 01:26:24,200 PREPREGNANCY TO TRIMESTER IS A 2324 01:26:24,200 --> 01:26:25,160 SIGNIFICANT INCREASE IN 2325 01:26:25,160 --> 01:26:27,240 ESTROGENS NOW IF WE LOOK IN THIS 2326 01:26:27,240 --> 01:26:28,920 COHORT AND LOOK AT THE 2327 01:26:28,920 --> 01:26:30,200 REGULATION OF OPA 1 IN 2328 01:26:30,200 --> 01:26:31,720 PREGNANCY, YOU CAN SEE HERE ON 2329 01:26:31,720 --> 01:26:34,240 THE LEFT THAT IF YOU GO FROM 2330 01:26:34,240 --> 01:26:35,880 PREPREGNANCY AND TO THOROUGH 2331 01:26:35,880 --> 01:26:38,360 TRIMESTER IS AN INDUCTION OF OPA 2332 01:26:38,360 --> 01:26:39,280 1, EXPRESSION IN PREGNANCY AND 2333 01:26:39,280 --> 01:26:41,840 THIS GOES DOWN IN THE POSTPARTUM 2334 01:26:41,840 --> 01:26:44,560 PERIOD, THE ADDITION THE 2335 01:26:44,560 --> 01:26:46,280 PROTEASE 1 E1 THAT REGULATES 2336 01:26:46,280 --> 01:26:47,960 CLEAVAGE IS ALSO REGULATED IN 2337 01:26:47,960 --> 01:26:49,840 PREGNANCY PEEKS IN THE THIRD 2338 01:26:49,840 --> 01:26:53,600 TRIMESTER AND FALLING BACK IN 2339 01:26:53,600 --> 01:26:54,120 THE POSTPARTUM PERIOD. 2340 01:26:54,120 --> 01:26:56,320 SO A BIT OF HANDLE ON THE 2341 01:26:56,320 --> 01:27:00,160 BIOLOGY OF OPA 1 AND PLATELETS 2342 01:27:00,160 --> 01:27:00,960 WE GENETICALLY MANIPULATED 2343 01:27:00,960 --> 01:27:03,000 LEVELS IN MALE AND FEMALE MICE 2344 01:27:03,000 --> 01:27:07,400 SPECIFICALLY IN THEIR PLATELETS 2345 01:27:07,400 --> 01:27:09,160 AND WE WERE VERY INTRIGUED TO 2346 01:27:09,160 --> 01:27:10,240 SEE SEX DIFFERENCES SUMMARIZED 2347 01:27:10,240 --> 01:27:11,640 IN THE NEXT FEW SLIDES SO FIRST 2348 01:27:11,640 --> 01:27:13,760 OF ALL THESE ARE DATA FROM MALE 2349 01:27:13,760 --> 01:27:15,760 MICE, AND IF YOU LOOK HERE, CAN 2350 01:27:15,760 --> 01:27:17,280 YOU SEE MITOCHONDRIA IN THE 2351 01:27:17,280 --> 01:27:20,600 WILD-TYPE MICE, IT'S A VERY NICE 2352 01:27:20,600 --> 01:27:23,280 CLEAR SEQ IN THE MALE MICE WITH 2353 01:27:23,280 --> 01:27:25,760 THE PLATELETS, YOU CAN SEE THAT 2354 01:27:25,760 --> 01:27:28,200 THEY ARE ALL CANNED WHAT INSTEAD 2355 01:27:28,200 --> 01:27:29,760 OF GRANULAR WHICH IS WHAT WE 2356 01:27:29,760 --> 01:27:32,320 EXPECT WITH THE DEFICIENCY AND 2357 01:27:32,320 --> 01:27:33,600 THERE'S A [INDISCERNIBLE] DNA IN 2358 01:27:33,600 --> 01:27:37,440 CONTRAST IN THE FEMALES, YOU 2359 01:27:37,440 --> 01:27:38,240 CAN--WE OBSERVED INFREQUENTLY 2360 01:27:38,240 --> 01:27:41,000 THAT THE MIGHT O CHOND AREA WAS 2361 01:27:41,000 --> 01:27:42,800 UNAFFECTED IN THE OP A 1 2362 01:27:42,800 --> 01:27:45,360 DEFICIENT FEMALES AND THERE'S NO 2363 01:27:45,360 --> 01:27:47,080 EVIDENCE OF MITOCHONDRIAL DNA 2364 01:27:47,080 --> 01:27:50,640 DEPLETION IN THE FEMALES, WE 2365 01:27:50,640 --> 01:27:53,880 THEN DID ARCHITECT ON THE MALES 2366 01:27:53,880 --> 01:27:55,600 ON THE FEMALES AND JUST TO 2367 01:27:55,600 --> 01:27:56,800 QUICKLY SUMMARIZE IS THAT WHAT 2368 01:27:56,800 --> 01:27:58,600 WE LEARNED FROM THAT EXPERIMENT 2369 01:27:58,600 --> 01:28:01,920 IS THAT WHEN WE LOOKED AT MALES, 2370 01:28:01,920 --> 01:28:04,640 AFTER WE TOOK THEIR GONADs OUT 2371 01:28:04,640 --> 01:28:09,400 YOU CAN SEE THAT THE PLOIT THAT 2372 01:28:09,400 --> 01:28:14,000 YOU CAN AND SHOW THE MORPHOLOGY 2373 01:28:14,000 --> 01:28:19,440 IN THE MALES THAT WERE 2374 01:28:19,440 --> 01:28:19,800 [INDISCERNIBLE]. 2375 01:28:19,800 --> 01:28:24,800 IN CONTRAST IN THE FEMALES WHO 2376 01:28:24,800 --> 01:28:25,880 HAD DEFICIENCIES WHERE THINGS 2377 01:28:25,880 --> 01:28:28,200 WERE NORMAL WHERE WE TOOK OUT 2378 01:28:28,200 --> 01:28:32,880 THEIR OVARIES WE SAW THAT THE 2379 01:28:32,880 --> 01:28:34,480 MORPHOLOGY WAS DISTURBED SO THIS 2380 01:28:34,480 --> 01:28:38,280 IS SHOWING THE CIRCULATING SEX 2381 01:28:38,280 --> 01:28:39,440 STEROIDS. 2382 01:28:39,440 --> 01:28:41,200 SO THEN ACTIVATION INVITRO AND 2383 01:28:41,200 --> 01:28:43,080 IN VIVO SO PATTERN A AND B IN 2384 01:28:43,080 --> 01:28:45,400 BLUE ARE SHOWING THE MALE KNOCK 2385 01:28:45,400 --> 01:28:47,800 OUT ANIMALS, HYPER ACTIVATION OF 2386 01:28:47,800 --> 01:28:50,640 PLATELETS, IN FEMALES THERE WAS 2387 01:28:50,640 --> 01:28:52,040 NO DIFFERENCE IN INVITRO 2388 01:28:52,040 --> 01:28:52,480 ACTIVATION. 2389 01:28:52,480 --> 01:28:55,600 WE DID A DVT EXPERIMENT AND YOU 2390 01:28:55,600 --> 01:28:57,800 CAN SEE THAT THE MALES HAD 2391 01:28:57,800 --> 01:28:59,880 BIGGER AND MORE THROMBI BUT THE 2392 01:28:59,880 --> 01:29:01,640 FEMALES HAD NO DIFFERENCE 2393 01:29:01,640 --> 01:29:02,840 COMPARED TO KNOCK OUTS AND 2394 01:29:02,840 --> 01:29:03,120 CONTROLS. 2395 01:29:03,120 --> 01:29:04,360 WE THEN LOOK AT ANOTHER MEASURE 2396 01:29:04,360 --> 01:29:05,960 OF THE FUNCTION WHICH IS 2397 01:29:05,960 --> 01:29:07,240 ARE--ADMINISTRATIVE TERIOLE 2398 01:29:07,240 --> 01:29:09,200 INCLUSION IN THE CAROTID ARTERY 2399 01:29:09,200 --> 01:29:11,600 AND WE OBSERVE THERE WAS A 2400 01:29:11,600 --> 01:29:13,160 REDUCTION IN THIS TABLE IN MALES 2401 01:29:13,160 --> 01:29:15,520 BUT IF FEMALES AS AN INCREASE IN 2402 01:29:15,520 --> 01:29:17,920 THE TIME TO [INDISCERNIBLE] SO 2403 01:29:17,920 --> 01:29:19,320 AGAIN 180-DEGREE DIFFERENCE IN 2404 01:29:19,320 --> 01:29:21,440 THE PHENOTYPE IN THESE ANIMALS. 2405 01:29:21,440 --> 01:29:23,040 SO WE WANT TO UNDERSTAND IF IN 2406 01:29:23,040 --> 01:29:25,200 IS SUBJECT TO THE HORMONE SO WE 2407 01:29:25,200 --> 01:29:26,600 DID A TRANSFER EXPERIMENT. 2408 01:29:26,600 --> 01:29:28,680 WHERE WE DEPLETED EITHER MALE OR 2409 01:29:28,680 --> 01:29:31,080 FEMALE MICE AND THEN TRANSFUSED 2410 01:29:31,080 --> 01:29:37,480 BACK INTO THEM, DONOR PLATELETS, 2411 01:29:37,480 --> 01:29:39,160 SO LET ME WALK YOU THROUGH THIS. 2412 01:29:39,160 --> 01:29:41,480 IN THIS EXPERIMENT WE'RE TAKING 2413 01:29:41,480 --> 01:29:42,760 MALE DONEAR PLATELETS AND 2414 01:29:42,760 --> 01:29:43,960 PUTTING THEM INTO A MALE HOST 2415 01:29:43,960 --> 01:29:46,480 AND CAN YOU SEE THAT WHEN YOU 2416 01:29:46,480 --> 01:29:48,400 PUT KNOCK OUT PLATELETS IN, WE 2417 01:29:48,400 --> 01:29:50,280 SAW THE REDUCTION TO STABLE 2418 01:29:50,280 --> 01:29:51,680 OCCLUSION, HOWEVER, WHEN WE 2419 01:29:51,680 --> 01:29:53,280 ACTUALLY DID THIS TRANSFUSION 2420 01:29:53,280 --> 01:29:55,400 INTO A FEMALE HOST WE SAW THAT 2421 01:29:55,400 --> 01:29:59,120 THE OP A 1 DEFICIENT PLATELETS 2422 01:29:59,120 --> 01:30:00,200 WHEN TRANSDUCED IS 2423 01:30:00,200 --> 01:30:01,120 [INDISCERNIBLE] INCREASED SO THE 2424 01:30:01,120 --> 01:30:03,360 OPPOSITE TO WHAT WE SAW IN THIS 2425 01:30:03,360 --> 01:30:03,680 EXPERIMENT. 2426 01:30:03,680 --> 01:30:08,680 SIMILARLY, WE DID A 2427 01:30:08,680 --> 01:30:10,000 FEMALE-FEMALE TRANSFER OF 2428 01:30:10,000 --> 01:30:12,040 PLATELETS, AGAIN WE SAW THAT 2429 01:30:12,040 --> 01:30:13,840 KNOCK OUT DONOR PLATE THAT'S IN 2430 01:30:13,840 --> 01:30:16,360 A FEMALE HOST SHOWED OCCLUSION 2431 01:30:16,360 --> 01:30:18,760 WHEREAS KNOCK OUT PLATELETS IN A 2432 01:30:18,760 --> 01:30:20,360 MALE HOST, THIS INFACT WENT AWAY 2433 01:30:20,360 --> 01:30:23,600 AND THEN WE FINALLY LOOKED AT 2434 01:30:23,600 --> 01:30:26,640 THE EFFECT OF CASTRATION ON BOTH 2435 01:30:26,640 --> 01:30:29,600 INVITRO AND IN VIVO MEASURES OF 2436 01:30:29,600 --> 01:30:30,200 PLATELET ACTIVITY. 2437 01:30:30,200 --> 01:30:31,440 SO IN PANEL E. 2438 01:30:31,440 --> 01:30:33,840 YOU CAN SEE THAT IN THE INTACT 2439 01:30:33,840 --> 01:30:35,360 ANIMALS THERE'S AN INCREASE IN 2440 01:30:35,360 --> 01:30:37,040 INVITRO ACTIVATION THAT WAS 2441 01:30:37,040 --> 01:30:40,080 ATTENUATE WHEN ANIMALS WERE 2442 01:30:40,080 --> 01:30:41,320 CASTRATED, WHEREAS IN THE 2443 01:30:41,320 --> 01:30:44,240 FEMALES YOU CAN SEE THAT THE 2444 01:30:44,240 --> 01:30:45,880 ABSENCE OF INCREASE IN 2445 01:30:45,880 --> 01:30:46,840 ACTIVATION INVITRO, WE NOW SEE 2446 01:30:46,840 --> 01:30:49,400 AN INCREASE IN THE ACTIVATION 2447 01:30:49,400 --> 01:30:51,440 INVITRO AFTER THE OVARIES WERE 2448 01:30:51,440 --> 01:30:51,680 REMOVED. 2449 01:30:51,680 --> 01:30:53,160 SIMILARLY WHEN WE TOOK MALES WHO 2450 01:30:53,160 --> 01:30:54,720 WERE INTACT AND I SHOWED YOU 2451 01:30:54,720 --> 01:30:56,840 THIS BEFORE, THEY HAVE A REDUCED 2452 01:30:56,840 --> 01:30:58,480 TIME TO OCCLUSION OF THEIR KNOCK 2453 01:30:58,480 --> 01:31:00,360 OUTS THAT REMOVAL OF THE GONADS 2454 01:31:00,360 --> 01:31:01,800 THERE IS NO OTHER INCREASE AND 2455 01:31:01,800 --> 01:31:03,640 IN FEMALES THAT WERE INTACT, 2456 01:31:03,640 --> 01:31:05,440 THAT WERE OP A 1 DEFICIENT IN 2457 01:31:05,440 --> 01:31:06,440 THE PLATELETS, THERE'S AN 2458 01:31:06,440 --> 01:31:08,240 INCREASE IN TERMS OF INCLUSION 2459 01:31:08,240 --> 01:31:10,720 WHICH IS IN FACT PREVENTED WHEN 2460 01:31:10,720 --> 01:31:12,120 WE TOOK THEIR OVARIES OUT AND 2461 01:31:12,120 --> 01:31:15,360 THEN WE TOOK MALE ANIMALS AND WE 2462 01:31:15,360 --> 01:31:17,160 IMPLANTED THEM WITH ESTRA-DIAL 2463 01:31:17,160 --> 01:31:20,000 PELLETS AND YOU CAN SEE THAT THE 2464 01:31:20,000 --> 01:31:20,960 TIME DEFICIENT WAS DECREASED 2465 01:31:20,960 --> 01:31:22,280 THIS WAS AGAIN REVERSED IN 2466 01:31:22,280 --> 01:31:26,400 ANIMALS THAT WERE TREATED 2467 01:31:26,400 --> 01:31:27,160 [INDISCERNIBLE]. 2468 01:31:27,160 --> 01:31:31,960 SO THE REQUESTY IS COULD 2469 01:31:31,960 --> 01:31:32,920 ESTROGEN DIRECTLY MODULATE 2470 01:31:32,920 --> 01:31:39,320 MITOCHONDRIAL OP A 1 DEFICIENT? 2471 01:31:39,320 --> 01:31:43,360 SO THIS ON THE TOP ARE PLATELETS 2472 01:31:43,360 --> 01:31:45,080 ISOLATED FROM ACTUAL BONE 2473 01:31:45,080 --> 01:31:47,880 ADIPOSE TISSUE, FOR PLATELETS 2474 01:31:47,880 --> 01:31:50,320 AND THESE ARE MITOCHONDRIAL FROM 2475 01:31:50,320 --> 01:31:52,600 OPA 1 DEFICIENT MICE AND YOU CAN 2476 01:31:52,600 --> 01:31:54,960 SEE AGAIN THE DISMORPHIC 2477 01:31:54,960 --> 01:31:56,040 APPEARANCE OF THE MITOCHONDRIAL 2478 01:31:56,040 --> 01:31:59,480 AND THIS IS NOT CHANGED BY 2479 01:31:59,480 --> 01:32:01,600 COLLECTERAL BUT WITH INCUBATION 2480 01:32:01,600 --> 01:32:03,720 TISSUE AND MACROPHAGES OX FEN 2481 01:32:03,720 --> 01:32:07,280 AND HISTOLOGIC OR FORMAICOLOGGIC 2482 01:32:07,280 --> 01:32:08,800 ESTRA-DIAL, YOU SEE THE 2483 01:32:08,800 --> 01:32:10,640 RESTORATION OF THE MITOCHONDRIAL 2484 01:32:10,640 --> 01:32:12,960 MORPHOLOGY AND THIS IS 2485 01:32:12,960 --> 01:32:13,400 QUANTIFIED ON HERE. 2486 01:32:13,400 --> 01:32:14,800 ON THE BOTTOM YOU CAN SEE THAT'S 2487 01:32:14,800 --> 01:32:16,080 A LOSS IN THE KNOCK OUTS AND IN 2488 01:32:16,080 --> 01:32:24,160 FACT THERE WAS A RESTORATION OF 2489 01:32:24,160 --> 01:32:25,120 LAMELLAR- CRISTACE, WHEN WE 2490 01:32:25,120 --> 01:32:26,320 PLRVE OBSERVED THAT IN THE 2491 01:32:26,320 --> 01:32:26,560 TUBES. 2492 01:32:26,560 --> 01:32:29,360 AND WE SAW THERE'S UPTAKE IN 2493 01:32:29,360 --> 01:32:31,920 MALES AND FEMALES WHEN WE 2494 01:32:31,920 --> 01:32:34,680 ACTUALLY MEASURED THIS BY MASS 2495 01:32:34,680 --> 01:32:35,360 SPECTROSCOPY. 2496 01:32:35,360 --> 01:32:37,120 SO TO SUMMARIZE THEN WHAT WE SEE 2497 01:32:37,120 --> 01:32:39,400 IS WHEN WE DELETE OPA 1 IN 2498 01:32:39,400 --> 01:32:42,640 PLATELETS WE SEE THAT THERE IS A 2499 01:32:42,640 --> 01:32:43,400 STRIKING RESPIRATORY PHENOTYPE 2500 01:32:43,400 --> 01:32:45,600 IN MALES AND ACTIVATION IN 2501 01:32:45,600 --> 01:32:47,360 INCREASE IN THROMBOSIS IN MALES 2502 01:32:47,360 --> 01:32:49,160 WHICH IS REVERSED BY ADOPTIVE 2503 01:32:49,160 --> 01:32:50,200 TRANSFER WHEREAS IN FEMALES WE 2504 01:32:50,200 --> 01:32:52,000 SEE THAT IN FACT THIS IS VERY 2505 01:32:52,000 --> 01:32:53,920 WELL TOLERATED AND IN FACT, 2506 01:32:53,920 --> 01:32:56,280 THERE'S A DECREASE IN OUR 2507 01:32:56,280 --> 01:32:57,840 THROMBOSIS, SO THE QUESTION S&P 2508 01:32:57,840 --> 01:32:59,720 THERE TRUE IN THIS HUMAN 2509 01:32:59,720 --> 01:33:04,880 PLATELETS SO TO ADDRESS THIS WE 2510 01:33:04,880 --> 01:33:08,400 DEVELOPED A CRISPR METHOD TO 2511 01:33:08,400 --> 01:33:11,040 DEVELOP HUMAN HEMATOPOIETIC STEM 2512 01:33:11,040 --> 01:33:12,400 CELLS AND UCARIO SIGHTS TBR 2513 01:33:12,400 --> 01:33:15,960 HUMANS AND THEN WE USE CRISPR TO 2514 01:33:15,960 --> 01:33:17,040 KNOCK DOWN OPA 1 AND WE DID THAT 2515 01:33:17,040 --> 01:33:19,240 HERE AND THIS WAS CHARACTERIZED 2516 01:33:19,240 --> 01:33:21,680 BY A LOSS OF MITOCHONDRIAL 2517 01:33:21,680 --> 01:33:22,280 MEMBRANE PROTENTIAL. 2518 01:33:22,280 --> 01:33:30,120 WE THEN EXPOSE THESE HUMAN 2519 01:33:30,120 --> 01:33:31,120 DERIVED SACKS THROUGH INVITRO 2520 01:33:31,120 --> 01:33:33,640 AND YOU CAN SEE MITOCHONDRIAL 2521 01:33:33,640 --> 01:33:41,080 SHOWN HERE IN ANIMALS THAT 2522 01:33:41,080 --> 01:33:42,880 WERE--SORRY, IN MEGACARIO SIGHTS 2523 01:33:42,880 --> 01:33:47,000 AND THEN WHEN WE SAW INVITRO WE 2524 01:33:47,000 --> 01:33:49,400 SAW RESTORATION OF THE 2525 01:33:49,400 --> 01:33:50,040 MITOCHONDRIAL PRISTINE 2526 01:33:50,040 --> 01:33:50,360 MORPHOLOGY. 2527 01:33:50,360 --> 01:33:52,400 SO FINALLY, IF THIS IS TRUE IN 2528 01:33:52,400 --> 01:33:52,760 HUMANS? 2529 01:33:52,760 --> 01:33:55,840 SO TO ADDRESS THIS JENNIFER 2530 01:33:55,840 --> 01:33:57,160 STREETER, CARDIOLOGIST IN OUR 2531 01:33:57,160 --> 01:34:02,120 LAB LOOKED AT A LARGE DATABASE 2532 01:34:02,120 --> 01:34:04,400 THAT IS PULLED FROM MILLIONS OF 2533 01:34:04,400 --> 01:34:05,040 ELECTRONIC MEDICAL RECORDS 2534 01:34:05,040 --> 01:34:07,800 ACROSS THE WORLD AND 2535 01:34:07,800 --> 01:34:08,760 SPECIFICALLY THE QUERIES LOOKED 2536 01:34:08,760 --> 01:34:11,840 AT WAS PATIENT WHO IS WERE 2537 01:34:11,840 --> 01:34:15,400 ADULTS WHO HAD AUTOSOMAL 2538 01:34:15,400 --> 01:34:16,800 DOMINANT ATROPHY AND CONFIRMED 2539 01:34:16,800 --> 01:34:18,000 BY SEQUENCING OR A GENE TEST AND 2540 01:34:18,000 --> 01:34:23,120 THEN LOOK FOR THE PRESENCE OR 2541 01:34:23,120 --> 01:34:24,640 ABSENCE OF VENUS THROMBI 2542 01:34:24,640 --> 01:34:26,600 EMBOLISM AND LET ME SHOW YOU 1 2543 01:34:26,600 --> 01:34:28,520 TABLE FROM THIS ANALYSIS, IT'S A 2544 01:34:28,520 --> 01:34:30,440 BUSY TABLE SO I WILL WALK YOU 2545 01:34:30,440 --> 01:34:31,480 THROUGH IT. 2546 01:34:31,480 --> 01:34:33,000 WE'RE MAKING COMPARISONS HERE, 2547 01:34:33,000 --> 01:34:34,480 WE ARE COMPARING PATIENTS WITH 2548 01:34:34,480 --> 01:34:35,720 ALL CONTROLS, GOOD NUMBERS OR 2549 01:34:35,720 --> 01:34:37,520 BAD NUMBERS AND MALES IN CONTROL 2550 01:34:37,520 --> 01:34:46,240 MALES OR FEMALES AND CONTROL IF 2551 01:34:46,240 --> 01:34:47,640 FEMALES ARE OPA 1, AND WE LOOK 2552 01:34:47,640 --> 01:34:49,280 AT THEM IN THE SYSTEM, I'M 2553 01:34:49,280 --> 01:34:51,800 SHOWING YOU THIS DATA FOR THE 2554 01:34:51,800 --> 01:34:53,560 NERVOUS SYSTEM, IS TRUE FOR WHEN 2555 01:34:53,560 --> 01:34:55,400 WE CONTROL FOR THE SARS UPDATE 2556 01:34:55,400 --> 01:34:55,720 IN THE SYSTEM. 2557 01:34:55,720 --> 01:34:57,840 SO CAN YOU SEE THAT IF YOU LOOK 2558 01:34:57,840 --> 01:35:01,080 AT THE RISK RATIO FOR VENUS THOM 2559 01:35:01,080 --> 01:35:02,640 BI EMBOLISM IN PATIENTS WITH 2560 01:35:02,640 --> 01:35:04,400 CONTROLS IT IS SIGNIFICANTLY 2561 01:35:04,400 --> 01:35:05,680 INCREASED IN THE ENTIRE 2562 01:35:05,680 --> 01:35:09,040 POPULATION, THAT'S ALSO TRUE IN 2563 01:35:09,040 --> 01:35:10,680 MALES, DISP ALSO TRUE IN FEMALES 2564 01:35:10,680 --> 01:35:12,440 IN THOSE WITH NO DISEASES OFF 2565 01:35:12,440 --> 01:35:14,600 THE NERVOUS SYSTEM AND APREACHES 2566 01:35:14,600 --> 01:35:16,200 STATISTICAL SIGNIFICANCE WHEN 2567 01:35:16,200 --> 01:35:17,920 YOU COMPARE OPA 1 EFFECTED MALES 2568 01:35:17,920 --> 01:35:18,320 AND FEMALES. 2569 01:35:18,320 --> 01:35:19,840 HOWEVER WHEN WE LOOK AT PATIENT 2570 01:35:19,840 --> 01:35:22,960 WHO IS HAD THESE ORDERS OF 2571 01:35:22,960 --> 01:35:25,600 UPDATE NERVOUS SYSTEM OR THE 2572 01:35:25,600 --> 01:35:26,840 MUSCULAR SYSTEM, THE FIRST 2573 01:35:26,840 --> 01:35:28,120 RELATIONSHIPS CONTINUE TO HOLD 2574 01:35:28,120 --> 01:35:29,320 TRUE BUT IMPORTANTLY AT THE 2575 01:35:29,320 --> 01:35:31,400 BOTTOM HERE, THE RELATIONSHIP 2576 01:35:31,400 --> 01:35:32,840 BETWEEN OPA 1 AND FEMALES IS 2577 01:35:32,840 --> 01:35:36,840 ACTUALLY AN INCREASED RISK OF 2578 01:35:36,840 --> 01:35:38,480 VENUS THROMBOLLISM IN OPA 1 2579 01:35:38,480 --> 01:35:41,600 MALES RELATIVE TO OPA 1 FEMALES. 2580 01:35:41,600 --> 01:35:42,960 SO JUST TO SUMMARIZE THEN, THIS 2581 01:35:42,960 --> 01:35:45,600 PART OF THE STUDY, MALES OR 2582 01:35:45,600 --> 01:35:47,760 FEMALES WITH OPA 1 MUTATIONS 2583 01:35:47,760 --> 01:35:49,120 HAVE INCREASED VENOUS 2584 01:35:49,120 --> 01:35:51,120 THROMBOW-'EM BOL ITCH RELATIVE 2585 01:35:51,120 --> 01:35:52,640 TO SUBJECTS WITHOUT OP A 1 2586 01:35:52,640 --> 01:35:54,760 MUTATIONS AND MALES WITH OPA 1 2587 01:35:54,760 --> 01:35:58,240 MUTATIONS HAVE INCREASED VENOUS 2588 01:35:58,240 --> 01:35:59,680 THROMBO-EMBOLISM RELATIVE TO 2589 01:35:59,680 --> 01:36:01,000 FEMALES WITH OPA 1 DISORDERS 2590 01:36:01,000 --> 01:36:01,800 THAT ARE PRESENT. 2591 01:36:01,800 --> 01:36:04,480 SO WHAT THIS SHOWS IS THAT THIS 2592 01:36:04,480 --> 01:36:05,240 IS INTERESTING INTERACTION 2593 01:36:05,240 --> 01:36:09,960 BETWEEN MIGHT O CHOPPEDRIAL 2594 01:36:09,960 --> 01:36:11,280 DYNAMICS AND WHAT THIS TELLS US 2595 01:36:11,280 --> 01:36:15,400 IS THAT PERHAPS IN PREGNANCY FOR 2596 01:36:15,400 --> 01:36:21,040 EXAMPLE, WHAT THE 2597 01:36:21,040 --> 01:36:23,000 ESTRA- DIOLs, THERE, I THINK 2598 01:36:23,000 --> 01:36:26,120 THAT'S HOLDING TRUE FOR GAPS IF 2599 01:36:26,120 --> 01:36:28,560 FUTURE DIRECTION IS COULD OPA 1 2600 01:36:28,560 --> 01:36:30,800 EXPRESSION IN PLATELETS BE USED 2601 01:36:30,800 --> 01:36:33,000 AS A BIOMARKER TO PREDICT RISK 2602 01:36:33,000 --> 01:36:35,120 OF DISEASE IN WOMEN PRIOR TO 2603 01:36:35,120 --> 01:36:36,080 ESTROGEN ADMINISTRATION. 2604 01:36:36,080 --> 01:36:37,760 DOES THE RELATIONSHIP BETWEEN 2605 01:36:37,760 --> 01:36:39,840 OPA 1 AND THROMBOSIS RISK HOLD 2606 01:36:39,840 --> 01:36:42,040 TRUE IN POST MENOPAUSAL WOMEN 2607 01:36:42,040 --> 01:36:44,640 AND WHAT ADDITIONAL BIOMARKERS 2608 01:36:44,640 --> 01:36:47,520 OF PLATELET ACTIVATION MIGHT BE 2609 01:36:47,520 --> 01:36:49,560 RELATED TO VARIATIONS FOR 2610 01:36:49,560 --> 01:36:50,440 OPARE--ADMINISTRATIVE 1 RISK 2611 01:36:50,440 --> 01:36:50,920 MODULATION? 2612 01:36:50,920 --> 01:36:52,320 THANK YOU FUR YOURCANDIDATES 2613 01:36:52,320 --> 01:36:52,560 ATTENTION. 2614 01:36:52,560 --> 01:36:53,920 >> RIGHT ON TIME. 2615 01:36:53,920 --> 01:36:54,520 THANK YOU. 2616 01:36:54,520 --> 01:36:56,080 AND SO I CERTAINLY HAVE A LOT OF 2617 01:36:56,080 --> 01:36:57,360 QUESTIONS, WE NEED TO MOVE TO 2618 01:36:57,360 --> 01:36:58,920 THE NEXT SPEAKER HERE, SO I 2619 01:36:58,920 --> 01:37:03,120 WOULD LIKE TO INTRODUCE 2620 01:37:03,120 --> 01:37:04,200 DR. ZUBAID RAFIQUE, ASSOCIATE 2621 01:37:04,200 --> 01:37:06,240 PROFESSOR AND ASSOCIATE RESEARCH 2622 01:37:06,240 --> 01:37:07,560 DIRECTOR OF EMERGENCY MEDICINE 2623 01:37:07,560 --> 01:37:09,040 AT BAYLOR AND FACULTY OF THE 2624 01:37:09,040 --> 01:37:10,240 AMERICAN COLLEGE OF EMERGENCY 2625 01:37:10,240 --> 01:37:12,400 PHYSICIANS, HIS RESEARCH 2626 01:37:12,400 --> 01:37:18,400 INTERESTS ARE IN HYPER COLEMMIA, 2627 01:37:18,400 --> 01:37:20,120 KIDNEY BIOMARKERS AND TBI. 2628 01:37:20,120 --> 01:37:21,200 DURING THE PANDEMIC HE ACCEPTED 2629 01:37:21,200 --> 01:37:24,480 UP TO DO WORK ON MULTIPLE COVID 2630 01:37:24,480 --> 01:37:26,200 RELATED STUDIES INCLUDING C3 PO 2631 01:37:26,200 --> 01:37:28,200 WHICH IS A CONVALESCENT PLASMA 2632 01:37:28,200 --> 01:37:30,400 TRIAL WHICH HE WILL SHARE TODAY. 2633 01:37:30,400 --> 01:37:32,200 HE'S BEEN AN EMERGENCY 2634 01:37:32,200 --> 01:37:34,040 DEPARTMENT BASE STUDIES AND HIS 2635 01:37:34,040 --> 01:37:36,320 EXPERIENCE RANGES FROM CUTTING 2636 01:37:36,320 --> 01:37:38,920 EDGE BIOMARKER TESTING AND 2637 01:37:38,920 --> 01:37:40,280 EVALUATING DRUGS FOR USE IN THE 2638 01:37:40,280 --> 01:37:47,800 SETTING, SO I WILL STOP HERE AND 2639 01:37:47,800 --> 01:37:48,720 DR. RAFIQUE, EXCITED TO SEE WHAT 2640 01:37:48,720 --> 01:37:49,680 YOU HAVE FOR US. 2641 01:37:49,680 --> 01:37:50,280 >> THANK YOU. 2642 01:37:50,280 --> 01:38:00,800 I WILL SHARE MY SCREEN FIRST. 2643 01:38:04,080 --> 01:38:05,880 >> THANK YOU TO THE ORGANIZERS 2644 01:38:05,880 --> 01:38:06,240 FOR INVITING ME. 2645 01:38:06,240 --> 01:38:07,360 CAN YOU SEE MY SCREEN? 2646 01:38:07,360 --> 01:38:12,600 DISMRKS -- 2647 01:38:12,600 --> 01:38:14,760 >> YES WE CAN. 2648 01:38:14,760 --> 01:38:17,160 >> I AM ZUBAID, RAFIQUY, BAYLOR 2649 01:38:17,160 --> 01:38:19,240 COLLEGE OF MEDICINE AND I WILL 2650 01:38:19,240 --> 01:38:21,400 TAKEN--THEYUC ABOUT CONVALESCENT 2651 01:38:21,400 --> 01:38:22,840 PLASMA STUDY, AND I AM GIVING 2652 01:38:22,840 --> 01:38:27,040 THIS TALK ON BEHALF OF THE 2653 01:38:27,040 --> 01:38:28,080 CPOPTRKS NO RELEVANT DISCLOSURES 2654 01:38:28,080 --> 01:38:31,440 SO THIS IS AGENDA FOR BACKGROUND 2655 01:38:31,440 --> 01:38:33,000 I WILL BRIEFLY DISCUSS GENDER 2656 01:38:33,000 --> 01:38:34,920 SPECIFIC OUTCOMES AND TALK ABOUT 2657 01:38:34,920 --> 01:38:38,280 THE C3 PO STUDY AND THIS WAS A 2658 01:38:38,280 --> 01:38:40,040 STUDY WITH DATA FROM HERE TO DO 2659 01:38:40,040 --> 01:38:42,000 THE GENDER SPECIFIC OUTCOME 2660 01:38:42,000 --> 01:38:42,200 STUDY. 2661 01:38:42,200 --> 01:38:44,400 HYPOTHESIS RESULT AND THEN OUR 2662 01:38:44,400 --> 01:38:45,040 CONTROL. 2663 01:38:45,040 --> 01:38:47,320 SO AS FAR BACKGROUND, THE 2664 01:38:47,320 --> 01:38:50,640 LAST--TODAY AND YESTERDAY WE 2665 01:38:50,640 --> 01:38:51,720 HAVE PLENTY OF STUDIES AND I 2666 01:38:51,720 --> 01:38:53,600 DON'T THINK I NEED TO CONVINCE 2667 01:38:53,600 --> 01:38:56,680 ANYMORE THAT MEN ARE ADVERSELY 2668 01:38:56,680 --> 01:38:58,680 OR MORE ADVERSEEE EFFECTED THAN 2669 01:38:58,680 --> 01:38:59,640 FEMALES IN OOSKT 19. 2670 01:38:59,640 --> 01:39:01,080 SO THERE ARE MULTIPLE STUDIES 2671 01:39:01,080 --> 01:39:01,480 OUT THERE. 2672 01:39:01,480 --> 01:39:03,280 NOW THERE ARE SOME STUDIES, SO 2673 01:39:03,280 --> 01:39:08,160 THIS IS NOT, UNIQUE TO COVID-19. 2674 01:39:08,160 --> 01:39:09,560 THERE IS A WHOLE BUNCH OF VIRAL 2675 01:39:09,560 --> 01:39:11,840 DID THEA AS WELL THAT MALES ARE 2676 01:39:11,840 --> 01:39:15,160 ADVERSELY AFFECTED IN NOSE IN 2677 01:39:15,160 --> 01:39:17,400 HEPATITISA AND TB AND HEP-C AS 2678 01:39:17,400 --> 01:39:19,200 WELL AS HIV VIRAL LOADS ARE 2679 01:39:19,200 --> 01:39:21,600 HIGHER IN MALES AND FEMALES MORE 2680 01:39:21,600 --> 01:39:23,800 ROBUST IMMUNE RESPONSE TO 2681 01:39:23,800 --> 01:39:24,640 VACCINES. 2682 01:39:24,640 --> 01:39:26,480 SO THESE STUDIES ALL SUGGEST 2683 01:39:26,480 --> 01:39:28,360 THAT A MORE ROBUST ABILITY AMONG 2684 01:39:28,360 --> 01:39:31,720 WOMEN TO CONTROL INFECTIOUS 2685 01:39:31,720 --> 01:39:32,040 AGENTS. 2686 01:39:32,040 --> 01:39:34,440 NOW THE TRENDS ARE REVERSED IN 2687 01:39:34,440 --> 01:39:38,480 LONG COVID WHERE FEMALE SEX AND 2688 01:39:38,480 --> 01:39:40,000 ASSOCIATED WITH LOWER LIKELIHOOD 2689 01:39:40,000 --> 01:39:40,720 TO RECOVER AT 1 YEAR. 2690 01:39:40,720 --> 01:39:42,520 THIS IS A STUDY OF 2000 PATIENTS 2691 01:39:42,520 --> 01:39:46,320 FOLLOWED FOR A YEAR AND ODDS 2692 01:39:46,320 --> 01:39:47,440 RATIO OF FEMALES. 2693 01:39:47,440 --> 01:39:49,800 SO WE HAVE THESE DISCREPANCIES 2694 01:39:49,800 --> 01:39:51,200 BETWEEN MALES AND FEMALES, THE 2695 01:39:51,200 --> 01:39:52,840 QUESTION IS DO WE FULLY 2696 01:39:52,840 --> 01:39:54,000 UNDERSTAND THE MECH INFORMS, 2697 01:39:54,000 --> 01:39:54,200 RIGHT? 2698 01:39:54,200 --> 01:39:56,320 AND THE EARLY STAGE WE ARE STILL 2699 01:39:56,320 --> 01:39:59,240 KIND OF UNDERSTAND. 2700 01:39:59,240 --> 01:40:01,520 NOW, NOW THERE ARE LOTS OF 2701 01:40:01,520 --> 01:40:02,440 HYPOTHESIS OUT THERE AND THERE 2702 01:40:02,440 --> 01:40:04,240 ARE LOTS OF SOCIAL DETERMINANTS 2703 01:40:04,240 --> 01:40:08,080 AND WE CHOSE TO WORK ON 1 OF THE 2704 01:40:08,080 --> 01:40:10,120 BIOLOGICAL DETERMINANTS. 2705 01:40:10,120 --> 01:40:11,000 SO CONVALESCENT PLASMA STUDY, SO 2706 01:40:11,000 --> 01:40:15,360 I WILL GO OVER TO THE PLASMA 2707 01:40:15,360 --> 01:40:17,000 STUDY, SO WE UNDERSTAND WHAT 2708 01:40:17,000 --> 01:40:18,880 KIND OF DATA, WHAT KIND WE CAN 2709 01:40:18,880 --> 01:40:22,160 LOOK AT SO THIS STUDY DOES CP 2710 01:40:22,160 --> 01:40:24,400 PREVENT PROGRESSION OF EARLY 2711 01:40:24,400 --> 01:40:26,240 MILD COVID ILLNESS FROM BECOMING 2712 01:40:26,240 --> 01:40:29,360 THIS WAS SPONSORED BY NHLBI, 2713 01:40:29,360 --> 01:40:34,640 PROGRAM OFFICER IS D 2714 01:40:34,640 --> 01:40:35,640 R. NAHED EL KASSAR, THIS WAS 2715 01:40:35,640 --> 01:40:37,720 COORDINATED BY SIREN BUT WE HAVE 2716 01:40:37,720 --> 01:40:42,160 MULTILE PIs AND FRED AND 2717 01:40:42,160 --> 01:40:44,920 VALERIE WORKED TOGETHER FOR THE 2718 01:40:44,920 --> 01:40:47,000 GENDER DISEASE RESEARCH AND THE 2719 01:40:47,000 --> 01:40:48,280 RESULTS WERE PUBLISHED LAST YEAR 2720 01:40:48,280 --> 01:40:50,760 IN THE NEW ENGLAND JOURNAL. 2721 01:40:50,760 --> 01:40:54,160 SO HERE'S THE PRIMARY OUTCOME OF 2722 01:40:54,160 --> 01:40:56,000 THE STUDY WHICH IS DEATH, 2723 01:40:56,000 --> 01:40:58,760 HOSPITAL ADMISSION OR EMERGENCY 2724 01:40:58,760 --> 01:40:59,200 OR RETURN VISITS. 2725 01:40:59,200 --> 01:41:01,360 AND SO HOW THIS HAPPENED IS, 2726 01:41:01,360 --> 01:41:02,560 PATIENTS WITH MILD DISEASE CAME 2727 01:41:02,560 --> 01:41:03,640 INTO THE EMERGENCY DEPARTMENT 2728 01:41:03,640 --> 01:41:06,840 AND THEY GOT RANDOMIZED TO 2729 01:41:06,840 --> 01:41:07,640 CONVALESCENT PLASMA OR SAILEN 2730 01:41:07,640 --> 01:41:10,320 AND THEY WERE FOLLOWED FOR PANE 2731 01:41:10,320 --> 01:41:12,240 DAYS AND PRIMARY OUTCOME FOR 30 2732 01:41:12,240 --> 01:41:13,800 DAYS, AND OVERHERE SAMPLE 1, 2, 2733 01:41:13,800 --> 01:41:15,760 3, AND 4, THESE ARE THE PLACES 2734 01:41:15,760 --> 01:41:18,720 WE COLLECTED BLOOD FROM THE 2735 01:41:18,720 --> 01:41:21,160 PATIENT, AND THOSE ARE THE BLOOD 2736 01:41:21,160 --> 01:41:23,560 SAMPLES WE USED FOR OUR STUDY. 2737 01:41:23,560 --> 01:41:26,480 SO ONCE AGAIN THE STUDY 2738 01:41:26,480 --> 01:41:30,000 PUPPULATION IS ADULTS WITH MILD 2739 01:41:30,000 --> 01:41:33,040 SYMPTOMS OF COVID-19 WHO ARE AT 2740 01:41:33,040 --> 01:41:34,360 RISK FOR PROGRESSIVELY SEVERE 2741 01:41:34,360 --> 01:41:37,680 ILLNESS AND AT THE TIME THEY 2742 01:41:37,680 --> 01:41:41,240 PRESENTED THEY 2743 01:41:41,240 --> 01:41:41,840 WERE--[INDISCERNIBLE] INCLUSION 2744 01:41:41,840 --> 01:41:43,200 CRITERIA WAS 1 OR MORE SYMPTOMS 2745 01:41:43,200 --> 01:41:47,680 OF COVID AND LAB CONFIRMED 2746 01:41:47,680 --> 01:41:49,520 DIAGNOSIS OF COVID, AND 1 OF THE 2747 01:41:49,520 --> 01:41:52,000 RISK FACTORS AGE, HYPERTENSION, 2748 01:41:52,000 --> 01:41:55,320 DIABETES, CDC RISK FACTORS FOR 2749 01:41:55,320 --> 01:42:02,120 SEVERE DISEASE. 2750 01:42:02,120 --> 01:42:04,120 PATIENTS FOR MANAGEMENT AND CP 2751 01:42:04,120 --> 01:42:06,080 AVAILABLE AND DURATION OF SIM 2752 01:42:06,080 --> 01:42:08,840 TOMS GREATER THAN 7 DAYS, AND 2753 01:42:08,840 --> 01:42:10,360 SIGNED INFORMED CONSENT. 2754 01:42:10,360 --> 01:42:11,560 EXCLUSION CRITERIA, YOUNGER THAN 2755 01:42:11,560 --> 01:42:14,040 18, IF YOU HAD REACTION TO BLOOD 2756 01:42:14,040 --> 01:42:15,880 TRODUCTS THEN YOU WERE EXCLUDED 2757 01:42:15,880 --> 01:42:18,680 OR YOU COULDN'T FOLLOW UP. 2758 01:42:18,680 --> 01:42:21,160 SO HERE'S THE PRIMARY COMPOSITE 2759 01:42:21,160 --> 01:42:24,800 OUTCOME WHICH IS YOU HAD 511 2760 01:42:24,800 --> 01:42:26,880 PATIENTS, 1 VALLEYSENT PLASMA 2761 01:42:26,880 --> 01:42:27,920 OVER HERE, PLACEBO GROUP OVER 2762 01:42:27,920 --> 01:42:29,920 HERE AND PATIENTS WITH DISEASE 2763 01:42:29,920 --> 01:42:34,160 PROGRESSION, SO IN THE 2764 01:42:34,160 --> 01:42:35,800 CONVALESCENT PLASMA GROUP, 30% 2765 01:42:35,800 --> 01:42:36,840 SEVERE ILLNESS OR PRIMARY 2766 01:42:36,840 --> 01:42:41,880 OUTCOME AND IN THE PLACEBO GROUP 2767 01:42:41,880 --> 01:42:44,560 IT WAS 95%, AND IT WAS NOT 2768 01:42:44,560 --> 01:42:45,760 SIGNIFICANT BETWEEN THE 2. 2769 01:42:45,760 --> 01:42:46,760 THERE WERE SUBGROUP ANALYSIS 2770 01:42:46,760 --> 01:42:48,560 DONE AND THERE WAS NO DIFFERENCE 2771 01:42:48,560 --> 01:42:50,400 BETWEEN THE SUBGROUPS FOR 2772 01:42:50,400 --> 01:42:50,800 TREATMENT EFFECT. 2773 01:42:50,800 --> 01:42:54,200 ALL RIGHT, I WILL TAKE A LOOK AT 2774 01:42:54,200 --> 01:42:55,600 THE MALE-FEMALE HOW THIS IS 2775 01:42:55,600 --> 01:42:58,040 PRESENTED TO THE NEXT SLIDE. 2776 01:42:58,040 --> 01:43:01,880 AND HERE WE GO, MALES HAD A 2777 01:43:01,880 --> 01:43:02,720 LITTLE WORSE OUTCOME THAN 2778 01:43:02,720 --> 01:43:06,560 FEMALES BUT THIS WAS NOT 2779 01:43:06,560 --> 01:43:07,360 SIGNIFICANTLY SIGNIFICANT. 2780 01:43:07,360 --> 01:43:08,120 THAT'S WHERE WE LEFT THAT. 2781 01:43:08,120 --> 01:43:10,120 WHAT WE DID FIND IS WE LOOKEDDA 2782 01:43:10,120 --> 01:43:14,440 THE JUST MALES OR JUST FEMALES, 2783 01:43:14,440 --> 01:43:15,880 THE WHOLE GROUP MALES HAD 2784 01:43:15,880 --> 01:43:17,960 PROGRESSED TO SEVERE ILL PS, 2785 01:43:17,960 --> 01:43:19,200 VERSUS 27%. 2786 01:43:19,200 --> 01:43:19,880 RIGHT? 2787 01:43:19,880 --> 01:43:20,880 SO THERE'S A 10% DIFFERENCE 2788 01:43:20,880 --> 01:43:23,200 BETWEEN MALES AND FEMALES IN 511 2789 01:43:23,200 --> 01:43:25,680 PATIENTS THAT WERE INVOLVED. 2790 01:43:25,680 --> 01:43:26,800 WHICH WE HAVE SEEN IN MULTIPLE 2791 01:43:26,800 --> 01:43:28,840 OTHER IS IT THES THAT THERE ARE 2792 01:43:28,840 --> 01:43:29,680 DIFFERENCES BETWEEN MALES AND 2793 01:43:29,680 --> 01:43:31,880 FEMALES IN THE LAST COUPLE DAYS 2794 01:43:31,880 --> 01:43:34,800 AND ALSO META-ANALYSIS OUT 2795 01:43:34,800 --> 01:43:35,520 THERE, LOOKING AT THIS 2796 01:43:35,520 --> 01:43:35,960 DIFFERENCE. 2797 01:43:35,960 --> 01:43:38,800 NOW THE QUESTION IS WHY THAT IS. 2798 01:43:38,800 --> 01:43:40,360 AND THE FIRST THING WE REACHED 2799 01:43:40,360 --> 01:43:44,760 OUT TO WAS THE ANTIBODIES RIGHT? 2800 01:43:44,760 --> 01:43:46,200 SO ANTIBODY LEVEL, VACCINES AND 2801 01:43:46,200 --> 01:43:48,080 ANTIBODY LEVELS HAVE BEEN AT THE 2802 01:43:48,080 --> 01:43:49,360 FOREFRONT OF THIS PANDEMIC FIGHT 2803 01:43:49,360 --> 01:43:51,160 SO WE THOUGHT MAYBE FEMALES WILL 2804 01:43:51,160 --> 01:43:53,440 HAVE HIGHER ANTIBODY LEVELS AND 2805 01:43:53,440 --> 01:43:55,000 THAT'S WHY THEY'RE PROTECTED. 2806 01:43:55,000 --> 01:43:56,120 SO THAT'S WHAT WE LOOKED AT. 2807 01:43:56,120 --> 01:43:58,480 SO BEFORE WE GET TO THE ANSWERS 2808 01:43:58,480 --> 01:44:00,040 THERE YOU WANTED TO MAKE SURE 2809 01:44:00,040 --> 01:44:02,880 THE GROUPS, MALES AND FEMALES 2810 01:44:02,880 --> 01:44:06,480 HAD SEVERE ILLNESS SEVERITY, 2811 01:44:06,480 --> 01:44:08,320 SIMILAR ILLNESS SEVERITY AND HOW 2812 01:44:08,320 --> 01:44:13,200 WE CONTROL THOSE WERE SYMPTOM 2813 01:44:13,200 --> 01:44:15,520 ONSET SO MEDIAN DAYS FROM ONSET 2814 01:44:15,520 --> 01:44:17,600 OF SYMPTOMS FOR MEN 4 DAYS, 2815 01:44:17,600 --> 01:44:19,280 WOMEN THEY WERE 3 DAYS AND THEY 2816 01:44:19,280 --> 01:44:19,880 WERE NOT SIGNIFICANTLY 2817 01:44:19,880 --> 01:44:22,680 DIFFERENCE IN THE 2 GROUPS. 2818 01:44:22,680 --> 01:44:23,840 HOWEVER, SYMPTOM ONSET IS 2819 01:44:23,840 --> 01:44:24,800 CORRELATED WITH OUTCOMES SO 2820 01:44:24,800 --> 01:44:26,360 THAT'S SOMETHING TO CONSIDER. 2821 01:44:26,360 --> 01:44:29,040 WE ALSO LOOKED AT A NUMBER OF 2822 01:44:29,040 --> 01:44:30,560 SYMPTOMS, SO, MEDIAN NUMBER OF 2823 01:44:30,560 --> 01:44:32,400 SYMPTOMS FROM MEN WERE 5 AND FOR 2824 01:44:32,400 --> 01:44:33,680 WOMEN WERE 6, AND THERE WAS NO 2825 01:44:33,680 --> 01:44:38,360 DIFFERENCE BETWEEN THE GROUPS 2826 01:44:38,360 --> 01:44:39,720 AND THEN NO RELATIONSHIP 2827 01:44:39,720 --> 01:44:39,960 OUTCOME. 2828 01:44:39,960 --> 01:44:41,280 WHAT WE DID FIND IN DIFFERENCES 2829 01:44:41,280 --> 01:44:43,960 IN THE GROUPS WERE AGE, TOBACCO 2830 01:44:43,960 --> 01:44:46,760 USE AND CORONARY ARTERY DISEASE, 2831 01:44:46,760 --> 01:44:47,800 CORONARY ARTERY DISEASE WE 2832 01:44:47,800 --> 01:44:49,800 DIDN'T HAVE AS MANY PATIENTS, 2833 01:44:49,800 --> 01:44:54,720 LESS THAN 10% AND MOW OUTCOME 2834 01:44:54,720 --> 01:44:54,960 EFFECT. 2835 01:44:54,960 --> 01:44:56,480 WITH CORONARY ARTERY DISEASE BUT 2836 01:44:56,480 --> 01:44:57,920 AGE AND TOBACCO WE ENTER THESE 2837 01:44:57,920 --> 01:45:00,640 IN THE REGRESSION MODEL AND SEX 2838 01:45:00,640 --> 01:45:02,200 WAS STILL A DRIVER FOR THE 2839 01:45:02,200 --> 01:45:02,800 OUTCOME DIFFERENCE. 2840 01:45:02,800 --> 01:45:06,440 WE ALSO LOOKEDDA THE COMORBID 2841 01:45:06,440 --> 01:45:07,720 CONDITIONS, OBESITY, 2842 01:45:07,720 --> 01:45:08,360 HYPERTENSION, DIABETES, THERE'S 2843 01:45:08,360 --> 01:45:10,080 1 ANOTHER THAT WE WILL SEE HERE, 2844 01:45:10,080 --> 01:45:11,720 COPD AND THERE WERE NO 2845 01:45:11,720 --> 01:45:14,000 DIFFERENCES BETWEEN THE 2846 01:45:14,000 --> 01:45:16,200 DIFFERENT GROUPS, OR, SORRY, 2 2847 01:45:16,200 --> 01:45:19,680 GROUPS OF THE HYPERTENSION WAS 2848 01:45:19,680 --> 01:45:21,360 THE ONLY 1 THAT WAS MORE LIKELY 2849 01:45:21,360 --> 01:45:23,880 TO HAVE AN OUTCOME IF YOU HAD 2850 01:45:23,880 --> 01:45:24,200 HYPERTENSION. 2851 01:45:24,200 --> 01:45:26,120 ALL RIGHT, SO THESE ARE ANTIBODY 2852 01:45:26,120 --> 01:45:29,280 TITERS SO AT BASE LINE MALES IF 2853 01:45:29,280 --> 01:45:30,280 FEMALES WERE SIMILAR. 2854 01:45:30,280 --> 01:45:31,160 SO THEY STARTED OFF SIMILAR, 2855 01:45:31,160 --> 01:45:36,440 WHICH IS GOOD AND THEN AT 15 2856 01:45:36,440 --> 01:45:38,320 DAYS, THE RISE IN ANTIBODY 2857 01:45:38,320 --> 01:45:39,800 LEVELS IN MALES WAS HIGHER THAN 2858 01:45:39,800 --> 01:45:41,600 IN FEMALE. 2859 01:45:41,600 --> 01:45:43,440 THIS IS THE MODEL OVER HERE, SO 2860 01:45:43,440 --> 01:45:46,080 MALES WERE A LITTLE HIGHER THAN 2861 01:45:46,080 --> 01:45:47,880 FEMALES, AND WHAT WE WERE 2862 01:45:47,880 --> 01:45:50,120 EXPECTING WITH THE FEMALES 2863 01:45:50,120 --> 01:45:51,440 HIGHER THAN MALES BECAUSE THEY 2864 01:45:51,440 --> 01:45:53,720 HAD A PROTECTED EFFECT, RIGHT? 2865 01:45:53,720 --> 01:45:58,240 SO WE--WE DIVIDED THIS UP 2866 01:45:58,240 --> 01:46:00,080 FURTHER CATEGORIZED IT BY 2867 01:46:00,080 --> 01:46:02,360 OUTCOME, OUTCOME 1 IS ACTUALLY 2868 01:46:02,360 --> 01:46:04,440 POOR OUTCOME, AND OUTCOME 2 IS 2869 01:46:04,440 --> 01:46:07,040 PATIENT WHO IS ARE NOT HAVING 2870 01:46:07,040 --> 01:46:08,320 SEVERE DISEASE. 2871 01:46:08,320 --> 01:46:10,000 O OUTCOME 1 SEVERE DISEASE, 2872 01:46:10,000 --> 01:46:12,040 OUTCOME 2 NOT SEVERE DISEASE AND 2873 01:46:12,040 --> 01:46:13,800 SAME TREND EXISTS, MALE HAVING 2874 01:46:13,800 --> 01:46:15,440 HIGHER ANTIBODY LEVELS 2875 01:46:15,440 --> 01:46:15,880 REGARDLESS OF OUTCOME. 2876 01:46:15,880 --> 01:46:18,520 SO IF THEY'RE SICK, OR NOT SICK, 2877 01:46:18,520 --> 01:46:20,320 MALE ALL HIGHER ANTIBODY LEVEL 2878 01:46:20,320 --> 01:46:25,240 ALTHOUGH THESE NUMBERS WERE NOT 2879 01:46:25,240 --> 01:46:26,960 SIGNIFICANT [INDISCERNIBLE]. 2880 01:46:26,960 --> 01:46:28,600 SO OUR CONCLUSIONS WERE MEN HAD 2881 01:46:28,600 --> 01:46:30,680 10% HIGHER RATE OF PROGRESSION 2882 01:46:30,680 --> 01:46:32,440 FROM MILD TO MODERATE DISEASE, 2883 01:46:32,440 --> 01:46:33,720 BASE LINE ANTIBODY LEVELS SAME 2884 01:46:33,720 --> 01:46:35,960 IN MEN AND WOMEN REGARDLESS 2885 01:46:35,960 --> 01:46:37,040 OUTCOME, RISE IN ANTIBODY LEVELS 2886 01:46:37,040 --> 01:46:39,360 IS LARGER IN MEN, REGARDLESS OF 2887 01:46:39,360 --> 01:46:45,680 OUTCOME AND THEN THE HIGHER 2888 01:46:45,680 --> 01:46:48,600 ANTIBODY LEVEL IN MEN REGARDLESS 2889 01:46:48,600 --> 01:46:50,920 OF OUTCOME. 2890 01:46:50,920 --> 01:46:52,400 THERE WERE LIMITATIONS INNED 2891 01:46:52,400 --> 01:46:55,080 STUDY FOR SYMPTOM SEVERITY, WE 2892 01:46:55,080 --> 01:46:56,400 WITH DAYS AND MOW MANY SYMPTOMS 2893 01:46:56,400 --> 01:46:58,360 THAT I CAME IN WITH AND THERE 2894 01:46:58,360 --> 01:46:59,680 ARE MUTATIONS THERE, THERE ARE 2895 01:46:59,680 --> 01:47:02,760 SOME MISSING DATA OVER HERE, 2896 01:47:02,760 --> 01:47:03,440 HOSPITAL INTERVENTIONS, PATIENTS 2897 01:47:03,440 --> 01:47:05,200 WHO ENDED UP IN HOSPITALS, AND 2898 01:47:05,200 --> 01:47:06,360 WHAT KIND OF INTERVENTIONS THEY 2899 01:47:06,360 --> 01:47:07,880 HAD, WE DON'T HAVE THAT DATA 2900 01:47:07,880 --> 01:47:10,120 OVER HERE IN THIS MODEL, AND 2901 01:47:10,120 --> 01:47:12,240 COULD THAT HAVE EFFECTED THE 2902 01:47:12,240 --> 01:47:13,640 ANTIBODY LEVEL AT 15 DAYS, IF 2903 01:47:13,640 --> 01:47:24,120 POSSIBLE SO WE DON'T HAVE THAT 2904 01:47:37,640 --> 01:47:41,920 AND AND WHOLE HOST OF OTHER 2905 01:47:41,920 --> 01:47:49,600 THINGS AND I AND INVOLVED IN 2906 01:47:49,600 --> 01:47:59,720 THIS, . 2907 01:48:01,720 --> 01:48:02,320 >> WONDERFUL THANK YOU VERY MUCH 2908 01:48:02,320 --> 01:48:03,280 VERY MUCH, THAT WAS REALLY 2909 01:48:03,280 --> 01:48:04,240 INTERESTING EXPW I HAVE A NUMBER 2910 01:48:04,240 --> 01:48:06,040 OF QUESTIONS I KNOW OTHERS DO AS 2911 01:48:06,040 --> 01:48:07,800 WELL, I'M GETTING MESSAGES ABOUT 2912 01:48:07,800 --> 01:48:11,000 THAT, SO, LET'S MOVE TO OUR NEXT 2913 01:48:11,000 --> 01:48:11,520 TALK. 2914 01:48:11,520 --> 01:48:15,000 THIS IS DR. MATTHEW NEAL WHO IS 2915 01:48:15,000 --> 01:48:16,000 ROBERTA SIMONS ASSOCIATE 2916 01:48:16,000 --> 01:48:18,120 PROFESSOR OF SURGERY, ASSOCIATE 2917 01:48:18,120 --> 01:48:19,640 PROFESSOR OF CRITICAL MEDICINE 2918 01:48:19,640 --> 01:48:20,920 AND CLINICAL TRANSLATIONAL 2919 01:48:20,920 --> 01:48:22,080 SCIENCE AT THE UNIVERSITY OF PIT 2920 01:48:22,080 --> 01:48:24,680 PITS, DR. NEAL IS A PRACTICING 2921 01:48:24,680 --> 01:48:26,400 TRAUMA SURGEON AND INTENSE 2922 01:48:26,400 --> 01:48:29,280 SURGEON SCIENTIST AT UPMC, 2923 01:48:29,280 --> 01:48:31,840 SERVES AS THE DOCTOR OF 2924 01:48:31,840 --> 01:48:34,200 PITTSBURGH TRAUMA AND 2925 01:48:34,200 --> 01:48:35,200 TRANSFUSION MEDICINE CENTER 2926 01:48:35,200 --> 01:48:38,440 WHICH COLLABORATION THROUGH 2927 01:48:38,440 --> 01:48:40,520 TRAUMA RESOURCE CONFUSION, AND 2928 01:48:40,520 --> 01:48:41,760 CLINICAL TRIALS AND AND 2929 01:48:41,760 --> 01:48:50,120 PERSONALLY ON MORE THAN 1 2930 01:48:50,120 --> 01:48:51,920 OCCASION, ACTIVE FOR A TRIAL, 2931 01:48:51,920 --> 01:48:53,640 AND 1 OF THE DIRECTORS OF THE 2932 01:48:53,640 --> 01:48:56,000 ACTIVE 4 CLINICAL AND DATA 2933 01:48:56,000 --> 01:48:58,320 COORDINATING CENTER WHICH ARE 2934 01:48:58,320 --> 01:48:59,160 NHLBI SPONSOR. 2935 01:48:59,160 --> 01:49:01,160 DR. NEAL WAS AN ORGANIZING AND 2936 01:49:01,160 --> 01:49:03,920 FOUNDING MEMBERS OF THE 2937 01:49:03,920 --> 01:49:14,360 MULTIPLATFORM RANDOMIZED 2938 01:49:16,560 --> 01:49:17,400 CLINICAL TRIAL, AND DR. NEAL 2939 01:49:17,400 --> 01:49:20,440 WILL SHARE WITH US HOW COVID 2940 01:49:20,440 --> 01:49:31,000 THROMBOTIC COMPLICATIONS MAY BE 2941 01:49:46,760 --> 01:49:47,520 PRESENT AND INFLUENCE-- 2942 01:49:47,520 --> 01:49:58,040 >> ISSUES RELATED TO SEX AND 2943 01:50:00,520 --> 01:50:00,840 GENDER. 2944 01:50:00,840 --> 01:50:02,880 --MENTIONED AS THE CO CHAIR OF 2945 01:50:02,880 --> 01:50:05,160 THE ACTIVE 4A TRIAL. 2946 01:50:05,160 --> 01:50:07,360 AND SO, I THINK NICELY SUMMARIZE 2947 01:50:07,360 --> 01:50:09,480 OVER THE COURSE OF MULTIPLE 2948 01:50:09,480 --> 01:50:12,120 TALKS THE LAST DAY AND A HALF IS 2949 01:50:12,120 --> 01:50:15,520 THE ROLE OF IMMUNO THOMBOSIS AND 2950 01:50:15,520 --> 01:50:16,720 THROMBOTIC COMPLICATIONS IN 2951 01:50:16,720 --> 01:50:19,400 COVID-19 AND I WANT TO EMPHASIZE 2952 01:50:19,400 --> 01:50:24,600 JUST BY BRIEF INTRODUCTION THAT 2953 01:50:24,600 --> 01:50:26,000 WE SOUGHT OUT WITH GREAT 2954 01:50:26,000 --> 01:50:27,360 INTEREST IN UNDERSTANDING BOTH 2955 01:50:27,360 --> 01:50:31,840 THE ROLE OF MICROVASCULAR AND 2956 01:50:31,840 --> 01:50:33,560 MACROVASCULAR THROMBOSIS IN 2957 01:50:33,560 --> 01:50:35,520 PATIENTS WITH COVID-19 AND THIS 2958 01:50:35,520 --> 01:50:37,920 REALLY SERVED AS THE RATIONAL 2959 01:50:37,920 --> 01:50:39,680 FOR THE INITIATION OF THE ACTIVE 2960 01:50:39,680 --> 01:50:42,760 4A TRIAL AND OTHER PLATFORMS 2961 01:50:42,760 --> 01:50:46,320 THAT STUDIED VARIOUS MECHANISMS 2962 01:50:46,320 --> 01:50:48,760 OF THROMBOW PROPHYLAXIS AND 2963 01:50:48,760 --> 01:50:49,800 ANTITHROMBOTTIC STRATEGIES IN 2964 01:50:49,800 --> 01:50:55,960 THE VASCULAR BIOLOGY OF 2965 01:50:55,960 --> 01:50:56,960 COVID-19. 2966 01:50:56,960 --> 01:50:58,600 DR. KANTHI MENTIONED THE 2967 01:50:58,600 --> 01:50:59,440 RANDOMIZED PLATFORM TRIAL AND I 2968 01:50:59,440 --> 01:51:00,840 WANT TO SUMMARIZE THAT BRIEFLY 2969 01:51:00,840 --> 01:51:03,320 HERE BEFORE THE RESULT SO THAT 2970 01:51:03,320 --> 01:51:05,240 YOU--SO THAT YOU UNDERSTAND THE 2971 01:51:05,240 --> 01:51:09,080 OUTCOMES AND HOW WE GOT THERE. 2972 01:51:09,080 --> 01:51:11,280 THIS INITIATIVE IS BY FAR THE 2973 01:51:11,280 --> 01:51:12,360 MOST COLLABORATIVE 1 THAT I HAVE 2974 01:51:12,360 --> 01:51:17,120 EVER BEEN A PART OF IN SCIENCE 2975 01:51:17,120 --> 01:51:20,800 AND ESSENTIALLY WHAT THE MPRCT 2976 01:51:20,800 --> 01:51:23,400 WAS A PROSPECTIVE ALIGNMENT OF 2977 01:51:23,400 --> 01:51:26,480 PLATFORMS, THE CANADIAN CHR 2978 01:51:26,480 --> 01:51:28,120 FUNDED ATTACK TRIAL. 2979 01:51:28,120 --> 01:51:29,600 THE INTERNATIONAL CAP REMAP 2980 01:51:29,600 --> 01:51:34,720 CONSORTIUM AND THE NHLBI ACTIVE 2981 01:51:34,720 --> 01:51:36,920 FUNDED 4 PROGRAM TO ALIGN 2982 01:51:36,920 --> 01:51:38,840 PLATFORMS TO DESIGN A HARMONIZED 2983 01:51:38,840 --> 01:51:42,600 TRIAL TO STUDY IN THE FIRST 2 2984 01:51:42,600 --> 01:51:45,360 ARMS THERAPEUTIC VERSUS USUAL 2985 01:51:45,360 --> 01:51:47,680 CARE OR PROLACTIC DOSE HEP A RIN 2986 01:51:47,680 --> 01:51:49,000 HAD HOSPITALIZED PATIENTS WITH 2987 01:51:49,000 --> 01:51:49,320 COVID-19. 2988 01:51:49,320 --> 01:51:52,560 NOW THERE HAVE BEEN NUMEROUS 2989 01:51:52,560 --> 01:51:54,120 OTHER STUDIES IN ANTICOAGULATION 2990 01:51:54,120 --> 01:52:00,560 AND THROMBOTICS I WILL TALK ONLY 2991 01:52:00,560 --> 01:52:03,320 ABOUT THE MPRCT AND ACTIV-4 NOW. 2992 01:52:03,320 --> 01:52:06,400 BUT I WILL HIGHLIGHT THAT IT WAS 2993 01:52:06,400 --> 01:52:07,920 ORGSUPPORT FREE DAY ANDS IT WAS 2994 01:52:07,920 --> 01:52:09,800 DAYS FREE OF ORGAN SUPPORT AND 2995 01:52:09,800 --> 01:52:11,680 IT ALIGNED WITH THE HYPOTHESIS 2996 01:52:11,680 --> 01:52:12,760 THAT REQUIREMENT FOR ORGAN 2997 01:52:12,760 --> 01:52:17,280 SUPPORT WAS SECONDARY TO 2998 01:52:17,280 --> 01:52:17,880 MICROVASCULAR THROMBOSIS AND 2999 01:52:17,880 --> 01:52:19,960 INJURY WITH THE HOPES THAT 3000 01:52:19,960 --> 01:52:21,680 INITIATION OF ANTICO AGZULATION 3001 01:52:21,680 --> 01:52:23,080 COULD REDUCE OR PREVENT THAT. 3002 01:52:23,080 --> 01:52:26,040 AS I MENTION THE FIRST 2 ARMS OF 3003 01:52:26,040 --> 01:52:28,120 THE MPRCT WERE STUDYING 3004 01:52:28,120 --> 01:52:30,240 THERAPEUTIC VERSUS USUAL CARE OF 3005 01:52:30,240 --> 01:52:36,320 HEP A RINs, THIS WAS A 3006 01:52:36,320 --> 01:52:37,800 MAGMATIC INTERNATIONAL TRIAL 3007 01:52:37,800 --> 01:52:41,800 CONTUCTED IN 10 COUNTRIESA THE 3008 01:52:41,800 --> 01:52:43,640 393 SITES. 3009 01:52:43,640 --> 01:52:47,120 SUBSEQUENT TO THE MPRCT, THE 3010 01:52:47,120 --> 01:52:51,000 ACTIV-4 PLATFORM AS CONTINUED 3011 01:52:51,000 --> 01:52:53,560 AND THE ACTIV-4 A HAS STUDIED 3012 01:52:53,560 --> 01:52:57,720 OTHER ARMS IN ADDITION TO 3013 01:52:57,720 --> 01:52:57,960 HEPARINS. 3014 01:52:57,960 --> 01:53:02,600 WE REPOTENT STATED ON THE ROLE 3015 01:53:02,600 --> 01:53:05,720 OF P2 Y12 IN JAMA OR IN MODERATE 3016 01:53:05,720 --> 01:53:08,720 STATE OR IN AWARD LEVEL CARE AND 3017 01:53:08,720 --> 01:53:10,160 IN SEVERELY PATIENTS IN THE 3018 01:53:10,160 --> 01:53:11,320 INTENSIVE CARE UNIT WITH 3019 01:53:11,320 --> 01:53:13,520 COVID-19 WE ARE ACTIVELY 3020 01:53:13,520 --> 01:53:16,440 ENROLLING IN THE P2 Y 12 DOMAIN 3021 01:53:16,440 --> 01:53:18,400 WITH 947 PATIENTS ENROLLED AS OF 3022 01:53:18,400 --> 01:53:19,200 EARLIER THIS WEEK. 3023 01:53:19,200 --> 01:53:24,240 WE ALSO HAVE ADDITIONAL ARMS 3024 01:53:24,240 --> 01:53:28,760 STUDYING SGLT2 INHIBITION AND 3025 01:53:28,760 --> 01:53:30,640 CRIZANLIZUMAB AS OTHER STRATEGY 3026 01:53:30,640 --> 01:53:32,560 FOR THE INTERSECTION OF 3027 01:53:32,560 --> 01:53:33,320 INFLAMMATION AND VASCULAR 3028 01:53:33,320 --> 01:53:35,680 BIOLOGY INJURY IN COVID-19. 3029 01:53:35,680 --> 01:53:37,840 SO I WANT TO SHOW YOU THE 3030 01:53:37,840 --> 01:53:39,640 RESULTS OF THESE STUDIES AND 3031 01:53:39,640 --> 01:53:41,240 WHAT I'VE HIGHLIGHTED ON EACH OF 3032 01:53:41,240 --> 01:53:43,920 THE SLIDES FOR THE RESULTS THAT 3033 01:53:43,920 --> 01:53:46,360 HAVE BEEN PUBLISHED TO DATE IS 3034 01:53:46,360 --> 01:53:49,200 THE ENROLLMENT BY SEX. 3035 01:53:49,200 --> 01:53:51,400 THE FIRST RESULT OF THE MPRCT 3036 01:53:51,400 --> 01:53:56,360 WAS IN THE SEVERE OR ICU STATES 3037 01:53:56,360 --> 01:53:57,680 STUDYING THERAPEUTIC VERSUS 3038 01:53:57,680 --> 01:54:00,080 PROPHYLACTIC DOSE HEPARINS, THIS 3039 01:54:00,080 --> 01:54:03,640 WAS STOPPED BY THE DSMB IN TBEPT 3040 01:54:03,640 --> 01:54:06,120 20 FOR A FINDING OF FUTILITY AND 3041 01:54:06,120 --> 01:54:07,360 WHAT YOU CAN SEE IF YOU'RE NOT 3042 01:54:07,360 --> 01:54:09,480 FAMILIAR WITH THE STACKS BAR 3043 01:54:09,480 --> 01:54:11,200 GRAPHS, I CALL YOUR ATTENTION TO 3044 01:54:11,200 --> 01:54:14,480 WHAT IS LABELED AS PANEL B, AND 3045 01:54:14,480 --> 01:54:17,560 FOR SIMPLICITY, RED IS BAD AND 3046 01:54:17,560 --> 01:54:19,840 BLUE IS GOOD. 3047 01:54:19,840 --> 01:54:20,840 THIS COMPOSITE OUTCOME ORGAN 3048 01:54:20,840 --> 01:54:22,760 SUPPORT FOR 3 DAYS INCLUDES 3049 01:54:22,760 --> 01:54:24,280 DEATH WHICH RECEIVES THE WORST 3050 01:54:24,280 --> 01:54:25,000 SCORE OF NEGATIVE 1. 3051 01:54:25,000 --> 01:54:30,040 SO FURTHER TO THE LEFT IS 3052 01:54:30,040 --> 01:54:31,800 NEGATIVE DEATH ON OUT TO THE 3053 01:54:31,800 --> 01:54:33,800 BLUEST BAR WHICH IS 21 DAYS FREE 3054 01:54:33,800 --> 01:54:34,520 OF REQUIREMENT FOR ORGAN SUPPORT 3055 01:54:34,520 --> 01:54:37,440 AND WHAT YOU CAN SEE IS THAT IN 3056 01:54:37,440 --> 01:54:40,320 THE BASIAN STAOF THETICICAL 3057 01:54:40,320 --> 01:54:43,040 MODEL UTILIZED IN THESE TRIAL, 3058 01:54:43,040 --> 01:54:46,120 THERE WAS A 99.9% POSTERIOR 3059 01:54:46,120 --> 01:54:47,360 PROBABILITY OF FUTILITY AND 3060 01:54:47,360 --> 01:54:49,760 ACTUALLY A TREND TOWARDS HARM 3061 01:54:49,760 --> 01:54:51,840 WITH HIGHER RISK OF PLEADING 3062 01:54:51,840 --> 01:54:54,640 COMPLICATIONS IN PATIENTS 3063 01:54:54,640 --> 01:54:55,800 RECEIVING THERAPEUTIC DOSE 3064 01:54:55,800 --> 01:54:56,160 ANTICOAGULATION. 3065 01:54:56,160 --> 01:54:58,000 SO YOU'LL SEE THAT A MAJORITY OF 3066 01:54:58,000 --> 01:55:02,240 THE PATIENTS ENROLLED IN THAT 3067 01:55:02,240 --> 01:55:03,440 STUDY WERE MALE SEX REFLECT 3068 01:55:03,440 --> 01:55:05,040 BEING LIKELY SOME OF THE DATA 3069 01:55:05,040 --> 01:55:06,960 THAT'S BEEN SUGGESTED EARLIER 3070 01:55:06,960 --> 01:55:08,320 ABOUT--ESPECIALLY EARLY IN THE 3071 01:55:08,320 --> 01:55:11,760 PANDEMIC, IN EARLY PHASES. 3072 01:55:11,760 --> 01:55:13,720 THE WORSENING DISEASE SEVERITY 3073 01:55:13,720 --> 01:55:17,560 IN MEN AND THE HIGHER LIKELIHOOD 3074 01:55:17,560 --> 01:55:21,760 FOR A REQUIREMENT OF ICU CARE. 3075 01:55:21,760 --> 01:55:23,120 SHORTLY THEREAFTER AND REALLY 1 3076 01:55:23,120 --> 01:55:28,000 OF THE MARVELS OF THE MPRCT IS 3077 01:55:28,000 --> 01:55:30,120 HOW QUICKLY WE WERE ABLE TO 3078 01:55:30,120 --> 01:55:32,760 ACCUMULATE DATA WAS A REPORTING 3079 01:55:32,760 --> 01:55:34,040 OF THE MODERATE STATE OR AWARD 3080 01:55:34,040 --> 01:55:35,240 LEVEL CARE AND HERE WE WERE 3081 01:55:35,240 --> 01:55:38,840 DELIGHTED TO BE ABLE TO REALLY 3082 01:55:38,840 --> 01:55:42,280 REPORT A POSITIVE OUTCOME AND IN 3083 01:55:42,280 --> 01:55:44,280 ICE--IN NONICU LEVEL OR HOSPITAL 3084 01:55:44,280 --> 01:55:47,920 BASED PATIENTS WITH COVID-19. 3085 01:55:47,920 --> 01:55:49,920 ED STUDY WAS ACTUALLY STOPPED 3086 01:55:49,920 --> 01:55:52,160 BUYER FOR A FINDING HITTING A 3087 01:55:52,160 --> 01:55:55,320 TRIGGER OF SUPERIORITY WITH A 3088 01:55:55,320 --> 01:56:00,200 98.6% POSTERIOR PROBABILITY FOR 3089 01:56:00,200 --> 01:56:02,600 BENEFIT OF THERAPEUTIC 3090 01:56:02,600 --> 01:56:03,640 ANTICOAGULATION WITH HEPARIN 3091 01:56:03,640 --> 01:56:04,280 OVER USUAL CARE. 3092 01:56:04,280 --> 01:56:05,520 IN THESE PATIENTS ENROLLED OVER 3093 01:56:05,520 --> 01:56:09,560 THE SAME TIME PERIOD, A SLIGHTLY 3094 01:56:09,560 --> 01:56:13,880 MORE BALANCED ENROLLMENT OF MEN 3095 01:56:13,880 --> 01:56:20,640 VERSUS WOMEN WITH RATES 3096 01:56:20,640 --> 01:56:21,800 APPROACHING THESE TODAYS? 3097 01:56:21,800 --> 01:56:24,040 THE MALES AGAIN BENEFITING 3098 01:56:24,040 --> 01:56:25,040 ANTICOAGULATION IN THE MODERATE 3099 01:56:25,040 --> 01:56:25,680 STATE. 3100 01:56:25,680 --> 01:56:28,200 AS I MENTIONED 4A CONTINUED ON 3101 01:56:28,200 --> 01:56:30,920 POST FINDINGS OF THE 2 ARMS IN 3102 01:56:30,920 --> 01:56:33,160 THE MPRCT TO STUDY THE 3103 01:56:33,160 --> 01:56:34,520 ANTIPLATELET STRATEGIES AND THE 3104 01:56:34,520 --> 01:56:37,120 USE OF P2 Z 12 INHIBITION, WE'VE 3105 01:56:37,120 --> 01:56:38,320 REPORTED AS RECENTLY AS THE 3106 01:56:38,320 --> 01:56:42,320 BEGINNING OF THIS YEAR ON THE 3107 01:56:42,320 --> 01:56:44,480 NONICU MODERATE STATE WITH A 3108 01:56:44,480 --> 01:56:47,960 FINDING OF NO BENEFIT, NEEDING A 3109 01:56:47,960 --> 01:56:50,560 TRIGGER FOR FUTILITY OF THE 3110 01:56:50,560 --> 01:56:52,120 ADDITION OF P2 Y 12 ININCREASE 3111 01:56:52,120 --> 01:56:54,720 IN BODY HIB THORSITION TO 3112 01:56:54,720 --> 01:56:56,280 ANTICOAGULATION AGAIN WITH A 3113 01:56:56,280 --> 01:56:57,160 MORE BALANCED ENROLLMENT OF MEN 3114 01:56:57,160 --> 01:56:58,760 AND WOMEN IN THIS PUBLICATION. 3115 01:56:58,760 --> 01:57:03,920 YOU CAN SEE THE CITATION LISTED 3116 01:57:03,920 --> 01:57:04,120 BELOW. 3117 01:57:04,120 --> 01:57:08,000 SO I WANT TO COVER THE SEX AND 3118 01:57:08,000 --> 01:57:08,800 GENDER SPECIFIC OUTCOMES AND YOU 3119 01:57:08,800 --> 01:57:11,960 KNOW I WOULD SAY THAT WE SORT OF 3120 01:57:11,960 --> 01:57:13,360 HAD A PRETEST PROBABILITY TO SAY 3121 01:57:13,360 --> 01:57:15,920 THAT THERE REALLY WOULD BE A 3122 01:57:15,920 --> 01:57:16,960 SIGNIFICANT DIFFERENCE AND A LOT 3123 01:57:16,960 --> 01:57:20,080 OF THAT IS DRIIVE BY WORK IN THE 3124 01:57:20,080 --> 01:57:21,720 LITERATURE THAT IS SUMMARIZED BY 3125 01:57:21,720 --> 01:57:23,480 THIS NICE PUBLICATION IN THE 3126 01:57:23,480 --> 01:57:24,640 AMERICAN JOURNAL OF CARDIOLOGY 3127 01:57:24,640 --> 01:57:26,400 FROM THE NYU GROUP PUBLISHED 3128 01:57:26,400 --> 01:57:31,200 JUST LAST MONTH WHICH SHOWS THE 3129 01:57:31,200 --> 01:57:32,840 DISPROPORTIONATE BURDEN OF 3130 01:57:32,840 --> 01:57:33,440 MACROTHROMBOTTIC COMPLICATIONS 3131 01:57:33,440 --> 01:57:35,920 IN MEN AS COMPARED TO WOMEN, BUT 3132 01:57:35,920 --> 01:57:36,760 WA'S REALLY INTERESTING IN THIS 3133 01:57:36,760 --> 01:57:38,840 STUDY WHEN YOU LOOK AT THE BAR 3134 01:57:38,840 --> 01:57:40,240 GRAPHS FURTHEST TO THE RIGHT IN 3135 01:57:40,240 --> 01:57:42,200 EACH COLUMN OR IN THE FOREST 3136 01:57:42,200 --> 01:57:44,800 PLOTS TO THE RIGHT, THAT THESE 3137 01:57:44,800 --> 01:57:46,520 FINDINGS OF A DISPROPORTIONATE 3138 01:57:46,520 --> 01:57:48,600 BURDEN OF DEATH OR 3139 01:57:48,600 --> 01:57:50,640 PROMULGATEBOSIS HOALTD UP WORSE 3140 01:57:50,640 --> 01:57:52,640 IN MEN AT YOUNGER AGE GROUPS BUT 3141 01:57:52,640 --> 01:57:55,040 ONCE WE REACH AN AGE OF GREATER 3142 01:57:55,040 --> 01:57:57,480 THAN 75, AS WE ALL HAVE LEARNED, 3143 01:57:57,480 --> 01:58:00,920 WHERE THERE IS A 3144 01:58:00,920 --> 01:58:02,920 DISPROPORTIONATE BURDEN OF 3145 01:58:02,920 --> 01:58:04,920 DISEASE IN COVID-19 THE 3146 01:58:04,920 --> 01:58:08,040 DIFFERENCE IN SEX FALLS OUT HERE 3147 01:58:08,040 --> 01:58:09,560 AND SO, A REALLY IMPORTANT 3148 01:58:09,560 --> 01:58:11,120 OBSERVATION OF THIS BURDEN OF 3149 01:58:11,120 --> 01:58:13,680 PERHAPS IN YOUNGER INDIVIDUALS 3150 01:58:13,680 --> 01:58:21,800 BUT MAYBE OUTCOME PETEED OUTCOE 3151 01:58:21,800 --> 01:58:22,200 WAYS. 3152 01:58:22,200 --> 01:58:23,680 SO WE'VE GONE BACK TO THE DATA 3153 01:58:23,680 --> 01:58:27,480 AS I CONCLUDE FOR THE MPRCT AND 3154 01:58:27,480 --> 01:58:28,880 THE ACTIV 4A TRIAL AND THERE'S A 3155 01:58:28,880 --> 01:58:30,120 LOT MORE WORK TO BE DONE BUT I 3156 01:58:30,120 --> 01:58:31,920 WILL SHARE WITH YOU WHAT WE 3157 01:58:31,920 --> 01:58:34,560 WHICH IS REALLY ALL UNPUBLISHED 3158 01:58:34,560 --> 01:58:35,680 DATA IN THIS SUMMARY SLIDE. 3159 01:58:35,680 --> 01:58:38,480 I WILL TUMOR SPECTRUM IN 3160 01:58:38,480 --> 01:58:39,360 PRESPECIFIED SUBGROUP ANALYSIS, 3161 01:58:39,360 --> 01:58:43,480 THERE WAS NO TREATMENT EFFECT 3162 01:58:43,480 --> 01:58:44,440 WHEN STRATIFIED BY SEX AND A 3163 01:58:44,440 --> 01:58:46,200 NUMBER OF OTHER VARIABLES BUT 3164 01:58:46,200 --> 01:58:48,560 IMPORTANTLY THIS IS FOR THE 3165 01:58:48,560 --> 01:58:49,600 PRIMARY OUTCOME OF ORGAN SUPPORT 3166 01:58:49,600 --> 01:58:50,880 DAYS AND YOU WILL REMEMBER THAT 3167 01:58:50,880 --> 01:58:53,720 WE BELIEVE THAT THIS REFLECTS 3168 01:58:53,720 --> 01:58:55,040 THE BURDEN OF MICROVASCULAR 3169 01:58:55,040 --> 01:58:56,160 THROMBOSIS, BUT AS HIGHLIGHTED 3170 01:58:56,160 --> 01:58:58,480 BY THE SECOND BULLET POINT, 3171 01:58:58,480 --> 01:59:00,200 WE'VE NOT DONE A DETAILED 3172 01:59:00,200 --> 01:59:04,800 ANALYSIS OF THE IMPACT OF 3173 01:59:04,800 --> 01:59:06,040 TREATMENT UPON PLOOK THROMBOW 3174 01:59:06,040 --> 01:59:07,000 BOLLIC EVENTS. 3175 01:59:07,000 --> 01:59:08,520 IMPORTANTLY WE HAVE A STRONG 3176 01:59:08,520 --> 01:59:10,000 INTEREST IN 90 DAY OUTCOMES 3177 01:59:10,000 --> 01:59:12,400 WHICH WE HAVE FROM THESE STUDIES 3178 01:59:12,400 --> 01:59:14,160 AS A PROXY AND AS EXTENSION INTO 3179 01:59:14,160 --> 01:59:21,000 THE STUDY OF LONG COVID. 3180 01:59:21,000 --> 01:59:23,720 IN INITIAL STUDIES WE HAVE NOT 3181 01:59:23,720 --> 01:59:26,960 SEEN SEX/GENDER AS AUNE VALID 3182 01:59:26,960 --> 01:59:28,240 AND RELIABLEIATE VARIABLE. 3183 01:59:28,240 --> 01:59:31,320 BUT A STUDY ONGOING NOW LOOKING 3184 01:59:31,320 --> 01:59:33,480 AT HETEROGENERATED AITY 3185 01:59:33,480 --> 01:59:36,200 TREATMENT EFFECT, WE FOUND 3186 01:59:36,200 --> 01:59:38,120 THERAPEUTIC BENEFITS BUT WE NEED 3187 01:59:38,120 --> 01:59:38,440 TO STUDY IT. 3188 01:59:38,440 --> 01:59:40,400 AS CAN YOU SEE IN THIS BULLET 3189 01:59:40,400 --> 01:59:42,360 POINT WHAT I'VE HIGHLIGHTED IS 3190 01:59:42,360 --> 01:59:44,840 THAT WE THINK IN OUR ONGOING 3191 01:59:44,840 --> 01:59:47,880 STUDIES THAT THE THERAPEUTIC 3192 01:59:47,880 --> 01:59:48,760 ANTICOAGULATION APPEARS TO BE 3193 01:59:48,760 --> 01:59:50,800 MOST BENEFICIAL IN PATIENTS WITH 3194 01:59:50,800 --> 01:59:52,320 ELEVATED D-DIMERS AND HIGH BASE 3195 01:59:52,320 --> 01:59:53,440 LINE OXYGEN REQUIREMENT THAT 3196 01:59:53,440 --> 01:59:54,680 SHOULD NOT BE SURPRISING TO 3197 01:59:54,680 --> 01:59:55,040 ANYBODY. 3198 01:59:55,040 --> 01:59:55,920 THESE ARE PERHAPS THE SICKER 3199 01:59:55,920 --> 01:59:57,720 PATIENT WHO IS ARE GOING TO BEN 3200 01:59:57,720 --> 02:00:00,040 FRIT FROM AN INTERVENTION BUT 3201 02:00:00,040 --> 02:00:01,000 SUGGESTLY THERE DOES SEEM TO BE 3202 02:00:01,000 --> 02:00:05,240 AN ASSOCIATION OF BENEFIT OF 3203 02:00:05,240 --> 02:00:06,160 THERAPEUTIC ANTICOAGULATION, 2 3204 02:00:06,160 --> 02:00:08,360 FEMALES BUT ONLY WHEN THEY DO 3205 02:00:08,360 --> 02:00:11,480 NOT MEET CRITERIA FOR OBESITY. 3206 02:00:11,480 --> 02:00:12,720 AND O I'M GOING TO CLEES HERE 3207 02:00:12,720 --> 02:00:15,160 AND SAY THAT YOU KNOW WE KNOW 3208 02:00:15,160 --> 02:00:17,120 FROM A LOT OF OBSERVATIONAL DATA 3209 02:00:17,120 --> 02:00:20,160 THAT THERE'S A CLEAR INCREASE IN 3210 02:00:20,160 --> 02:00:22,120 MACROTHROMBOTTIC RISK IN MEN. 3211 02:00:22,120 --> 02:00:23,880 WE KNOW FROM OUR STUDIES NOW 3212 02:00:23,880 --> 02:00:26,280 THAT THERE'S NO OBVIOUS 3213 02:00:26,280 --> 02:00:28,000 TREATMENT BENEFIT DIFFERENTIAL 3214 02:00:28,000 --> 02:00:29,880 AND ANTICOAGULATION IN MALE 3215 02:00:29,880 --> 02:00:32,040 VERSUS FEMALE SEX OR OUR PRIMARY 3216 02:00:32,040 --> 02:00:34,440 OUTCOME BUT WE REALLY NEED AN 3217 02:00:34,440 --> 02:00:37,680 INDEPTH ANALYSIS OF SEX AND 3218 02:00:37,680 --> 02:00:39,800 GENDER ON THERAPY FOR 3219 02:00:39,800 --> 02:00:40,320 MACROTHROMBOTTIC EEIVETS. 3220 02:00:40,320 --> 02:00:43,680 BUT WHAT I WOULD PROPOSE TO THIS 3221 02:00:43,680 --> 02:00:46,200 AUDIENCE IS THE CONSIDERATION OF 3222 02:00:46,200 --> 02:00:49,160 NOT JUST SEX OR GENDER ASUNE 3223 02:00:49,160 --> 02:00:51,160 VALID AND RELIABLEIATE VARIABLES 3224 02:00:51,160 --> 02:00:53,000 BUT BASED ON THESE OBSERVATIONS 3225 02:00:53,000 --> 02:00:54,760 OF COMPETING RISK WITH AGE AND 3226 02:00:54,760 --> 02:00:56,400 BMI THAT WE'VE SEEN, IS TO 3227 02:00:56,400 --> 02:00:58,400 REALLY LOOK AT THE INTERACTION 3228 02:00:58,400 --> 02:01:02,160 VARIABLE OF SEX AND GENDER WITH 3229 02:01:02,160 --> 02:01:05,640 OTHER CRITICAL PARTS OF THE 3230 02:01:05,640 --> 02:01:06,600 PATHOPHYSIOLOGY AND PREDICTERS 3231 02:01:06,600 --> 02:01:07,320 OF DISEASE SEVERITY WITH 3232 02:01:07,320 --> 02:01:08,520 COVID-19 AND I THINK THAT'S GOT 3233 02:01:08,520 --> 02:01:11,440 TO BE REALLY CRITICAL FOR US IN 3234 02:01:11,440 --> 02:01:12,920 MOVING FORWARD AND IN THAT VAIN 3235 02:01:12,920 --> 02:01:15,720 AND AS I CLOSE, I JUST PUT UP A 3236 02:01:15,720 --> 02:01:16,960 CONTACT INFORMATION THERE 3237 02:01:16,960 --> 02:01:18,840 BECAUSE WE ARE VERY MUCH OPEN 3238 02:01:18,840 --> 02:01:20,800 FOR OPPORTUNITIES FOR 3239 02:01:20,800 --> 02:01:22,960 COLLABORATION AND FOR FUTURE 3240 02:01:22,960 --> 02:01:24,960 ANALYSIS AS WE BETTER UNDERSTAND 3241 02:01:24,960 --> 02:01:26,120 THE IMPORTANT IMPLICATIONS OF 3242 02:01:26,120 --> 02:01:29,360 SEX AND JEBDER ON OUR 3243 02:01:29,360 --> 02:01:30,680 ANTITHROMBOTTIC THERAPIES FOR 3244 02:01:30,680 --> 02:01:30,960 COVID-19. 3245 02:01:30,960 --> 02:01:35,800 THANK YOU VERY MUCH. 3246 02:01:35,800 --> 02:01:36,160 SNRK EXCELLENT. 3247 02:01:36,160 --> 02:01:37,320 THANK YOU VERY MUCH DR. NEAL, WE 3248 02:01:37,320 --> 02:01:38,840 WILL FIELD QUESTIONS IN THE 3249 02:01:38,840 --> 02:01:41,200 DISCUSSION SECTION THAT WILL 3250 02:01:41,200 --> 02:01:42,640 FOLLOW OUR NEXT PRESENTER. 3251 02:01:42,640 --> 02:01:48,200 SO THIS IS DR. ALEX TSOI. 3252 02:01:48,200 --> 02:01:49,480 DR. TSOI IS A RESEARCHER 3253 02:01:49,480 --> 02:01:51,960 INVESTIGATOR AT THE UNIVERSITY 3254 02:01:51,960 --> 02:01:53,720 OF MICHIGAN. 3255 02:01:53,720 --> 02:01:55,960 HIS RESEARCH FOCUSED ON 3256 02:01:55,960 --> 02:01:56,480 IDENTIFYING GENETIC AND 3257 02:01:56,480 --> 02:01:57,960 DENATIONAL LIBRARY OF MEDICINIC 3258 02:01:57,960 --> 02:01:59,000 COMOPPOSITE BEHAVIORIAL 3259 02:01:59,000 --> 02:02:00,640 PHENOTYPENTS FOR AUTOIMMUNE 3260 02:02:00,640 --> 02:02:02,840 DISEASES AND HOW THEY MAY 3261 02:02:02,840 --> 02:02:04,880 TRIBUTE TO DISEASE 3262 02:02:04,880 --> 02:02:06,280 HETEROGENERATED AITY, DR. TTOI 3263 02:02:06,280 --> 02:02:09,000 IS THE DIRECTOR OF THE CENTER 3264 02:02:09,000 --> 02:02:10,600 FOR CUE TAINIOUS BIO-INFORMATICS 3265 02:02:10,600 --> 02:02:12,240 AT THE UNIVERSITY OF MICHIGAN 3266 02:02:12,240 --> 02:02:13,440 AND DIRECTOR OF FUNCTIONAL 3267 02:02:13,440 --> 02:02:15,720 ANALYTIC CORE OF THE P30 FUNDED 3268 02:02:15,720 --> 02:02:17,240 UNIVERSITY OF MICHIGAN SKIN 3269 02:02:17,240 --> 02:02:21,560 BIOLOGY DISEASE AND RESOURCE 3270 02:02:21,560 --> 02:02:22,880 CENTER. 3271 02:02:22,880 --> 02:02:25,440 DR. TSOI HAS BEEN CONDUCTING 3272 02:02:25,440 --> 02:02:28,120 STUDIES TO HAPPENED THE POGHT O 3273 02:02:28,120 --> 02:02:30,240 PHYSIOLOGY FOR DISORD EROZANS 3274 02:02:30,240 --> 02:02:33,800 SUCH AS SORTING SIGNALS ICEIS, 3275 02:02:33,800 --> 02:02:35,560 SORTING SIGNALSIATIC ARTHRITIS 3276 02:02:35,560 --> 02:02:38,600 AND LUPUS, BY USING APPROACHES 3277 02:02:38,600 --> 02:02:39,880 HIS GROUP REVEALED DISEASE 3278 02:02:39,880 --> 02:02:42,800 SIGNALS IN CANDIDATES FOR DOWN 3279 02:02:42,800 --> 02:02:46,200 TREME ASSAYS OF PSORIASIS AND 3280 02:02:46,200 --> 02:02:48,440 GENETIC CIGNA NATURE FOR SORTING 3281 02:02:48,440 --> 02:02:49,320 SIGNALSIATIC ARTHRITIS RISK AND 3282 02:02:49,320 --> 02:02:51,240 HIS RESEARCH FOCUS ON THE 3283 02:02:51,240 --> 02:02:52,160 DEVELOPMENT AND IMPLEMENTATION 3284 02:02:52,160 --> 02:02:54,440 OF PIPELINES FOR GENOMIC DATA TO 3285 02:02:54,440 --> 02:02:55,840 HELP IDENTIFY NOVEL DISEASE 3286 02:02:55,840 --> 02:03:00,280 ASSOCIATED TRANSCRIPTS AS WELL 3287 02:03:00,280 --> 02:03:02,160 AS CONTACTS SPECIFIC RESPONSES 3288 02:03:02,160 --> 02:03:02,520 AND DISORDERS. 3289 02:03:02,520 --> 02:03:04,120 THEY WILL SPEAK TO US TODAY 3290 02:03:04,120 --> 02:03:05,040 ABOUT ELECTRONIC HEALTH RECORDS 3291 02:03:05,040 --> 02:03:07,000 AND SKIN AND BLOOD STUDIES AND 3292 02:03:07,000 --> 02:03:08,920 HOW THEY MIGHT INTERSECT IN 3293 02:03:08,920 --> 02:03:12,640 COVID-19 INFECTION. 3294 02:03:12,640 --> 02:03:14,360 DR. TSOI. 3295 02:03:14,360 --> 02:03:14,760 >> THANK YOU. 3296 02:03:14,760 --> 02:03:15,160 [INDISCERNIBLE]. 3297 02:03:15,160 --> 02:03:17,520 GOOD AFTERNOON EVERYONE, THANK 3298 02:03:17,520 --> 02:03:18,520 YOU FOR LETTING ME SHARE OUR 3299 02:03:18,520 --> 02:03:21,280 WORK WITH YOU ALL. 3300 02:03:21,280 --> 02:03:23,120 SO MY RESEARCH FOCUSED ON 3301 02:03:23,120 --> 02:03:24,640 IDENTIFYING AND UNDERSTAND 3302 02:03:24,640 --> 02:03:27,560 GENETIC COMPONENT FOR DIFFERENT 3303 02:03:27,560 --> 02:03:28,280 INFLAMMATTORY CONDITIONS. 3304 02:03:28,280 --> 02:03:30,240 IN MY PRESENTATION TODAY, I WILL 3305 02:03:30,240 --> 02:03:33,120 SHARE WITH YOU SOME RECENT WORK 3306 02:03:33,120 --> 02:03:35,440 HOW THE SKIN DISEASES COULD BE 3307 02:03:35,440 --> 02:03:37,360 RELATED TO COVID INFECTION. 3308 02:03:37,360 --> 02:03:41,800 AND WE ALSO TRY TO LINK SOME OF 3309 02:03:41,800 --> 02:03:43,200 THESE OBSERVATIONS TO POETIC 3310 02:03:43,200 --> 02:03:44,800 KENTIAL CONTEXT SPECIFIC 3311 02:03:44,800 --> 02:03:45,560 INFLAMMATORY RESPONSE IN SKIN 3312 02:03:45,560 --> 02:03:47,800 AND HOW WOULD THEY PLAY A ROLE 3313 02:03:47,800 --> 02:03:52,360 IN POTENTIAL SEX BIAS OF 3314 02:03:52,360 --> 02:03:52,640 PHENOTYPES. 3315 02:03:52,640 --> 02:03:54,160 I HAVE NO CONFLICTS TO DISCLOSE. 3316 02:03:54,160 --> 02:04:00,320 BUT TO GIVE YOU BACKGROUND 3317 02:04:00,320 --> 02:04:01,480 INFORMATION, STUDIES SHOW THAT 3318 02:04:01,480 --> 02:04:03,120 20% OF COVID PATIENTS PRESENT 3319 02:04:03,120 --> 02:04:05,720 WITH A SKIN RASH AS A SYMPTOM 3320 02:04:05,720 --> 02:04:07,760 AND IN PATIENTS WITH SKIN 3321 02:04:07,760 --> 02:04:09,600 DISEASE SUCH AS PSORIASIS CAN BE 3322 02:04:09,600 --> 02:04:14,200 A GREATER RISK OF COVID 3323 02:04:14,200 --> 02:04:16,960 INFECTION AND COVID COULD ALSO 3324 02:04:16,960 --> 02:04:20,720 EXACERBATE EXISTING SKIN 3325 02:04:20,720 --> 02:04:21,000 CONDITIONS. 3326 02:04:21,000 --> 02:04:24,000 SO THERE WILL BE 3 MAJOR TALK 3327 02:04:24,000 --> 02:04:26,200 PARTS OF MY PRESENTATION, I WILL 3328 02:04:26,200 --> 02:04:28,840 SHARE WITH YOU RECENT FINDINGS 3329 02:04:28,840 --> 02:04:30,720 ABOUT HOW WE IDENTIFY SOME 3330 02:04:30,720 --> 02:04:34,080 SHARED COMPONENT WITH COVID AND 3331 02:04:34,080 --> 02:04:36,880 SKIN DISEASES, FOCUSING ON THE 3332 02:04:36,880 --> 02:04:37,600 SKIN CONDITIONS AND THE WORK 3333 02:04:37,600 --> 02:04:40,520 WITH YOU AND HOW WE IDENTIFY 3334 02:04:40,520 --> 02:04:41,920 CONTACTS DEPENDENT ON THE 3335 02:04:41,920 --> 02:04:42,760 INTERFERON RESPONSES IN SKIN AND 3336 02:04:42,760 --> 02:04:45,320 AT THE END I WILL SHARE WITH YOU 3337 02:04:45,320 --> 02:04:46,960 RECENT FINDINGS ABOUT THE SEX 3338 02:04:46,960 --> 02:04:51,840 DIFFERENCES IN MONOCYTE AND 3339 02:04:51,840 --> 02:04:53,040 DENDRITIC CELLS AMONG COVID 3340 02:04:53,040 --> 02:04:53,400 PATIENTS. 3341 02:04:53,400 --> 02:05:01,240 SO 1 OF OUR EARLY WORK WAS TO 3342 02:05:01,240 --> 02:05:11,760 PROVIDE BETTER BEDDING OF--HOW 3343 02:05:12,720 --> 02:05:13,920 WE CONDUCT THIS 2 YORES AGO AND 3344 02:05:13,920 --> 02:05:22,320 WE TRY TO ACTUALLY LOOK INTO THE 3345 02:05:22,320 --> 02:05:24,800 EPIDEMIOLOGICAL STUDY OF 400,000 3346 02:05:24,800 --> 02:05:28,800 PATIENTS AND AT LEAST 1 HEALTH 3347 02:05:28,800 --> 02:05:30,280 SYSTEM ENCOUNTER THAT INCLUDED 3348 02:05:30,280 --> 02:05:34,760 OVER 1000 COVID PATIENTS. 3349 02:05:34,760 --> 02:05:37,680 SO STUDIES AND THOSE AS WITH 3350 02:05:37,680 --> 02:05:41,480 OTHER SPEAKERS, NOW OLDER AGE 3351 02:05:41,480 --> 02:05:42,240 GROUP, OBESITY, AFRICAN AMERICAN 3352 02:05:42,240 --> 02:05:43,880 HAVE A HIGHER RISK OF COVID 3353 02:05:43,880 --> 02:05:46,320 INFECTION AND FOR THE OTHER 3354 02:05:46,320 --> 02:05:47,800 DIFFERENT CLINICAL FEATURES SUCH 3355 02:05:47,800 --> 02:05:49,920 AS--WE WILL ALSO BE ABLE TO 3356 02:05:49,920 --> 02:05:52,360 REPLICATE THAT INCLUDES 3357 02:05:52,360 --> 02:05:53,160 DIABETES, HEART DISEASES, ALSO 3358 02:05:53,160 --> 02:05:56,640 HAVE HIGH RATE OF COVID 3359 02:05:56,640 --> 02:05:58,400 INFECTION. 3360 02:05:58,400 --> 02:05:59,960 SO INTERESTINGLY EVEN SOMEONE 3361 02:05:59,960 --> 02:06:01,600 CAN INDIVIDUALLY BUT WE FIND 3362 02:06:01,600 --> 02:06:03,080 THAT MULTIPLE DIFFERENT SKIN 3363 02:06:03,080 --> 02:06:05,840 CONDITIONS, HAVE A HIGHER RISK 3364 02:06:05,840 --> 02:06:07,360 OF COVID INFECTION SO THEN WE 3365 02:06:07,360 --> 02:06:13,560 TRY TO GROUP THOSE TOGETHER, 3366 02:06:13,560 --> 02:06:18,040 THAT INCLUDE ACME ALOPECIA, 3367 02:06:18,040 --> 02:06:21,760 DERMA TITIS, LUPUS, PSORIASIS, 3368 02:06:21,760 --> 02:06:23,200 ROSE ASIA, AND WHEN WE GROAP 3369 02:06:23,200 --> 02:06:25,600 THIS SIGNATURE AND SEE THE 3370 02:06:25,600 --> 02:06:27,960 OBSERVATION, ASSOCIATIONS WITH 3371 02:06:27,960 --> 02:06:30,560 COVID INFECTION, WE FIND THESE 3372 02:06:30,560 --> 02:06:31,800 RESULTS. 3373 02:06:31,800 --> 02:06:33,040 AND INDICATING THOSE INDIVIDUALS 3374 02:06:33,040 --> 02:06:35,000 AT LEAST SOME KIN CONDITION TEND 3375 02:06:35,000 --> 02:06:37,160 TO HAVE A HIGHER INFECTION RATE. 3376 02:06:37,160 --> 02:06:38,920 SO SIMILARLY WE CONDUCT THE 3377 02:06:38,920 --> 02:06:41,240 ANALYSIS TO ASK WHAT DEMOGRAPHIC 3378 02:06:41,240 --> 02:06:44,360 OR CLINICAL VARIABLES WOULD BE 3379 02:06:44,360 --> 02:06:45,520 ASSOCIATED WITH MORE SEVERE FORM 3380 02:06:45,520 --> 02:06:46,240 OF COVID. 3381 02:06:46,240 --> 02:06:48,520 USING THE REQUIREMENT OF 3382 02:06:48,520 --> 02:06:50,800 MECHANICAL VENTILATION AS A 3383 02:06:50,800 --> 02:06:52,880 SURROGATE, SO I THINK AMERICAN 3384 02:06:52,880 --> 02:06:54,640 OLDER AGE GROUP, NOW OBESITY 3385 02:06:54,640 --> 02:06:58,160 TEND TO HAVE MORE SEVERE FIRM, 3386 02:06:58,160 --> 02:07:01,160 RESULT IS A BIT SURPRISING FOR 3387 02:07:01,160 --> 02:07:02,320 US, HIGHLIGHTING THAT 3388 02:07:02,320 --> 02:07:03,960 INDIVIDUALS WITH SKIN CONDITIONS 3389 02:07:03,960 --> 02:07:05,800 ACTUALLY TEBD TO HAVE LOWER RISK 3390 02:07:05,800 --> 02:07:08,800 OF HAVING MORE SEVERE FORM OF 3391 02:07:08,800 --> 02:07:09,160 INFECTION. 3392 02:07:09,160 --> 02:07:11,320 SO, OUR HR ANALYSIS TRY TO 3393 02:07:11,320 --> 02:07:15,200 EXAMINE IF OUR OBSERVATIONS 3394 02:07:15,200 --> 02:07:18,320 COULD BE BIAS OR SKEWED TOWARDS 3395 02:07:18,320 --> 02:07:19,400 THE IMMUNOSUPPRESSIVE TREATMENT 3396 02:07:19,400 --> 02:07:20,800 BECAUSE OF THOSE--MANY OF THOSE 3397 02:07:20,800 --> 02:07:23,680 SUPPRESSIVE TREATMENT HAVE BEEN 3398 02:07:23,680 --> 02:07:26,280 USED TO DESCRIBE TO TREAT 3399 02:07:26,280 --> 02:07:27,040 DIFFERENT SKIN CONDITIONS. 3400 02:07:27,040 --> 02:07:30,520 BUT EVEN OTHER CONTROLLING FOR 3401 02:07:30,520 --> 02:07:31,480 THE IMMUNO [INDISCERNIBLE] 3402 02:07:31,480 --> 02:07:32,200 TREATMENT, THE OBSERVATIONS THAT 3403 02:07:32,200 --> 02:07:34,480 I JUST SHARED WITH YOU STILL 3404 02:07:34,480 --> 02:07:34,680 HOLD. 3405 02:07:34,680 --> 02:07:39,520 SO NEXT WE WANT TO ASK WHAT KIND 3406 02:07:39,520 --> 02:07:44,720 OF--HOW WOULD THE SKIN DISEASES 3407 02:07:44,720 --> 02:07:46,000 WE POTENTIALLY SHARE INTRINSIC 3408 02:07:46,000 --> 02:07:47,160 FACTORS WITH COVID INFECTION, 3409 02:07:47,160 --> 02:07:48,360 SOPHISTICATEDY WE USE SORTING 3410 02:07:48,360 --> 02:07:53,600 SIGNALS ICA SIS AS A MODEL, 3411 02:07:53,600 --> 02:07:56,000 GENETIC FOR, YOU KNOW, FOR A 3412 02:07:56,000 --> 02:07:58,480 WHILE AND THEN WE COLLECTED OVER 3413 02:07:58,480 --> 02:08:01,000 10,000 GENO TYPES, OR I TAKE 3414 02:08:01,000 --> 02:08:04,240 INDIVIDUALS SO WE TRY TO SEE, 3415 02:08:04,240 --> 02:08:06,040 COMPARE THESE GENETIC SIGNALS 3416 02:08:06,040 --> 02:08:08,680 WITH ANOTHER INDEPENDENT STUDY, 3417 02:08:08,680 --> 02:08:11,320 THE STUDY, THE GENDER SPECIFIC 3418 02:08:11,320 --> 02:08:13,200 SUSCEPTIBLE FOR COVID INFECTION, 3419 02:08:13,200 --> 02:08:14,000 THAT CONSISTS OF 1600 3420 02:08:14,000 --> 02:08:18,440 INDIVIDUALS AT THAT TIME. 3421 02:08:18,440 --> 02:08:23,040 SO THIS IS--AMONG THE MANY 3422 02:08:23,040 --> 02:08:26,000 VARIANTS WE EXAMINED WE REVEALED 3423 02:08:26,000 --> 02:08:28,760 1 LOCUS FOR EACH ASSOCIATION, SO 3424 02:08:28,760 --> 02:08:29,960 EACH IS THE GENETIC VALID AND 3425 02:08:29,960 --> 02:08:32,520 RELIABLE YAGZ AND THE LONG TIME 3426 02:08:32,520 --> 02:08:34,600 P-VALUE FOR THE ASSOCIATION, 3427 02:08:34,600 --> 02:08:36,320 THIS IS LOCUS AND THEN THE 1S WE 3428 02:08:36,320 --> 02:08:38,280 HIGHLIGHT IN COLOR HERE ARE THE 3429 02:08:38,280 --> 02:08:42,120 1S SHOWING WHEN WE CONDUCTED 3430 02:08:42,120 --> 02:08:43,760 TIMES, DISEASE, ANALYSIS AND 3431 02:08:43,760 --> 02:08:47,080 SHOWED MOST OF THE CELLS. 3432 02:08:47,080 --> 02:08:50,400 SO WHAT POTENTIALLY EFFECT THESE 3433 02:08:50,400 --> 02:08:50,800 LOCUS WOULD HAVE. 3434 02:08:50,800 --> 02:08:55,440 SO THIS IS A LOCUS THAT 3435 02:08:55,440 --> 02:08:57,040 [INDISCERNIBLE] GENETIC SIGNAL 3436 02:08:57,040 --> 02:09:00,200 SOCKED WITH EXPRESSION OF 3437 02:09:00,200 --> 02:09:04,360 LCE-GENES, SO THESE LCE-GENES 3438 02:09:04,360 --> 02:09:05,520 FROM THE [INDISCERNIBLE] COMPLEX 3439 02:09:05,520 --> 02:09:07,280 IN CHROMOSOME 1 HAS BEEN SHOWN 3440 02:09:07,280 --> 02:09:11,200 TO PLAY ROLE IN SKIN INJURY, 3441 02:09:11,200 --> 02:09:13,040 INFLAMMATION OR HAVE 3442 02:09:13,040 --> 02:09:13,960 ANTI[INDISCERNIBLE] ACTIVITY. 3443 02:09:13,960 --> 02:09:17,600 SO INTERESTINGLY THIS GENES ALSO 3444 02:09:17,600 --> 02:09:20,000 UPREGULATED IN AN 3445 02:09:20,000 --> 02:09:20,560 RNARE--ADMINISTRATIVE-SEQ 3446 02:09:20,560 --> 02:09:21,320 INVESTIGATOR, AND HOW THESE 3447 02:09:21,320 --> 02:09:24,200 CELLS WOULD RESPOND TO THE COVID 3448 02:09:24,200 --> 02:09:25,680 INFECTION, SO WHEN WE 3449 02:09:25,680 --> 02:09:28,280 INVESTIGATE THIS GENES 3450 02:09:28,280 --> 02:09:32,120 EXPRESSIONS, A PROFILE ACROSS 3451 02:09:32,120 --> 02:09:32,520 MULTIPLE DIFFERENT 3452 02:09:32,520 --> 02:09:34,080 [INDISCERNIBLE] THESE SHOW THE 3453 02:09:34,080 --> 02:09:35,840 HIGHEST EXPRESSIONS IN SKIN AND 3454 02:09:35,840 --> 02:09:37,360 THE ESOPHAGUS, SO THE RISK CAN 3455 02:09:37,360 --> 02:09:38,720 HIGHLIGHT THAT FOR INDIVIDUALS 3456 02:09:38,720 --> 02:09:41,200 THAT CARRYING THE GENETIC BURDEN 3457 02:09:41,200 --> 02:09:43,720 OF THESE LOCUS TEND TO HAVE A 3458 02:09:43,720 --> 02:09:45,360 HIGHER TENDENCY TO RESPOND TO 3459 02:09:45,360 --> 02:09:46,720 INFLAMMATION OR INFECTION, 3460 02:09:46,720 --> 02:09:48,240 FUTURE STUDY, WOULD LEAD TOO 3461 02:09:48,240 --> 02:09:49,280 INVESTIGATOR IF THIS INDIVIDUAL 3462 02:09:49,280 --> 02:09:52,200 WERE TO BE LESS LIKELY TO BE 3463 02:09:52,200 --> 02:09:55,600 [INDISCERNIBLE] WHEN INFECT WIDE 3464 02:09:55,600 --> 02:09:56,080 COVID. 3465 02:09:56,080 --> 02:09:58,160 SO IN ADDITION TO GERONTOLOGYSTS 3466 02:09:58,160 --> 02:10:01,720 GENETIC WE LOOK AT GENOMEEC SO 3467 02:10:01,720 --> 02:10:04,240 WE'RE TRYING STUDY HOW THESE 3468 02:10:04,240 --> 02:10:05,320 GENES DIFFERENT IN SKIN 3469 02:10:05,320 --> 02:10:06,840 CONDITIONS COULD BE SHARING SOME 3470 02:10:06,840 --> 02:10:10,560 GENES THAT ALSO HAVE THE SAME 3471 02:10:10,560 --> 02:10:12,480 DIRECTION OF DISREGULATION IN 3472 02:10:12,480 --> 02:10:14,080 EPITHELIAL STYLES WHEN INFEBLGHT 3473 02:10:14,080 --> 02:10:16,360 WIDE COVID, SO THIS IS A LIST OF 3474 02:10:16,360 --> 02:10:18,600 GENES AND WHEN WE LOOK INTO THE 3475 02:10:18,600 --> 02:10:22,120 SHARED PATHWAY, WE IDENTIFY 3476 02:10:22,120 --> 02:10:25,400 MULTIPLE PATHWAY THAT ARE TO BE 3477 02:10:25,400 --> 02:10:27,480 SHARED THAT INCLUDE SIGNALING, 3478 02:10:27,480 --> 02:10:31,280 TNP SIGNALING AND ALSO IRPT 3479 02:10:31,280 --> 02:10:32,320 FERON SIGNALING. 3480 02:10:32,320 --> 02:10:33,640 SO I'M GOING TO SWITCH GEARS A 3481 02:10:33,640 --> 02:10:35,920 BIT AND SHARE WITH YOU HOW WE 3482 02:10:35,920 --> 02:10:37,760 SCHEME FROM DIFFERENT 3483 02:10:37,760 --> 02:10:42,840 INDIVIDUALS CAN RESPOND 3484 02:10:42,840 --> 02:10:44,040 DIFFERENTLY TO SIGNALING. 3485 02:10:44,040 --> 02:10:46,800 SO INTERFERON SIGNAL WAS IN 3486 02:10:46,800 --> 02:10:49,440 DIFFERENT SKIN CONDITIONS 3487 02:10:49,440 --> 02:10:50,240 INCLUDING LUPUS, PSORIASIS, AND 3488 02:10:50,240 --> 02:10:53,080 WE TRIED TO EXAMINE HOW THE 3489 02:10:53,080 --> 02:10:54,840 KERATINOCYTES FROM THE PATIENTS 3490 02:10:54,840 --> 02:10:57,560 WOULD RESPOND POTENTIALLY 3491 02:10:57,560 --> 02:10:58,640 DIFFERENTLY. 3492 02:10:58,640 --> 02:11:00,160 SO WE GOT LUPUS IN PATIENTS AND 3493 02:11:00,160 --> 02:11:03,040 THEN WE TRIED TO STIMULATE WITH 3494 02:11:03,040 --> 02:11:04,360 TYPE 1, TYPE 2 INTERFERONS, SO 3495 02:11:04,360 --> 02:11:06,440 WHAT WE'RE SHOWING HERE IS 3496 02:11:06,440 --> 02:11:09,760 ACTUALLY THE EFFECTS SIZE OF THE 3497 02:11:09,760 --> 02:11:11,880 STIMULATIONS, AND THEN, EACH DOT 3498 02:11:11,880 --> 02:11:14,760 HERE REPRESENTING A GENE AND THE 3499 02:11:14,760 --> 02:11:19,600 Y-REPRESENTING THE EFFECT IN THE 3500 02:11:19,600 --> 02:11:22,320 INTERFERON STIMULATION FOR 3501 02:11:22,320 --> 02:11:23,600 KERATINOCYTES COMING FROM THE 3502 02:11:23,600 --> 02:11:25,760 INBE FEKSS AND WE SEE 3503 02:11:25,760 --> 02:11:27,920 CONSISTENTLY BIASED TOWARDS A 3504 02:11:27,920 --> 02:11:29,640 HIGHER ASKED WHAT IN INDUCTION 3505 02:11:29,640 --> 02:11:32,040 AMONG THE LUPUS PATIENTS WHEN 3506 02:11:32,040 --> 02:11:34,400 THE CAR O 10 O SIGHTS ARE 3507 02:11:34,400 --> 02:11:38,200 INDUCED BY INTERFERON SO NOT 3508 02:11:38,200 --> 02:11:39,800 ONLY THE CONNOTATIVE BIAS, THAT 3509 02:11:39,800 --> 02:11:42,240 WHO WAS THE LUPUS PATIENT BUT AT 3510 02:11:42,240 --> 02:11:43,600 THE SAME TIME WE WERE ABLE GIIVE 3511 02:11:43,600 --> 02:11:44,640 THE SAME NUMBER OF PATIENTS 3512 02:11:44,640 --> 02:11:47,520 GIVEN THE SAME NUMBER OF 3513 02:11:47,520 --> 02:11:48,600 KERATINOCYTES THAT WERE USED 3514 02:11:48,600 --> 02:11:51,160 THERE ARE MORE NUMBERS OF GENES 3515 02:11:51,160 --> 02:11:53,720 THAT ARE DISREGULATED FOR 3516 02:11:53,720 --> 02:11:55,040 KERATINOCYTES COMES FROM LUPUS 3517 02:11:55,040 --> 02:11:58,560 AND THE HISTOGRAM IS LIKE THE 3518 02:11:58,560 --> 02:11:59,720 [INDISCERNIBLE] JUST TO SHOW YOU 3519 02:11:59,720 --> 02:12:04,240 THE DIFFERENCES IN THE EFFECTS 3520 02:12:04,240 --> 02:12:05,000 SIZE UPON STIMULATION BETWEEN 3521 02:12:05,000 --> 02:12:08,280 THE LUPUS AND THE CONTROL AND 3522 02:12:08,280 --> 02:12:09,920 LOOKING AT ALL THE GENES AND 3523 02:12:09,920 --> 02:12:12,480 WHEN WE LOOK AT GENES THAT TEND 3524 02:12:12,480 --> 02:12:14,200 TO BE INDUCED BY INTERFERON, 3525 02:12:14,200 --> 02:12:18,800 AGAIN, THEY ARE THE EFFECTS SIZE 3526 02:12:18,800 --> 02:12:21,600 TEND TO BE HIGHER AMONG THOSE 3527 02:12:21,600 --> 02:12:21,920 PATIENTS. 3528 02:12:21,920 --> 02:12:23,680 SO SINCE MANY CONDITIONS LIKE 3529 02:12:23,680 --> 02:12:25,320 WILL YOU PLEASEUS HAVE STRONG 3530 02:12:25,320 --> 02:12:27,080 SEX BIAS WE IDENTIFY POTENTIAL 3531 02:12:27,080 --> 02:12:30,240 MECHANISMS FOR THAT OBSERVATION 3532 02:12:30,240 --> 02:12:33,120 BI COMPARING SKIN FROM MALE AND 3533 02:12:33,120 --> 02:12:36,120 FEMALE, SO WE WE BUILD LIKE OVER 3534 02:12:36,120 --> 02:12:40,200 600 EXPRESSED GENES AND THEN 3535 02:12:40,200 --> 02:12:42,440 THAT INCLUDES TRANSCRIPTION 3536 02:12:42,440 --> 02:12:44,440 FACTOR FOR IGGIL3 AND THIS IS 3537 02:12:44,440 --> 02:12:45,840 REGULATING MULTIPLE GENES 3538 02:12:45,840 --> 02:12:48,800 ASSOCIATE WIDE AUTOIMMUNE 3539 02:12:48,800 --> 02:12:49,360 CONDITIONS. 3540 02:12:49,360 --> 02:12:52,240 SO THE SEX DIFFERENCES CAN BE 3541 02:12:52,240 --> 02:12:53,960 CONTEXT SPECIFIC AS WELL, SO A 3542 02:12:53,960 --> 02:12:56,640 RECENT WORK WITH US, TRYING TO 3543 02:12:56,640 --> 02:13:00,360 STUDY THE IMENT PACT OF SEX UPON 3544 02:13:00,360 --> 02:13:02,360 STIMULATION IN CAR O 10 O SIGHTS 3545 02:13:02,360 --> 02:13:03,560 SO THIS IS ANALOGOUS TO WHAT I 3546 02:13:03,560 --> 02:13:05,320 JUST SHARE WITH YOU, SO THIS IS 3547 02:13:05,320 --> 02:13:07,120 HERE IN THE LUPUS, WE ARE 3548 02:13:07,120 --> 02:13:08,880 LOOKING AT THE EFFECTS SO IF 3549 02:13:08,880 --> 02:13:11,400 THERE ARE STIMULATION IN FEMALE 3550 02:13:11,400 --> 02:13:15,400 AND THEN, THIS IS ACTUALLY IN 3551 02:13:15,400 --> 02:13:17,800 THE STIMULATION IN MALE AND YOU 3552 02:13:17,800 --> 02:13:21,080 CAN SEE HOW THE [INDISCERNIBLE] 3553 02:13:21,080 --> 02:13:24,280 FEMALE EXHIBIT HIGHER EFFECT 3554 02:13:24,280 --> 02:13:25,840 SIZES IN ENDOCRINE RESPONSE. 3555 02:13:25,840 --> 02:13:28,120 SO ARE WE ABLE TO SEE SIMILAR 3556 02:13:28,120 --> 02:13:30,640 EFFECT DIFFERENCES IN OTHER CELL 3557 02:13:30,640 --> 02:13:30,880 TYPES? 3558 02:13:30,880 --> 02:13:39,760 SO THIS A RECENT STUDY--SO THE 3559 02:13:39,760 --> 02:13:41,680 SEX DIFFERENCES IN THE STUDIES 3560 02:13:41,680 --> 02:13:46,000 AMONG PATIENTS USING SINGLE CELL 3561 02:13:46,000 --> 02:13:48,200 RNASEQ, FOR WHOLE BLOOD, SO HERE 3562 02:13:48,200 --> 02:13:50,080 ARE THE DIFFERENT CELL TYPES 3563 02:13:50,080 --> 02:13:51,840 THAT WE IDENTIFY BUT WHEN WE 3564 02:13:51,840 --> 02:13:52,800 LOOK AT DIFFERENT SEX 3565 02:13:52,800 --> 02:13:54,040 DIFFERENCES FOR EACH CELL TYPES 3566 02:13:54,040 --> 02:13:56,480 BETWEEN MALE AND FEMALE SO WE 3567 02:13:56,480 --> 02:13:58,720 WERE ABLE TO SHOW DIFFERENCES IN 3568 02:13:58,720 --> 02:13:59,880 MONOCYTES AND DENDRITIC CELLS. 3569 02:13:59,880 --> 02:14:02,680 AND WE LOOK INTO THE MONOCYTES 3570 02:14:02,680 --> 02:14:04,280 AND THIS PATIENT WITH COVID, 3571 02:14:04,280 --> 02:14:07,520 THEY ACTUALLY SHOW ENHANCED 3572 02:14:07,520 --> 02:14:09,120 CYTOKINE RESPONSES AND CYTOKINES 3573 02:14:09,120 --> 02:14:12,480 THAT HAVE BEEN EMERGED AS THE 3574 02:14:12,480 --> 02:14:15,840 ACTIVATED IN MAU THAT, WILL 3575 02:14:15,840 --> 02:14:18,800 INCLUDE INTERFERON IL6 AND IL1 3576 02:14:18,800 --> 02:14:19,200 BETA. 3577 02:14:19,200 --> 02:14:21,280 SO I WILL RESULTS, WE HIGHLIGHT 3578 02:14:21,280 --> 02:14:24,400 THERE ARE CELL TYPES TO SEE IF 3579 02:14:24,400 --> 02:14:26,040 THEY'RE SEX BIAS GENETIC AND WE 3580 02:14:26,040 --> 02:14:29,440 TRY TO UNDERSTAND INFECTION AND 3581 02:14:29,440 --> 02:14:32,280 PROGNOSIS OF COVID AND THEN, THE 3582 02:14:32,280 --> 02:14:35,120 FINDINGS LEAVE US WITH MORE 3583 02:14:35,120 --> 02:14:37,080 QUESTIONS TO UNDERSTAND THE 3584 02:14:37,080 --> 02:14:38,320 MECHANISM. 3585 02:14:38,320 --> 02:14:41,160 SO THAT CLIEWNDS WHY WOULD COVID 3586 02:14:41,160 --> 02:14:42,240 INFECTION ASSOCIATED WITH SKIN 3587 02:14:42,240 --> 02:14:44,640 CONDITIONS AND GIVEN THE STRONG 3588 02:14:44,640 --> 02:14:46,120 IMMUNE RESPONSE FOR MALE OR 3589 02:14:46,120 --> 02:14:48,160 FEMALE IS THERE ANY ASSOCIATION 3590 02:14:48,160 --> 02:14:50,200 BETWEEN SEX BIAS IN COVID 3591 02:14:50,200 --> 02:14:52,320 INFECTION OR SEX BIAS IN 3592 02:14:52,320 --> 02:14:54,840 INFLAMED RESPONSE AND HOW SEX 3593 02:14:54,840 --> 02:14:56,040 BIAS RESPONDS WITHIN DIFFERENT 3594 02:14:56,040 --> 02:14:58,000 CELL TYPES, THAT WOULD BE SEX 3595 02:14:58,000 --> 02:15:00,240 BIAS AS WELL AND HOW WOULD THAT 3596 02:15:00,240 --> 02:15:00,640 AFFECT PATIENTS. 3597 02:15:00,640 --> 02:15:01,920 SO WITH THEY WOULD LIKE TO THANK 3598 02:15:01,920 --> 02:15:03,240 ALL MY COLLEAGUES AND WE WILL BE 3599 02:15:03,240 --> 02:15:08,400 HAPPY TO DISCUSS A FEW MORE IN 3600 02:15:08,400 --> 02:15:09,920 THE PANEL DISCUSSION. 3601 02:15:09,920 --> 02:15:11,720 SNRKSZ FAB TAFTIC THANK YOU VERY 3602 02:15:11,720 --> 02:15:12,160 MUCH DR. TSOI. 3603 02:15:12,160 --> 02:15:14,160 IF I COULD ASK THE PANELISTS TO 3604 02:15:14,160 --> 02:15:16,760 TURN YOUR CAMERAS AND 3605 02:15:16,760 --> 02:15:18,160 MICROPHONES ON. 3606 02:15:18,160 --> 02:15:19,640 WONDERFUL WE HAVE--SO WE HAVE A 3607 02:15:19,640 --> 02:15:21,080 NUMBER OF QUESTIONS THAT HAVE 3608 02:15:21,080 --> 02:15:21,720 COME THROUGH. 3609 02:15:21,720 --> 02:15:22,880 THIS WAS REALLY TERRIFIC. 3610 02:15:22,880 --> 02:15:26,000 IF I MAY JUST START, WITH 3611 02:15:26,000 --> 02:15:27,520 DR. TSOI, ON YOUR LAST SLIDE, 3612 02:15:27,520 --> 02:15:29,000 YOU STARTED TO ASK A QUESTION, 3613 02:15:29,000 --> 02:15:32,480 AN IMPORTANT 1 IS THERE AN 3614 02:15:32,480 --> 02:15:33,560 INTERACTION BETWEEN SEX BASED 3615 02:15:33,560 --> 02:15:35,400 DIFFERENCES IN COVID INFECTION 3616 02:15:35,400 --> 02:15:37,520 AND SEX BASED DIFFERENCES IN 3617 02:15:37,520 --> 02:15:38,800 INFLAMMATORY DISEASE AS IT MIGHT 3618 02:15:38,800 --> 02:15:40,200 RELATE TO SKIN AS BEING A 3619 02:15:40,200 --> 02:15:40,440 SOURCE? 3620 02:15:40,440 --> 02:15:42,560 SO SKIN OF COURSE IS A LARGE 3621 02:15:42,560 --> 02:15:43,760 IMMUNE ORGAN AND RESERVOIR AS 3622 02:15:43,760 --> 02:15:45,360 WELL, SO WOULD YOU COMEBT A BIT 3623 02:15:45,360 --> 02:15:48,400 MORE ON THAT AND MAYBE WE ADD 3624 02:15:48,400 --> 02:15:50,120 SOME INSIGHT? 3625 02:15:50,120 --> 02:15:51,360 >> YEAH, I WOULD PROBABLY NEXT 3626 02:15:51,360 --> 02:15:55,560 TIME COMMENT BUT I MAY ADD MORE 3627 02:15:55,560 --> 02:15:56,080 CONFUSION. 3628 02:15:56,080 --> 02:16:02,360 YOU KNOW THAT'S ACTUALLY, YOU 3629 02:16:02,360 --> 02:16:03,560 KNOW [INDISCERNIBLE] LIKE LUPUS, 3630 02:16:03,560 --> 02:16:08,880 THERE WOULD BE FEMALE BIAS, WE 3631 02:16:08,880 --> 02:16:09,880 ALSO ENCOUNTER CONDITIONS LIKE 3632 02:16:09,880 --> 02:16:11,520 SORTING SIGNALS ICA SIS DOES NOT 3633 02:16:11,520 --> 02:16:14,360 HAVE THAT SEX BIAS AS WELL. 3634 02:16:14,360 --> 02:16:17,720 BUT IF WE'RE USING THE 3635 02:16:17,720 --> 02:16:19,640 INTERFERON STIMULATION AS AN 3636 02:16:19,640 --> 02:16:26,760 EXAMPLE, WE DO SEE INFUSED 3637 02:16:26,760 --> 02:16:28,400 RESPONSES ONLY FER CAR O 10 O 3638 02:16:28,400 --> 02:16:30,760 SIGHTS, WE DIDN'T SEE THIS ON 3639 02:16:30,760 --> 02:16:32,200 OTHER CELL SITES SEE WE DON'T 3640 02:16:32,200 --> 02:16:32,600 KNOW THE EFFECTS. 3641 02:16:32,600 --> 02:16:34,400 AND 1 OF THE THINGS I WANT TO 3642 02:16:34,400 --> 02:16:36,440 BRING UP AND I DIDN'T PUT IT IN 3643 02:16:36,440 --> 02:16:38,600 THE SLIDE IS THAT THERE ARE 3644 02:16:38,600 --> 02:16:42,240 DIFFERENT SKIN CONDITIONS THAT 3645 02:16:42,240 --> 02:16:43,680 ACTUALLY SHOW ELEVATED 3646 02:16:43,680 --> 02:16:44,680 EXPRESSION FOR [INDISCERNIBLE]. 3647 02:16:44,680 --> 02:16:46,720 SO FOR LIKE FOR EXAMPLE IN 3648 02:16:46,720 --> 02:16:49,360 PSORIASIS THEY HAVE ELEVATED 3649 02:16:49,360 --> 02:16:52,120 EXPRESSION OF [INDISCERNIBLE], 3650 02:16:52,120 --> 02:16:54,320 SO I'M NOT SAYING THAT THOSE 3651 02:16:54,320 --> 02:16:55,200 PISHTS WITH SKIN DISEASE MAKE 3652 02:16:55,200 --> 02:16:58,840 THAT IN FACT WITHED WHAT. 3653 02:16:58,840 --> 02:17:01,640 BECAUSE THAT WOULD BE A SYSTEMIC 3654 02:17:01,640 --> 02:17:02,720 INFLAMMATION GOING ON SO THIS 3655 02:17:02,720 --> 02:17:05,080 COULD BE ELEVATED IN BLOOD FOR 3656 02:17:05,080 --> 02:17:08,040 THOSE PATIENTS. 3657 02:17:08,040 --> 02:17:10,000 SO I THINK THAT COULD BE A GOOD 3658 02:17:10,000 --> 02:17:13,120 INTERACTION WHEN WE TRY TO LINK 3659 02:17:13,120 --> 02:17:15,480 THE ELEVATED COVID INFECTION, 3660 02:17:15,480 --> 02:17:16,600 WEIGHT FOR SKIN OF THESE 3661 02:17:16,600 --> 02:17:18,360 PATIENTS AND THEN WITH WE LOOK 3662 02:17:18,360 --> 02:17:20,880 INTO THE SPECS, DIFFERENCES, WE 3663 02:17:20,880 --> 02:17:22,520 SEE THE SKIN, WE DO NOT FIND ANY 3664 02:17:22,520 --> 02:17:23,560 DIFFERENCE BUT WE HAVE NOT 3665 02:17:23,560 --> 02:17:27,400 REALLY TRIED TO LOOK INTO THE 3666 02:17:27,400 --> 02:17:28,800 AC2 EXPRESSION IN BLOOD FOR 3667 02:17:28,800 --> 02:17:29,120 BETWEEN SEX. 3668 02:17:29,120 --> 02:17:31,280 SO THAT COULD BE--THERE'S A LOT 3669 02:17:31,280 --> 02:17:32,720 OF THINGS TO LOOK AT. 3670 02:17:32,720 --> 02:17:35,160 >> SO, YOU KNOW BUILDING A 3671 02:17:35,160 --> 02:17:37,760 LITTLE BIT ON SOME OF OUR OTHER 3672 02:17:37,760 --> 02:17:40,080 PRESENTATIONS ESPECIALLY 3673 02:17:40,080 --> 02:17:44,080 DR. NEAL'S, HESERVED SERVED--OBD 3674 02:17:44,080 --> 02:17:45,720 AND SHARED THAT THE DIFFERENCES 3675 02:17:45,720 --> 02:17:49,640 IN THROMBOSIS BY SEX WERE MOST 3676 02:17:49,640 --> 02:17:50,920 PROMINENT IN YOUNGER MALES AND 3677 02:17:50,920 --> 02:17:54,080 SO I WONDERED, YOU KNOW IN YOUR 3678 02:17:54,080 --> 02:17:55,480 SINGLE CELL RNA SEQUENCING 3679 02:17:55,480 --> 02:17:58,720 STUDY, YOU NOTE THAD THERE WAS 3680 02:17:58,720 --> 02:18:00,800 MORE INFLAMMATORY SIGNATURES AND 3681 02:18:00,800 --> 02:18:02,440 CYTOKINES AND MONOCYTES AND 3682 02:18:02,440 --> 02:18:03,640 DENDRITIC CELLS IN MALES DO YOU 3683 02:18:03,640 --> 02:18:05,160 THINK THAT MIGHT SEPARATE OUT BY 3684 02:18:05,160 --> 02:18:07,160 AGE AS WELL, IS THERE A 3685 02:18:07,160 --> 02:18:08,440 TEMPERRAL ASPECT TO THIS? 3686 02:18:08,440 --> 02:18:09,840 >> YEAH, I THINK THIS IS 3687 02:18:09,840 --> 02:18:13,280 SOMETHING THAT WE WOULD BE WANT 3688 02:18:13,280 --> 02:18:16,720 TO LOOK INTO ESPECIALLY SOME OF 3689 02:18:16,720 --> 02:18:18,200 THE SPEAKERS BROUGHT UP ANY 3690 02:18:18,200 --> 02:18:19,440 INTERACTION BETWEEN AGE AND THE 3691 02:18:19,440 --> 02:18:19,640 SEX. 3692 02:18:19,640 --> 02:18:21,040 I THINK THIS WOULD BE A REALLY 3693 02:18:21,040 --> 02:18:23,040 GOOD DIRECTION FOR US TO REALLY 3694 02:18:23,040 --> 02:18:25,680 LOOK INTO. 3695 02:18:25,680 --> 02:18:26,080 YEAH. 3696 02:18:26,080 --> 02:18:26,400 >> THANKS. 3697 02:18:26,400 --> 02:18:28,560 AND THEN SO PERHAPS A GOOD TIME 3698 02:18:28,560 --> 02:18:32,440 TO ACTUALLY JUST ASK DR. NEAL, A 3699 02:18:32,440 --> 02:18:33,160 VERY SIMILAR QUESTION, YOU KNOW 3700 02:18:33,160 --> 02:18:36,520 WHAT DO YOU THINK MIGHT DRIVE 3701 02:18:36,520 --> 02:18:38,400 THESE DIFFERENCES IN THROMBOSIS 3702 02:18:38,400 --> 02:18:40,840 THAT THROMBOTIC RISK THAT MAY 3703 02:18:40,840 --> 02:18:42,040 HAPPEN WITH AGE? 3704 02:18:42,040 --> 02:18:43,880 AND USING SEX AS AN INTERACTION 3705 02:18:43,880 --> 02:18:46,560 VARIABLE AS YOU MENTION. 3706 02:18:46,560 --> 02:18:48,520 >> YEAH, GREAT QUESTION. 3707 02:18:48,520 --> 02:18:49,480 DR. KANTHI, AND THE SHORT ANSWER 3708 02:18:49,480 --> 02:18:56,760 IS I DON'T KNOW. 3709 02:18:56,760 --> 02:18:58,840 I LED WITH THIS AS I THINK AN 3710 02:18:58,840 --> 02:19:02,280 EXAMPLE OF YOU KNOW IMMUNO 3711 02:19:02,280 --> 02:19:04,280 THROMBOSIS AT AN INTERSECTION 3712 02:19:04,280 --> 02:19:05,600 WITH INFLAMMATORY SIGNALING AND 3713 02:19:05,600 --> 02:19:10,360 THROMBOTIC DEVELOPMENT AND SO, I 3714 02:19:10,360 --> 02:19:13,680 THINK THAT THERE ARE MULTIPLE 3715 02:19:13,680 --> 02:19:14,600 PATHWAYS THAT CHANGE 3716 02:19:14,600 --> 02:19:17,240 SIGNIFICANTLY WITH AGE THAT 3717 02:19:17,240 --> 02:19:18,400 REGULATE RESPONSE TO 3718 02:19:18,400 --> 02:19:20,040 INFLAMMATION AND SO WHETHER 3719 02:19:20,040 --> 02:19:22,680 THERE ARE UNIQUE THROMBOTIC 3720 02:19:22,680 --> 02:19:25,120 COMPONENTS YOU KNOW WHETHER 3721 02:19:25,120 --> 02:19:27,400 THAT'S PLATELET BASED BIOLOGY AS 3722 02:19:27,400 --> 02:19:31,440 WE HEARD FROM DR. ABEL'S TALK OR 3723 02:19:31,440 --> 02:19:32,720 OTHER ELEMENTS OF COAGULATION 3724 02:19:32,720 --> 02:19:33,800 THAT ARE ORDERED OR IS IT A 3725 02:19:33,800 --> 02:19:35,720 REACTION TO THE WAY THAT 3726 02:19:35,720 --> 02:19:36,760 INFLAMMATION IS INITIATED IN AND 3727 02:19:36,760 --> 02:19:42,160 THEN THE SAME IS TRUE FOR THE 3728 02:19:42,160 --> 02:19:42,680 SEX BASED DIFFERENCES. 3729 02:19:42,680 --> 02:19:44,880 I THINK A LOT OF THIS GOES BACK 3730 02:19:44,880 --> 02:19:49,160 TO THE BASIC BIOLOGY OF 3731 02:19:49,160 --> 02:19:50,360 INFLAMMATION AS IT CHANGES 3732 02:19:50,360 --> 02:19:52,560 BETWEEN MALES AND FEMALES AND 3733 02:19:52,560 --> 02:19:57,840 SO, IT'S NOT TO MINIMIZE 3734 02:19:57,840 --> 02:20:00,040 THROMBOSIS AS A UNIQUE RISK AND 3735 02:20:00,040 --> 02:20:02,360 THE SPECIFIC MECHANISMS OF IT, 3736 02:20:02,360 --> 02:20:04,440 BUT I THINK WE--THOSE OF US THAT 3737 02:20:04,440 --> 02:20:07,000 THOUGHT A LOT ABOUT IMMUNO 3738 02:20:07,000 --> 02:20:07,920 THROMBOSIS AND STUDIED IT AND 3739 02:20:07,920 --> 02:20:09,480 HAD TO INTRODUCE IT PRECOVID 3740 02:20:09,480 --> 02:20:12,360 DON'T HAVE TO DO THAT ANYMORE. 3741 02:20:12,360 --> 02:20:15,120 >> THAT'S WONDERFUL THANK YOU. 3742 02:20:15,120 --> 02:20:15,880 DR. ABEL, BUILDING ON 3743 02:20:15,880 --> 02:20:18,520 THROMBOSIS AND AGE, YOU KNOW I'M 3744 02:20:18,520 --> 02:20:21,040 INTERESTED TO HEAR, YOU'RE AN 3745 02:20:21,040 --> 02:20:22,640 ENDOCRINOLOGIST BY TRAINING AND 3746 02:20:22,640 --> 02:20:23,480 YOU'VE MANAGED TO CROSS 3747 02:20:23,480 --> 02:20:26,160 BOUNDARIES AND DO A LOT OF 3748 02:20:26,160 --> 02:20:26,760 CARDIOVASCULAR AND HEMEATOLOGY 3749 02:20:26,760 --> 02:20:30,280 WORK AS WELL, SO HOW MIGHT WE 3750 02:20:30,280 --> 02:20:32,640 START TO THINK ABOUT DECISIONS 3751 02:20:32,640 --> 02:20:33,320 ABOUT HORMONE THERAPY AND I 3752 02:20:33,320 --> 02:20:35,360 DON'T WANT TO SAY HORMONE 3753 02:20:35,360 --> 02:20:36,480 REPLACEMENT THERAPY I LEARNED 3754 02:20:36,480 --> 02:20:38,880 YESTERDAY THAT'S NOT THE RIGHT 3755 02:20:38,880 --> 02:20:39,960 TERMINOLOGY BECAUSE THERE'S NO 3756 02:20:39,960 --> 02:20:42,000 REPLACEMENT BUT HOW DO YOU 3757 02:20:42,000 --> 02:20:43,480 APPROACHY DECISIONS ABOUT 3758 02:20:43,480 --> 02:20:45,720 HORMONE THERAPY IN POST 3759 02:20:45,720 --> 02:20:47,880 MENOPAUSAL WOMEN WITH REGARD TO 3760 02:20:47,880 --> 02:20:49,320 THE CARDIOVASCULAR RISK AND 3761 02:20:49,320 --> 02:20:50,080 THROMBOTIC RISK. 3762 02:20:50,080 --> 02:20:50,920 >> YEAH, THAT'S AN INTERESTING 3763 02:20:50,920 --> 02:20:52,600 QUESTION BECAUSE FOR ME THERE'S 3764 02:20:52,600 --> 02:20:54,600 VERY CLEAR EPIDEMIOLOGY THAT 3765 02:20:54,600 --> 02:20:55,640 HORMONE THERAPY CERTAINLY DOES 3766 02:20:55,640 --> 02:20:57,880 INCREASE THE RISK OF THROMBOSIS 3767 02:20:57,880 --> 02:20:59,000 IN POST MENOPAUSAL WOMEN. 3768 02:20:59,000 --> 02:21:00,600 SO THE QUESTION THEN IS HOW CAN 3769 02:21:00,600 --> 02:21:03,080 WE ACTUALLY MITIGATE THAT, 3770 02:21:03,080 --> 02:21:04,920 SEEING THERE ARE CLEARLY 3771 02:21:04,920 --> 02:21:06,640 BENEFITS POTENTIALLY OF HORMONE 3772 02:21:06,640 --> 02:21:07,120 REPLACEMENT THERAPY. 3773 02:21:07,120 --> 02:21:10,040 AND SO I THINK THAT, YOU KNOW 3774 02:21:10,040 --> 02:21:11,200 WHAT HER APPLIEDS NEEDS TO BE 3775 02:21:11,200 --> 02:21:13,520 DONE IS TO UNDERSTAND WHAT ARE 3776 02:21:13,520 --> 02:21:14,720 THE OTHER DRIVERS OF THE 3777 02:21:14,720 --> 02:21:16,360 INCREASE TD RISK FOR THROMBOSIS 3778 02:21:16,360 --> 02:21:20,160 FOR AGING AND HOW MIGHT THIS BE 3779 02:21:20,160 --> 02:21:22,600 EXACKER BITED BY H. I.T. SO IN 3780 02:21:22,600 --> 02:21:25,040 WORK THAT IS PUBLISHED BUT 3781 02:21:25,040 --> 02:21:26,800 PREPARED FOR SUBMISSION, WE AND 3782 02:21:26,800 --> 02:21:27,760 OTHER COLLABORATORS HAVE SHOWN 3783 02:21:27,760 --> 02:21:30,320 THAT FOR EXAMPLE, AS YOU AGE AND 3784 02:21:30,320 --> 02:21:32,280 STUDIES FROM HUMAN SAMPLES, 3785 02:21:32,280 --> 02:21:33,680 THERE'S ACTUALLY MORE OXIDATIVE 3786 02:21:33,680 --> 02:21:36,400 STRESS IN THE PLATELETS. 3787 02:21:36,400 --> 02:21:37,960 AND AGAIN WE THINK THIS IS 3788 02:21:37,960 --> 02:21:40,760 COMING IN PARPT FROM 3789 02:21:40,760 --> 02:21:41,480 MITOCHONDRIA, SO 1 KIND OF 3790 02:21:41,480 --> 02:21:42,840 THOUGHT MIGHT BE IF THERE ARE 3791 02:21:42,840 --> 02:21:45,000 WAYS WE CAN ACTUALLY MITIGATE 3792 02:21:45,000 --> 02:21:49,480 SOME OF THAT, THEN POTENTIALLY, 3793 02:21:49,480 --> 02:21:51,480 THE LIKELIHOOD OF ESTROGENS 3794 02:21:51,480 --> 02:21:52,880 INCREASING RISK OF THROMBOSIS 3795 02:21:52,880 --> 02:21:54,400 COULD BE SOMEWHAT MITIGATED SO 3796 02:21:54,400 --> 02:21:56,560 THAT IS REALLY 1 APPROACH THAT 1 3797 02:21:56,560 --> 02:22:01,200 COULD TAKE TO KIND EVER DO THAT 3798 02:22:01,200 --> 02:22:02,640 YING-YANG IN TERMS OF DERIVING 3799 02:22:02,640 --> 02:22:05,000 BENEFIT AT THE SAME TIME NOT 3800 02:22:05,000 --> 02:22:05,920 EXACERBATING THOSE PATHWAYS 3801 02:22:05,920 --> 02:22:09,000 EVERY TIME YOU GET THE 3802 02:22:09,000 --> 02:22:09,320 THROMBOSIS? 3803 02:22:09,320 --> 02:22:11,640 SO A QUESTION THAT HAS BEEN 3804 02:22:11,640 --> 02:22:14,520 POSED TO ME SEVERAL TIMES NOW 3805 02:22:14,520 --> 02:22:18,240 INCLUDING JUST 2 WEEKS AGO AND 3806 02:22:18,240 --> 02:22:19,680 WHAT DO--WHAT SHOULD PEOPLE WHO 3807 02:22:19,680 --> 02:22:21,360 ARE TAKING HORMONE THERAPY DO 3808 02:22:21,360 --> 02:22:22,520 WITH THAT HORMONE THERAPY IF 3809 02:22:22,520 --> 02:22:28,400 THEY GET ACUTE COVID FOR 3810 02:22:28,400 --> 02:22:28,680 EXAMPLE. 3811 02:22:28,680 --> 02:22:29,640 >> WOW THAT'S A GREAT QUESTION. 3812 02:22:29,640 --> 02:22:31,720 I DON'T THINK WE HAVE EVIDENCE 3813 02:22:31,720 --> 02:22:33,800 TO ACTUALLY REALLY MAKE A 3814 02:22:33,800 --> 02:22:36,560 RECOMMENDATION AS TO WHAT THEY 3815 02:22:36,560 --> 02:22:36,720 DO. 3816 02:22:36,720 --> 02:22:38,440 AND SO, I THINK IT'S GOING TO BE 3817 02:22:38,440 --> 02:22:46,120 1 OF THESE KIND OF CONVERSATIONS 3818 02:22:46,120 --> 02:22:47,760 WITH YOUR PHYSICIAN IN TERMS OF 3819 02:22:47,760 --> 02:22:49,520 SHARED DECISION MAKING IN TERMS 3820 02:22:49,520 --> 02:22:53,120 OF WHAT MIGHT BE THE BEST 3821 02:22:53,120 --> 02:22:54,560 APPROACH THAT THERE'S MUTUAL 3822 02:22:54,560 --> 02:22:55,680 COMFORT IN TERMS OF MOVING 3823 02:22:55,680 --> 02:22:56,000 FORWARD. 3824 02:22:56,000 --> 02:22:57,480 BECAUSE I CAN IMAGINE THERE 3825 02:22:57,480 --> 02:22:59,320 WOULD BE SOME WOMEN WHO MAY 3826 02:22:59,320 --> 02:23:01,280 REALLY HAVE SIGNIFICANT BENEFITS 3827 02:23:01,280 --> 02:23:04,800 FROM HRT, AND YOU KNOW SOME OF 3828 02:23:04,800 --> 02:23:07,680 THE SYMPTOMS FOR EXAMPLE OF 3829 02:23:07,680 --> 02:23:09,640 MENOPAUSE MAY OVERLAP WITH SOME 3830 02:23:09,640 --> 02:23:11,240 OF THE SYMPTOMS OF LONG COVID SO 3831 02:23:11,240 --> 02:23:14,440 HOW DO YOU THEN BEGIN TO MANAGE 3832 02:23:14,440 --> 02:23:14,800 THAT? 3833 02:23:14,800 --> 02:23:17,080 AND I THINK THERE REALLY HAS TO 3834 02:23:17,080 --> 02:23:17,920 BE A REALLY OPEN CONVERSATION 3835 02:23:17,920 --> 02:23:20,720 ABOUT YOU KNOW THE RISK AND 3836 02:23:20,720 --> 02:23:26,040 BENEFITS AND ESSENTIALLY, YOU 3837 02:23:26,040 --> 02:23:28,480 KNOW A PLAN TO DEROOT SYMPTOMS 3838 02:23:28,480 --> 02:23:30,480 IF THEY DECIDE TO STOP THERAPY 3839 02:23:30,480 --> 02:23:31,880 AND WITH THE SYMPTOMS 3840 02:23:31,880 --> 02:23:33,200 CONCURRENTLY WITH THE RISK THAT 3841 02:23:33,200 --> 02:23:34,480 SYMPTOMS MIGHT BE ATTRIBUTABLE 3842 02:23:34,480 --> 02:23:36,880 TO A POST VIRAL SYNDROME. 3843 02:23:36,880 --> 02:23:37,480 >> AND CERTAINLY EMPHASIZES, 3844 02:23:37,480 --> 02:23:39,280 THANK YOU FOR THOSE COMMENTS IT 3845 02:23:39,280 --> 02:23:40,480 EMPHASIZES PART OF THE 3846 02:23:40,480 --> 02:23:41,800 CONVERSATION WE HAD YESTERDAY 3847 02:23:41,800 --> 02:23:43,080 ABOUT HORMONE THERAPY IN 3848 02:23:43,080 --> 02:23:44,840 TRANSGENDER POPULATIONS AS WELL. 3849 02:23:44,840 --> 02:23:45,920 SO, THIS CERTAINLY DOES 3850 02:23:45,920 --> 02:23:49,080 UNDERLINE IT, THERE'S A QUESTION 3851 02:23:49,080 --> 02:23:49,720 DR. ABEL FROM THE VIDEOCAST AND 3852 02:23:49,720 --> 02:23:52,200 I WILL STATE THE QUESTION HERE 3853 02:23:52,200 --> 02:23:55,120 IN BRIEF FORM, ESTROGEN MAY BE A 3854 02:23:55,120 --> 02:23:56,400 CARCINOGEN OF MANY CANCERS BUT 3855 02:23:56,400 --> 02:24:00,760 IN YOUR STUDIES YOU SUGGEST THAT 3856 02:24:00,760 --> 02:24:04,120 THAT IT MAY BE PROTECTIVE. 3857 02:24:04,120 --> 02:24:06,800 COULD YOU SHED LIGHT ON THE 3858 02:24:06,800 --> 02:24:09,120 POSITIVES AND NEGATIVES ON 3859 02:24:09,120 --> 02:24:09,680 ESTROGEN? 3860 02:24:09,680 --> 02:24:10,800 CANCER AND COVID? 3861 02:24:10,800 --> 02:24:15,200 >> YEAH, AGAIN, SO A VERY 3862 02:24:15,200 --> 02:24:15,760 COMPLEX QUESTION, RIGHT? 3863 02:24:15,760 --> 02:24:18,960 AGAIN IN THE SENSE THAT YES, 3864 02:24:18,960 --> 02:24:23,480 THERE ARE ESTROGEN DEPENDENT 3865 02:24:23,480 --> 02:24:23,720 TUMORS. 3866 02:24:23,720 --> 02:24:26,000 I THINK 1 TAKES A STEP BACK AND 3867 02:24:26,000 --> 02:24:28,800 AGAIN LOOKING AT THE 3868 02:24:28,800 --> 02:24:29,600 EPIDEMIOLOGICAL STUDIES 3869 02:24:29,600 --> 02:24:30,040 PARTICULARLY FOR THOSE 3870 02:24:30,040 --> 02:24:32,400 INDIVIDUAL WHO IS ARE STARTING 3871 02:24:32,400 --> 02:24:34,680 EARLY ON HRT, I THINK PART OF 3872 02:24:34,680 --> 02:24:37,200 THE ISSUE WITH ERT IS THAT OTHER 3873 02:24:37,200 --> 02:24:40,000 STUDIES PUT ALL COMERS IN HRT 3874 02:24:40,000 --> 02:24:41,440 EVEN A DECADE AFTER MENOPAUSE SO 3875 02:24:41,440 --> 02:24:43,360 IF YOU LOOK CLOSELY, ARE THOSE 3876 02:24:43,360 --> 02:24:45,800 INDIVIDUAL WHO IS ARE PUT ON I 3877 02:24:45,800 --> 02:24:48,040 WILL SAY LOW DOSE REPLACEMENT TO 3878 02:24:48,040 --> 02:24:49,520 MANAGE SYMPTOMS EARLY IN THE 3879 02:24:49,520 --> 02:24:54,600 POST MANY O PAUSAL PERIOD, THE 3880 02:24:54,600 --> 02:24:57,000 EVIDENCE, THE RISK OF CANCER IS 3881 02:24:57,000 --> 02:24:58,720 NOT AS COMPELLING. 3882 02:24:58,720 --> 02:25:01,520 THERE WAS ANOTHER QUESTION IN 3883 02:25:01,520 --> 02:25:04,400 THE CHAT AND I'M ADVISED I 3884 02:25:04,400 --> 02:25:06,240 SHOULD SPEAK TO IT BECAUSE NOT 3885 02:25:06,240 --> 02:25:09,800 EVERYBODY ON THE WEBCAST IS 3886 02:25:09,800 --> 02:25:10,600 KNOWLEDGEABLE AND IT'S THE 3887 02:25:10,600 --> 02:25:13,640 QUESTION WAS THE MOLECULAR 3888 02:25:13,640 --> 02:25:15,960 MECHANISMS FOR THE LACK OF 3889 02:25:15,960 --> 02:25:18,520 CHANGES IN MEDICAL 3890 02:25:18,520 --> 02:25:19,680 [INDISCERNIBLE] IN FEMALES, AND 3891 02:25:19,680 --> 02:25:23,680 THEN ALSO SECONDLY WHAT WAS THE 3892 02:25:23,680 --> 02:25:25,160 [INDISCERNIBLE] CONTENT IN THESE 3893 02:25:25,160 --> 02:25:25,680 MICE? 3894 02:25:25,680 --> 02:25:27,560 SO THEREYA NO DIFFERENCE IN THE 3895 02:25:27,560 --> 02:25:30,080 KOWBTS, ARE THERE PROTEINS THAT 3896 02:25:30,080 --> 02:25:31,960 DRIVE MITOCHONDRIAL INTEGRITY 3897 02:25:31,960 --> 02:25:32,680 CALLED MCOS COMPLEX, AND THOSE 3898 02:25:32,680 --> 02:25:33,920 ARE THERE, AND I THINK WHAT'S 3899 02:25:33,920 --> 02:25:36,840 HAPPENING IS THE ESTROGEN IS 3900 02:25:36,840 --> 02:25:38,040 PROBABLY IMPACTING MITOCHONDRIAL 3901 02:25:38,040 --> 02:25:40,000 IN THE MEMBRANE FLU ID SO THAT 3902 02:25:40,000 --> 02:25:40,920 THE REMAINING PROTEINS ARE ABLE 3903 02:25:40,920 --> 02:25:43,120 TO KIND OF RESTORE, MAINTAIN THE 3904 02:25:43,120 --> 02:25:45,320 [INDISCERNIBLE] IN THE ABSENCE 3905 02:25:45,320 --> 02:25:46,160 OF OPARE--ADMINISTRATIVE 1 IN 3906 02:25:46,160 --> 02:25:47,120 MALES THAT DOESN'T HAPPEN 3907 02:25:47,120 --> 02:25:50,440 BECAUSE THEY HAVE LESS ESTROGEN, 3908 02:25:50,440 --> 02:25:52,160 IN THEIR MITOCHONDRIAL. 3909 02:25:52,160 --> 02:25:54,080 >> WONDERFUL AND ARE THERE--IS 3910 02:25:54,080 --> 02:25:56,960 OPA 1 REGULATED BY ACUTE 3911 02:25:56,960 --> 02:25:58,360 STRESSORS LIKE INFECTIONS OF 3912 02:25:58,360 --> 02:25:59,680 COVID OR WOULD YOU SPECULATE 3913 02:25:59,680 --> 02:26:02,200 WHAT MIGHT HAPPEN IN THE POST 3914 02:26:02,200 --> 02:26:02,400 ACUTE-- 3915 02:26:02,400 --> 02:26:03,240 >> GREAT QUESTION. 3916 02:26:03,240 --> 02:26:06,120 SO WE ACTUALLY DON'T KNOW BUT I 3917 02:26:06,120 --> 02:26:08,400 THINK THAT THERE MUST BE PEOPLE 3918 02:26:08,400 --> 02:26:11,480 ON THIS CALL OR ANSWER WHO HAVE 3919 02:26:11,480 --> 02:26:13,000 SAMPLES OF PATIENTS THAT WE 3920 02:26:13,000 --> 02:26:15,160 COULD LOOK AT THE TRANSCRIPT 3921 02:26:15,160 --> 02:26:17,520 LEVELS OF OP A 1 IN PLATELETS IN 3922 02:26:17,520 --> 02:26:18,920 INDIVIDUALS WITH COVID AND 3923 02:26:18,920 --> 02:26:19,680 NONCOVID IN THE RECOVERY PERIOD 3924 02:26:19,680 --> 02:26:21,480 SO I THINK THAT WILL BE A REALLY 3925 02:26:21,480 --> 02:26:22,320 INTERESTING QUESTIONS, I DON'T 3926 02:26:22,320 --> 02:26:24,160 KNOW THE ANSWER TO THAT BUT I 3927 02:26:24,160 --> 02:26:25,480 THINK THERE'S SAMPLES WHERE DO I 3928 02:26:25,480 --> 02:26:28,160 HAVE THIS IN FACT COULD BE 3929 02:26:28,160 --> 02:26:28,560 EVALUATED THERE. 3930 02:26:28,560 --> 02:26:30,360 >> THAT'S A PERPECT SEGUE TO ASK 3931 02:26:30,360 --> 02:26:34,560 ANOTHER QUESTION, DR. NEAL, AND 3932 02:26:34,560 --> 02:26:37,160 DR. RAFIQUE, YOU BOTH HELPED 3933 02:26:37,160 --> 02:26:38,480 LEAD VERY, VERY LARGE CLINICAL 3934 02:26:38,480 --> 02:26:40,680 TRIALS THAT HAVE CROSSED, THAT 3935 02:26:40,680 --> 02:26:41,840 HAVE CROSSED BOUNDARIES AND YOU 3936 02:26:41,840 --> 02:26:44,080 KNOW WOULD YOU SHARE WITH US 3937 02:26:44,080 --> 02:26:44,640 WHETHER THERE ARE 3938 02:26:44,640 --> 02:26:45,400 BIOREPOSITORIES THAT WERE BUILT 3939 02:26:45,400 --> 02:26:48,480 IN THIS AND IF SO, HOW DO 3940 02:26:48,480 --> 02:26:49,560 INVESTIGATORS ACCESS THOSE 3941 02:26:49,560 --> 02:27:00,040 EITHER CLINICAL OR RESEARCH 3942 02:27:05,760 --> 02:27:08,520 SAMPLE BIOREPOSITORYS. 3943 02:27:08,520 --> 02:27:11,400 >> --THANK YOU FOR THAT. 3944 02:27:11,400 --> 02:27:16,640 THE PROGRAM HAS BUILD A ROBUST 3945 02:27:16,640 --> 02:27:17,960 BIOREPOSITORY THAT'S RUN BY RUSS 3946 02:27:17,960 --> 02:27:18,640 TRACE NEUROECTODERMAL THE 3947 02:27:18,640 --> 02:27:21,000 UNIVERSITY OF VERMONT WHO 3948 02:27:21,000 --> 02:27:22,280 OVERSAW ALL THE BIOREPOSITORY 3949 02:27:22,280 --> 02:27:24,280 CONNECTION FOR THE NHLBI 3950 02:27:24,280 --> 02:27:27,120 CONNECTS SPONSORED TRIALS AND 3951 02:27:27,120 --> 02:27:29,320 SO, THE PROCESS FOR OBTAINING 3952 02:27:29,320 --> 02:27:31,240 SAMPLES EXTERNAL TO THE TRIALS 3953 02:27:31,240 --> 02:27:33,840 IS ACTIVELY BEING DEVELOPED AND 3954 02:27:33,840 --> 02:27:36,400 I THINK WE HOPE WILL BE FORTH 3955 02:27:36,400 --> 02:27:37,160 COMING VERY SOON. 3956 02:27:37,160 --> 02:27:40,600 I THINK ANYONE WHO HAS SPECIFIC 3957 02:27:40,600 --> 02:27:43,200 QUESTIONS CERTAINLY WELCOME TO 3958 02:27:43,200 --> 02:27:45,720 REACH OUT TO ME OR ANY OF THE 3959 02:27:45,720 --> 02:27:47,080 INVESTIGATORS AND WE CAN CONNECT 3960 02:27:47,080 --> 02:27:48,960 AND THE SAME IS TRUE FOR 3961 02:27:48,960 --> 02:27:49,840 CLINICAL DATA. 3962 02:27:49,840 --> 02:27:52,200 ALL THE CLINICAL DATA OF COURSE 3963 02:27:52,200 --> 02:27:53,120 WILL BECOME PUBLICLY AVAILABLE 3964 02:27:53,120 --> 02:27:56,240 AND AT LEAST THE FIRST VERSION 3965 02:27:56,240 --> 02:27:58,600 OF THE DATA FROM THE FIRST 2 3966 02:27:58,600 --> 02:28:01,920 MANUCRYPTS THAT I SHOWED YOU NEW 3967 02:28:01,920 --> 02:28:02,920 ENGLAND JOURNAL ARE NOT ONLY 3968 02:28:02,920 --> 02:28:04,880 AVAILABLE THERE BUT HAVE BEEN 3969 02:28:04,880 --> 02:28:08,720 PLACED INTO A PUBLIC DATA 3970 02:28:08,720 --> 02:28:10,960 REPOSITORY AND AGAIN THAT 3971 02:28:10,960 --> 02:28:12,120 INFORMATION IS BROADLY AVAILABLE 3972 02:28:12,120 --> 02:28:16,560 EITHER THERE OR BI REQUEST. 3973 02:28:16,560 --> 02:28:18,000 >> WONDERFUL, DR. RAFIQUE, WHAT 3974 02:28:18,000 --> 02:28:20,760 ABOUT FROM THE C3 PO TRIAL. 3975 02:28:20,760 --> 02:28:22,040 >> THERE IS A BIOREPOS 3976 02:28:22,040 --> 02:28:23,440 IDENTITIORY AND THERE ARE 3977 02:28:23,440 --> 02:28:24,640 SECONDARY ANALYSIS BEING ROWN 3978 02:28:24,640 --> 02:28:25,840 NOW AND IT DEPENDS ON WHAT KIND 3979 02:28:25,840 --> 02:28:30,200 OF SAMPLES YOU NEED AND HOW MUCH 3980 02:28:30,200 --> 02:28:31,840 AND THAT ARE COMPATIBLE WITH HOW 3981 02:28:31,840 --> 02:28:33,040 IT WAS COLLECTED SO THAT'S 3982 02:28:33,040 --> 02:28:35,560 SOMETHING TO LOOK INTO BUT IF 3983 02:28:35,560 --> 02:28:37,160 YOU HAVE A--THIS IS WHAT YOU 3984 02:28:37,160 --> 02:28:39,080 NEED AND THE COLLECTION AND HOW 3985 02:28:39,080 --> 02:28:40,440 MUCH, THEN THAT'S SOMETHING WE 3986 02:28:40,440 --> 02:28:42,400 CAN ALWAYS LOOK INTO AND SEE IF 3987 02:28:42,400 --> 02:28:43,600 THAT'S AVAILABLE. 3988 02:28:43,600 --> 02:28:43,960 >> WONDERFUL. 3989 02:28:43,960 --> 02:28:47,920 THANK YOU DR. RAFIQUE, IN THE C3 3990 02:28:47,920 --> 02:28:50,920 PO TRIAL, YOU SHOWED US THAT 3991 02:28:50,920 --> 02:28:54,120 THERE WAS NO DIFFERENCE BETWEEN 3992 02:28:54,120 --> 02:28:56,440 PLACEBO AND CONVALESCENT PLASMA 3993 02:28:56,440 --> 02:28:59,000 TRANSFUSION PATIENTS TO PATIENT 3994 02:28:59,000 --> 02:29:01,200 WHO IS REPORTED TOAGE EMERGENCY 3995 02:29:01,200 --> 02:29:01,840 DEPARTMENT WITH SYMPTOMS. 3996 02:29:01,840 --> 02:29:04,240 THERE HAVE BEEN VARIED DATA 3997 02:29:04,240 --> 02:29:05,200 ACROSS DIFFERENT STUDIES AND I 3998 02:29:05,200 --> 02:29:06,880 HOPE YOU MIGHT BE ABLE TO SPEAK 3999 02:29:06,880 --> 02:29:07,960 TO THE HETEROGENERATED AITY OF 4000 02:29:07,960 --> 02:29:09,120 THAT AND OTHER FACTORS THAT WE 4001 02:29:09,120 --> 02:29:10,320 NEED TO BE CONSIDERED WHETHER 4002 02:29:10,320 --> 02:29:12,960 IT'S WHAT'S IN THE PLASMA OR 4003 02:29:12,960 --> 02:29:13,840 WHETHER THERE IS SOME 4004 02:29:13,840 --> 02:29:17,640 SPECIFICITY TO THE PATIENT'S 4005 02:29:17,640 --> 02:29:20,960 SEVERITY LOCATION, SEX, GENDER 4006 02:29:20,960 --> 02:29:23,480 AND OTHER POTENTIAL VARIABLES. 4007 02:29:23,480 --> 02:29:26,080 >> ABSOLUTELY, THERE WERE MIXED 4008 02:29:26,080 --> 02:29:28,560 DATA SO INITIALLY, CONVALESCENT 4009 02:29:28,560 --> 02:29:29,440 PLASMA WAS SUPPOSED TO HELP AND 4010 02:29:29,440 --> 02:29:33,000 THEN IT WAS THOUGHT THAT MAYBE 4011 02:29:33,000 --> 02:29:34,840 IT WAS GIVEN PRETTY LATE SO 4012 02:29:34,840 --> 02:29:37,760 MAYBE WE SHOULD MOVE IT EARLIER 4013 02:29:37,760 --> 02:29:39,120 BECAUSE GIVING CONVALESCENT 4014 02:29:39,120 --> 02:29:41,600 PLASMA WHICH IS PASSIVE IMMUNITY 4015 02:29:41,600 --> 02:29:44,080 IF YOU GIVE IT TOO LATE HOW DOES 4016 02:29:44,080 --> 02:29:44,680 THAT HELP, RIGHT? 4017 02:29:44,680 --> 02:29:46,200 SO GIVING TO PATIENT WHO IS ARE 4018 02:29:46,200 --> 02:29:47,600 HOSPITALIZED OR IN THE ICU ALL 4019 02:29:47,600 --> 02:29:50,400 RIGHT MAY NOT BE HELPFUL. 4020 02:29:50,400 --> 02:29:52,720 SO THERE WAS MIXED DATA SO WE 4021 02:29:52,720 --> 02:29:55,240 TRY TO MOVE IT UP EARLIER AND 4022 02:29:55,240 --> 02:29:57,920 EARLIER AND SAY HEY, IF MACS ARE 4023 02:29:57,920 --> 02:29:59,320 LESS SEVERELY ILL MAYBE THAT 4024 02:29:59,320 --> 02:30:01,760 WOULD HELP IN THAT REGARD. 4025 02:30:01,760 --> 02:30:07,480 I THINK AT THIS POINT IT 4026 02:30:07,480 --> 02:30:08,600 [INDISCERNIBLE] HELP I HAVE TO 4027 02:30:08,600 --> 02:30:10,640 SAY, WE ARE DOING REANALYSIS OF 4028 02:30:10,640 --> 02:30:14,840 END POINT WE LOOKEDDA THIS THE 4029 02:30:14,840 --> 02:30:17,600 IS ALL COMER, ALL COMPOSITE 4030 02:30:17,600 --> 02:30:18,640 GOING, EVERYONE GOING TO THE 4031 02:30:18,640 --> 02:30:23,800 HOSPITAL OR HAVING DEATH OR VIS 4032 02:30:23,800 --> 02:30:24,880 WILLING EMERGENCY DEPARTMENT OR 4033 02:30:24,880 --> 02:30:26,200 URGENT CARE WHICH INITIALLY WE 4034 02:30:26,200 --> 02:30:28,600 DID NOT BREAK IT DOWN WAS THE 4035 02:30:28,600 --> 02:30:31,560 REASON WAS FOR COVID OR NOT AND 4036 02:30:31,560 --> 02:30:32,840 THAT'S SOMETHING ELSE TO LOOK 4037 02:30:32,840 --> 02:30:33,920 INTO, BECAUSE THEY'RE ALL COMERS 4038 02:30:33,920 --> 02:30:36,560 IF YOU END UP IN THE ENGINEER 4039 02:30:36,560 --> 02:30:37,760 DEPARTMENT, WE COUNT YOU AS 1 4040 02:30:37,760 --> 02:30:40,800 BUT AT THIS TIME, I DON'T--I 4041 02:30:40,800 --> 02:30:42,440 DON'T THINK CONVALESCENT PLASMA 4042 02:30:42,440 --> 02:30:43,400 IS HELPING, SO THAT'S THE 4043 02:30:43,400 --> 02:30:47,080 QUESTION THAT WE LOOKED AT 4044 02:30:47,080 --> 02:30:48,360 RIGGOUSLY AND THAT'S WHAT WE 4045 02:30:48,360 --> 02:30:49,920 HAVE AT THIS POINT. 4046 02:30:49,920 --> 02:30:53,640 >> AND CERTAINLY INTRIGUING TO 4047 02:30:53,640 --> 02:30:55,040 THINK ABOUT WHETHER THERE'S 4048 02:30:55,040 --> 02:30:56,120 POTENTIAL FOR DIFFERENT FACTORS 4049 02:30:56,120 --> 02:30:56,960 IN PLASMA TO HAVE DIFFERENT 4050 02:30:56,960 --> 02:30:58,520 EFFECTS AND YOU SHOWED THE 4051 02:30:58,520 --> 02:30:59,480 LEVELS OF ANTIBODIES WERE HIGHER 4052 02:30:59,480 --> 02:31:02,200 IN MALES BUT IT DOESN'T 4053 02:31:02,200 --> 02:31:03,480 TRANSLATE TO ANY DIFFERENCE IN 4054 02:31:03,480 --> 02:31:05,640 OUTCOMES AND I WONDER IF THERE 4055 02:31:05,640 --> 02:31:07,880 ARE OTHER NONSARS COV-2 4056 02:31:07,880 --> 02:31:08,440 NEUTRALIZING ANTIBODIES AND 4057 02:31:08,440 --> 02:31:09,840 OTHER FACTORS THAT MIGHT BE IN 4058 02:31:09,840 --> 02:31:10,640 CIRCULATION THAT MIGHT AFFECT 4059 02:31:10,640 --> 02:31:11,840 SOME OF THESE CHANGES SO WE WILL 4060 02:31:11,840 --> 02:31:14,880 HAVE TO WAIT TO SEE WHAT SOME OF 4061 02:31:14,880 --> 02:31:17,240 THE SECONDARY ANALYSIS HAVE FROM 4062 02:31:17,240 --> 02:31:17,920 THE BIOREPOSITTORIES AND I THANK 4063 02:31:17,920 --> 02:31:21,320 YOU FOR THAT INFORMATION AS 4064 02:31:21,320 --> 02:31:21,560 WELL. 4065 02:31:21,560 --> 02:31:23,360 SO 1 LAST QUESTION HERE AND I 4066 02:31:23,360 --> 02:31:24,440 THINK THIS IS--IT'S NOT MEANT TO 4067 02:31:24,440 --> 02:31:25,880 BE A LEADING QUESTION BUT 1 THAT 4068 02:31:25,880 --> 02:31:26,800 WE CAN START TALKING ABOUT LEER 4069 02:31:26,800 --> 02:31:28,360 AND WE MAY NEED TO DISCUSS LATER 4070 02:31:28,360 --> 02:31:31,320 IN THE BREAK OUT SESSION. 4071 02:31:31,320 --> 02:31:33,080 SO THIS IS FOR ALL 4 PANELISTS, 4072 02:31:33,080 --> 02:31:35,760 WHAT IS THE RIGHT WAY AS WE 4073 02:31:35,760 --> 02:31:38,160 THINK ABOUT MOVING FORWARD TO BE 4074 02:31:38,160 --> 02:31:39,800 ABLE TO INCORPORATE SEX AND 4075 02:31:39,800 --> 02:31:40,840 GENDER INTO CLINICAL TRIALS. 4076 02:31:40,840 --> 02:31:46,000 THIS IS NOT JUST IN THE ANALYSIS 4077 02:31:46,000 --> 02:31:50,800 OF THE RESULTS BUT HISTORICALLY 4078 02:31:50,800 --> 02:31:52,440 DR. BAIRY-MERZ DID NOT 4079 02:31:52,440 --> 02:31:53,520 NECESSARILY ENROLL RATES AS MEN 4080 02:31:53,520 --> 02:31:55,120 AND THAT HAS IMPROVED OVER TIME 4081 02:31:55,120 --> 02:31:57,680 BUT HOW DO WE DO THIS IN THE 4082 02:31:57,680 --> 02:31:58,400 FUTURE? 4083 02:31:58,400 --> 02:32:00,800 SHOULD WE BE PRESPECIFYING 4084 02:32:00,800 --> 02:32:04,360 RANDOMIZATION CRITERIA SO THAT 4085 02:32:04,360 --> 02:32:07,000 WE HAVE STRATA WHERE WE TARGET 4086 02:32:07,000 --> 02:32:11,680 EQUAL NUMBERS OF MEN AND WOMEN 4087 02:32:11,680 --> 02:32:13,080 AND ALSO--LET ME REPHRASE THAT 4088 02:32:13,080 --> 02:32:17,320 TSHOULD BE MEN, WOMEN AND 4089 02:32:17,320 --> 02:32:17,960 TRANSGENDER. 4090 02:32:17,960 --> 02:32:19,040 >> SO THAT'S A--I'M NOT SURE I 4091 02:32:19,040 --> 02:32:22,280 HAVE A BRIEF ANSWER TO A REALLY 4092 02:32:22,280 --> 02:32:25,080 COMPLEX QUESTION DR. KANTHI, I 4093 02:32:25,080 --> 02:32:27,320 WILL OPINE ON 1 PART, THE 4094 02:32:27,320 --> 02:32:31,520 CONTRUCT OF THE MPRCT WAS A 4095 02:32:31,520 --> 02:32:33,600 BASIAN ADAPTIVE TRIAL DESIGN AND 4096 02:32:33,600 --> 02:32:39,120 1 OF THE BENEFITS OF AN ADAPTIVE 4097 02:32:39,120 --> 02:32:44,640 PLATFORM DESIGN ALLOWS FOR 4098 02:32:44,640 --> 02:32:48,000 PRESPECIFIED STOPPING RULES 4099 02:32:48,000 --> 02:32:50,200 WITHIN STRATA AND LOOKING AT 4100 02:32:50,200 --> 02:32:52,640 SUBGROUPS TO FIND AS PRIORITY AS 4101 02:32:52,640 --> 02:32:54,360 A DOMAIN WITHIN THAT SO THE 4102 02:32:54,360 --> 02:32:55,680 CHALLENGE IS WHEN YOU DON'T KNOW 4103 02:32:55,680 --> 02:32:58,520 WHETHER THERE'S GOING TO BE A 4104 02:32:58,520 --> 02:33:00,480 DIFFERENTIAL EFFECT AND ARE 4105 02:33:00,480 --> 02:33:02,920 CHALLENGED IN CREATING SORT OF A 4106 02:33:02,920 --> 02:33:04,640 PRETEST PROBABILITY, BUT I THINK 4107 02:33:04,640 --> 02:33:07,000 FOR A SPECIFIC AREA WHERE THAT 4108 02:33:07,000 --> 02:33:12,720 QUESTION IS THOUGHT TO BE HIGHLY 4109 02:33:12,720 --> 02:33:14,000 RELEVANT, UTILIZING ANALYSIS 4110 02:33:14,000 --> 02:33:16,320 PLAN THAT ACCOUNTS FOR SEX AND 4111 02:33:16,320 --> 02:33:18,800 GENDER BASED DIFFERENCES IN 4112 02:33:18,800 --> 02:33:21,480 ADVANCE WITH, YOU KNOW UNIQUE 4113 02:33:21,480 --> 02:33:24,440 STOPPING RULES AS PART OF AN 4114 02:33:24,440 --> 02:33:25,720 ADAPTIVE DESIGN IS 12 TENTIAL 4115 02:33:25,720 --> 02:33:29,360 STRATEGY WHERE YOU COULD LOOK TO 4116 02:33:29,360 --> 02:33:38,240 ENHANCE ENROLLMENT IN A SPECIFIC 4117 02:33:38,240 --> 02:33:40,240 STRATA IF YOU SUE A PLAN. 4118 02:33:40,240 --> 02:33:43,360 >> WOULD YOU LIKE TO COMMENT? 4119 02:33:43,360 --> 02:33:46,720 YEAH, DR. KANTHI, THERE IS 4120 02:33:46,720 --> 02:33:48,120 PRECEDENT FOR NHLBI FOR THIS 4121 02:33:48,120 --> 02:33:51,320 ENROLLMENT TO BE PROPORTIONATE 4122 02:33:51,320 --> 02:33:53,800 TO THE PRETENSE OF MEN AND WOMEN 4123 02:33:53,800 --> 02:33:56,920 IMPACTED BY IT IN THE NHLBI 4124 02:33:56,920 --> 02:33:59,440 DYNAMIC REGISTRY WHICH IS AN 4125 02:33:59,440 --> 02:34:00,400 EARLY STINT REGISTRIES, IT WAS 4126 02:34:00,400 --> 02:34:02,400 DETERMINE THAD IT WOULD BE 4127 02:34:02,400 --> 02:34:03,680 50/50, WOMEN AND MEN AND ASOON 4128 02:34:03,680 --> 02:34:07,560 AS THEY HIT THE 50% MEN, SOMEHOW 4129 02:34:07,560 --> 02:34:11,120 THEY FOUND THOSE WOMEN. 4130 02:34:11,120 --> 02:34:13,640 SO I THINK WE COULD CONSIDER 4131 02:34:13,640 --> 02:34:16,400 THOSE KINDS OF STRATEGIES GOING 4132 02:34:16,400 --> 02:34:17,680 FORWARD AND REMEMBER THAT IN THE 4133 02:34:17,680 --> 02:34:20,640 PAST IT ACTUALLY WORKED AND 4134 02:34:20,640 --> 02:34:23,040 ENROLLMENT ENDED ON TIME. 4135 02:34:23,040 --> 02:34:24,880 WE'VE HAD NO TROUBLE ENROLLING 4136 02:34:24,880 --> 02:34:26,440 OUR WOMEN ONLY STUDIES AND 4137 02:34:26,440 --> 02:34:28,040 PEOPLE HAVE THIS IDEA THAT WOMEN 4138 02:34:28,040 --> 02:34:29,320 WON'T PARTICIPATE IN RESEARCH 4139 02:34:29,320 --> 02:34:32,320 AND IT'S JUST NOT TRUE. 4140 02:34:32,320 --> 02:34:34,160 >> THANK YOU FOR THAT COMMENT IT 4141 02:34:34,160 --> 02:34:36,680 CERTAINLY GIVES US A CALL TO 4142 02:34:36,680 --> 02:34:37,080 ACTION. 4143 02:34:37,080 --> 02:34:38,080 THERE ARE SEVERAL OTHER COMMENTS 4144 02:34:38,080 --> 02:34:39,080 AND QUESTIONS THAT HAVE POPPED 4145 02:34:39,080 --> 02:34:41,640 UP IN THE CHAT BOX, I WILL ASK 4146 02:34:41,640 --> 02:34:43,280 OUR PANELISTS TO KINDLY ADDRESS 4147 02:34:43,280 --> 02:34:43,520 THOSE. 4148 02:34:43,520 --> 02:34:45,280 WE DO NEED TO TAKE A BREAK FOR 4149 02:34:45,280 --> 02:34:47,160 LUNCH AND IF OKAY WITH THE GROUP 4150 02:34:47,160 --> 02:34:50,280 WE WILL RESUME IN ABOUT 22 4151 02:34:50,280 --> 02:34:51,840 MINUTES AT 1:55 P.M. EASTERN FOR 4152 02:34:51,840 --> 02:34:53,240 OUR NEXT SESSION WHICH WILL 4153 02:34:53,240 --> 02:34:56,280 FOCUS ON SLEEP AND LUNG RELATED 4154 02:34:56,280 --> 02:34:56,560 DISEASES. 4155 02:34:56,560 --> 02:34:58,200 WONDERFUL, THANK YOU TO ALL OF 4156 02:34:58,200 --> 02:34:59,120 OUR SPEAKERS, OUR PANELISTS AND 4157 02:34:59,120 --> 02:35:01,760 THOSE WHO AD HOCS ADDED 4158 02:35:01,760 --> 02:35:01,880 COMMENTS. 4159 02:35:01,880 --> 02:35:07,280 >>WELCOME BACK, EXCITED THAT 4160 02:35:07,280 --> 02:35:09,840 THE MORNING SESSIONS HAVE 4161 02:35:09,840 --> 02:35:13,080 BEEN FUN, INTERESTING, 4162 02:35:13,080 --> 02:35:13,440 DYNAMIC AND 4163 02:35:13,440 --> 02:35:14,080 ENGAGING AND LOOKING FORWARD 4164 02:35:14,080 --> 02:35:16,560 TO THE REST OF THE AFTERNOON. 4165 02:35:16,560 --> 02:35:17,120 IF YOU HAVE QUESTIONS OR 4166 02:35:17,120 --> 02:35:17,720 COMMENTS PLEASE PLACE US IN 4167 02:35:17,720 --> 02:35:19,920 THE Q&A BOX. 4168 02:35:19,920 --> 02:35:21,520 YOUR ENGAGEMENT IS VITAL TO 4169 02:35:21,520 --> 02:35:22,160 THE SUCCESS OF THIS WORKSHOP. 4170 02:35:22,160 --> 02:35:24,400 I THINK THE PANELISTS ARE 4171 02:35:24,400 --> 02:35:25,040 REALLY EXCITED AND INTERESTED 4172 02:35:25,040 --> 02:35:26,720 AS YOU CAN SEE FROM THE 4173 02:35:26,720 --> 02:35:31,880 MORNING SESSION IN 4174 02:35:31,880 --> 02:35:32,520 ENGAGING WITH YOU AND HELP TO 4175 02:35:32,520 --> 02:35:33,080 CREATE NEW SYNERGIES FOR 4176 02:35:33,080 --> 02:35:33,680 COLLABORATION AS WE ADVANCE 4177 02:35:33,680 --> 02:35:34,080 OUR SCIENCE SO 4178 02:35:34,080 --> 02:35:34,720 OUR NEXT SESSION IS GOING TO 4179 02:35:34,720 --> 02:35:35,320 BE ON SESSION 6: SEX/GENDER 4180 02:35:35,320 --> 02:35:35,960 DIFFERENCES IN COVID RELATED 4181 02:35:35,960 --> 02:35:36,320 TO SLEEP AND 4182 02:35:36,320 --> 02:35:40,760 LUNG DISEASE, 4183 02:35:40,760 --> 02:35:41,720 I'D LIKE TO INTRODUCE OUR 4184 02:35:41,720 --> 02:35:49,840 MODERATOR, DR. PATRICIA 4185 02:35:49,840 --> 02:35:50,480 SILVEIRA ASSOCIATE PROFESSOR 4186 02:35:50,480 --> 02:35:50,880 AT THE INDIANA 4187 02:35:50,880 --> 02:35:51,960 UNIVERSITY SCHOOL OF PUBLIC 4188 02:35:51,960 --> 02:35:52,560 HEALTH AND HER RESEARCH IS 4189 02:35:52,560 --> 02:35:53,840 FOCUSED ON SECTOR DIFFERENCES 4190 02:35:53,840 --> 02:35:54,160 IN THE ROLE 4191 02:35:54,160 --> 02:35:55,160 OF STEROID HORMONE RECEPTORS 4192 02:35:55,160 --> 02:36:01,320 IN LUNG FORMATION, AND 4193 02:36:01,320 --> 02:36:01,960 NACELLE FACULTY POSITIONS AT 4194 02:36:01,960 --> 02:36:02,280 PENN STATE, 4195 02:36:02,280 --> 02:36:07,440 DIVERSITY OF NORTH CAROLINA 4196 02:36:07,440 --> 02:36:07,880 WHERE SHE LED THE 4197 02:36:07,880 --> 02:36:08,520 BIOBEHAVIORAL LAB BEFORE SHE 4198 02:36:08,520 --> 02:36:08,960 WAS RECRUITED TO 4199 02:36:08,960 --> 02:36:09,600 INDIANA UNIVERSITY WORK WHERE 4200 02:36:09,600 --> 02:36:13,840 SHE DEVELOPED AN NIH FUNDED 4201 02:36:13,840 --> 02:36:14,480 PROGRAM TO STUDY DIFFERENCES 4202 02:36:14,480 --> 02:36:17,720 OF -- IN 4203 02:36:17,720 --> 02:36:18,320 AIRWAY DISEASE AND RECEIVED 4204 02:36:18,320 --> 02:36:22,120 NUMEROUS AWARDS IN HER 4205 02:36:22,120 --> 02:36:22,840 EFFORTS TO PROMOTE DIVERSITY 4206 02:36:22,840 --> 02:36:28,200 IN STEM 'S TERMS 4207 02:36:28,200 --> 02:36:28,680 IN VARIOUS NATIONAL 4208 02:36:28,680 --> 02:36:29,320 ORGANIZATIONS AND COMMITTEES 4209 02:36:29,320 --> 02:36:29,920 INCLUDING THE SOCIETY FOR THE 4210 02:36:29,920 --> 02:36:33,000 ADVANCEMENT OF 4211 02:36:33,000 --> 02:36:35,280 CHICANOS, HISPANICS, NATIVE 4212 02:36:35,280 --> 02:36:37,760 AMERICANS IN SCIENCE, AND IS 4213 02:36:37,760 --> 02:36:40,200 A MEMBER OF THE BOARD OF 4214 02:36:40,200 --> 02:36:40,720 HIGHER EDUCATION 4215 02:36:40,720 --> 02:36:44,000 AND WORKFORCE AND COCHAIR OF 4216 02:36:44,000 --> 02:36:45,440 THE NEW VOICES IN SCIENCE 4217 02:36:45,440 --> 02:36:47,080 ENGINEERING MEDICINES. I LOOK 4218 02:36:47,080 --> 02:36:47,440 FORWARD TO 4219 02:36:47,440 --> 02:36:48,120 THIS EXCITING SESSION. 4220 02:36:48,120 --> 02:36:55,200 >> DR. SILVEIRA: 4221 02:36:55,200 --> 02:36:59,400 THANK YOU FOR THE ORGANIZERS 4222 02:36:59,400 --> 02:37:00,520 AND INVITING ME TO MODERATE 4223 02:37:00,520 --> 02:37:01,040 THE SESSION, SESSION 6: 4224 02:37:01,040 --> 02:37:01,360 SEX/GENDER 4225 02:37:01,360 --> 02:37:02,000 DIFFERENCES IN COVID RELATED 4226 02:37:02,000 --> 02:37:03,520 TO SLEEP AND LUNG DISEASE. 4227 02:37:03,520 --> 02:37:04,480 WE ARE GOING TO BE HEARING 4228 02:37:04,480 --> 02:37:09,360 FROM FOUR EXPERTS IN THESE 4229 02:37:09,360 --> 02:37:10,080 TOPICS. WE ARE GOING TO BE 4230 02:37:10,080 --> 02:37:11,400 DISCUSSING SEX 4231 02:37:11,400 --> 02:37:15,920 DIFFERENCES IN MECHANISMS IN 4232 02:37:15,920 --> 02:37:16,600 LUNG INFECTION AND IMMUNE 4233 02:37:16,600 --> 02:37:23,880 MEDIATORS IN CVOID-19 AND 4234 02:37:23,880 --> 02:37:24,240 HEARE ABOUT 4235 02:37:24,240 --> 02:37:25,240 DIFFERENCES IN CLINICAL 4236 02:37:25,240 --> 02:37:25,840 DIFFERENCES IN CLINICAL 4237 02:37:25,840 --> 02:37:28,320 FEATURES OF POSTACUTE 4238 02:37:28,320 --> 02:37:38,760 SEQUELAE OF SARS COV-2 4239 02:37:38,760 --> 02:37:44,240 (PASC) 4240 02:37:44,240 --> 02:37:44,880 INTRODUCE NOVEL SIX SPECIFIC 4241 02:37:44,880 --> 02:37:45,480 MECHANISMS AND TALK ABOUT 4242 02:37:45,480 --> 02:37:47,080 DIFFERENCES. 4243 02:37:47,080 --> 02:37:47,680 YOU HAVE THE BIOS FROM THE 4244 02:37:47,680 --> 02:37:48,200 SPEAKERS THAT WILL BE 4245 02:37:48,200 --> 02:37:49,800 SPEAKING TODAY. 4246 02:37:49,800 --> 02:37:50,400 I HAVE SUMMARIZED THEM IN THE 4247 02:37:50,400 --> 02:37:51,680 INTEREST OF TIME. 4248 02:37:51,680 --> 02:37:52,320 I AM GOING TO START WITH OUR 4249 02:37:52,320 --> 02:37:55,720 FIRST SPEAKER, DR. CHARLES 4250 02:37:55,720 --> 02:37:59,480 DELA CRUZ, . ASSOCIATE 4251 02:37:59,480 --> 02:37:59,920 PROFESSOR AT YALE 4252 02:37:59,920 --> 02:38:10,480 UNIVERSITY SCHOOL OF MEDICINE 4253 02:40:26,520 --> 02:40:26,960 >> LUNG INFECTION IN 4254 02:40:26,960 --> 02:40:33,600 MEDIATORS, BY DR. DELA CRUZ. 4255 02:40:33,600 --> 02:40:34,080 COVID-RELATED LUNG 4256 02:40:34,080 --> 02:40:44,640 MICROVASCULAR AND PARENCHYMAL 4257 02:41:08,600 --> 02:41:10,360 SEQUELAE. 4258 02:41:10,360 --> 02:41:16,000 >> THANK YOU DR. SYLVEIRA FOR 4259 02:41:16,000 --> 02:41:16,520 THE INTRODUCTION OF THE 4260 02:41:16,520 --> 02:41:17,160 SESSION INTO THE ORGANIZERS 4261 02:41:17,160 --> 02:41:17,440 ON THIS 4262 02:41:17,440 --> 02:41:18,280 IMPORTANT TOPIC. 4263 02:41:18,280 --> 02:41:19,280 I WAS ASKED TO TALK ABOUT IS 4264 02:41:19,280 --> 02:41:25,280 CURRENTLY KNOWN ABOUT 4265 02:41:25,280 --> 02:41:25,880 CVOID-19 LUNG INFECTION AND 4266 02:41:25,880 --> 02:41:26,200 SIX/GENDER 4267 02:41:26,200 --> 02:41:26,840 DIFFERENCES. 4268 02:41:26,840 --> 02:41:27,440 I DO NOT HAVE ANYTHING TO 4269 02:41:27,440 --> 02:41:27,840 DISCLOSE. 4270 02:41:27,840 --> 02:41:29,440 >> DR. DELA CRUZ: 4271 02:41:29,440 --> 02:41:30,080 BY NOW WE KNOW THAT AFTER TWO 4272 02:41:30,080 --> 02:41:33,840 YEARS AND MORE OF THIS 4273 02:41:33,840 --> 02:41:34,480 PANDEMIC THAT THERE ARE SECTS 4274 02:41:34,480 --> 02:41:34,800 AND GENDER 4275 02:41:34,800 --> 02:41:38,360 DIFFERENCES IN CVOID-19. 4276 02:41:38,360 --> 02:41:38,920 YOU HAVE HEARD ELOQUENTLY 4277 02:41:38,920 --> 02:41:49,440 FROM OTHER SPEAKERS DURING 4278 02:41:55,880 --> 02:41:56,400 THIS WORKSHOP THAT THERE ARE 4279 02:41:56,400 --> 02:41:56,640 SOME 4280 02:41:56,640 --> 02:41:57,520 DISPARITIES IN TERMS OF THE 4281 02:41:57,520 --> 02:42:00,320 OUTCOME OF CVOID-19. 4282 02:42:00,320 --> 02:42:00,800 MALES HAVE A HIGHER 4283 02:42:00,800 --> 02:42:02,840 MORTALITY, 4284 02:42:02,840 --> 02:42:03,320 AND DIFFERENCES WITH 4285 02:42:03,320 --> 02:42:10,120 COMPLIANCE FOR PREVENTIVE 4286 02:42:10,120 --> 02:42:10,600 MEASURES HIGHER RISK 4287 02:42:10,600 --> 02:42:11,240 BEHAVIORS AND RISKS AND JOBS 4288 02:42:11,240 --> 02:42:11,880 AND THERE ARE OTHER HORMONAL 4289 02:42:11,880 --> 02:42:14,600 FACTORS. 4290 02:42:14,600 --> 02:42:15,160 SPECIFICALLY WE KNOW THAT 4291 02:42:15,160 --> 02:42:18,600 ESTROGEN IS ASSOCIATED WITH 4292 02:42:18,600 --> 02:42:24,800 DECREASED ACE2 RECEPTORS, 4293 02:42:24,800 --> 02:42:25,440 TESTOSTERONE IS 4294 02:42:25,440 --> 02:42:26,080 HAVING SUPPRESSIVE EFFECT ON 4295 02:42:26,080 --> 02:42:26,520 IMMUNE FUNCTIONS. 4296 02:42:26,520 --> 02:42:27,960 --- 4297 02:42:27,960 --> 02:42:28,600 AND I WILL SUMMARIZE WHAT IS 4298 02:42:28,600 --> 02:42:31,280 KNOWN IN REGARDS TO SOME OF 4299 02:42:31,280 --> 02:42:31,800 THESE DIFFERENCES IN 4300 02:42:31,800 --> 02:42:32,240 NEUROLOGICAL AND 4301 02:42:32,240 --> 02:42:33,320 INFLAMMATORY RESPONSES. 4302 02:42:33,320 --> 02:42:34,320 --- 4303 02:42:34,320 --> 02:42:34,920 FOR MANY YEARS WE KNOW THAT 4304 02:42:34,920 --> 02:42:39,640 THERE ARE SIX DIFFERENCES IN 4305 02:42:39,640 --> 02:42:40,240 IMMUNITY ESPECIALLY AGAINST 4306 02:42:40,240 --> 02:42:40,560 RESPIRATORY 4307 02:42:40,560 --> 02:42:46,280 INFECTION INCLUDING VIRUSES. 4308 02:42:46,280 --> 02:42:52,120 THERE ARE X-LINKED GENES 4309 02:42:52,120 --> 02:42:55,080 ENCODING IN IMMUNE RELATED 4310 02:42:55,080 --> 02:42:55,400 PROTEINS, 4311 02:42:55,400 --> 02:42:56,000 CONTRIBUTING TO MECHANISMS 4312 02:42:56,000 --> 02:42:57,840 AND PATHOGENESIS OF INFECTION 4313 02:42:57,840 --> 02:42:58,840 INCLUDING CVOID-19 4314 02:42:58,840 --> 02:43:02,000 SPECIFICALLY TLR 7 HAS 4315 02:43:02,000 --> 02:43:03,600 BEEN HIGHLIGHTED IN THIS 4316 02:43:03,600 --> 02:43:04,160 PANDEMIC AND ALL OF THIS 4317 02:43:04,160 --> 02:43:04,760 LEADS TO SECTOR DIFFERENCES 4318 02:43:04,760 --> 02:43:09,520 IN BOTH INNATE AND 4319 02:43:09,520 --> 02:43:10,120 ADAPTIVE RESPONSES LEADING TO 4320 02:43:10,120 --> 02:43:10,920 THESE DIFFERENTIAL RESPONSES, 4321 02:43:10,920 --> 02:43:12,920 DURING ACUTE INFECTION WITH 4322 02:43:12,920 --> 02:43:13,360 MALES. 4323 02:43:13,360 --> 02:43:14,360 --- 4324 02:43:14,360 --> 02:43:24,840 WE ALSO KNOW THAT THERE ARE 4325 02:43:27,640 --> 02:43:29,640 MECHANISMS-- FOR EXAMPLE 4326 02:43:29,640 --> 02:43:31,720 IMMUNEMODULATORY EFFECTS, 4327 02:43:31,720 --> 02:43:32,160 MORE SEEN IN THE 4328 02:43:32,160 --> 02:43:33,680 FEMALE POPULATION WHICH IS 4329 02:43:33,680 --> 02:43:36,840 IMPORTANT AS POSSIBLY 4330 02:43:36,840 --> 02:43:40,400 IDEOLOGY FOR SOME OF THE 4331 02:43:40,400 --> 02:43:40,920 DISCREPANCIES IN TERMS 4332 02:43:40,920 --> 02:43:41,640 OF PREFERENTIAL SEXTON 4333 02:43:41,640 --> 02:43:44,520 DIFFERENCES IN PATIENTS WITH 4334 02:43:44,520 --> 02:43:48,360 PAC AND LUNG COVID. 4335 02:43:48,360 --> 02:43:53,480 --- 4336 02:43:53,480 --> 02:43:55,240 SOME OF THE WORK DONE IN YALE 4337 02:43:55,240 --> 02:44:01,640 LED BY DR. TAKAHASHI AND 4338 02:44:01,640 --> 02:44:02,160 OTHER, HAVE TRIED TO 4339 02:44:02,160 --> 02:44:02,720 UNDERSTAND 4340 02:44:02,720 --> 02:44:03,280 INFLAMMATORY RESPONSES TO 4341 02:44:03,280 --> 02:44:06,120 CVOID-19. 4342 02:44:06,120 --> 02:44:08,360 MOST OF THE INNATE 4343 02:44:08,360 --> 02:44:08,960 INFLAMMATORY RESPONSES HAVE 4344 02:44:08,960 --> 02:44:09,560 BEEN SIMILAR BETWEEN MALES 4345 02:44:09,560 --> 02:44:10,880 AND FEMALES. 4346 02:44:10,880 --> 02:44:12,720 SOME OF THE INITIAL 4347 02:44:12,720 --> 02:44:13,320 DESCRIPTION HAS SHOWN FOR 4348 02:44:13,320 --> 02:44:16,200 EXAMPLE THAT IN INFECTED 4349 02:44:16,200 --> 02:44:17,680 MALES COMPARED TO CONTROLS 4350 02:44:17,680 --> 02:44:21,640 THAT ARE HIRED LEVELS OF IL18 4351 02:44:21,640 --> 02:44:23,680 AND IL-8 AND CONTRIBUTE TO 4352 02:44:23,680 --> 02:44:26,240 THESE CONSEQUENCES AND IN 4353 02:44:26,240 --> 02:44:27,200 ADDITION 4354 02:44:27,200 --> 02:44:31,320 CHEMOLINES LEVELS OF CCL5 4355 02:44:31,320 --> 02:44:32,280 HAVE BEEN INCREASING MALE 4356 02:44:32,280 --> 02:44:32,600 POPULATIONS. 4357 02:44:32,600 --> 02:44:34,560 --- 4358 02:44:34,560 --> 02:44:36,560 INTERFERE IN RESPONSE IN 4359 02:44:36,560 --> 02:44:39,880 EARLY STAGES IS IMPORTANT FOR 4360 02:44:39,880 --> 02:44:41,880 ANTIVIRAL EFFECTS IN BC AND 4361 02:44:41,880 --> 02:44:42,280 INCREASE THE 4362 02:44:42,280 --> 02:44:44,840 CORRELATES WITH SEVERITY 4363 02:44:44,840 --> 02:44:45,680 DISEASE AND THE INITIAL EARLY 4364 02:44:45,680 --> 02:44:47,160 RESPONSES OF THE INFECTIONS 4365 02:44:47,160 --> 02:44:47,560 HAVE BEEN SHOWN 4366 02:44:47,560 --> 02:44:48,200 IN OTHER DISEASES TO BE MORE 4367 02:44:48,200 --> 02:44:50,320 ENHANCED IN FEMALES RATHER 4368 02:44:50,320 --> 02:44:51,720 THAN MALES AND LIKELY 4369 02:44:51,720 --> 02:44:54,400 CONTRIBUTED 4370 02:44:54,400 --> 02:44:55,000 POTENTIALLY THE PROTECTION 4371 02:44:55,000 --> 02:44:55,600 THAT WE WILL HAVE SEEN FOR 4372 02:44:55,600 --> 02:44:56,920 ACUTE PNEUMONIA FOR CVOID-19. 4373 02:44:56,920 --> 02:44:57,560 --- 4374 02:44:57,560 --> 02:45:01,280 AND THIS IS THE CASE FOR 4375 02:45:01,280 --> 02:45:01,840 CVOID-19 AND SOME OF THE 4376 02:45:01,840 --> 02:45:02,480 EARLY STUDIES HAVE SHOWN THAT 4377 02:45:02,480 --> 02:45:03,120 THERE ARE EARLY 4378 02:45:03,120 --> 02:45:08,520 INTERFERON ALPHA 2 RESPONSES 4379 02:45:08,520 --> 02:45:09,920 INTIMATES COMPARED TO MALES 4380 02:45:09,920 --> 02:45:10,560 AND WE DON'T SEE THESE OTHER 4381 02:45:10,560 --> 02:45:11,560 KINDS OF 4382 02:45:11,560 --> 02:45:12,040 DIFFERENCES IN OTHER 4383 02:45:12,040 --> 02:45:13,680 INTERFERENCE IN THIS COULD BE 4384 02:45:13,680 --> 02:45:18,760 DUE TO THE TLR7 ENCODED IN 4385 02:45:18,760 --> 02:45:19,120 THE X-LINKED 4386 02:45:19,120 --> 02:45:19,480 CHROMOSOME. 4387 02:45:19,480 --> 02:45:23,720 --- 4388 02:45:23,720 --> 02:45:24,360 AND AUTOANTIBODIES HAVE BEEN 4389 02:45:24,360 --> 02:45:25,160 ISOLATED AND DETECTED WHEN 4390 02:45:25,160 --> 02:45:28,400 PEOPLE WITH CVOID-19 AND 4391 02:45:28,400 --> 02:45:34,920 TYPICALLY WITH 4392 02:45:34,920 --> 02:45:36,720 THE STUDIES LISTED HERE THEY 4393 02:45:36,720 --> 02:45:37,280 HAVE SHOWN THAT IN MALES 4394 02:45:37,280 --> 02:45:37,800 THERE ARE MORE OF THESE 4395 02:45:37,800 --> 02:45:39,400 AUTOANTIBODIES IN 4396 02:45:39,400 --> 02:45:44,440 TYPE I IFNS COMPARED TO WOMEN 4397 02:45:44,440 --> 02:45:45,040 OF THESE ARE IMPORTANT FOR 4398 02:45:45,040 --> 02:45:48,400 THE EARLY CONTROL OF VIRUS IS 4399 02:45:48,400 --> 02:45:48,720 NOT LIKELY 4400 02:45:48,720 --> 02:45:49,360 ABLE TO NEUTRALIZE LEVELS OF 4401 02:45:49,360 --> 02:45:52,440 THIS IN THE PATIENTS. SOME OF 4402 02:45:52,440 --> 02:45:53,080 THEM HAVE LOW AND UNDETECTED 4403 02:45:53,080 --> 02:46:02,920 LEVEL. 4404 02:46:02,920 --> 02:46:03,560 HOWEVER THERE ARE DIFFERENCES 4405 02:46:03,560 --> 02:46:04,080 IN THE AUUTOANTIBODIES 4406 02:46:04,080 --> 02:46:04,600 BETWEEN MALE AND FEMALE 4407 02:46:04,600 --> 02:46:05,080 POPULATIONS AND IN 4408 02:46:05,080 --> 02:46:05,760 TERMS OF ANTIBODY RESPONSES 4409 02:46:05,760 --> 02:46:06,400 THERE HAVE BEEN MANY STUDIES 4410 02:46:06,400 --> 02:46:08,400 LOOKING AT PACIFIC ANTIBODY 4411 02:46:08,400 --> 02:46:08,720 RESPONSES 4412 02:46:08,720 --> 02:46:19,240 INSPECTING PROTEINS IGG AND 4413 02:46:20,520 --> 02:46:21,040 IGM, NO DIFFERENCES BETWEEN 4414 02:46:21,040 --> 02:46:21,720 MALES AND THE MOTION WAS 4415 02:46:21,720 --> 02:46:24,000 STUDY HAS SHOWN 4416 02:46:24,000 --> 02:46:24,560 AND INCREASE IN ANTIBODY 4417 02:46:24,560 --> 02:46:26,320 STEWARDS SPIKING PROTEINS 4418 02:46:26,320 --> 02:46:27,800 INCLUDING NEUTRALIZING 4419 02:46:27,800 --> 02:46:30,600 ANTIBODY SHOWN HERE AND 4420 02:46:30,600 --> 02:46:32,960 THE EFFECT IS RELATIVELY 4421 02:46:32,960 --> 02:46:33,560 MODEST MOST OF THIS LIKELY 4422 02:46:33,560 --> 02:46:34,200 RELATED TO THE FACT THAT MEN 4423 02:46:34,200 --> 02:46:34,680 TEND TO HAVE MORE 4424 02:46:34,680 --> 02:46:35,080 SEVERE DISEASE. 4425 02:46:35,080 --> 02:46:36,480 --- 4426 02:46:36,480 --> 02:46:38,160 T CELL RESPONSE IS IMPORTANT 4427 02:46:38,160 --> 02:46:40,400 AGAINST CVOID-19. 4428 02:46:40,400 --> 02:46:41,960 MOST OF THE STUDIES HAVE 4429 02:46:41,960 --> 02:46:47,200 SHOWN THAT TOTAL CIRCULATING 4430 02:46:47,200 --> 02:46:47,840 T CELLS ARE VERY SIMILAR WITH 4431 02:46:47,840 --> 02:46:48,160 REGARDS TO 4432 02:46:48,160 --> 02:46:50,520 ITS FREQUENCY. 4433 02:46:50,520 --> 02:46:51,320 ONE STUDY SHOWS THAT IN 4434 02:46:51,320 --> 02:46:55,880 FEMALE CVOID-19 PATIENTS 4435 02:46:55,880 --> 02:46:56,480 THERE IS A HIGHER FREQUENCY 4436 02:46:56,480 --> 02:46:57,040 OF ACTIVATED T CELLS. 4437 02:46:57,040 --> 02:47:01,760 STUDIES USING BALF CELLS 4438 02:47:01,760 --> 02:47:02,360 SHOW THE TORRENTIAL RESULTS 4439 02:47:02,360 --> 02:47:03,520 BETWEEN MALES AND FEMALES. 4440 02:47:03,520 --> 02:47:03,920 ONE SHOWS THAT 4441 02:47:03,920 --> 02:47:13,680 MALES HAVE POOR T-CELL 4442 02:47:13,680 --> 02:47:17,840 ACTIVATION, INEFFECTIVE VIRAL 4443 02:47:17,840 --> 02:47:21,840 CLEARANCE AND THE STUDY THAT 4444 02:47:21,840 --> 02:47:22,200 WAS DONE AT 4445 02:47:22,200 --> 02:47:23,200 JAILS HAS SHOWN THAT IN MALES 4446 02:47:23,200 --> 02:47:24,080 THERE ARE ASSOCIATIONS WITH 4447 02:47:24,080 --> 02:47:26,920 POOR CD8 T CELL ACTIVATION 4448 02:47:26,920 --> 02:47:27,760 AND 4449 02:47:27,760 --> 02:47:34,320 PRODUCTION OF IFNG AND IT IS 4450 02:47:34,320 --> 02:47:36,520 CORRELATED WITH THE PATIENT'S 4451 02:47:36,520 --> 02:47:39,960 AGE IS SEEN IN THE GRAPH 4452 02:47:39,960 --> 02:47:40,360 ALTHOUGH NOT 4453 02:47:40,360 --> 02:47:42,400 SEEN IN FEMALE PATIENTS. 4454 02:47:42,400 --> 02:47:45,760 SO IT SUGGESTS THAT THIS IS 4455 02:47:45,760 --> 02:47:46,960 POTENTIALLY A PROTECTIVE 4456 02:47:46,960 --> 02:47:47,440 (INDISCERNIBLE). 4457 02:47:47,440 --> 02:47:48,600 --- 4458 02:47:48,600 --> 02:47:53,840 OTHERS HAVE SHOWN THAT USING 4459 02:47:53,840 --> 02:47:56,040 THE IMMUNO METABOLOME STUDIES 4460 02:47:56,040 --> 02:47:57,840 THAT THERE ARE OTHER MARKERS 4461 02:47:57,840 --> 02:47:58,160 AND HERE 4462 02:47:58,160 --> 02:48:07,120 YOU CAN SEE KYNURENIC ACID 4463 02:48:07,120 --> 02:48:11,400 CORRELATED, AND PATIENTS WITH 4464 02:48:11,400 --> 02:48:13,720 WORSE OUTCOMES AS YOU SEE IN 4465 02:48:13,720 --> 02:48:14,000 THIS BOX 4466 02:48:14,000 --> 02:48:15,960 HERE, ESPECIALLY IN THE MALE 4467 02:48:15,960 --> 02:48:16,560 POPULATION, THIS TENDS TO BE 4468 02:48:16,560 --> 02:48:18,920 A GOOD MARKER FOR THIS 4469 02:48:18,920 --> 02:48:21,360 INFECTION. 4470 02:48:21,360 --> 02:48:25,000 THERE ARE ALSO DIFFERENTIAL 4471 02:48:25,000 --> 02:48:26,040 MONOCYTE DIFFERENCES COMPARED 4472 02:48:26,040 --> 02:48:29,080 TO INFECTED AND UNINFECTED 4473 02:48:29,080 --> 02:48:31,400 PATIENTS. 4474 02:48:31,400 --> 02:48:33,120 IN GENERAL WHAT HAS BEEN SEEN 4475 02:48:33,120 --> 02:48:35,160 IS THAT THERE ARE SOME 4476 02:48:35,160 --> 02:48:37,080 INCREASED NONCLASSICAL 4477 02:48:37,080 --> 02:48:39,480 MONOCYTES IN MALES. 4478 02:48:39,480 --> 02:48:40,080 AND THIS IS SUGGESTIVE THAT 4479 02:48:40,080 --> 02:48:44,160 POSSIBLY PROGRESSION FROM THE 4480 02:48:44,160 --> 02:48:49,320 CLASSICAL MONOCYTES SOMEHOW 4481 02:48:49,320 --> 02:48:49,640 INSTEAD OF 4482 02:48:49,640 --> 02:48:50,160 BEING ARRESTED IN THE 4483 02:48:50,160 --> 02:48:50,760 INTERMEDIATE PHASE IN THE 4484 02:48:50,760 --> 02:48:51,160 FEMALE PATIENTS. 4485 02:48:51,160 --> 02:48:51,360 --- 4486 02:48:51,360 --> 02:48:52,440 A LITTLE BIT ABOUT COVID. 4487 02:48:52,440 --> 02:49:03,000 WE KNOW THAT CVOID-19 AS BEEN 4488 02:49:04,040 --> 02:49:04,520 SHOWN TO SHOW THE FEMALE 4489 02:49:04,520 --> 02:49:05,120 SECTOR BE MORE AT RISK FOR 4490 02:49:05,120 --> 02:49:05,440 LUNG COVID 4491 02:49:05,440 --> 02:49:06,080 SYNDROME AND THERE ARE MANY 4492 02:49:06,080 --> 02:49:06,720 PHENOTYPES AND FLAVORS, MORE 4493 02:49:06,720 --> 02:49:08,480 NEUROLOGICAL SYMPTOMS, MORE 4494 02:49:08,480 --> 02:49:08,760 CARDIAC 4495 02:49:08,760 --> 02:49:12,880 SYMPTOMS AND THERE ARE MANY 4496 02:49:12,880 --> 02:49:13,440 MECHANISMS THAT HAVE BEEN 4497 02:49:13,440 --> 02:49:14,040 PROPOSED TO SUGGEST WHETHER 4498 02:49:14,040 --> 02:49:15,160 OR NOT THE 4499 02:49:15,160 --> 02:49:25,600 REASONS FOR LONG COVID, 4500 02:49:26,480 --> 02:49:27,000 WHETHER VIRAL PERSISTENCE OR 4501 02:49:27,000 --> 02:49:28,440 AUTOIMMUNITY AND OTHERS IN 4502 02:49:28,440 --> 02:49:29,200 THIS STUDY SHOWS 4503 02:49:29,200 --> 02:49:35,560 THAT THERE IS IN GENERAL-- IN 4504 02:49:35,560 --> 02:49:37,880 THIS POPULATION-- THE 4505 02:49:37,880 --> 02:49:38,760 MAJORITY OF THE POPULATION 4506 02:49:38,760 --> 02:49:45,520 ARE FEMALES AND 4507 02:49:45,520 --> 02:49:49,440 IL-6 HAS MORE ELEVATION AS A 4508 02:49:49,440 --> 02:49:50,000 BIOMARKER IN THE FEMALE 4509 02:49:50,000 --> 02:49:52,120 POPULATION COMPARED TO MALES. 4510 02:49:52,120 --> 02:49:55,760 AND WORK FROM THE NIH HAS 4511 02:49:55,760 --> 02:50:01,440 STARTED TO REPORT SOME OF 4512 02:50:01,440 --> 02:50:03,360 THIS POST-COVID STUDIES IN 4513 02:50:03,360 --> 02:50:04,200 SOME OF THE EARLY 4514 02:50:04,200 --> 02:50:05,520 EXPLORATORY STUDIES HAVE NOT 4515 02:50:05,520 --> 02:50:06,400 SHOWN CLEAR EVIDENCE OF 4516 02:50:06,400 --> 02:50:10,200 PERSISTENT VIRAL INFECTION, 4517 02:50:10,200 --> 02:50:10,600 AUTOIMMUNITY OR 4518 02:50:10,600 --> 02:50:11,400 ABNORMAL IMMUNE ACTIVATION IN 4519 02:50:11,400 --> 02:50:18,240 PARTICIPANTS WITH PASC, 4520 02:50:18,240 --> 02:50:18,840 DESPITE THE FACT THAT THERE 4521 02:50:18,840 --> 02:50:22,840 IS AN INCREASE 4522 02:50:22,840 --> 02:50:24,120 IN RISKS FOR WOMEN AND WE ARE 4523 02:50:24,120 --> 02:50:26,920 DISSECTING THIS FROM THE 4524 02:50:26,920 --> 02:50:27,480 SINGLE CELL APPROACH AND 4525 02:50:27,480 --> 02:50:29,800 IDENTIFIED WITH 4526 02:50:29,800 --> 02:50:31,560 SENSUAL RISK FACTORS SUCH AS 4527 02:50:31,560 --> 02:50:32,640 PRE-EXISTING CONDITIONS LIKE 4528 02:50:32,640 --> 02:50:37,600 DIABETES, AUTOANTIBODIES AND 4529 02:50:37,600 --> 02:50:37,920 VIREMIA AND 4530 02:50:37,920 --> 02:50:38,560 LIKELY WITH SEVERAL POTENTIAL 4531 02:50:38,560 --> 02:50:42,080 CLUSTERS OF PASCS SYMPTOMS. 4532 02:50:42,080 --> 02:50:49,080 --- 4533 02:50:49,080 --> 02:50:49,680 THE LAST STUDY SHOWS THAT 4534 02:50:49,680 --> 02:50:54,120 DESPITE THE FACT THAT AUDIT 4535 02:50:54,120 --> 02:50:55,520 IMMUNITY COULD BE A HALLMARK 4536 02:50:55,520 --> 02:50:58,280 FOR LONG COVID, 4537 02:50:58,280 --> 02:51:08,760 THE ANTIBODIES FOR LAMBDA 4538 02:51:09,440 --> 02:51:09,920 WERE MORE ASSOCIATED WITH 4539 02:51:09,920 --> 02:51:10,360 ORATORY SYMPTOMS. 4540 02:51:10,360 --> 02:51:13,080 --- 4541 02:51:13,080 --> 02:51:15,240 WE KNOW THAT THERE ARE 4542 02:51:15,240 --> 02:51:17,200 DIFFERENCES WITH MALES AND 4543 02:51:17,200 --> 02:51:20,800 FEMALES HAVE GREATER 4544 02:51:20,800 --> 02:51:21,520 ANTIVIRAL, HUMORAL AND 4545 02:51:21,520 --> 02:51:25,280 ADAPTIVE RESPONSES LIKELY TO 4546 02:51:25,280 --> 02:51:26,800 HORMONAL EFFECTS BUT THESE 4547 02:51:26,800 --> 02:51:27,360 EFFECTS COULD POTENTIALLY 4548 02:51:27,360 --> 02:51:27,760 EXPLAIN SOME OF 4549 02:51:27,760 --> 02:51:30,640 THE INCREASED HETEROGENEITY 4550 02:51:30,640 --> 02:51:31,720 IN THE PREDISPOSITION WOMEN 4551 02:51:31,720 --> 02:51:38,200 WITH PASC AND LONG COVID 4552 02:51:38,200 --> 02:51:40,360 SYMPTOMS SO SOME 4553 02:51:40,360 --> 02:51:48,240 OF THESE FUTURE STUDIES NEED 4554 02:51:48,240 --> 02:51:49,760 TO CONSIDER THAT MANY OF THE 4555 02:51:49,760 --> 02:51:50,400 STUDIES DID NOT HAVE CAREFUL 4556 02:51:50,400 --> 02:51:51,160 CONSIDERATION UPSET AND 4557 02:51:51,160 --> 02:51:51,680 GENDER, AND THE ROLE OF 4558 02:51:51,680 --> 02:51:53,480 SECTION GENDER NEEDS TO BE 4559 02:51:53,480 --> 02:51:54,040 EVALUATED APPROPRIATELY 4560 02:51:54,040 --> 02:51:57,760 AND THERE ARE OPPORTUNITIES 4561 02:51:57,760 --> 02:51:58,200 TO EVALUATE EARLY 4562 02:51:58,200 --> 02:51:58,760 NEUROLOGICAL DYSFUNCTION 4563 02:51:58,760 --> 02:51:59,360 BASED ON THE DIFFERENCES 4564 02:51:59,360 --> 02:52:01,480 FOR TARGETED APPROACHES AND I 4565 02:52:01,480 --> 02:52:04,600 HAVE NOT DISCUSSED THE ROLE 4566 02:52:04,600 --> 02:52:09,400 OF PERIPARTUM AND INTRAPARTUM 4567 02:52:09,400 --> 02:52:09,720 IMPACT ON 4568 02:52:09,720 --> 02:52:16,160 IMMUNITY AND WITH REGARDS TO 4569 02:52:16,160 --> 02:52:16,760 THE VARIOUS PHENOTYPES WE 4570 02:52:16,760 --> 02:52:17,320 NEED TO CONSIDER VARIOUS 4571 02:52:17,320 --> 02:52:17,720 FACTORS SUCH AS 4572 02:52:17,720 --> 02:52:19,040 STRESS LEVELS, TREATMENT 4573 02:52:19,040 --> 02:52:19,560 EFFECTS AND IMPACT ON 4574 02:52:19,560 --> 02:52:20,320 IMMUNITY. 4575 02:52:20,320 --> 02:52:29,240 THANK YOU VERY MUCH. 4576 02:52:29,240 --> 02:52:37,680 >> THANK YOU DR. DELA CRUZ. 4577 02:52:37,680 --> 02:52:38,480 DR. OELSNER? 4578 02:52:38,480 --> 02:52:43,200 >> DR. OELSNER: 4579 02:52:43,200 --> 02:52:45,760 LET ME SHARE MY SCREEN. 4580 02:52:45,760 --> 02:52:46,400 THANK YOU SO MUCH FOR BELLAMY 4581 02:52:46,400 --> 02:52:50,520 TO SPEAK WITH YOU TODAY ABOUT 4582 02:52:50,520 --> 02:52:51,000 COVID-RELATED LUNG 4583 02:52:51,000 --> 02:52:55,680 MICROVASCULAR AND 4584 02:52:55,680 --> 02:52:59,240 SEQUELAE. 4585 02:52:59,240 --> 02:53:01,400 TO START IS A GENERAL 4586 02:53:01,400 --> 02:53:03,520 INTERNIST LET'S STEAK A STEP 4587 02:53:03,520 --> 02:53:04,520 BACK AND DISCUSS WHAT WE HAVE 4588 02:53:04,520 --> 02:53:04,920 DISCUSSED OVER 4589 02:53:04,920 --> 02:53:11,160 THE PAST FEW DAYS BUT 4590 02:53:11,160 --> 02:53:11,760 CVOID-19 IMPACTS THE LUNGS 4591 02:53:11,760 --> 02:53:13,200 AND CAUSE ACUTE GENERATE WITH 4592 02:53:13,200 --> 02:53:13,680 RESPIRATORY FAILURE 4593 02:53:13,680 --> 02:53:16,960 BEING THE LEADING CAUSE OF 4594 02:53:16,960 --> 02:53:19,840 COVID-RELATED DEATH AND 4595 02:53:19,840 --> 02:53:21,560 COVERT MORTALITY IS HIGHER IN 4596 02:53:21,560 --> 02:53:22,000 MALES AND FEMALES 4597 02:53:22,000 --> 02:53:22,760 AND OFTEN ACUTE ILLNESS MAY 4598 02:53:22,760 --> 02:53:23,320 BE WORSE IN MALES VERSUS 4599 02:53:23,320 --> 02:53:24,640 FEMALES. 4600 02:53:24,640 --> 02:53:26,000 --- AN INCREASINGLY WE ARE 4601 02:53:26,000 --> 02:53:28,240 SEEING THAT COVID CAN BE 4602 02:53:28,240 --> 02:53:31,240 ASSOCIATED WITH POST-COVID 4603 02:53:31,240 --> 02:53:34,080 LUNG SEQUELAE. 4604 02:53:34,080 --> 02:53:34,640 UP TO ONE IN FIVE PERSONS 4605 02:53:34,640 --> 02:53:36,040 INFECTED WITH SARS COV-2 MAY 4606 02:53:36,040 --> 02:53:41,160 HAVE AT LEAST ONE 4607 02:53:41,160 --> 02:53:41,640 COVID-ATTRIBUTABLE 4608 02:53:41,640 --> 02:53:44,520 CONDITION DEVELOP SUBSEQUENT 4609 02:53:44,520 --> 02:53:45,120 TO INFECTION AND LOOK LIKELY 4610 02:53:45,120 --> 02:53:45,760 POLYMERIC CONDITIONS ARE THE 4611 02:53:45,760 --> 02:53:46,000 MOST 4612 02:53:46,000 --> 02:53:47,560 PROBLEMATIC SO THERE'S A 4613 02:53:47,560 --> 02:53:54,400 TWO-TIME HIGH-RISK A 4614 02:53:54,400 --> 02:53:56,760 PULMONARY EMBOLISM'S AFTER 4615 02:53:56,760 --> 02:53:57,280 INFECTION ACCORDING TO 4616 02:53:57,280 --> 02:54:04,040 RECENT CDC ESTIMATES AND 4617 02:54:04,040 --> 02:54:04,640 AFTER SIX MONTHS POSTCOVID 4618 02:54:04,640 --> 02:54:05,200 THE BURDEN OF COUGH AND 4619 02:54:05,200 --> 02:54:05,640 SHORTNESS OF BREATH 4620 02:54:05,640 --> 02:54:06,240 SINCE HIGHER IN FEMALES AND 4621 02:54:06,240 --> 02:54:06,480 MALES. 4622 02:54:06,480 --> 02:54:07,240 --- 4623 02:54:07,240 --> 02:54:08,720 THIS IS ALL OCCURRING IN A 4624 02:54:08,720 --> 02:54:09,360 BROADER CONTEXT OF TAKING UP 4625 02:54:09,360 --> 02:54:10,560 A FURTHER STEP BACK ACUTE 4626 02:54:10,560 --> 02:54:11,200 LUNG INJURY DUE 4627 02:54:11,200 --> 02:54:17,200 TO COVID AND POST-COVID LUNG 4628 02:54:17,200 --> 02:54:18,600 SEQUELAE MAY BE IN PERSONS 4629 02:54:18,600 --> 02:54:21,400 WITH CHRONIC LUNG DISEASE, 4630 02:54:21,400 --> 02:54:21,800 FOURTH LEADING 4631 02:54:21,800 --> 02:54:27,680 CAUSE OF DEATH AND COPD WAS 4632 02:54:27,680 --> 02:54:28,320 HIGHER IN MALES THAN FEMALES 4633 02:54:28,320 --> 02:54:33,840 AND WHAT I WANT TO TALK ABOUT 4634 02:54:33,840 --> 02:54:34,120 TODAY IS 4635 02:54:34,120 --> 02:54:34,720 HOW WE CAN LEVERAGE SOME OF 4636 02:54:34,720 --> 02:54:40,680 THE TOOLS TO BETTER 4637 02:54:40,680 --> 02:54:41,480 UNDERSTAND THE MECHANISMS OF 4638 02:54:41,480 --> 02:54:46,320 LUNG DISEASE, LUNG 4639 02:54:46,320 --> 02:54:48,040 SEQUELAE AND SIX DIFFERENCES 4640 02:54:48,040 --> 02:54:48,640 AND FOR MANY YEARS WE HAVE 4641 02:54:48,640 --> 02:54:49,240 BEEN WORKING TO UNDERSTAND 4642 02:54:49,240 --> 02:54:49,520 CHRONIC 4643 02:54:49,520 --> 02:54:54,240 DISEASES SUCH AS COPD, 4644 02:54:54,240 --> 02:54:56,320 ASTHMA, BY SAMPLING DIVERSE 4645 02:54:56,320 --> 02:54:58,080 POPULATIONS AND APPLYING 4646 02:54:58,080 --> 02:54:58,520 QUANTITATIVE LUNG 4647 02:54:58,520 --> 02:55:00,160 IMAGING THAT CAN GENERATE 4648 02:55:00,160 --> 02:55:01,920 IMAGING BIOMARKERS OF 4649 02:55:01,920 --> 02:55:05,480 SPECIFIC ASPECTS OF LUNG 4650 02:55:05,480 --> 02:55:06,000 STRUCTURE AND FUNCTION 4651 02:55:06,000 --> 02:55:16,480 INCLUDING MICROVASCULAR 4652 02:55:18,840 --> 02:55:21,400 PROFUSION, INFLAMMATION AND 4653 02:55:21,400 --> 02:55:22,080 OTHERS AND HOW WE APPLY THESE 4654 02:55:22,080 --> 02:55:24,200 TOOLS TO 4655 02:55:24,200 --> 02:55:24,880 UNDERSTAND COVID-RELATED LUNG 4656 02:55:24,880 --> 02:55:25,120 DAMAGE. 4657 02:55:25,120 --> 02:55:25,920 --- 4658 02:55:25,920 --> 02:55:32,360 IN THE SPRING OF 2022, A 4659 02:55:32,360 --> 02:55:32,920 32-YEAR-OLD WHITE MALE 4660 02:55:32,920 --> 02:55:35,000 MARATHON RUNNER AND ROLL IS A 4661 02:55:35,000 --> 02:55:35,400 HEALTHY, NEVER 4662 02:55:35,400 --> 02:55:36,000 SMOKING CONTROL SUBJECT IN 4663 02:55:36,000 --> 02:55:40,080 THE LUNGS (CORRECTION) 4664 02:55:40,080 --> 02:55:49,080 LONGITUDINAL STUDY AND RAN 5 4665 02:55:49,080 --> 02:55:49,560 MILES BEFORE COMING 4666 02:55:49,560 --> 02:55:53,480 IN FOR THE BASELINE STUDY. 4667 02:55:53,480 --> 02:55:54,120 THE RADIOLOGIST FOR THE STUDY 4668 02:55:54,120 --> 02:55:56,680 PROMPTLY REACHED OUT TO THE 4669 02:55:56,680 --> 02:55:57,240 PARTICIPANT AND NOTIFIED 4670 02:55:57,240 --> 02:55:57,640 THEM ABOUT THE 4671 02:55:57,640 --> 02:55:59,440 ABNORMALITY AND ENCOURAGED 4672 02:55:59,440 --> 02:56:01,360 COVID TESTING AND 4673 02:56:01,360 --> 02:56:01,840 PARTICIPATING BEING 4674 02:56:01,840 --> 02:56:02,360 COMPLETELY WELL TESTED 4675 02:56:02,360 --> 02:56:02,680 POSITIVE 4676 02:56:02,680 --> 02:56:07,200 FOR SARS COV-2 LATER THAT 4677 02:56:07,200 --> 02:56:07,800 DAY AND THE PERSON KINDLY 4678 02:56:07,800 --> 02:56:08,400 AGREED TO UNDERGO ADDITIONAL 4679 02:56:08,400 --> 02:56:09,680 IMAGING AT 30, 4680 02:56:09,680 --> 02:56:18,920 60, 90 DAYS AFTER DIAGNOSIS 4681 02:56:18,920 --> 02:56:19,440 REMAINING ASYSTEMATIC 4682 02:56:19,440 --> 02:56:20,040 THROUGHOUT AND SOME OF THE 4683 02:56:20,040 --> 02:56:20,520 THINGS WE SAW ON THE 4684 02:56:20,520 --> 02:56:21,040 QUANTITATIVE IMAGING. 4685 02:56:21,040 --> 02:56:23,720 --- 4686 02:56:23,720 --> 02:56:24,280 THE STANDARD RESULTS ARE 4687 02:56:24,280 --> 02:56:24,920 SHOWN AT THE TOP AT BASELINE 4688 02:56:24,920 --> 02:56:27,920 30 DAYS AND 90 DAYS FOLLOW-UP 4689 02:56:27,920 --> 02:56:28,280 AND AFTER 30 4690 02:56:28,280 --> 02:56:28,880 DAYS LUCKILY HIS LUNGS LOOK 4691 02:56:28,880 --> 02:56:29,440 COMPLETELY NORMAL AND THE 4692 02:56:29,440 --> 02:56:33,120 LUNG CAPACITY GGO DISAPPEARED 4693 02:56:33,120 --> 02:56:33,480 AND WHEN YOU 4694 02:56:33,480 --> 02:56:35,360 LOOK AT THE QUANTITATIVE 4695 02:56:35,360 --> 02:56:37,680 MEASURES FOR RESEARCH WE FIND 4696 02:56:37,680 --> 02:56:38,200 SOME ABNORMALITIES THAT 4697 02:56:38,200 --> 02:56:38,560 PERSISTED OR 4698 02:56:38,560 --> 02:56:43,120 INCREASED OVER TIME. SO THE 4699 02:56:43,120 --> 02:56:48,240 SECOND ROW SHOWS SOME 4700 02:56:48,240 --> 02:56:51,280 PARENCHYMAL MEASURES IMPROVED 4701 02:56:51,280 --> 02:56:52,240 WITH 30 DAYS BUT 4702 02:56:52,240 --> 02:56:56,520 SUBTLE CHANGES AT 60-90 DAYS. 4703 02:56:56,520 --> 02:56:58,560 BY 90 DAYS OF THE GREEN SPOT 4704 02:56:58,560 --> 02:57:02,560 OCCURRED IN NEW AREAS AS WELL 4705 02:57:02,560 --> 02:57:07,000 AS SOME OF THE EMERGING 4706 02:57:07,000 --> 02:57:07,360 HETEROGENEITY 4707 02:57:07,360 --> 02:57:08,000 OF EXPANSION OF THE LONG BUT 4708 02:57:08,000 --> 02:57:08,560 AS MENTIONED THE PATIENT 4709 02:57:08,560 --> 02:57:09,080 REMAINED COMPLETELY 4710 02:57:09,080 --> 02:57:09,960 ASYMPTOMATIC. 4711 02:57:09,960 --> 02:57:10,600 IN THE BOTTOM ROW YOU LOOK AT 4712 02:57:10,600 --> 02:57:12,720 BASILAR MEASURES AND IN THESE 4713 02:57:12,720 --> 02:57:16,560 MEASURES WHAT IS OUR INTEREST 4714 02:57:16,560 --> 02:57:17,400 IS WHERE 4715 02:57:17,400 --> 02:57:18,000 THE BLOOD IS GOING AND YOU 4716 02:57:18,000 --> 02:57:20,800 SEE THAT ON THE LEFT BASELINE 4717 02:57:20,800 --> 02:57:21,520 THERE WERE A LOT OF PLACES 4718 02:57:21,520 --> 02:57:21,840 WITH ORANGE 4719 02:57:21,840 --> 02:57:23,520 WHERE THE BLOOD WAS GOING. 4720 02:57:23,520 --> 02:57:25,080 THERE WERE A LOT OF PLACES 4721 02:57:25,080 --> 02:57:25,720 WHERE THE BLOOD WAS NOT GOING 4722 02:57:25,720 --> 02:57:26,040 THAT WERE 4723 02:57:26,040 --> 02:57:28,520 STILL GETTING VENTILATED AND 4724 02:57:28,520 --> 02:57:32,280 THE V/Q MISMATCH WERE 4725 02:57:32,280 --> 02:57:32,880 ELEVATED AT BASELINE AND 4726 02:57:32,880 --> 02:57:34,520 LUCKILY FOR THIS 4727 02:57:34,520 --> 02:57:35,800 PARTICIPANT OF DAYS 30 AND 90 4728 02:57:35,800 --> 02:57:46,280 THE V/Q HAS RESOLVED AND 4729 02:57:48,240 --> 02:57:49,400 APPEARS NORMAL SO NOTHING 4730 02:57:49,400 --> 02:57:49,800 DEFINITELY TO BE 4731 02:57:49,800 --> 02:57:50,560 EXTRAPOLATED BECAUSE IT IS 4732 02:57:50,560 --> 02:57:52,040 ONE INDIVIDUAL BUT THIS CAN 4733 02:57:52,040 --> 02:57:52,640 PROVIDE INFORMATION THAT IS 4734 02:57:52,640 --> 02:57:53,040 NONCLINICAL CT 4735 02:57:53,040 --> 02:57:53,560 SCAN TO THE NAKED EYE. 4736 02:57:53,560 --> 02:57:56,400 --- 4737 02:57:56,400 --> 02:57:57,000 SO IMAGING HAS BEEN APPLIED 4738 02:57:57,000 --> 02:57:57,600 OVER THE PAST TWO YEARS TO 4739 02:57:57,600 --> 02:57:58,200 BETTER UNDERSTAND SPECIFIC 4740 02:57:58,200 --> 02:58:00,840 MECHANISMS OF 4741 02:58:00,840 --> 02:58:01,400 COVID SEQUELAE AND I WILL 4742 02:58:01,400 --> 02:58:04,040 SHOW YOU A FEW EXAMPLES. 4743 02:58:04,040 --> 02:58:07,520 THIS IS A SMALL STUDY OF 23 4744 02:58:07,520 --> 02:58:09,520 POST-COVID CASES OF MEDICALLY 4745 02:58:09,520 --> 02:58:09,960 AND EXPAND DYSPNEA, 4746 02:58:09,960 --> 02:58:10,400 INDIVIDUALS WITH 4747 02:58:10,400 --> 02:58:12,800 SYMPTOMS AFTER COVID BOTH 4748 02:58:12,800 --> 02:58:16,560 HOSPITALIZED AND NOT 4749 02:58:16,560 --> 02:58:17,160 HOSPITALIZED PARTICIPANTS AND 4750 02:58:17,160 --> 02:58:17,680 CONTROL SUBJECTS AND 4751 02:58:17,680 --> 02:58:18,320 CONTINUE WITH THE DIFFERENCE 4752 02:58:18,320 --> 02:58:19,960 OF THE UNDERLINING EPD 4753 02:58:19,960 --> 02:58:30,400 ANALOGY (CORRECTION) 4754 02:58:38,280 --> 02:58:38,680 EPIDEMEOLOGY, ALL HAD 4755 02:58:38,680 --> 02:58:42,320 NORMAL/NEAR-NORMAL CT AFTER 4756 02:58:42,320 --> 02:58:45,360 MRI POST INHALATION OF HYPER 4757 02:58:45,360 --> 02:58:49,160 POLARIZED XENON GAS, 4758 02:58:49,160 --> 02:58:50,800 WHICH CAN BE USED AS A 4759 02:58:50,800 --> 02:58:51,360 CONTEXT OF THE DIFFUSION 4760 02:58:51,360 --> 02:58:51,960 CAPACITY OF THE LOGAN THESE 4761 02:58:51,960 --> 02:58:53,920 ARE PARTICIPANTS WHO 4762 02:58:53,920 --> 02:58:57,120 HAD CVOID-19 AND RESIDUAL 4763 02:58:57,120 --> 02:58:59,680 PULMONARY SYMPTOMS AND AT THE 4764 02:58:59,680 --> 02:59:02,840 TOP YOU HAVE THE BEST RESULTS 4765 02:59:02,840 --> 02:59:03,160 IN TERMS OF 4766 02:59:03,160 --> 02:59:03,800 THE DIVISION YOU SEE A LOT OF 4767 02:59:03,800 --> 02:59:04,400 THE GAS IN THE IMAGE BELOW 4768 02:59:04,400 --> 02:59:05,240 HERE YOU SEE VERY LITTLE 4769 02:59:05,240 --> 02:59:06,920 DIFFUSION. 4770 02:59:06,920 --> 02:59:09,280 INDEED ACROSS THE ROOT 4771 02:59:09,280 --> 02:59:09,880 IMPAIRMENT OF GAS TRANSFER 4772 02:59:09,880 --> 02:59:11,880 WAS OBSERVED IN POST COVID 4773 02:59:11,880 --> 02:59:13,240 CASES IN BOTH 4774 02:59:13,240 --> 02:59:16,040 HOSPITALIZED AND 4775 02:59:16,040 --> 02:59:16,600 NON-HOSPITALIZED ROUTING 4776 02:59:16,600 --> 02:59:17,160 CORRELATED WITH THE MORE 4777 02:59:17,160 --> 02:59:21,200 TRADITIONAL MEASURE OF DLCO, 4778 02:59:21,200 --> 02:59:21,640 POSSIBLY SHOWING 4779 02:59:21,640 --> 02:59:22,280 MICROVASCULAR DAMAGE BECAUSE 4780 02:59:22,280 --> 02:59:25,360 OF THE THICKENING OF THE 4781 02:59:25,360 --> 02:59:25,920 ALVEOLAR MEMBRANE, AND 4782 02:59:25,920 --> 02:59:26,480 CERTAINLY SOMETHING THAT 4783 02:59:26,480 --> 02:59:27,600 OTHER STUDIES ARE LOOKING 4784 02:59:27,600 --> 02:59:27,840 INTO. 4785 02:59:27,840 --> 02:59:30,640 --- 4786 02:59:30,640 --> 02:59:31,200 IN THIS SEPARATE STUDY IT 4787 02:59:31,200 --> 02:59:40,200 LOOKED MORE AND AIRWAYS, 100 4788 02:59:40,200 --> 02:59:46,640 PATIENTS WITH POST SYMPTOMS 4789 02:59:46,640 --> 02:59:48,720 OR COMPARED 4790 02:59:48,720 --> 02:59:49,440 WITH 106 CONTROLS AND THERE 4791 02:59:49,440 --> 02:59:55,160 WERE CTS PERFORMS AT FULL 4792 02:59:55,160 --> 02:59:59,160 EXPLORATION AND INSPIRATION. 4793 02:59:59,160 --> 02:59:59,720 THIS FIGURE PRETTY MUCH 4794 02:59:59,720 --> 03:00:00,320 SPEAKS FOR ITSELF THE IMAGE 4795 03:00:00,320 --> 03:00:01,120 OF THE LUNGS SHOWS IN PINK 4796 03:00:01,120 --> 03:00:01,560 AREAS OF THE LUNG 4797 03:00:01,560 --> 03:00:03,960 THAT SEEMS TO HAVE AIR 4798 03:00:03,960 --> 03:00:10,640 TRAPPING IN A REPRESENTATIVE 4799 03:00:10,640 --> 03:00:12,800 POST COVID PATIENT AND 4800 03:00:12,800 --> 03:00:13,240 COMPARED ACROSS THE 4801 03:00:13,240 --> 03:00:13,880 GROUPS IT SEEMS THAT IT WAS 4802 03:00:13,880 --> 03:00:15,200 MUCH HIGHER IN THE POST COVID 4803 03:00:15,200 --> 03:00:16,240 CASES THAT IN ANY OF THE 4804 03:00:16,240 --> 03:00:16,640 CONTROL CENTER 4805 03:00:16,640 --> 03:00:18,480 THE SAME TIME THE MORE 4806 03:00:18,480 --> 03:00:21,480 TRADITIONAL MEASURE OF 4807 03:00:21,480 --> 03:00:26,240 AIRFLOW STRUCTURE, FEV1/FVC, 4808 03:00:26,240 --> 03:00:26,680 NOT SIGNIFICANTLY 4809 03:00:26,680 --> 03:00:29,120 DIFFERENT ACROSS GROUPS, 4810 03:00:29,120 --> 03:00:29,760 THERE MAY BE SMALLER CHANGES 4811 03:00:29,760 --> 03:00:31,880 IN AIRWAY STRUCTURE THAN THE 4812 03:00:31,880 --> 03:00:33,000 TRADITIONAL 4813 03:00:33,000 --> 03:00:33,600 SPIROMETRY MEASURES. 4814 03:00:33,600 --> 03:00:40,640 --- 4815 03:00:40,640 --> 03:00:41,280 TAKING ANOTHER STEP BACK. HOW 4816 03:00:41,280 --> 03:00:41,840 ABOUT COULD TEACH IT WILL 4817 03:00:41,840 --> 03:00:42,480 CHANGE YOUR LIABILITY TO HAVE 4818 03:00:42,480 --> 03:00:42,800 A MORE 4819 03:00:42,800 --> 03:00:44,600 SEVERE COVID INFECTION? 4820 03:00:44,600 --> 03:00:50,560 THIS WORD IMAGES DONE BY -- 4821 03:00:50,560 --> 03:00:54,360 COMPARING FULL LUNG VOLUME 4822 03:00:54,360 --> 03:00:57,680 AND UNLESS YOU SEE SOMEONE 4823 03:00:57,680 --> 03:00:58,120 WITH A SMALL AIR 4824 03:00:58,120 --> 03:00:58,720 ENTRY COMPARED TO THE SIZE OF 4825 03:00:58,720 --> 03:01:02,960 THEIR LUNGS, AIRWAY TREE 4826 03:01:02,960 --> 03:01:03,600 CALIBER AND IN THE MIDDLE YOU 4827 03:01:03,600 --> 03:01:03,960 SEE SOMEONE 4828 03:01:03,960 --> 03:01:04,560 WITH AN AVERAGE AIRWAY TREE 4829 03:01:04,560 --> 03:01:07,920 COMPARED TO THE LUNG SIZE 4830 03:01:07,920 --> 03:01:12,920 ANOTHER BOTTOM RIGHT YOU SEE 4831 03:01:12,920 --> 03:01:13,520 SOMEONE WITH A 4832 03:01:13,520 --> 03:01:15,640 RELATIVELY LARGE AIRWAY TREE 4833 03:01:15,640 --> 03:01:16,200 CALIBER AND THE SMALLER 4834 03:01:16,200 --> 03:01:19,320 CALIBER MAY INCREASE 4835 03:01:19,320 --> 03:01:19,840 PARTICULATE DEFINITION 4836 03:01:19,840 --> 03:01:20,480 FOR BOTH TOBACCO SMOKE AND 4837 03:01:20,480 --> 03:01:21,440 PROVIDE PROTOCOLS SUCH AS 4838 03:01:21,440 --> 03:01:22,080 CVOID-19. 4839 03:01:22,080 --> 03:01:24,680 --- 4840 03:01:24,680 --> 03:01:25,520 AND WOMEN HAVE A SMALL AIRWAY 4841 03:01:25,520 --> 03:01:29,000 TREE CALIBER THAN MEN ON 4842 03:01:29,000 --> 03:01:29,680 AVERAGE AND THIS IS NOT 4843 03:01:29,680 --> 03:01:32,280 INSTANT AND IN 4844 03:01:32,280 --> 03:01:34,520 ADULT STUDIES THE AIRWAY TREE 4845 03:01:34,520 --> 03:01:35,560 CALIBER HAS PREDICTED RISK OF 4846 03:01:35,560 --> 03:01:38,440 LUNG MORTALITY, LUNG CANCER 4847 03:01:38,440 --> 03:01:40,000 AND COPD. 4848 03:01:40,000 --> 03:01:40,680 WHETHER IT IS A RISK FACTOR 4849 03:01:40,680 --> 03:01:46,680 FOR CVOID-19 ILLNESS OR 4850 03:01:46,680 --> 03:01:48,000 SEQUELAE IS WORKING PROGRESS 4851 03:01:48,000 --> 03:01:48,400 IT REQUIRES WE 4852 03:01:48,400 --> 03:01:49,040 HAVE THESE MEASURES AVAILABLE 4853 03:01:49,040 --> 03:01:49,640 IN LARGE NUMBERS OF PEOPLE 4854 03:01:49,640 --> 03:01:50,560 BUT ALSO HAVE INFORMATION 4855 03:01:50,560 --> 03:01:52,840 UNDER COVID 4856 03:01:52,840 --> 03:01:53,440 OUTCOMES WE ARE WPPORTING 4857 03:01:53,440 --> 03:01:54,520 THIS KINK BY TRYING 4858 03:01:54,520 --> 03:01:57,280 TO HARMONIZE CT DATA ACROSS 4859 03:01:57,280 --> 03:01:57,640 COHORTS THAT 4860 03:01:57,640 --> 03:02:01,720 HAD PRE-EXISTING LUNG CT 4861 03:02:01,720 --> 03:02:02,280 BEFORE THE PANDEMIC AND A 4862 03:02:02,280 --> 03:02:02,800 COLLABORATIVE COHORT OF 4863 03:02:02,800 --> 03:02:05,200 COHORTS FOR CVOID-19 4864 03:02:05,200 --> 03:02:07,960 RESEARCH BRINGS TOGETHER 14 4865 03:02:07,960 --> 03:02:08,760 NIH COHORTS TO PERFORM 4866 03:02:08,760 --> 03:02:10,800 STANDARDIZED COVID 4867 03:02:10,800 --> 03:02:12,560 ASSESSMENTS IN 50,000 4868 03:02:12,560 --> 03:02:16,200 DIVERSE PARTICIPANTS AND 4869 03:02:16,200 --> 03:02:18,760 HARMONIZING LUNG STRUCTURE 4870 03:02:18,760 --> 03:02:21,240 AND THERE WERE MEASURES. ONE 4871 03:02:21,240 --> 03:02:22,640 IMPORTANT 4872 03:02:22,640 --> 03:02:23,240 ISSUE IS THAT MANY OF THESE 4873 03:02:23,240 --> 03:02:23,840 ARE THE VASCULAR COHORT THAT 4874 03:02:23,840 --> 03:02:25,880 OBTAINED CARDIAC CT SO THEY 4875 03:02:25,880 --> 03:02:28,080 NEED TO BE 4876 03:02:28,080 --> 03:02:31,880 CARDIAC CTS TO HARMONIZE 4877 03:02:31,880 --> 03:02:33,360 STANDARDIZED MEASURES AND THE 4878 03:02:33,360 --> 03:02:34,000 GOAL IS TO TEST ASSOCIATIONS 4879 03:02:34,000 --> 03:02:34,360 BETWEEN PRE- 4880 03:02:34,360 --> 03:02:41,240 AND POST COVID LONG HEALTH 4881 03:02:41,240 --> 03:02:42,960 AND DISTINGUISH RISK FACTORS. 4882 03:02:42,960 --> 03:02:46,840 IN CONCLUSION CVOID-19 IS 4883 03:02:46,840 --> 03:02:47,320 ANTICIPATED TO SAP 4884 03:02:47,320 --> 03:02:48,240 SUBSTANTIAL CLINICAL ANSWER 4885 03:02:48,240 --> 03:02:49,440 CLINICAL SEQUELAE FOR 4886 03:02:49,440 --> 03:02:59,720 LUNG HEALTH. 4887 03:03:06,680 --> 03:03:07,080 SECTOR DIFFERENCES ARE 4888 03:03:07,080 --> 03:03:08,920 OBSERVED WITH RESPECT TO 4889 03:03:08,920 --> 03:03:09,240 PRE-COVID. 4890 03:03:09,240 --> 03:03:09,760 I WANT TO THANK MY KEY 4891 03:03:09,760 --> 03:03:10,840 COLLABORATORS INCLUDING 4892 03:03:10,840 --> 03:03:14,720 DOCTORS BARR, HOFFMA, SMITH, 4893 03:03:14,720 --> 03:03:23,240 WILD AND LAINE AND THE 4894 03:03:23,240 --> 03:03:29,360 ENTIRE C4R LUNG STUDY GROUP. 4895 03:03:29,360 --> 03:03:31,080 >> THANK YOU VERY MUCH FOR 4896 03:03:31,080 --> 03:03:31,680 YOUR INTERESTING DATA, PUT 4897 03:03:31,680 --> 03:03:32,280 QUESTIONS IN THE Q&A, SO WE 4898 03:03:32,280 --> 03:03:32,640 CAN DISCUSS 4899 03:03:32,640 --> 03:03:35,000 LATER. 4900 03:03:35,000 --> 03:03:40,280 AND THE NEXT SPEAKER WILL BE 4901 03:03:40,280 --> 03:03:40,960 DR. OKUDA. 4902 03:03:40,960 --> 03:03:51,240 >> DR. OKUDA> 4903 03:04:02,840 --> 03:04:03,400 THANK YOU FOR INVITING ME FOR 4904 03:04:03,400 --> 03:04:04,000 THIS IMPORTANT WORKSHOP AND 4905 03:04:04,000 --> 03:04:04,640 I'M GLAD TO PRESENT OUR DATA 4906 03:04:04,640 --> 03:04:08,440 HERE. 4907 03:04:08,440 --> 03:04:11,840 POSTACUTE SEQUELAE OF COVID, 4908 03:04:11,840 --> 03:04:13,680 PASC. 4909 03:04:13,680 --> 03:04:15,880 PERSISTENT SYMPTOMS AND/OR 4910 03:04:15,880 --> 03:04:19,120 OBLIGATIONS OF SARS MORE THAN 4911 03:04:19,120 --> 03:04:19,720 FOUR WEEKS AFTER THE INITIAL 4912 03:04:19,720 --> 03:04:22,920 ONSET. 4913 03:04:22,920 --> 03:04:29,920 PREVALENCE, 52.5% AT 30 DAYS, 4914 03:04:29,920 --> 03:04:34,120 35.0% AT 60 DAYS POST ONSENT 4915 03:04:34,120 --> 03:04:40,920 IN MILD CVOID-19. 4916 03:04:40,920 --> 03:04:45,400 WE FOCUS ON THE PASC-RELATED 4917 03:04:45,400 --> 03:04:47,760 LUNG DISEASE AND CT STUDIES 4918 03:04:47,760 --> 03:04:58,280 SHOW THAT 72% OF SEVERE TO 4919 03:04:58,760 --> 03:04:59,000 MODERATE HAD 4920 03:04:59,000 --> 03:05:02,600 FIBROSIS LIKE CHANGES, AND 4921 03:05:02,600 --> 03:05:03,200 ANOTHER STUDY SHOWING AN 4922 03:05:03,200 --> 03:05:09,440 INCREASE IN SPECIAL 4923 03:05:09,440 --> 03:05:10,000 PREVAILING THESE STUDIES 4924 03:05:10,000 --> 03:05:11,600 ESPECIALLY POST MORTEM 4925 03:05:11,600 --> 03:05:16,760 CVOID-19 LUNGS ARE VERY 4926 03:05:16,760 --> 03:05:17,960 VALUABLE RESOURCE TO STUDY 4927 03:05:17,960 --> 03:05:28,320 MECHANISMS OF CVOID-19. 4928 03:05:28,320 --> 03:05:29,360 HOWEVER, THESE LINES 4929 03:05:29,360 --> 03:05:34,000 REPRESENT SEVERE END OF STAGE 4930 03:05:34,000 --> 03:05:36,320 PHENOTYPE. 4931 03:05:36,320 --> 03:05:41,440 WE NEED A MODEL SO WE CAN 4932 03:05:41,440 --> 03:05:44,240 STUDY ACUTE AND CHRONIC 4933 03:05:44,240 --> 03:05:44,640 DISEASE IN THE 4934 03:05:44,640 --> 03:05:45,080 (INDISCERNIBLE). 4935 03:05:45,080 --> 03:05:47,520 --- 4936 03:05:47,520 --> 03:05:54,320 WE UTILIZED A SARS COV-2 4937 03:05:54,320 --> 03:06:02,240 VIRUS CALLED >> MAN: 4938 03:06:02,240 --> 03:06:03,840 -- >> MAN: 4939 03:06:03,840 --> 03:06:06,520 (CORRECTION) 4940 03:06:06,520 --> 03:06:09,120 CALLED >> MAN: 4941 03:06:09,120 --> 03:06:19,400 CALLED MA 10. 4942 03:06:22,800 --> 03:06:25,480 >> THIS FIBROSIS SCORE DATA 4943 03:06:25,480 --> 03:06:27,320 SHOWS PERSISTENT FIBROSIS 4944 03:06:27,320 --> 03:06:31,160 THROUGH 120 DAYS 4945 03:06:31,160 --> 03:06:32,720 POST-INFECTION. 4946 03:06:32,720 --> 03:06:33,520 AND THIS REPRESENTS AN IMAGE 4947 03:06:33,520 --> 03:06:37,120 OF MICE AT 120 DAYS 4948 03:06:37,120 --> 03:06:39,680 POST-INFECTIONS. 4949 03:06:39,680 --> 03:06:42,800 IT SHOWS THE -- 4950 03:06:42,800 --> 03:06:46,800 (INDISCERNIBLE) --. 4951 03:06:46,800 --> 03:06:52,240 AND ALSO WHEN WE LOOK AT THE 4952 03:06:52,240 --> 03:06:53,400 IMMUNE CELLS, THERE IS AN 4953 03:06:53,400 --> 03:06:56,680 ABNORMALLY EXTENDED, 4954 03:06:56,680 --> 03:06:57,200 PROLONGED INFILTRATION 4955 03:06:57,200 --> 03:06:59,880 OF IMMUNE CELLS THAT INCUR 4956 03:06:59,880 --> 03:07:05,760 SOME (INDISCERNIBLE) AND 4957 03:07:05,760 --> 03:07:10,440 MACROPHAGES. 4958 03:07:10,440 --> 03:07:18,400 AND IN THE INFECTED, 30 DAYS 4959 03:07:18,400 --> 03:07:21,240 POST INFECTION IT SHOWS A 4960 03:07:21,240 --> 03:07:23,760 MACRO PHASE SUBSET INCREASE 4961 03:07:23,760 --> 03:07:24,280 IN INFECTED 4962 03:07:24,280 --> 03:07:24,520 MICE. 4963 03:07:24,520 --> 03:07:26,840 --- 4964 03:07:26,840 --> 03:07:27,960 TO BETTER UNDERSTAND 4965 03:07:27,960 --> 03:07:37,360 (INDISCERNIBLE) WE UTILIZE 4966 03:07:37,360 --> 03:07:42,920 THE GEOMX DSP ANALYSIS AT 2, 4967 03:07:42,920 --> 03:07:46,840 15, AND 30 DAYS 4968 03:07:46,840 --> 03:07:49,840 POST-INFECTION. 4969 03:07:49,840 --> 03:07:53,880 OUR PREVIOUS STUDY IDENTIFIED 4970 03:07:53,880 --> 03:07:56,880 THE CELLS IN THE AIRWAYS AND 4971 03:07:56,880 --> 03:07:59,280 THE (INDISCERNIBLE) AND ALSO 4972 03:07:59,280 --> 03:08:03,040 WE 4973 03:08:03,040 --> 03:08:05,680 SELECTED ROIS, IN THE 4974 03:08:05,680 --> 03:08:06,240 MORPHOLOGICALLY INTACT 4975 03:08:06,240 --> 03:08:07,000 REASONS AND MORPHOLOGICALLY 4976 03:08:07,000 --> 03:08:10,720 DISORGANIZED SUB 4977 03:08:10,720 --> 03:08:11,280 (INDISCERNIBLE) REGION 4978 03:08:11,280 --> 03:08:14,240 BECAUSE OF THE HETEROGENEITY 4979 03:08:14,240 --> 03:08:15,480 OF LUNG DISEASE AT THE 4980 03:08:15,480 --> 03:08:16,440 CHRONIC TIME POINT. 4981 03:08:16,440 --> 03:08:18,000 --- 4982 03:08:18,000 --> 03:08:21,240 FIRST WE LOOKED AT THE VIRAL 4983 03:08:21,240 --> 03:08:24,600 GENES IN THE (INDISCERNIBLE) 4984 03:08:24,600 --> 03:08:27,080 AND DISTAL AND ALVEOLI 4985 03:08:27,080 --> 03:08:32,440 REGIONS. 4986 03:08:32,440 --> 03:08:36,480 THE VARIOUS GENES ARE NOT 4987 03:08:36,480 --> 03:08:40,480 IDENTIFIED AFTER 15 DAYS POST 4988 03:08:40,480 --> 03:08:41,280 INFECTION, AND THESE VIRAL 4989 03:08:41,280 --> 03:08:41,600 EXPRESSIONS 4990 03:08:41,600 --> 03:08:42,120 AFFECTED THE GLOBAL 4991 03:08:42,120 --> 03:08:43,680 TRANSCRIPTIONAL PROFILE IN 4992 03:08:43,680 --> 03:08:50,560 ROIS. 4993 03:08:50,560 --> 03:08:52,440 SO THESE PURPLE SQUARES, THE 4994 03:08:52,440 --> 03:08:59,840 ROI IS IN THE DISEASED MICE 2 4995 03:08:59,840 --> 03:09:04,480 DAYS POST-INFECTION. 4996 03:09:04,480 --> 03:09:11,160 AND THESE ARE MOCK AND INTACT 4997 03:09:11,160 --> 03:09:21,520 ROIS 15, 30 DPI. 4998 03:09:23,360 --> 03:09:29,000 THE ALVEOLAR ROIS, MOCK AND 4999 03:09:29,000 --> 03:09:34,680 INTACT ROIS 15, 30 DPI. 5000 03:09:34,680 --> 03:09:37,040 THIS MORPHOLOGICAL 5001 03:09:37,040 --> 03:09:38,840 DISORGANIZED ROIS ARE 5002 03:09:38,840 --> 03:09:42,520 SEPARATED FROM MOCK AND 5003 03:09:42,520 --> 03:09:52,160 INTACT REGION. SO THE DATA 5004 03:09:52,160 --> 03:09:52,360 FOR 5005 03:09:52,360 --> 03:09:53,400 THE TRANSCRIPTIONAL NETWORK, 5006 03:09:53,400 --> 03:09:56,360 IN THE MORPHOLOGICALLY 5007 03:09:56,360 --> 03:09:59,160 DISEASED REAGIONS. 5008 03:09:59,160 --> 03:10:04,800 AND THIS PINK BAR IS A MOCK 5009 03:10:04,800 --> 03:10:10,160 ROI AND THE SECOND ROW IN RED 5010 03:10:10,160 --> 03:10:16,400 ARE DAY 2, GREY IS INTACT AND 5011 03:10:16,400 --> 03:10:17,120 THIS IS 5012 03:10:17,120 --> 03:10:27,560 DAY 30 INTACT DISEASE. 5013 03:10:31,760 --> 03:10:33,360 15 CAN SEE A DRAMATIC 5014 03:10:33,360 --> 03:10:33,960 DECREASE AND A DRAMATIC 5015 03:10:33,960 --> 03:10:44,320 INCREASE IN ISGS. 5016 03:10:48,320 --> 03:10:48,800 THIS UP-AND-DOWN RECOVERS 5017 03:10:48,800 --> 03:10:51,200 AFTER 15 DAYS POST INFECTION. 5018 03:10:51,200 --> 03:10:55,320 YOU CAN SEE FIBROSIS RELATED 5019 03:10:55,320 --> 03:10:57,800 GENES UPREGULATED. 5020 03:10:57,800 --> 03:11:01,440 INCLUDING (INDISCERNIBLE). 5021 03:11:01,440 --> 03:11:04,280 CONSISTENT WITH THIS, SFTPC, 5022 03:11:04,280 --> 03:11:09,600 IS A DRAMATICALLY DECREASED 5023 03:11:09,600 --> 03:11:10,800 UPDATE POSTINFECTION. 5024 03:11:10,800 --> 03:11:15,200 AND THEN NORMAL AND MIDDLE 5025 03:11:15,200 --> 03:11:16,640 HYPERACTIVE AFTER 15 DAYS 5026 03:11:16,640 --> 03:11:17,720 POST INFECTION. 5027 03:11:17,720 --> 03:11:25,000 ALSO THIS DATA SHOWS SPP1, 5028 03:11:25,000 --> 03:11:28,240 MACROPHAGE MARKER AND THIS IS 5029 03:11:28,240 --> 03:11:37,440 A FIBROSIS MARKER, HIGHLY 5030 03:11:37,440 --> 03:11:38,320 AGGREGRATED AND 5031 03:11:38,320 --> 03:11:38,880 (INDISCERNIBLE). 5032 03:11:38,880 --> 03:11:44,480 --- 5033 03:11:44,480 --> 03:11:45,120 ANOTHER THING WE FOUND IN OUR 5034 03:11:45,120 --> 03:11:52,320 MICE IS A TRANSITIONAL 5035 03:11:52,320 --> 03:11:53,520 ALVEOLAR EPITHELIAL CELLS 5036 03:11:53,520 --> 03:11:56,680 INVOLVED IN 5037 03:11:56,680 --> 03:11:59,440 FIBROTIC ALVEOLAR REMODELING 5038 03:11:59,440 --> 03:12:04,200 FOLLOWING SARS COV-2 MA10 5039 03:12:04,200 --> 03:12:05,720 INFECTION. 5040 03:12:05,720 --> 03:12:09,400 THESE MARKERS UPDATE TOO AND 5041 03:12:09,400 --> 03:12:13,360 ALSO AT DAYS 15, 30. 5042 03:12:13,360 --> 03:12:18,280 HOWEVER THIS TIMING OF 5043 03:12:18,280 --> 03:12:25,640 UPREGULATION OF THESE GENES 5044 03:12:25,640 --> 03:12:26,240 DEPENDS ON EACH GENE AND THAT 5045 03:12:26,240 --> 03:12:26,560 SUGGESTED 5046 03:12:26,560 --> 03:12:27,080 ALTHOUGH THE GENES ARE 5047 03:12:27,080 --> 03:12:29,360 REPORTED IN TERMS OF 5048 03:12:29,360 --> 03:12:33,320 (INDISCERNIBLE) EACH GENE 5049 03:12:33,320 --> 03:12:34,920 PLAYS A DIFFERENT ROLE AT A 5050 03:12:34,920 --> 03:12:38,960 DIFFERENT STAGE. 5051 03:12:38,960 --> 03:12:44,360 THESE ARE IMAGES SHOWING THE 5052 03:12:44,360 --> 03:12:45,960 DRAMATIC INCREASE OF THE 5053 03:12:45,960 --> 03:12:49,720 (INDISCERNIBLE) CELLS 2 DAYS 5054 03:12:49,720 --> 03:12:52,200 POST INFECTION. 5055 03:12:52,200 --> 03:12:52,800 AND THIS NUMBER OVER THE 5056 03:12:52,800 --> 03:12:56,000 CELLS IS GETTIN GLESS BUT AT 5057 03:12:56,000 --> 03:13:01,440 15 DPI THESE CELLS STILL 5058 03:13:01,440 --> 03:13:02,480 REMAIN ACCUMULATED 5059 03:13:02,480 --> 03:13:06,320 IN THIS REGION. 5060 03:13:06,320 --> 03:13:08,600 ALSO POSITIVE. 5061 03:13:08,600 --> 03:13:11,160 THIS DATA MIGHT SUGGEST AN 5062 03:13:11,160 --> 03:13:13,400 INTERACTION OF 5063 03:13:13,400 --> 03:13:14,560 (INDISCERNIBLE). 5064 03:13:14,560 --> 03:13:15,960 --- 5065 03:13:15,960 --> 03:13:18,560 AND FINALLY WE TEST IF THE 5066 03:13:18,560 --> 03:13:29,080 REDUCTION OF ANTIVIRAL IN THE 5067 03:13:32,040 --> 03:13:34,280 EIDD-2801 REDUCES FIBROSIS. 5068 03:13:34,280 --> 03:13:39,040 IN THIS ANTIVIRAL DRUG 5069 03:13:39,040 --> 03:13:49,560 IMPROVED SURVIVAL AND LUNG 5070 03:13:51,720 --> 03:13:52,400 DAMAGE AND FIBROSIS ALSO 5071 03:13:52,400 --> 03:13:53,960 IMPROVED. 5072 03:13:53,960 --> 03:13:55,480 THIS DATA SUGGESTS A 5073 03:13:55,480 --> 03:14:00,000 REDUCTION OF THE 5074 03:14:00,000 --> 03:14:02,640 (INDISCERNIBLE) OF THE VIRUS 5075 03:14:02,640 --> 03:14:04,320 THAT MIGHT PREVENT SUBSEQUENT 5076 03:14:04,320 --> 03:14:04,880 FIBROTIC REMODELING. 5077 03:14:04,880 --> 03:14:05,760 --- 5078 03:14:05,760 --> 03:14:08,920 IN CONCLUSION OUR MOUSE MODEL 5079 03:14:08,920 --> 03:14:19,480 STUDY SHOWS SARS INFECTION IN 5080 03:14:39,040 --> 03:14:40,080 MICE PRODUCES CHRONIC 5081 03:14:40,080 --> 03:14:40,400 PULMONARY 5082 03:14:40,400 --> 03:14:46,520 DISEASES. 5083 03:14:46,520 --> 03:14:47,080 PERSISTENT IMMUNE CELL 5084 03:14:47,080 --> 03:14:50,840 INVITATION. 5085 03:14:50,840 --> 03:14:53,480 FIBROTIC AVAILABLE REMODELING. 5086 03:14:53,480 --> 03:14:54,000 ACCUMULATION OF POPULAR 5087 03:14:54,000 --> 03:14:55,200 INTERMEDIATE CELLS. 5088 03:14:55,200 --> 03:14:57,760 QUESTIONS. 5089 03:14:57,760 --> 03:14:58,320 ANY SEXIST DIFFERENCES IN 5090 03:14:58,320 --> 03:15:00,400 MAJOR COMPONENTS OF PASC 5091 03:15:00,400 --> 03:15:03,760 PATHOGENESIS? 5092 03:15:03,760 --> 03:15:04,320 WHAT IS A MECHANISM THAT 5093 03:15:04,320 --> 03:15:05,120 PRODUCES THE SPECIFIC 5094 03:15:05,120 --> 03:15:05,600 DIFFERENCES IN THESE 5095 03:15:05,600 --> 03:15:06,280 COMPONENTS? 5096 03:15:06,280 --> 03:15:15,480 MAGNITUDE OF SARS COV-2 VIRAL 5097 03:15:15,480 --> 03:15:16,080 INFECTION: RECEPTOR BINDING 5098 03:15:16,080 --> 03:15:19,200 DOMAINS, 5099 03:15:19,200 --> 03:15:19,720 SIX DIFFERENCES IN THE 5100 03:15:19,720 --> 03:15:20,880 RECEPTOR BINDING DOMAIN 5101 03:15:20,880 --> 03:15:22,680 EXPRESSION OR ANY DIFFERENCE 5102 03:15:22,680 --> 03:15:25,360 IN THE TISSUE AND 5103 03:15:25,360 --> 03:15:28,120 CELLULAR TROPISM. 5104 03:15:28,120 --> 03:15:31,680 ACUTE LUNG INJURY> IMMUNE 5105 03:15:31,680 --> 03:15:32,680 RESPONSE, HOUSED IN A DEFENSE 5106 03:15:32,680 --> 03:15:35,600 RESPONSE, ISGS. 5107 03:15:35,600 --> 03:15:38,520 AND FIBROTIC ALVEOLAR 5108 03:15:38,520 --> 03:15:41,160 REMODELING. 5109 03:15:41,160 --> 03:15:41,800 THOSE ARE POSSIBLE QUESTIONS 5110 03:15:41,800 --> 03:15:42,320 BUT I WOULD BE HAPPY TO 5111 03:15:42,320 --> 03:15:43,840 DISCUSS MORE IN THE BREAKOUT 5112 03:15:43,840 --> 03:15:45,040 SESSIONS LATER. 5113 03:15:45,040 --> 03:15:46,240 THANK YOU SO MUCH. 5114 03:15:46,240 --> 03:15:48,640 >> DR. SILVEYRA: 5115 03:15:48,640 --> 03:15:56,640 THANK YOU SO MUCH DR. 5116 03:15:56,640 --> 03:15:59,400 OKAYURA. 5117 03:15:59,400 --> 03:16:07,840 I LOST CONNECTION SO DR. 5118 03:16:07,840 --> 03:16:10,600 MULLINGTON IS A PROFESSOR OF 5119 03:16:10,600 --> 03:16:20,880 -- (READING BIO) 5120 03:16:37,480 --> 03:16:47,680 DR. MULLINGTON? 5121 03:17:10,280 --> 03:17:13,360 >> DR. MULLINGTON: 5122 03:17:13,360 --> 03:17:14,120 THANK YOU FOR THE INVITATION 5123 03:17:14,120 --> 03:17:15,760 AND THE INTRODUCTION. 5124 03:17:15,760 --> 03:17:19,960 I'M GOING TO TALK ABOUT 5125 03:17:19,960 --> 03:17:30,480 ISSUES RELATED TO SLEEP IN 5126 03:17:42,520 --> 03:17:44,320 CIRCADIAN RHYTHMS. 5127 03:17:44,320 --> 03:17:46,240 I HAVE NO CONFLICTS IN THIS 5128 03:17:46,240 --> 03:17:46,840 PRESENTATION AND I WANT TO 5129 03:17:46,840 --> 03:17:47,560 COLLEGE MY TEAMING 5130 03:17:47,560 --> 03:17:51,600 PARTICULARLY MONICA 5131 03:17:51,600 --> 03:17:52,200 HAACK INVOLVED IN MUCH OF THE 5132 03:17:52,200 --> 03:17:53,240 RESEARCH THAT I WILL SHOW BY 5133 03:17:53,240 --> 03:17:55,400 WAY OF BACKGROUND. 5134 03:17:55,400 --> 03:17:59,080 SO AS WE HAVE HEARD, THERE'S 5135 03:17:59,080 --> 03:17:59,640 AN OVERREPRESENTATION OF 5136 03:17:59,640 --> 03:18:03,760 WOMEN IN AUTOIMMUNE DISEASE, 5137 03:18:03,760 --> 03:18:05,680 CHRONIC PAIN 5138 03:18:05,680 --> 03:18:07,440 CONDITIONS, PSYCHIATRIC 5139 03:18:07,440 --> 03:18:10,000 DISORDERS AND INSOMNIA. 5140 03:18:10,000 --> 03:18:12,840 CHRONIC INSOMNIA IS 1.5 TIMES 5141 03:18:12,840 --> 03:18:14,560 MORE COMMON IN WOMEN THAN IN 5142 03:18:14,560 --> 03:18:17,880 MEN. 5143 03:18:17,880 --> 03:18:21,400 DISTURBED SLEEP IMPACTS MANY 5144 03:18:21,400 --> 03:18:25,400 PHYSIOLOGICAL SYMPTOMS. SLEEP 5145 03:18:25,400 --> 03:18:26,200 IS REALLY A BIOLOGICAL 5146 03:18:26,200 --> 03:18:29,000 IMPERATIVE. 5147 03:18:29,000 --> 03:18:38,720 AND SLEEP PROTECTS THE HOST 5148 03:18:38,720 --> 03:18:41,080 IF THERE'S MICROBIAL OR VIRAL 5149 03:18:41,080 --> 03:18:46,440 CHALLENGES. IT AFFECTS SLEEP. 5150 03:18:46,440 --> 03:18:49,560 AND AT THE RIGHT LEVEL OF 5151 03:18:49,560 --> 03:18:51,440 CHALLENGE, HOST DEFENSES ARE 5152 03:18:51,440 --> 03:18:52,800 SUPPORTED AND SLOW AIRWAY IS 5153 03:18:52,800 --> 03:18:55,040 ENHANCED AND 5154 03:18:55,040 --> 03:18:57,600 IF IT IS INSUFFICIENT AND 5155 03:18:57,600 --> 03:18:58,160 DISTURBED IT MAY LEAD TO 5156 03:18:58,160 --> 03:18:59,240 DISEASE. 5157 03:18:59,240 --> 03:19:06,280 AND SLEEP DISTURBANCE IMPACTS 5158 03:19:06,280 --> 03:19:07,480 HYPOTHALAMIC PITUITARY- 5159 03:19:07,480 --> 03:19:11,480 ADRENAL AXIS. 5160 03:19:11,480 --> 03:19:12,080 IT IS VERY IMPORTANT FOR 5161 03:19:12,080 --> 03:19:12,640 ANCHORING THE CIRCADIAN 5162 03:19:12,640 --> 03:19:13,560 RHYTHMS. 5163 03:19:13,560 --> 03:19:19,520 IT HELPS IN RELATING THE 5164 03:19:19,520 --> 03:19:21,160 GLYMPHATICS IN A CENTRAL 5165 03:19:21,160 --> 03:19:25,360 NERVOUS SYSTEM AND IT IS 5166 03:19:25,360 --> 03:19:28,200 INVOLVED IN PAIN 5167 03:19:28,200 --> 03:19:30,400 SENSITIVITY REGULATION, 5168 03:19:30,400 --> 03:19:32,960 AUTONOMIC MODULATION, 5169 03:19:32,960 --> 03:19:35,000 HYPERTENSION IS ASSOCIATED 5170 03:19:35,000 --> 03:19:35,560 WITH INSUFFICIENT SLEEP 5171 03:19:35,560 --> 03:19:36,160 OR SLEEP THAT IS LESS THAN 5172 03:19:36,160 --> 03:19:40,240 THE RECOMMENDED 7-8 HOURS. 5173 03:19:40,240 --> 03:19:50,760 AND SLEEP INSUFFICIENCY HAS A 5174 03:19:52,120 --> 03:19:56,360 TIGHTER CORRELATION IN WOMEN 5175 03:19:56,360 --> 03:19:57,200 THAN IN MEN ACROSS THE ADULT 5176 03:19:57,200 --> 03:19:57,520 LIFESPAN. 5177 03:19:57,520 --> 03:20:04,600 --- 5178 03:20:04,600 --> 03:20:07,160 SLEEP HAS A REGULATORY 5179 03:20:07,160 --> 03:20:10,080 INFLUENCE IN ALL MAJOR 5180 03:20:10,080 --> 03:20:16,920 PSYCHOLOGICAL SYSTEM. 5181 03:20:16,920 --> 03:20:19,120 MELATONIN IS REGULATED, THE 5182 03:20:19,120 --> 03:20:21,360 MASTER CLOCK. 5183 03:20:21,360 --> 03:20:23,440 CORTISOL, PEAKING AFTER 5184 03:20:23,440 --> 03:20:33,600 RISING. 5185 03:28:29,840 --> 03:28:30,240 >> 5186 03:28:30,240 --> 03:28:30,880 SEX/GENDER-SPECIFIC CVOID-19 5187 03:28:30,880 --> 03:28:31,480 OUTCOMES RELEVANT FOR HLBS 5188 03:28:31,480 --> 03:28:32,040 DISORDERS: FROM BENCH TO 5189 03:28:32,040 --> 03:28:42,280 BEDSIDE>> 5190 03:28:48,800 --> 03:28:59,040 >> DR. MULLINGTON: 5191 03:29:09,280 --> 03:29:13,640 >> DR. MULLINGTON: 5192 03:29:13,640 --> 03:29:15,520 THERE ARE LARGE COHORTS WE 5193 03:29:15,520 --> 03:29:16,200 NEED TO LOOK AT BIOLOGICAL, 5194 03:29:16,200 --> 03:29:23,760 SEX AND GENDER VARIABLES. 5195 03:29:23,760 --> 03:29:24,400 AND WITH REGARDS TO SLEEP WE 5196 03:29:24,400 --> 03:29:26,560 REALLY NEED TO BE ABLE TO 5197 03:29:26,560 --> 03:29:28,440 TRACK THE TIME COURSE. THERE 5198 03:29:28,440 --> 03:29:28,840 ARE REPORTS OF 5199 03:29:28,840 --> 03:29:31,120 INSOMNIA LEADING TO 5200 03:29:31,120 --> 03:29:31,680 HYPERSOMNIA. THERE'S BEEN 5201 03:29:31,680 --> 03:29:34,000 REPORTS OF CONDITIONS THAT 5202 03:29:34,000 --> 03:29:38,240 MAY BE RELATED TO 5203 03:29:38,240 --> 03:29:41,840 NEURODEGENERATIVE DISEASE, 5204 03:29:41,840 --> 03:29:42,400 REM BEHAVIOR DISORDER HAS 5205 03:29:42,400 --> 03:29:43,400 BEEN DOCUMENTED. 5206 03:29:43,400 --> 03:29:49,360 ALSO BE PREVALENT IN PASC. 5207 03:29:49,360 --> 03:29:51,880 AND THIS LEADS TO PARKINSON'S 5208 03:29:51,880 --> 03:29:52,120 DISEASE. 5209 03:29:52,120 --> 03:29:52,720 I THINK THE CONCOURSE NEEDS 5210 03:29:52,720 --> 03:29:56,560 TO BE ADDRESSED. 5211 03:29:56,560 --> 03:29:58,280 AND I THINK WE NEED TO TAKE 5212 03:29:58,280 --> 03:30:00,200 ADVANTAGE OF THE OPPORTUNITY 5213 03:30:00,200 --> 03:30:02,400 TO DEVELOP SOME BIOMARKERS SO 5214 03:30:02,400 --> 03:30:02,840 WE CAN 5215 03:30:02,840 --> 03:30:07,800 BETTER TRACK AND INVEST IN 5216 03:30:07,800 --> 03:30:10,160 PIPELINE DEVELOPMENT AND 5217 03:30:10,160 --> 03:30:11,560 COMMUNITY ENGAGEMENT. 5218 03:30:11,560 --> 03:30:16,400 WE NEED A DIVERSE WORKFORCE 5219 03:30:16,400 --> 03:30:20,680 AS WE DISCUSSED YESTERDAY OF 5220 03:30:20,680 --> 03:30:21,280 INVESTIGATORS ABLE TO REACH 5221 03:30:21,280 --> 03:30:21,800 OUT TO THE 5222 03:30:21,800 --> 03:30:24,120 COMMUNITY, AND LEAD TO A 5223 03:30:24,120 --> 03:30:25,360 BETTER SCIENTIFIC 5224 03:30:25,360 --> 03:30:27,280 UNDERSTANDING FOR ALL. 5225 03:30:27,280 --> 03:30:37,760 SO I WILL STOP THE SHARE 5226 03:32:49,680 --> 03:32:50,200 >> 5227 03:32:50,200 --> 03:32:52,240 >> DR. DELA CRUZ: 5228 03:32:52,240 --> 03:32:59,440 THERE'S BEEN SOME DIFFERENCES 5229 03:32:59,440 --> 03:33:01,680 BETWEEN THE BIOLOGICAL 5230 03:33:01,680 --> 03:33:04,280 FACTORS, AND FOR THE HUMAN 5231 03:33:04,280 --> 03:33:04,680 STUDIES WE DON'T 5232 03:33:04,680 --> 03:33:07,560 REALLY HAVE A CLEAR APPROACH 5233 03:33:07,560 --> 03:33:10,200 ESPECIALLY WITH COVID, 5234 03:33:10,200 --> 03:33:12,800 BECAUSE THERE'S MANY 5235 03:33:12,800 --> 03:33:13,320 DIFFERENT THINGS THAT 5236 03:33:13,320 --> 03:33:15,000 IMPACT. 5237 03:33:15,000 --> 03:33:23,400 FOR EXAMPLE -- ACTIVITY, ACE 5238 03:33:23,400 --> 03:33:24,000 PRECEPTORS, THE HORMONAL 5239 03:33:24,000 --> 03:33:28,880 IMPACT ITSELF ON IMMUNITY. IT 5240 03:33:28,880 --> 03:33:29,240 IS A REALLY 5241 03:33:29,240 --> 03:33:35,840 COMPLICATED SYSTEM TO DISSECT. 5242 03:33:35,840 --> 03:33:36,400 BUT GIVEN THE NUMBERS OF 5243 03:33:36,400 --> 03:33:36,880 PATIENTS THAT WE HAVE 5244 03:33:36,880 --> 03:33:38,160 EXPERIENCED, 5245 03:33:38,160 --> 03:33:41,480 THAT QUESTION CAN BE ANSWERED. 5246 03:33:41,480 --> 03:33:42,080 WE HAVE TONS OF BIOLOGICAL 5247 03:33:42,080 --> 03:33:42,880 SAMPLES FROM MULTIPLE STUDIES 5248 03:33:42,880 --> 03:33:44,480 AND CLINICAL TRIALS TO SOME 5249 03:33:44,480 --> 03:33:44,720 OF THE 5250 03:33:44,720 --> 03:33:48,680 EFFORTS WITH NIH, THE ACTIVE 5251 03:33:48,680 --> 03:33:52,960 TRIALS AND THINGS LIKE THAT. 5252 03:33:52,960 --> 03:33:53,560 IT WILL BE REALLY IMPORTANT 5253 03:33:53,560 --> 03:33:55,560 TO ADDRESS. 5254 03:33:55,560 --> 03:33:57,560 THAT AND EMERGING ARE SOME OF 5255 03:33:57,560 --> 03:33:59,000 THE IMMUNOMODULATORS AGAINST 5256 03:33:59,000 --> 03:34:02,000 CVOID-19. 5257 03:34:02,000 --> 03:34:02,640 I HEARD THROUGH THE GRAPEVINE 5258 03:34:02,640 --> 03:34:05,240 THAT SOME THE 5259 03:34:05,240 --> 03:34:07,040 IMMUNOMODULATORS STUDIES 5260 03:34:07,040 --> 03:34:07,560 POTENTIALLY HAVE SEXY 5261 03:34:07,560 --> 03:34:09,200 RESPONSE DIFFERENCES IN TERMS 5262 03:34:09,200 --> 03:34:19,520 OF THE TREATMENT, 5263 03:34:35,600 --> 03:34:36,080 AND AT THIS STAGE WE DON'T 5264 03:34:36,080 --> 03:34:37,320 KNOW THE ANSWER TO WHAT 5265 03:34:37,320 --> 03:34:41,840 YOU'RE ASKING. 5266 03:34:41,840 --> 03:34:45,080 >> DR. SILVEYRA: 5267 03:34:45,080 --> 03:34:46,760 I HAVE A QUESTION FOR DR. 5268 03:34:46,760 --> 03:34:49,320 OELSNER. 5269 03:34:49,320 --> 03:34:57,480 CAN YOU TALK ABOUT THE 5270 03:34:57,480 --> 03:34:58,120 QUALITATIVE IMAGING MARKERS 5271 03:34:58,120 --> 03:34:58,640 CORRELATE WITH CLINICAL 5272 03:34:58,640 --> 03:34:59,040 PRESENTATION AT 5273 03:34:59,040 --> 03:35:00,160 DIFFERENT TIME POINTS IN YOUR 5274 03:35:00,160 --> 03:35:00,760 STUDY AT 30 OR 90 DAYS AND 5275 03:35:00,760 --> 03:35:02,280 WHETHER YOU FIND ANY 5276 03:35:02,280 --> 03:35:02,680 DIFFERENCES IN 5277 03:35:02,680 --> 03:35:03,160 GENDER DIFFERENCES? 5278 03:35:03,160 --> 03:35:05,800 >> DR. OELSNER: 5279 03:35:05,800 --> 03:35:07,960 IT IS AN IMPORTANT QUESTION. 5280 03:35:07,960 --> 03:35:09,880 THE DATA I PRESENTED WAS VERY 5281 03:35:09,880 --> 03:35:10,400 SMALL, ONE PERSON WHO 5282 03:35:10,400 --> 03:35:11,920 REMAINED A SYMPTOMATIC, 5283 03:35:11,920 --> 03:35:13,240 THROUGHOUT SO WE 5284 03:35:13,240 --> 03:35:15,200 HIGHLIGHTED THE IMAGING THAT 5285 03:35:15,200 --> 03:35:18,960 HE CAN BE -- WITH SYMPTOMS 5286 03:35:18,960 --> 03:35:19,520 AND THERE COULD BE A LONG 5287 03:35:19,520 --> 03:35:19,920 ANSWER TO THIS 5288 03:35:19,920 --> 03:35:20,880 QUESTION. 5289 03:35:20,880 --> 03:35:24,280 INSTEAD I WANTED TO-- BECAUSE 5290 03:35:24,280 --> 03:35:24,800 I CANNOT GET THERE IN A 5291 03:35:24,800 --> 03:35:27,760 COUPLE OF MINUTES -- I WANTED 5292 03:35:27,760 --> 03:35:28,120 TO HIGHLIGHT 5293 03:35:28,120 --> 03:35:28,760 THAT THERE'S A LOT OF STUDIES 5294 03:35:28,760 --> 03:35:30,160 AND GOING, AND A LOT OF WORK 5295 03:35:30,160 --> 03:35:33,080 IT IS TO BE DONE ON THIS IN 5296 03:35:33,080 --> 03:35:33,320 SOME 5297 03:35:33,320 --> 03:35:33,960 IMPORTANT AREAS WHERE WE CAN 5298 03:35:33,960 --> 03:35:37,320 DO THAT WORK WHICH IS WITH 5299 03:35:37,320 --> 03:35:37,960 THE RECOVER INITIATIVE WHICH 5300 03:35:37,960 --> 03:35:40,800 OTHERS 5301 03:35:40,800 --> 03:35:41,360 MENTIONED, DOING REPEAT 5302 03:35:41,360 --> 03:35:44,880 IMAGING AFTER ACUTE ILLNESS. 5303 03:35:44,880 --> 03:35:45,480 WE ARE REALLY GOING TO NEED 5304 03:35:45,480 --> 03:35:48,160 TO SEPARATE MORE SEVERE LESS 5305 03:35:48,160 --> 03:35:48,720 SEVERE AND ACUTE ILLNESS 5306 03:35:48,720 --> 03:35:49,280 UNDERSTAND THE 5307 03:35:49,280 --> 03:35:49,920 DIFFERENCE WITH WHAT HAS BEEN 5308 03:35:49,920 --> 03:35:54,440 SEEN WITH MANY ACUTE LUNG 5309 03:35:54,440 --> 03:35:59,320 CASES POST ALI FIBROSIS 5310 03:35:59,320 --> 03:35:59,720 BECAUSE MANY THAT 5311 03:35:59,720 --> 03:36:00,320 IS MEDICAL WITH SPECIFIC 5312 03:36:00,320 --> 03:36:01,320 PROCESS VERSUS THINGS THAT 5313 03:36:01,320 --> 03:36:05,480 ARE SUCH AS SARS COV-2. 5314 03:36:05,480 --> 03:36:08,520 AND WE CAN MAKE A LOT OF 5315 03:36:08,520 --> 03:36:09,120 HYPOTHESES IN OUR UPCOMING 5316 03:36:09,120 --> 03:36:09,760 BRAINSTORMING SESSIONS AND IN 5317 03:36:09,760 --> 03:36:12,160 ADDITION TO THE 5318 03:36:12,160 --> 03:36:15,640 RECOVERY, C4R PARTICIPATES IN 5319 03:36:15,640 --> 03:36:19,040 THE RECOVERY AND HAS IMAGING 5320 03:36:19,040 --> 03:36:21,280 BIO BANK. 5321 03:36:21,280 --> 03:36:24,160 AND IN SOME OF THESE SUBTLE 5322 03:36:24,160 --> 03:36:26,440 CASES WHERE PEOPLE ARE NOT SO 5323 03:36:26,440 --> 03:36:27,080 ASYMPTOMATIC, WE NEED TO KNOW 5324 03:36:27,080 --> 03:36:27,600 WHETHER 5325 03:36:27,600 --> 03:36:33,560 SOME ABNORMALITY OF FIBROSIS 5326 03:36:33,560 --> 03:36:42,560 OR AIRWAY DISEASE OR AIRWAY 5327 03:36:42,560 --> 03:36:43,160 DISEASE WAS PRESENT BEFORE 5328 03:36:43,160 --> 03:36:43,400 COVID 5329 03:36:43,400 --> 03:36:44,000 INFECTION THEREFORE BETTER 5330 03:36:44,000 --> 03:36:48,080 LOOK THAT BEFORE THE ILLNESS 5331 03:36:48,080 --> 03:36:51,560 VERSUS SEQUELAE OF THE 5332 03:36:51,560 --> 03:36:51,960 ILLNESS AND ALL 5333 03:36:51,960 --> 03:36:52,520 THIS NEEDS TO BE ASSESSED 5334 03:36:52,520 --> 03:36:54,920 INTENTIONALLY. 5335 03:36:54,920 --> 03:36:57,080 >> DR. SILVEYRA: 5336 03:36:57,080 --> 03:36:59,800 I HAVE TWO QUESTIONS FOR DR. 5337 03:36:59,800 --> 03:37:02,520 ODUKA. 5338 03:37:02,520 --> 03:37:07,320 IF YOU'RE ABLE TO OBSERVE 5339 03:37:07,320 --> 03:37:07,920 MICRO THROMBOSIS IN THE MODEL 5340 03:37:07,920 --> 03:37:08,560 AND THE SECOND QUESTION COMES 5341 03:37:08,560 --> 03:37:08,800 AFTER 5342 03:37:08,800 --> 03:37:10,560 LISTENING TO THE LAST TALK. 5343 03:37:10,560 --> 03:37:12,960 HAVE YOU MEASURED ANY STRESS 5344 03:37:12,960 --> 03:37:13,560 MARKERS IN THE BLOOD OF THE 5345 03:37:13,560 --> 03:37:14,920 ANIMALS WERE IDENTIFIED ANY 5346 03:37:14,920 --> 03:37:15,240 BEHAVIORAL 5347 03:37:15,240 --> 03:37:15,640 SLEEP PATTERNS? 5348 03:37:15,640 --> 03:37:25,920 >> DR. OKUDA: 5349 03:37:27,840 --> 03:37:31,680 WE LOOKED AT THE HISTORY OF 5350 03:37:31,680 --> 03:37:35,600 THE LONG AND DID NOT FIND 5351 03:37:35,600 --> 03:37:36,200 DIRECT MICRO THROMBOSIS IN 5352 03:37:36,200 --> 03:37:37,240 THE LUNG BUT WE 5353 03:37:37,240 --> 03:37:40,560 DID NOT STUDY ANY OTHER 5354 03:37:40,560 --> 03:37:41,160 ORGANS. IT IS POSSIBLE THAT 5355 03:37:41,160 --> 03:37:41,680 THERE COULD BE MICRO 5356 03:37:41,680 --> 03:37:42,240 THROMBOSIS IN SOME OTHER 5357 03:37:42,240 --> 03:37:42,680 ORGAN. 5358 03:37:42,680 --> 03:37:45,760 >> DR. SILVEYRA: 5359 03:37:45,760 --> 03:37:48,000 REGARDING BLOOD BIOMARKERS 5360 03:37:48,000 --> 03:37:48,560 FOR STRESS OR ANYTHING? 5361 03:37:48,560 --> 03:37:55,400 >> DR. OKUDA: 5362 03:37:55,400 --> 03:37:57,640 WE HAVE NOT CHECKED THE 5363 03:37:57,640 --> 03:38:02,000 (INDISCERNIBLE) IN THE BLOOD 5364 03:38:02,000 --> 03:38:03,640 SERUM, AND IN THE REGULAR 5365 03:38:03,640 --> 03:38:04,880 (INDISCERNIBLE), 5366 03:38:04,880 --> 03:38:08,600 ARE UPREGULATED AS EXPECTED. 5367 03:38:08,600 --> 03:38:15,160 THERE ARE DIFFERENCES IN THE 5368 03:38:15,160 --> 03:38:15,800 AGE BUT WE HAVE NOT FOUND SEX 5369 03:38:15,800 --> 03:38:17,080 DIFFERENCES. 5370 03:38:17,080 --> 03:38:17,880 BUT IT IS A GREAT IDEA. 5371 03:38:17,880 --> 03:38:23,160 >> DR. SILVEYRA: 5372 03:38:23,160 --> 03:38:30,040 THANK YOU. THEY'RE INTERESTED 5373 03:38:30,040 --> 03:38:30,640 IN YOUR TALK ABOUT POSSIBLE 5374 03:38:30,640 --> 03:38:31,280 BIOLOGICAL EFFECTS ASSOCIATED 5375 03:38:31,280 --> 03:38:31,640 WITH SLEEP 5376 03:38:31,640 --> 03:38:34,640 DEPRIVATION DR. MULLINGTON. 5377 03:38:34,640 --> 03:38:36,120 FOR CAREGIVERS, SOCIAL 5378 03:38:36,120 --> 03:38:36,920 WORKERS, ETC. 5379 03:38:36,920 --> 03:38:40,480 >> DR. MULLINGTON: 5380 03:38:40,480 --> 03:38:40,960 ACTUALLY, THAT IS AN 5381 03:38:40,960 --> 03:38:41,720 IMPORTANT AREA TO UNDERSTAND 5382 03:38:41,720 --> 03:38:43,760 PARTICULARLY WHEN WE ARE 5383 03:38:43,760 --> 03:38:45,600 TALKING ABOUT SEX AND 5384 03:38:45,600 --> 03:38:51,680 GENDER. 5385 03:38:51,680 --> 03:38:55,800 AND IT IS KNOWN THAT SHIFT 5386 03:38:55,800 --> 03:39:04,040 WORK INCREASES YOUR 5387 03:39:04,040 --> 03:39:07,320 VULNERABILITY TO A NUMBER OF 5388 03:39:07,320 --> 03:39:07,800 DISEASES, METABOLIC 5389 03:39:07,800 --> 03:39:09,680 AND CANCER RELATED DISEASES. 5390 03:39:09,680 --> 03:39:17,720 AND THIS MAY BE DUE TO 5391 03:39:17,720 --> 03:39:18,360 SHIFTING AND DISREGULATION OF 5392 03:39:18,360 --> 03:39:20,080 THE CIRCADIAN 5393 03:39:20,080 --> 03:39:20,560 SYSTEM, BUT ALSO THE 5394 03:39:20,560 --> 03:39:23,360 IRREGULARITY OF THE SLEEP 5395 03:39:23,360 --> 03:39:24,080 PERIOD CAUSES DYSREGULATION 5396 03:39:24,080 --> 03:39:29,360 OF THE CIRCADIAN 5397 03:39:29,360 --> 03:39:29,880 RHYTHMS; IT MAKES IT 5398 03:39:29,880 --> 03:39:30,680 DIFFICULT FOR THOSE RHYTHMS 5399 03:39:30,680 --> 03:39:37,120 TO ALIGN AND OPTIMALLY 5400 03:39:37,120 --> 03:39:38,240 SUPPORT HEALTH. 5401 03:39:38,240 --> 03:39:38,840 AND THIS IS FREQUENTLY SEEN 5402 03:39:38,840 --> 03:39:42,840 IN SHIFTWORK BUT ALSO IN 5403 03:39:42,840 --> 03:39:43,480 CONDITIONS WHERE PEOPLE HAVE 5404 03:39:43,480 --> 03:39:44,280 TO WORK LONG 5405 03:39:44,280 --> 03:39:45,600 HOURS OR DON'T HAVE ADEQUATE 5406 03:39:45,600 --> 03:39:48,720 OPPORTUNITY FOR SAFE SLEEP. 5407 03:39:48,720 --> 03:39:52,720 AND AS IN SOME COMMUNITIES 5408 03:39:52,720 --> 03:39:57,480 WHERE THERE ARE FRONT LINES, 5409 03:39:57,480 --> 03:39:58,840 THIS IS A VERY IMPORTANT AREA 5410 03:39:58,840 --> 03:40:00,000 FOR FURTHER 5411 03:40:00,000 --> 03:40:00,400 INVESTIGATION. 5412 03:40:00,400 --> 03:40:01,680 --- 5413 03:40:01,680 --> 03:40:07,640 ALSO, FOR NEW PARENTS, THIS 5414 03:40:07,640 --> 03:40:08,600 IS A COMMON STRUGGLE. 5415 03:40:08,600 --> 03:40:09,800 >> DR. SILVEYRA: 5416 03:40:09,800 --> 03:40:13,800 THANK YOU. 5417 03:40:13,800 --> 03:40:17,920 THERE IS A SIMILAR QUESTION 5418 03:40:17,920 --> 03:40:20,760 ABOUT WHETHER THESE SLEEP 5419 03:40:20,760 --> 03:40:21,520 DISTURBANCES ARE SIMILAR OR 5420 03:40:21,520 --> 03:40:21,960 DIFFERENT TO 5421 03:40:21,960 --> 03:40:23,120 (INDISCERNIBLE). 5422 03:40:23,120 --> 03:40:24,720 >> DR. MULLINGTON: 5423 03:40:24,720 --> 03:40:25,360 WHAT WAS THE LAST PART OF THE 5424 03:40:25,360 --> 03:40:25,680 QUESTION? 5425 03:40:25,680 --> 03:40:27,840 >> DR. SILVEYRA: 5426 03:40:27,840 --> 03:40:29,200 HOW SIMILAR THEY ARE WITH 5427 03:40:29,200 --> 03:40:32,880 PATIENTS THAT SUFFER FROM 5428 03:40:32,880 --> 03:40:33,360 POST SEPSIS SYNDROME 5429 03:40:33,360 --> 03:40:33,960 (PHONETIC)? 5430 03:40:33,960 --> 03:40:37,400 >> DR. MULLINGTON: 5431 03:40:37,400 --> 03:40:41,600 SO WHAT WE ARE SEEING WITH 5432 03:40:41,600 --> 03:40:45,800 THE COMPLAINTS OF-- SLEEP 5433 03:40:45,800 --> 03:40:47,960 CONCERNS-- IS A LOT OF 5434 03:40:47,960 --> 03:40:48,320 INSOMNIA AND 5435 03:40:48,320 --> 03:40:51,840 DISRUPTION OF SLEEP 5436 03:40:51,840 --> 03:40:54,400 FRAGMENTATION. 5437 03:40:54,400 --> 03:40:55,000 THIS PREVENTS CONSOLIDATED 5438 03:40:55,000 --> 03:40:59,480 SLEEP NEEDED TO DO THE 5439 03:40:59,480 --> 03:41:00,800 LYMPHATIC CLEARANCE, THE 5440 03:41:00,800 --> 03:41:01,240 CONSOLIDATION OF 5441 03:41:01,240 --> 03:41:07,960 LEARNING AND MEMORY. 5442 03:41:07,960 --> 03:41:09,120 WE NEED A CERTAIN AMOUNT OF 5443 03:41:09,120 --> 03:41:12,240 CONSOLIDATED SLEEP. 5444 03:41:12,240 --> 03:41:12,880 FRAGMENTATION OF SLEEP CAUSES 5445 03:41:12,880 --> 03:41:23,200 AN INABILITY TO 5446 03:41:24,080 --> 03:41:24,480 REGULATE HOMEOSTATIC 5447 03:41:24,480 --> 03:41:33,320 FUNCTIONS. 5448 03:41:33,320 --> 03:41:33,840 WHAT WE ARE NOTICING IS 5449 03:41:33,840 --> 03:41:34,320 INSOMNIA MAY LEAD TO 5450 03:41:34,320 --> 03:41:36,520 HYPERSOMNIA; WE KNOW THAT 5451 03:41:36,520 --> 03:41:37,160 FATIGUE IS INCREASED IN 5452 03:41:37,160 --> 03:41:38,760 PATIENTS THAT HAVE SLEEP 5453 03:41:38,760 --> 03:41:39,280 DISTURBANCES BUT ALSO 5454 03:41:39,280 --> 03:41:40,040 INSOMNIA. 5455 03:41:40,040 --> 03:41:41,720 --- 5456 03:41:41,720 --> 03:41:44,800 ONE THING THAT HAS BEEN 5457 03:41:44,800 --> 03:41:47,040 REPORTED, OR HAS BEEN NOTED 5458 03:41:47,040 --> 03:41:49,080 CLINICALLY IS INCREASED 5459 03:41:49,080 --> 03:41:51,560 COMPLAINTS OF DAYTIME 5460 03:41:51,560 --> 03:41:52,280 SLEEPINESS AND ONSETS WHICH 5461 03:41:52,280 --> 03:42:00,760 MAY INDICATE CHANGES IN THE 5462 03:42:00,760 --> 03:42:01,400 CNS; REM ONSETS ARE NORMALLY 5463 03:42:01,400 --> 03:42:04,040 JUST SEEN IN 5464 03:42:04,040 --> 03:42:07,000 NARCOLEPSY. AND THE REM 5465 03:42:07,000 --> 03:42:11,160 BEHAVIOR DISORDER, THE 5466 03:42:11,160 --> 03:42:12,840 INCREASING NIGHTMARES ARE 5467 03:42:12,840 --> 03:42:13,640 ALSO SYMPTOMS THAT 5468 03:42:13,640 --> 03:42:14,040 WARRANT FURTHER 5469 03:42:14,040 --> 03:42:14,440 INVESTIGATION. 5470 03:42:14,440 --> 03:42:15,520 >> DR. SILVEYRA: 5471 03:42:15,520 --> 03:42:17,120 THANK YOU. 5472 03:42:17,120 --> 03:42:20,440 I HAVE ONE MORE QUESTION. 5473 03:42:20,440 --> 03:42:22,520 IT COULD BE FOR DR. DELA CRUZ 5474 03:42:22,520 --> 03:42:28,000 OR OTHERS. 5475 03:42:28,000 --> 03:42:28,560 THE PERSON WHO AFTER HIS 5476 03:42:28,560 --> 03:42:29,360 WONDERING WHY THERE IS SUCH A 5477 03:42:29,360 --> 03:42:37,360 FOCUS ON DLR7 AND NOT DLR8 AS 5478 03:42:37,360 --> 03:42:37,720 BOTH ARE IN 5479 03:42:37,720 --> 03:42:40,680 THE X CHROMOSOMES. 5480 03:42:40,680 --> 03:42:41,280 AND ALSO THE FACT THAT THE 5481 03:42:41,280 --> 03:42:42,720 PRIMARY INTERFERON RESPONSES 5482 03:42:42,720 --> 03:42:45,480 ALMOST NONEXISTENT IN HUMAN 5483 03:42:45,480 --> 03:42:49,000 LUNGS AND THE 5484 03:42:49,000 --> 03:42:49,640 DLR7 MAY NOT BE INACTIVATED 5485 03:42:49,640 --> 03:42:54,000 DUE TO DLR8. 5486 03:42:54,000 --> 03:42:55,000 CAN ANYBODY COMMENT ON THIS? 5487 03:42:55,000 --> 03:42:56,360 >> DR. DELA CRUZ: 5488 03:42:56,360 --> 03:42:57,000 THAT IS A GREAT QUESTION AND 5489 03:42:57,000 --> 03:43:01,160 I SUSPECT THAT THE TLR7 FOCUS 5490 03:43:01,160 --> 03:43:02,680 IS BEEN SHOWN IN INDIVIDUALS 5491 03:43:02,680 --> 03:43:03,680 WHO HAVE 5492 03:43:03,680 --> 03:43:13,120 HAD GENETIC MUTATION IN SOME 5493 03:43:13,120 --> 03:43:13,720 OF THESE PATHWAYS, INCLUDING 5494 03:43:13,720 --> 03:43:18,720 SOME OF THE OTHER TLR ANOTHER 5495 03:43:18,720 --> 03:43:20,960 INTERFERENCE AS WELL AND THE 5496 03:43:20,960 --> 03:43:25,200 ROLE OF TLR7 IS PROBABLY MORE 5497 03:43:25,200 --> 03:43:27,040 LOCAL FROM THE NASAL PASSAGES 5498 03:43:27,040 --> 03:43:27,320 IN THE 5499 03:43:27,320 --> 03:43:28,440 UPPER AIRWAY FOR SOME EARLY 5500 03:43:28,440 --> 03:43:30,600 PROTECTION I SUSPECT. 5501 03:43:30,600 --> 03:43:31,640 PART OF THE REASON WE HAVE 5502 03:43:31,640 --> 03:43:33,440 NOT LOOKED AT THE ROLE OF THE 5503 03:43:33,440 --> 03:43:39,120 OTHER TLRS INCLUDING TLR7 AS 5504 03:43:39,120 --> 03:43:39,480 POINTED OUT 5505 03:43:39,480 --> 03:43:40,080 BY YOUR PARTICIPANT IS THAT 5506 03:43:40,080 --> 03:43:47,600 WE DON'T HAVE A LOT OF 5507 03:43:47,600 --> 03:43:48,120 BRONCHOSCOPIES ON THESE 5508 03:43:48,120 --> 03:43:49,120 PATIENTS AND SO IN SOME 5509 03:43:49,120 --> 03:43:50,760 INSTITUTIONS THEY HAVE DONE 5510 03:43:50,760 --> 03:44:01,280 THAT MORE THAN OTHERS TO LOOK 5511 03:44:03,520 --> 03:44:04,000 FOR CONGENIC SUSCEPTIBILITY 5512 03:44:04,000 --> 03:44:04,360 OF SOME OF 5513 03:44:04,360 --> 03:44:10,760 THESE CASES. 5514 03:44:10,760 --> 03:44:12,680 WOULD WE HAVE AUTOPSY 5515 03:44:12,680 --> 03:44:13,280 SAMPLES, THE GENETIC 5516 03:44:13,280 --> 03:44:18,040 EXPRESSION IN TERMS OF MRNA, 5517 03:44:18,040 --> 03:44:18,560 PROTEIN EXPRESSIONS ARE 5518 03:44:18,560 --> 03:44:20,280 ALTERED BY OTHER THINGS SO IS 5519 03:44:20,280 --> 03:44:23,960 HARD TO TEASE THAT APART. 5520 03:44:23,960 --> 03:44:24,560 I THINK PRIMARILY A LOT OF IT 5521 03:44:24,560 --> 03:44:26,360 IS DRIVEN BY SOME OF THE 5522 03:44:26,360 --> 03:44:27,640 GENETIC ANALYSIS INITIALLY 5523 03:44:27,640 --> 03:44:28,760 FOR PATIENTS WHO 5524 03:44:28,760 --> 03:44:31,200 HAVE KNOWN MUTATIONS FROM 5525 03:44:31,200 --> 03:44:31,920 THIS ASSOCIATION. 5526 03:44:31,920 --> 03:44:34,440 >> DR. SILVEYRA: 5527 03:44:34,440 --> 03:44:37,000 THANK YOU SO MUCH. 5528 03:44:37,000 --> 03:44:37,680 UNFORTUNATELY WE HAVE TO WRAP 5529 03:44:37,680 --> 03:44:39,360 UP. 5530 03:44:39,360 --> 03:44:41,560 I WANT TO THANK ALL THE 5531 03:44:41,560 --> 03:44:42,160 SPEAKERS IN THE SESSION AND 5532 03:44:42,160 --> 03:44:42,640 THE AUDIENCE FOR THE 5533 03:44:42,640 --> 03:44:44,080 WONDERFUL QUESTIONS. 5534 03:44:44,080 --> 03:44:46,160 THIS WAS VERY INTERESTING, 5535 03:44:46,160 --> 03:44:48,720 AND WE LEARNED A LOT. 5536 03:44:48,720 --> 03:44:52,880 >> THANK YOU SO MUCH DR. 5537 03:44:52,880 --> 03:44:53,400 SYLVEIRA AND ALL OF THE 5538 03:44:53,400 --> 03:44:57,160 PANELISTS. 5539 03:44:57,160 --> 03:44:57,760 IT WAS A DYNAMITE DISCUSSION 5540 03:44:57,760 --> 03:44:59,080 AND THE CONVERSATION STARTED 5541 03:44:59,080 --> 03:45:00,360 TO ENCOMPASS BROADER CONCEPTS 5542 03:45:00,360 --> 03:45:04,560 THEN LUNG 5543 03:45:04,560 --> 03:45:05,160 AND SLEEP DISORDERS SO THIS 5544 03:45:05,160 --> 03:45:05,800 WILL BE QUITE AN INTERESTING 5545 03:45:05,800 --> 03:45:06,440 BREAKOUT SESSION THAT WE HAVE 5546 03:45:06,440 --> 03:45:08,280 AS WELL. 5547 03:45:08,280 --> 03:45:08,800 I WOULD LIKE TO REMIND 5548 03:45:08,800 --> 03:45:10,840 EVERYONE THAT WE HAVE HAD A 5549 03:45:10,840 --> 03:45:12,400 SLIGHT CHANGE IN SCHEDULE TO 5550 03:45:12,400 --> 03:45:13,760 SMOOTHEN THE FLOW 5551 03:45:13,760 --> 03:45:16,000 HERE. 5552 03:45:16,000 --> 03:45:18,160 NEXT I WILL GIVE A SUMMARY 5553 03:45:18,160 --> 03:45:19,880 OF-- OR WILL TRY TO 5554 03:45:19,880 --> 03:45:20,480 SUMMARIZE-- SOME ASPECTS OF 5555 03:45:20,480 --> 03:45:21,000 WHAT WE HAVE DISCUSSED 5556 03:45:21,000 --> 03:45:24,720 TO DAY ON DAY 2. 5557 03:45:24,720 --> 03:45:25,240 AND THEN WILL HAVE A 45 5558 03:45:25,240 --> 03:45:26,640 MINUTE DISCUSSION IN THE 5559 03:45:26,640 --> 03:45:32,960 BREAKOUT SESSIONS AND TAKE A 5560 03:45:32,960 --> 03:45:33,400 10-MIN. BREAK AND 5561 03:45:33,400 --> 03:45:33,960 THEN COME BACK TO HAVE 5562 03:45:33,960 --> 03:45:34,560 ANOTHER 45 MINUTE DISCUSSION 5563 03:45:34,560 --> 03:45:40,200 TO REPORT SOME OF THE 5564 03:45:40,200 --> 03:45:40,720 FINDINGS AND WE HAVE 5565 03:45:40,720 --> 03:45:41,400 BOTH GROUPS FROM THE BREAKOUT 5566 03:45:41,400 --> 03:45:43,000 SESSIONS CROSS POLLINATING 5567 03:45:43,000 --> 03:45:43,600 IDEAS AND FIGURE OUT WHAT 5568 03:45:43,600 --> 03:45:43,840 FUTURE 5569 03:45:43,840 --> 03:45:44,360 DIRECTIONS MIGHT BE. 5570 03:45:44,360 --> 03:45:51,280 X SO I WILL START BY SHARING 5571 03:45:51,280 --> 03:45:54,880 SOME SLIDES, SPECIFICALLY 5572 03:45:54,880 --> 03:45:58,320 ABOUT THE SESSIONS. 5573 03:45:58,320 --> 03:46:00,240 AND BEFORE WE SUMMARIZE, I 5574 03:46:00,240 --> 03:46:03,080 WANT TO FOREMOST THANK OUR 5575 03:46:03,080 --> 03:46:03,640 PATIENTS WILL SHARE THEIR 5576 03:46:03,640 --> 03:46:06,960 EXPENSES WITHOUT. 5577 03:46:06,960 --> 03:46:12,600 I THINK WE CAN ALL 5578 03:46:12,600 --> 03:46:13,200 ACKNOWLEDGE THE STRENGTH OF 5579 03:46:13,200 --> 03:46:13,800 WHICH THEY PROVIDED THEIR 5580 03:46:13,800 --> 03:46:20,800 INPUT. 5581 03:46:20,800 --> 03:46:21,400 IT IS AN HONOR THAT THEY'RE 5582 03:46:21,400 --> 03:46:24,720 SHARING THE VOICE AND INPUT. 5583 03:46:24,720 --> 03:46:25,360 THERE INSIGHT AND INPUT WILL 5584 03:46:25,360 --> 03:46:26,680 INFORM THE DIRECTION OF 5585 03:46:26,680 --> 03:46:27,560 RESEARCH AS WE SEEK TO TRY TO 5586 03:46:27,560 --> 03:46:27,960 UNDERSTAND THE 5587 03:46:27,960 --> 03:46:30,240 BIOLOGIC AND NONBIOLOGICAL 5588 03:46:30,240 --> 03:46:33,400 SEX AND GENDER RELATED 5589 03:46:33,400 --> 03:46:34,000 FACTORS THAT INFLUENCE THIS 5590 03:46:34,000 --> 03:46:35,640 DISEASE BOTH COVID 5591 03:46:35,640 --> 03:46:38,400 AND THE POSTACUTE SEQUELAE OF 5592 03:46:38,400 --> 03:46:38,960 COVID. 5593 03:46:38,960 --> 03:46:40,040 --- 5594 03:46:40,040 --> 03:46:42,040 TODAY WE STARTED WITH SESSION 5595 03:46:42,040 --> 03:46:45,160 4 WHERE WE HAD A NUMBER OF 5596 03:46:45,160 --> 03:46:49,880 LUMINARY SPEAKERS WHO TALK 5597 03:46:49,880 --> 03:46:50,120 ABOUT 5598 03:46:50,120 --> 03:46:50,920 CARDIOVASCULAR AND METABOLIC 5599 03:46:50,920 --> 03:46:57,240 ASPECTS OF COVID AND 5600 03:46:57,240 --> 03:47:01,560 POST-ACUTE COVID. FIRST 5601 03:47:01,560 --> 03:47:02,480 DESCRIBING SEX DIFFERENCES IN 5602 03:47:02,480 --> 03:47:03,080 PRE-EXISTING CARDIOVASCULAR 5603 03:47:03,080 --> 03:47:05,800 DISEASE DO IMPACT COVID 5604 03:47:05,800 --> 03:47:06,200 OUTCOMES UNDER 5605 03:47:06,200 --> 03:47:08,720 OUR SEX DIFFERENCES IN THE 5606 03:47:08,720 --> 03:47:09,120 IMMUNO BIOLOGY OF 5607 03:47:09,120 --> 03:47:12,360 CARDIOVASCULAR AND LET THIS 5608 03:47:12,360 --> 03:47:12,960 IS A VERY BY CONTEXT AND 5609 03:47:12,960 --> 03:47:15,800 BY AGE. 5610 03:47:15,800 --> 03:47:21,080 WE SEE THAT THERE IS A COMMON 5611 03:47:21,080 --> 03:47:22,920 THEME THAT POPS UP ACROSS ALL 5612 03:47:22,920 --> 03:47:23,320 ORGAN SYSTEMS. 5613 03:47:23,320 --> 03:47:27,120 --- 5614 03:47:27,120 --> 03:47:37,640 COVID CAN BE A STRESS TEST 5615 03:47:46,480 --> 03:47:46,880 LINCOLN SUB MASK SOME 5616 03:47:46,880 --> 03:47:47,480 CLINICAL DISEASE OR IT CAN 5617 03:47:47,480 --> 03:47:47,920 TRIGGER DE NOVO 5618 03:47:47,920 --> 03:47:58,080 DISEASE 5619 03:47:58,840 --> 03:47:59,280 Q LIKE ACUTE VENOUS AND 5620 03:47:59,280 --> 03:48:05,760 ARTERIAL THROMBOSIS. 5621 03:48:05,760 --> 03:48:06,360 --- IN THE FIRST WAY THERE 5622 03:48:06,360 --> 03:48:07,000 WAS A LOT OF GREAT WORK THAT 5623 03:48:07,000 --> 03:48:08,280 HAPPENED AND IN THE SECOND 5624 03:48:08,280 --> 03:48:08,680 WAVE THERE WAS 5625 03:48:08,680 --> 03:48:09,320 ALSO SOME WORK THAT HAPPENED 5626 03:48:09,320 --> 03:48:09,960 BUT IN THE THIRD WAVE WE ARE 5627 03:48:09,960 --> 03:48:11,360 GETTING PERHAPS A LITTLE BIT 5628 03:48:11,360 --> 03:48:12,320 OF COVID 5629 03:48:12,320 --> 03:48:17,720 FATIGUE IT STARTS TO SET IN 5630 03:48:17,720 --> 03:48:18,960 ON ALL SIDES OF DISCUSSION WE 5631 03:48:18,960 --> 03:48:19,600 NEED TO KEEP ATTENTION TO IT 5632 03:48:19,600 --> 03:48:19,880 BECAUSE 5633 03:48:19,880 --> 03:48:20,520 THERE ARE OTHER FACTORS THAT 5634 03:48:20,520 --> 03:48:21,960 COME INTO PLAY, NOT JUST WITH 5635 03:48:21,960 --> 03:48:32,320 A VARIANCE BUT ALSO 5636 03:48:32,320 --> 03:48:32,640 UNDERLINING 5637 03:48:32,640 --> 03:48:33,240 COMORBIDITIES OR DISEASES 5638 03:48:33,240 --> 03:48:33,760 THAT CAST ILLNESS THAT 5639 03:48:33,760 --> 03:48:34,360 MANIFEST IN DIFFERENT WAYS. 5640 03:48:34,360 --> 03:48:35,240 --- 5641 03:48:35,240 --> 03:48:37,280 WE NEED TO HAVE ACCURATE 5642 03:48:37,280 --> 03:48:39,760 DIAGNOSIS OF CARDIOVASCULAR 5643 03:48:39,760 --> 03:48:40,320 DISEASE AND THAT REQUIRES 5644 03:48:40,320 --> 03:48:40,760 BOTH APPROPRIATE 5645 03:48:40,760 --> 03:48:42,280 TESTING MODALITIES, WHETHER 5646 03:48:42,280 --> 03:48:44,800 BIOLOGIC OR IMAGING BASED. 5647 03:48:44,800 --> 03:48:45,320 AND WE NEED APPROPRIATE 5648 03:48:45,320 --> 03:48:46,200 CONTROLS IN ORDER TO BE ABLE 5649 03:48:46,200 --> 03:48:49,240 TO DRAW CORRECT CONCLUSIONS. 5650 03:48:49,240 --> 03:48:50,880 --- 5651 03:48:50,880 --> 03:48:51,560 WE HEARD A FEW DIFFERENT 5652 03:48:51,560 --> 03:48:56,200 SIDES OF MYOCARDITIS, 5653 03:48:56,200 --> 03:48:58,640 STRESS-RELATED 5654 03:48:58,640 --> 03:48:59,800 CARDIOMYOPATHY; ALSO DILATED 5655 03:48:59,800 --> 03:49:10,280 CARDIOMYOPATHY FROM OTHER 5656 03:49:11,160 --> 03:49:13,160 ETIOLOGY THAT CAN VARY BY 5657 03:49:13,160 --> 03:49:14,000 DIFFERENT SEVERITIES, AND 5658 03:49:14,000 --> 03:49:15,400 THERE IS CLINICAL 5659 03:49:15,400 --> 03:49:15,920 DIFFERENCES SUPPORT SEX 5660 03:49:15,920 --> 03:49:16,600 DIFFERENCES IN MYOCARDITIS 5661 03:49:16,600 --> 03:49:21,360 MORE COMMON IN SEVERE COVID. 5662 03:49:21,360 --> 03:49:21,840 AND WE HEARD ABOUT 5663 03:49:21,840 --> 03:49:24,520 TRAUMATIC INFARCT IN UP TO 5664 03:49:24,520 --> 03:49:32,800 1/4 OF THE PATIENTS WITH 5665 03:49:32,800 --> 03:49:33,440 SEVERE COVID THAT CAN LEAD TO 5666 03:49:33,440 --> 03:49:33,840 SCAR TISSUE AND 5667 03:49:33,840 --> 03:49:37,800 WE NEED TO HAVE A FIRST AND 5668 03:49:37,800 --> 03:49:40,920 SUPPORT NEEDED TO CONTRIBUTE 5669 03:49:40,920 --> 03:49:41,880 DATA TO UNMASK THIS DISEASE. 5670 03:49:41,880 --> 03:49:43,720 --- 5671 03:49:43,720 --> 03:49:45,880 WE ALSO HEARD ABOUT POSTACUTE 5672 03:49:45,880 --> 03:49:48,000 COVID DISPROPORTIONATELY 5673 03:49:48,000 --> 03:49:50,320 AFFECTING FEMALES. 5674 03:49:50,320 --> 03:49:50,920 AND THESE COMPLICATIONS THAT 5675 03:49:50,920 --> 03:49:52,400 COME WITH IT ARE OFTEN 5676 03:49:52,400 --> 03:49:54,280 MANIFESTED WITH VASCULAR, 5677 03:49:54,280 --> 03:49:56,320 NEUROVASCULAR 5678 03:49:56,320 --> 03:49:56,880 DYSFUNCTION, PERSISTENT 5679 03:49:56,880 --> 03:49:58,360 IMMUNE ACTIVATION ALTHOUGH 5680 03:49:58,360 --> 03:50:01,280 THERE MAY BE NUANCES TO THIS. 5681 03:50:01,280 --> 03:50:06,800 THERE IS DISCUSSION ABOUT 5682 03:50:06,800 --> 03:50:07,400 COAGULOPATHY AND THE DATA IS 5683 03:50:07,400 --> 03:50:08,040 STILL MIXED IN THIS SPACE BUT 5684 03:50:08,040 --> 03:50:08,400 IT IS WORTH 5685 03:50:08,400 --> 03:50:08,800 INVESTIGATING. 5686 03:50:08,800 --> 03:50:09,600 --- 5687 03:50:09,600 --> 03:50:20,080 WE HEARD FROM -- AND THE 5688 03:50:20,480 --> 03:50:21,680 INCIDENCE MAY BE EXACERBATED 5689 03:50:21,680 --> 03:50:23,840 IN COVID BUT THERE IS A 5690 03:50:23,840 --> 03:50:24,280 DISTINCT LACK OF 5691 03:50:24,280 --> 03:50:26,400 STUDIES ON THE MECHANISM, 5692 03:50:26,400 --> 03:50:27,040 TREATMENT AND TRAFFIC WE NEED 5693 03:50:27,040 --> 03:50:29,560 TO ADVANCE TO UNDERSTAND AND 5694 03:50:29,560 --> 03:50:29,920 MANAGE THE 5695 03:50:29,920 --> 03:50:32,160 DISEASE BETTER. 5696 03:50:32,160 --> 03:50:33,200 AND THEN WE HAD A 5697 03:50:33,200 --> 03:50:34,160 CONVERSATION ABOUT 5698 03:50:34,160 --> 03:50:35,880 MULTIDISCIPLINARY COORDINATED 5699 03:50:35,880 --> 03:50:36,480 CARE WITH ALL STAKEHOLDERS 5700 03:50:36,480 --> 03:50:36,720 THAT 5701 03:50:36,720 --> 03:50:39,680 IS IMPORTANT IN ALL OF THIS 5702 03:50:39,680 --> 03:50:40,480 DISEASE MANIFESTATIONS IN 5703 03:50:40,480 --> 03:50:45,880 ORDER TO MAKE BREAKERS AND WE 5704 03:50:45,880 --> 03:50:46,240 HEAR ABOUT 5705 03:50:46,240 --> 03:50:51,560 THIS IN CLINIC THAT EXPLORE 5706 03:50:51,560 --> 03:50:55,680 IMMUNO BIOLOGY, AUTONOMIC 5707 03:50:55,680 --> 03:50:56,160 DYSFUNCTION ACROSS 5708 03:50:56,160 --> 03:50:56,720 DISCIPLINES THAT ALLOW US 5709 03:50:56,720 --> 03:50:58,840 TO BRING TOGETHER DIFFERENT 5710 03:50:58,840 --> 03:50:59,320 PEOPLE AND DIFFERENT 5711 03:50:59,320 --> 03:51:00,080 EXPERTISE TO THE TABLE. 5712 03:51:00,080 --> 03:51:01,800 --- 5713 03:51:01,800 --> 03:51:02,360 THERE HAS BEEN DISCUSSION 5714 03:51:02,360 --> 03:51:05,640 ABOUT POLICY STUDIES IN ACUTE 5715 03:51:05,640 --> 03:51:10,360 COVID AND ALSO IN LONG COVID 5716 03:51:10,360 --> 03:51:13,120 THAT MAY BE 5717 03:51:13,120 --> 03:51:15,120 GOOD VENUES TO REPURPOSE 5718 03:51:15,120 --> 03:51:15,720 EXISTING DRUGS THE WEEKEND 5719 03:51:15,720 --> 03:51:16,360 TARGET PLACES THAT MIGHT BE 5720 03:51:16,360 --> 03:51:25,840 LEADING SITES OF 5721 03:51:25,840 --> 03:51:29,680 INJURY LIKE THE ENDOTHELIUM, 5722 03:51:29,680 --> 03:51:30,320 INFORMATIONAL THROMBOSIS AND 5723 03:51:30,320 --> 03:51:31,440 DEVELOP RESCORING SYSTEMS TO 5724 03:51:31,440 --> 03:51:41,600 TAILOR OR 5725 03:51:41,600 --> 03:51:42,120 TREATMENT/PREVENTIVE 5726 03:51:42,120 --> 03:51:43,120 STRATEGIES IN ACUTE 5727 03:51:43,120 --> 03:51:43,600 TREATMENT. 5728 03:51:43,600 --> 03:51:46,120 --- 5729 03:51:46,120 --> 03:51:48,720 THE NEXT SESSION NUMBER 5, 5730 03:51:48,720 --> 03:51:55,120 UNDERLINING BLOOD DISEASES IN 5731 03:51:55,120 --> 03:51:55,720 CVOID-19 WITH THE TERRIFIC 5732 03:51:55,720 --> 03:51:56,040 SLATE OF 5733 03:51:56,040 --> 03:51:56,680 SPEAKERS THAT SPAN THE 5734 03:51:56,680 --> 03:51:57,320 SPECTRUM FROM BIOINFORMATICS 5735 03:51:57,320 --> 03:51:58,480 TO ELECTRONIC HEALTH RECORDS, 5736 03:51:58,480 --> 03:52:00,320 MOLECULAR 5737 03:52:00,320 --> 03:52:00,960 CELLULAR BIOLOGY AND CLINICAL 5738 03:52:00,960 --> 03:52:05,920 TRIALS. 5739 03:52:05,920 --> 03:52:06,520 WILL LEARN THAT ELECTRONIC 5740 03:52:06,520 --> 03:52:07,120 HEALTH RECORDS IN DATABASES 5741 03:52:07,120 --> 03:52:09,120 CAN BE LEVERAGED AS IMPORTANT 5742 03:52:09,120 --> 03:52:09,560 TOOLS TO HELP 5743 03:52:09,560 --> 03:52:12,800 US SEE AND STUDY PATTERNS AND 5744 03:52:12,800 --> 03:52:13,440 OCCULT DISEASE RELATIONSHIPS 5745 03:52:13,440 --> 03:52:14,360 WE HAVE NOT THOUGHT ABOUT AND 5746 03:52:14,360 --> 03:52:17,120 DOCTOR -- 5747 03:52:17,120 --> 03:52:17,680 TALK ABOUT IMPORTANCE OF 5748 03:52:17,680 --> 03:52:21,080 SKIN CONDITIONS AND COVID 5749 03:52:21,080 --> 03:52:22,920 SEVERITY AND PRE-EXISTING 5750 03:52:22,920 --> 03:52:25,080 LUNG DISEASE OF 5751 03:52:25,080 --> 03:52:27,360 RESOURCE SECTION 6 THAT IS 5752 03:52:27,360 --> 03:52:27,960 ALSO IMPORTANT IN THE IDEA 5753 03:52:27,960 --> 03:52:29,840 THAT SIX PACIFIC GENE 5754 03:52:29,840 --> 03:52:31,400 EXPRESSION CAN BE 5755 03:52:31,400 --> 03:52:34,600 IMPORTANT IN SKIN AND BLOOD 5756 03:52:34,600 --> 03:52:35,200 AND OTHER ORGAN SYSTEMS TO 5757 03:52:35,200 --> 03:52:36,160 INFORM INFORMATION ACROSS 5758 03:52:36,160 --> 03:52:36,600 TRADITIONAL ORGAN 5759 03:52:36,600 --> 03:52:45,080 BOUNDARIES AND 5760 03:52:45,080 --> 03:52:45,720 HEART/LUNG/BLOOD/SLEEP ACROSS 5761 03:52:45,720 --> 03:52:48,640 IMMUNE DISORDERS AND HOW SKIN 5762 03:52:48,640 --> 03:52:49,120 MANIFESTATIONS ARE 5763 03:52:49,120 --> 03:52:50,440 COMMON IN COVID. 5764 03:52:50,440 --> 03:52:52,200 --- 5765 03:52:52,200 --> 03:52:55,520 WE ALSO HEARD ABOUT FROM 5766 03:52:55,520 --> 03:53:06,080 DOCTOR ABLE ABOUT THREE AND 5767 03:53:06,720 --> 03:53:08,920 POST CLINICAL EVIDENCE THAT 5768 03:53:08,920 --> 03:53:09,240 SUPPORTS 5769 03:53:09,240 --> 03:53:09,880 TREATMENT AND THROMBOSIS AND 5770 03:53:09,880 --> 03:53:10,480 THERE IS CLINICAL EVIDENCE 5771 03:53:10,480 --> 03:53:11,680 FROM THE ACTIVE >> [RECORDING 5772 03:53:11,680 --> 03:53:15,000 IN PROGRESS] 5773 03:53:15,000 --> 03:53:16,720 (CORRECTION) 5774 03:53:16,720 --> 03:53:22,080 ACTIVE 4A TRIAL, AND 5775 03:53:22,080 --> 03:53:24,440 DIFFERENCES THAT ARE WORTH 5776 03:53:24,440 --> 03:53:31,920 INVESTIGATING, AND BOTH -- -- 5777 03:53:31,920 --> 03:53:32,440 EXPLORE REPOSITORIES 5778 03:53:32,440 --> 03:53:35,120 THAT CAME OUT IN SPONSORED 5779 03:53:35,120 --> 03:53:40,880 TRUST TO ADDRESS ACUTE COVID 5780 03:53:40,880 --> 03:53:41,480 AND THIS MIGHT BE USEFUL TO 5781 03:53:41,480 --> 03:53:41,720 OTHER 5782 03:53:41,720 --> 03:53:47,120 INVESTIGATORS AND HEARD ABOUT 5783 03:53:47,120 --> 03:53:47,720 TRANS ORGAN AND TRANSISTOR 5784 03:53:47,720 --> 03:53:48,240 INTERACTIONS NEED TO BE 5785 03:53:48,240 --> 03:53:48,600 CONSIDERED IN 5786 03:53:48,600 --> 03:53:50,000 MECHANISTIC AND CLINICAL 5787 03:53:50,000 --> 03:53:51,600 STUDIES OF BLOOD AND VASCULAR 5788 03:53:51,600 --> 03:53:52,200 DISORDERS AND I WOULD ARGUE 5789 03:53:52,200 --> 03:53:52,720 MOVING THIS 5790 03:53:52,720 --> 03:53:57,880 BEYOND TWO OTHER DISORDERS. 5791 03:53:57,880 --> 03:54:01,160 DOCTOR-- SHOWED US THAT 5792 03:54:01,160 --> 03:54:01,800 IMMUNE DISORDERS CAN START TO 5793 03:54:01,800 --> 03:54:02,120 CROSS OVER 5794 03:54:02,120 --> 03:54:02,680 MULTIPLE DIFFERENT ORGAN 5795 03:54:02,680 --> 03:54:02,960 SYSTEMS. 5796 03:54:02,960 --> 03:54:04,720 --- 5797 03:54:04,720 --> 03:54:05,360 AND EXAMPLES PRESENTED WERE 5798 03:54:05,360 --> 03:54:07,080 HOW HORMONES CAN INTERACT 5799 03:54:07,080 --> 03:54:15,600 WITH PLATELETS AND 5800 03:54:15,600 --> 03:54:16,080 MITOCHONDRIA AND HAVE 5801 03:54:16,080 --> 03:54:16,560 INNATE IMMUNITY IN 5802 03:54:16,560 --> 03:54:17,160 COAGULATION START INTERSECT 5803 03:54:17,160 --> 03:54:20,320 INTO DIFFERENT NETWORKS. 5804 03:54:20,320 --> 03:54:22,520 I HEARD ABOUT HOW SKIN AND 5805 03:54:22,520 --> 03:54:23,160 AUTOIMMUNE DISEASES CAN START 5806 03:54:23,160 --> 03:54:23,760 INDIRECT CHAPTER AS WELL. 5807 03:54:23,760 --> 03:54:33,880 --- 5808 03:54:51,760 --> 03:54:52,160 WE ALSO LEARNED THAT 5809 03:54:52,160 --> 03:54:52,800 THROMBOINFLAMMATION MAY BE A 5810 03:54:52,800 --> 03:54:53,320 DOMINANT CAUSE OF ORGAN 5811 03:54:53,320 --> 03:54:53,800 FAILURE AND DEATH. 5812 03:54:53,800 --> 03:55:04,360 AND HOW TREATMENTS TARGETING 5813 03:55:05,800 --> 03:55:06,280 TRHOMBOINFLAMMATION IMPROVE 5814 03:55:06,280 --> 03:55:11,160 MODERATE COVID OUTCOMES. 5815 03:55:11,160 --> 03:55:13,080 SEX GENDER DIFFERENCES IN 5816 03:55:13,080 --> 03:55:13,440 MICROVASCULAR 5817 03:55:13,440 --> 03:55:16,200 THROMBOSIS/DEATH 5818 03:55:16,200 --> 03:55:16,720 ARE MORE PRONOUNCED THE 5819 03:55:16,720 --> 03:55:17,320 GENDER AGE AND MORE STUDIES 5820 03:55:17,320 --> 03:55:19,320 ARE NEEDED IN 5821 03:55:19,320 --> 03:55:21,120 MACRO/MICROVASCULAR 5822 03:55:21,120 --> 03:55:21,680 THROMBOINFLAMMATION FOR 5823 03:55:21,680 --> 03:55:22,600 TREATMENT. 5824 03:55:22,600 --> 03:55:24,160 --- 5825 03:55:24,160 --> 03:55:24,800 AND THERE IS DISCUSSION ABOUT 5826 03:55:24,800 --> 03:55:25,520 PATIENT SELECTION AND TIMING, 5827 03:55:25,520 --> 03:55:29,120 ANTIBODY PROFILES, RECIPIENT 5828 03:55:29,120 --> 03:55:29,320 POST 5829 03:55:29,320 --> 03:55:31,240 ISSUE RESPONSES IT CAN HELP 5830 03:55:31,240 --> 03:55:31,840 REFINE SOME OF THE RESULTS 5831 03:55:31,840 --> 03:55:32,480 AND IT IS WORTH DISCUSSING IN 5832 03:55:32,480 --> 03:55:39,360 OUR BREAKOUT 5833 03:55:39,360 --> 03:55:46,840 SESSION HOW WE GO ABOUT DOING 5834 03:55:46,840 --> 03:55:47,480 THIS WE ARE TRYING TO DESIGN 5835 03:55:47,480 --> 03:55:51,040 TRIALS PROACTIVELY. 5836 03:55:51,040 --> 03:56:01,120 --- 5837 03:56:02,440 --> 03:56:02,960 -- SHARE THE PASSIVE IMMUNITY 5838 03:56:02,960 --> 03:56:07,640 TRANSFER TO TREAT ACUTE COVID 5839 03:56:07,640 --> 03:56:08,240 HAS VIABLE CLINICAL TRIALS 5840 03:56:08,240 --> 03:56:08,560 AND THERE 5841 03:56:08,560 --> 03:56:11,480 IS NO BENEFIT CONFERRED BY 5842 03:56:11,480 --> 03:56:12,120 PASSING IMMUNITY TRANSFER BUT 5843 03:56:12,120 --> 03:56:15,520 HE DID SHOW THAT MALES 5844 03:56:15,520 --> 03:56:15,800 RECEIVING 5845 03:56:15,800 --> 03:56:17,640 CONVALESCENT PLASMA HAD 5846 03:56:17,640 --> 03:56:18,200 HIGHER RATES OF DISEASE 5847 03:56:18,200 --> 03:56:19,800 PROGRESSION AND THE 5848 03:56:19,800 --> 03:56:20,400 IMPLICATIONS ARE NOT REALLY 5849 03:56:20,400 --> 03:56:22,120 CLEAR AND THE MECHANISMS 5850 03:56:22,120 --> 03:56:24,080 UNDERLINING INTERNET PEERS WE 5851 03:56:24,080 --> 03:56:25,040 DO NOT KNOW HOW TO ADVANCES 5852 03:56:25,040 --> 03:56:26,560 WE NEED TO HAVE 5853 03:56:26,560 --> 03:56:27,160 MORE STUDIES TO UNDERSTAND 5854 03:56:27,160 --> 03:56:27,760 THE POTENTIAL DIFFERENCES. 5855 03:56:27,760 --> 03:56:29,680 --- 5856 03:56:29,680 --> 03:56:31,160 WITHIN MOVED ONTO SESSION 6, 5857 03:56:31,160 --> 03:56:37,320 WHERE WE ADDRESSED SLEEP AND 5858 03:56:37,320 --> 03:56:38,760 LUNG DISEASES WITH A TERRIFIC 5859 03:56:38,760 --> 03:56:39,040 GROUP OF 5860 03:56:39,040 --> 03:56:39,600 SPEAKERS THAT STARTED TO 5861 03:56:39,600 --> 03:56:42,240 BRING TOGETHER A LOT OF HOW 5862 03:56:42,240 --> 03:56:44,240 WE THINK ABOUT PRE-EXISTING 5863 03:56:44,240 --> 03:56:45,000 DISEASE, ACUTE 5864 03:56:45,000 --> 03:56:47,200 DISEASE AND POSTACUTE 5865 03:56:47,200 --> 03:56:49,000 SEQUELAE OF COVID. 5866 03:56:49,000 --> 03:56:51,320 AND CERTAINLY SEX AND GENDER 5867 03:56:51,320 --> 03:56:55,040 DIFFERENCES AND LUNG DISEASE 5868 03:56:55,040 --> 03:56:57,800 ESPECIALLY COPD PREDATE COVID 5869 03:56:57,800 --> 03:56:58,560 BUT IN 5870 03:56:58,560 --> 03:57:00,800 ACUTE COVID THESE DIFFERENCES 5871 03:57:00,800 --> 03:57:01,480 MAY BE AMPLIFIED. 5872 03:57:01,480 --> 03:57:05,720 AT LEAST IN PULMONARY AND 5873 03:57:05,720 --> 03:57:07,920 IMMUNE MANIFESTATIONS. 5874 03:57:07,920 --> 03:57:10,320 WE SAW THAT MALES HAVE MORE 5875 03:57:10,320 --> 03:57:16,960 INFORMATION, MORE TYPE I 5876 03:57:16,960 --> 03:57:19,080 OTHER ANTIBODIES, T CELL 5877 03:57:19,080 --> 03:57:20,320 DYSFUNCTIONS AND 5878 03:57:20,320 --> 03:57:22,800 FEMALES HAVE A MORE ANTIVIRAL 5879 03:57:22,800 --> 03:57:25,000 RESPONSE, BETTER HUMORAL 5880 03:57:25,000 --> 03:57:25,480 RESPONSE AND ADAPTIVE 5881 03:57:25,480 --> 03:57:28,440 RESPONSES AND 5882 03:57:28,440 --> 03:57:31,040 X-LINKED GENES MAY PROTECT, 5883 03:57:31,040 --> 03:57:33,400 SET HORMONES MAY MODULATE 5884 03:57:33,400 --> 03:57:34,000 IMMUNITY AND QUESTIONS WERE 5885 03:57:34,000 --> 03:57:34,440 RAISED ABOUT HOW 5886 03:57:34,440 --> 03:57:44,920 THIS MIGHT PLAY ROLES IN 5887 03:57:49,320 --> 03:57:49,840 PERIPARTUM/INTRAPARTUM AND IN 5888 03:57:49,840 --> 03:57:50,440 DEVELOPING POST PARTUM, AND 5889 03:57:50,440 --> 03:57:51,480 WE NEED TO 5890 03:57:51,480 --> 03:57:54,520 IDENTIFY EARLY IMMUNE 5891 03:57:54,520 --> 03:57:57,840 DYSFUNCTION BIOMARKERS 5892 03:57:57,840 --> 03:58:00,920 INTELLIGENT STUDIES AND USER 5893 03:58:00,920 --> 03:58:04,680 STUDIES TO COLLECT BLOOD 5894 03:58:04,680 --> 03:58:05,280 SAMPLES AND BIO REPOSITORIES 5895 03:58:05,280 --> 03:58:06,280 THAT WILL ALLOW US TO PROBE 5896 03:58:06,280 --> 03:58:08,800 HOW THIS WORKED OR NOT 5897 03:58:08,800 --> 03:58:09,240 WORKING WE HEARD 5898 03:58:09,240 --> 03:58:11,120 ABOUT MECHANISTIC AND 5899 03:58:11,120 --> 03:58:11,720 CLINICAL STUDIES THAT ARE 5900 03:58:11,720 --> 03:58:16,320 NECESSARY AND CALL FOR TRYING 5901 03:58:16,320 --> 03:58:16,720 TO UNDERSTAND WHY 5902 03:58:16,720 --> 03:58:17,360 THE MORE FREQUENT RESPIRATORY 5903 03:58:17,360 --> 03:58:19,280 SYMPTOMS THAT WE SEE IN 5904 03:58:19,280 --> 03:58:21,640 POSTACUTE COVID ARE MORE 5905 03:58:21,640 --> 03:58:23,360 FREQUENT IN FEMALES 5906 03:58:23,360 --> 03:58:24,440 AND WHY FEMALES HAVE MORE 5907 03:58:24,440 --> 03:58:26,440 FREQUENT POSTACUTE SEQUELAE 5908 03:58:26,440 --> 03:58:29,520 OF COVID ANYWAY. AND HOW THIS 5909 03:58:29,520 --> 03:58:31,520 MAY BE 5910 03:58:31,520 --> 03:58:32,120 DIFFERENT OVER THE SPECTRUM 5911 03:58:32,120 --> 03:58:32,680 OF MANIFESTATIONS OF THE 5912 03:58:32,680 --> 03:58:36,320 DISEASE BECAUSE SOME HAVE 5913 03:58:36,320 --> 03:58:36,920 QUITE MILD SYMPTOMS 5914 03:58:36,920 --> 03:58:39,880 AND WE ASKED THE PATIENT 5915 03:58:39,880 --> 03:58:40,360 WITNESSES, THERE ARE 5916 03:58:40,360 --> 03:58:40,880 MANIFESTATIONS THAT ARE 5917 03:58:40,880 --> 03:58:43,080 EXTREMELY SEVERE AND 5918 03:58:43,080 --> 03:58:47,000 LIFESTYLE LIMITING. 5919 03:58:47,000 --> 03:58:49,600 AND WE HEARD ABOUT 5920 03:58:49,600 --> 03:58:50,760 HYPOTHESIS, SOME CLINICAL 5921 03:58:50,760 --> 03:58:51,280 STUDIES THAT SUPPORT 5922 03:58:51,280 --> 03:58:55,280 HYPOTHESES FOR THIS FUNCTION 5923 03:58:55,280 --> 03:58:55,480 IN 5924 03:58:55,480 --> 03:58:57,040 SMALL AIRWAYS AND GAS 5925 03:58:57,040 --> 03:58:57,680 TRANSFER AND WHERE THERE ARE 5926 03:58:57,680 --> 03:59:03,080 OCCLUSIONS IN THE 5927 03:59:03,080 --> 03:59:03,720 MICROVASCULARTURE OR SCARRING 5928 03:59:03,720 --> 03:59:08,400 AND SUGGESTIONS THAT LARGE 5929 03:59:08,400 --> 03:59:09,000 COHORT STUDIES LIKE THE C4R 5930 03:59:09,000 --> 03:59:09,520 THAT WE HEARD ABOUT ARE 5931 03:59:09,520 --> 03:59:11,280 IMPORTANT 5932 03:59:11,280 --> 03:59:11,800 AND CAN BE LEVERAGED TO 5933 03:59:11,800 --> 03:59:15,280 IDENTIFY WHAT IMAGING 5934 03:59:15,280 --> 03:59:15,840 BIOMARKERS CAN BE USED TO 5935 03:59:15,840 --> 03:59:17,080 CORRELATE WITH CLINICAL 5936 03:59:17,080 --> 03:59:17,680 OUTCOMES TO REACH BIOLOGICAL 5937 03:59:17,680 --> 03:59:18,080 OUTCOMES. 5938 03:59:18,080 --> 03:59:21,320 --- 5939 03:59:21,320 --> 03:59:27,480 WE HEARD IN THE SECOND TO 5940 03:59:27,480 --> 03:59:27,960 LAST SPEAKER THAT SEX 5941 03:59:27,960 --> 03:59:32,720 DIFFERENCES IN THE 5942 03:59:32,720 --> 03:59:33,360 BIOLOGICAL RESPONSES TO SLEEP 5943 03:59:33,360 --> 03:59:34,000 DISTURBANCE MAY CONTRIBUTE TO 5944 03:59:34,000 --> 03:59:36,480 SIX DISPARITIES IN IMMUNE 5945 03:59:36,480 --> 03:59:38,640 RESPONSES, CARDIOVASCULAR, 5946 03:59:38,640 --> 03:59:40,480 METABOLIC, 5947 03:59:40,480 --> 03:59:41,000 AUTONOMIC, AUTOIMMUNE 5948 03:59:41,000 --> 03:59:42,240 DISORDERS AND PASC. 5949 03:59:42,240 --> 03:59:44,480 --- 5950 03:59:44,480 --> 03:59:45,680 WE HEARD FROM OUR SPEAKER 5951 03:59:45,680 --> 03:59:47,080 FROM NORTH CAROLINA THAT THE 5952 03:59:47,080 --> 03:59:54,400 ANIMAL MODELS OF LONG COVID 5953 03:59:54,400 --> 03:59:54,760 ARE NEEDED TO 5954 03:59:54,760 --> 03:59:55,320 STUDY DISEASE BIOLOGY AND 5955 03:59:55,320 --> 03:59:55,920 INTERVENTIONS IN ONE MODEL 5956 03:59:55,920 --> 03:59:56,560 PROPOSED BY THE MODIFICATION 5957 03:59:56,560 --> 03:59:57,360 OF THE SARS 5958 03:59:57,360 --> 04:00:01,480 COV-2 WHERE THE RBD DOMAIN 5959 04:00:01,480 --> 04:00:02,040 WAS ADAPTED TO BE ABLE TO 5960 04:00:02,040 --> 04:00:09,600 TEST IT IN MICE, SPECIFICALLY 5961 04:00:09,600 --> 04:00:11,000 DR. OKUDA 5962 04:00:11,000 --> 04:00:16,960 TESTED THIS IN FEMALE MICE. 5963 04:00:16,960 --> 04:00:17,440 AND THERE WAS LONG 5964 04:00:17,440 --> 04:00:22,200 DYSFUNCTION FIBROSIS MYLAR 5965 04:00:22,200 --> 04:00:24,640 CELLS PRESENT IN THE LUNGS. 5966 04:00:24,640 --> 04:00:26,640 AND BRINGING BACK CONCEPTS 5967 04:00:26,640 --> 04:00:29,480 FROM DOCTOR ACKERMAN'S PAPER 5968 04:00:29,480 --> 04:00:30,080 IN THE NEW ENGLAND JOURNAL 5969 04:00:30,080 --> 04:00:30,320 WITH A 5970 04:00:30,320 --> 04:00:37,960 DEMONSTRATED EMERGENT AND IN 5971 04:00:37,960 --> 04:00:38,440 NEO ANGI-GENESIS WITH 5972 04:00:38,440 --> 04:00:48,920 PATIENTS WITH ACUTE COVID. 5973 04:00:52,280 --> 04:00:52,840 AND USING ANIMAL MODELS COULD 5974 04:00:52,840 --> 04:00:53,320 REDUCE THE LONG TERMS 5975 04:00:53,320 --> 04:00:56,120 SCARRING. 5976 04:00:56,120 --> 04:00:56,760 AND WE SHOULD BE ABLE TO TEST 5977 04:00:56,760 --> 04:00:57,560 THIS IN ANIMAL MODELS FOR 5978 04:00:57,560 --> 04:00:58,160 THIS DISEASE. 5979 04:00:58,160 --> 04:00:59,120 --- 5980 04:00:59,120 --> 04:01:02,520 I WILL STOP HERE. 5981 04:01:02,520 --> 04:01:07,520 AND HAND THIS BACK OVER TO 5982 04:01:07,520 --> 04:01:10,160 RASHAD TO HELP US FIGURE OUT 5983 04:01:10,160 --> 04:01:11,560 HOW WE NAVIGATE THE BREAKOUT 5984 04:01:11,560 --> 04:01:11,840 SESSIONS. 5985 04:01:11,840 --> 04:01:13,120 REALLY LOOKING FORWARD TO 5986 04:01:13,120 --> 04:01:14,360 THESE DISCUSSIONS. 5987 04:01:14,360 --> 04:01:17,400 I THINK THEY WILL BE DYNAMIC, 5988 04:01:17,400 --> 04:01:19,040 AND ENGAGING AND REALLY WILL 5989 04:01:19,040 --> 04:01:20,120 HELP US SET A ROADMAP FOR 5990 04:01:20,120 --> 04:01:20,440 WHERE WE 5991 04:01:20,440 --> 04:01:22,880 SHOULD GO FROM HERE. THANK 5992 04:01:22,880 --> 04:01:26,040 YOU RASHAD. 5993 04:01:26,040 --> 04:01:27,440 >> WERE GOING TO TRANSITION 5994 04:01:27,440 --> 04:01:29,800 TO THE BREAKOUT SESSIONS. 5995 04:01:29,800 --> 04:01:32,920 PLEASE SELF-SELECTED TWO 5996 04:01:32,920 --> 04:01:33,760 SESSIONS BELOW 5997 04:01:33,760 --> 04:01:38,680 EITHER BREAKOUT 1 OR 2. 5998 04:01:38,680 --> 04:01:39,280 YOU SHOULD HAVE RECEIVED AN 5999 04:01:39,280 --> 04:01:42,360 EMAIL WITH THE LINKS. WE HAVE 6000 04:01:42,360 --> 04:01:43,000 ALSO POSTED THEM IN THE CHAT 6001 04:01:43,000 --> 04:01:43,320 INVOLVING 6002 04:01:43,320 --> 04:01:45,400 THE BREAKOUT SESSIONS WE WILL 6003 04:01:45,400 --> 04:01:46,040 RETURN TO THIS ROOM USING THE 6004 04:01:46,040 --> 04:01:47,320 SAME LINK YOU USED TO ENTER 6005 04:01:47,320 --> 04:01:47,600 EARLIER 6006 04:01:47,600 --> 04:01:48,400 TODAY. 6007 04:01:48,400 --> 04:01:50,840 --- 6008 04:01:50,840 --> 04:01:51,480 FOLLOWING THE BREAKOUT THERE 6009 04:01:51,480 --> 04:01:52,040 WILL BE ANY REPORT OUT 6010 04:01:52,040 --> 04:01:55,440 SESSION AT 4:15 P.M. 6011 04:01:55,440 --> 04:01:59,840 WE WILL SEE YOU THEN. 6012 04:01:59,840 --> 04:02:01,920 ENJOY YOUR SESSION. 6013 04:02:01,920 --> 04:02:04,320 WELCOME BACK EVERYBODY, WE 6014 04:02:04,320 --> 04:02:04,920 ARE ALMOST DONE AND I LOOK 6015 04:02:04,920 --> 04:02:05,560 FORWARD TO SEEING EVERYBODY 6016 04:02:05,560 --> 04:02:07,600 AT THE BAR. 6017 04:02:07,600 --> 04:02:08,440 WE WERE TASKED IN BREAKOUT 6018 04:02:08,440 --> 04:02:12,200 ROOM 1 ABOUT WHAT OTHER 6019 04:02:12,200 --> 04:02:12,800 GROUPS, AND KNOWLEDGE ABOUT 6020 04:02:12,800 --> 04:02:13,280 THE MECHANISMS OF 6021 04:02:13,280 --> 04:02:16,320 CVOID-19 IN TERMS OF THE ROLE 6022 04:02:16,320 --> 04:02:19,720 OF SEX AND GENDER. 6023 04:02:19,720 --> 04:02:20,560 WE SPENT HALF THE TIME 6024 04:02:20,560 --> 04:02:23,520 TALKING ABOUT ANIMAL MODELS, 6025 04:02:23,520 --> 04:02:26,840 AND THE REFINEMENT NEEDED 6026 04:02:26,840 --> 04:02:28,200 WHICH WAS MADE CLEAR 6027 04:02:28,200 --> 04:02:34,640 BY DOCTOR PERLMAN. 6028 04:02:34,640 --> 04:02:37,240 AND SO WE TALKED ABOUT WHAT 6029 04:02:37,240 --> 04:02:39,080 CAN ANIMALS WE REALLY NEED 6030 04:02:39,080 --> 04:02:40,240 AND WHETHER WE SHOULD INVEST 6031 04:02:40,240 --> 04:02:41,640 IN A MOUSE, 6032 04:02:41,640 --> 04:02:42,680 EVEN THOUGH THE MOUSE DOES 6033 04:02:42,680 --> 04:02:50,280 NOT DEVELOP AS A SEVERE 6034 04:02:50,280 --> 04:02:53,720 DISEASES OTHER MODELS. 6035 04:02:53,720 --> 04:02:54,320 THE CONSENSUS OF THE GROUP 6036 04:02:54,320 --> 04:02:54,960 WAS THAT LET'S NOT THROW OUT 6037 04:02:54,960 --> 04:02:55,680 THE MOUSE MODELS. 6038 04:02:55,680 --> 04:02:56,240 THEY ARE ACTUALLY REALLY 6039 04:02:56,240 --> 04:02:58,320 VALUABLE. 6040 04:02:58,320 --> 04:03:00,960 WE CAN USE THEM TO GET SOME 6041 04:03:00,960 --> 04:03:06,200 CLUES ABOUT THE MECHANISMS OF 6042 04:03:06,200 --> 04:03:06,760 COVID EVEN IF WE HAVE TO 6043 04:03:06,760 --> 04:03:07,680 MODIFY THE 6044 04:03:07,680 --> 04:03:11,000 VIRUS SOMEWHAT OR MODIFY THE 6045 04:03:11,000 --> 04:03:14,440 ACE THAT THE ANIMALS USES TO 6046 04:03:14,440 --> 04:03:18,920 RESPOND TO THE VIRUS. 6047 04:03:18,920 --> 04:03:22,080 BUT WE HAVE TO CONSIDER THAT 6048 04:03:22,080 --> 04:03:27,680 ONE MOUSE IS NOT ALL MICE. WE 6049 04:03:27,680 --> 04:03:29,600 NEED TO CONSIDER THAT THERE 6050 04:03:29,600 --> 04:03:29,800 ARE 6051 04:03:29,800 --> 04:03:32,760 DIFFERENT STRAINS OF MICE, 6052 04:03:32,760 --> 04:03:35,480 AND THAT WILL BE AN IMPORTANT 6053 04:03:35,480 --> 04:03:36,080 CONSIDERATION BECAUSE SOME 6054 04:03:36,080 --> 04:03:37,360 MICE STRAINS 6055 04:03:37,360 --> 04:03:39,840 ARE MUCH MORE SUSCEPTIBLE AND 6056 04:03:39,840 --> 04:03:40,400 IT COULD BE MORE VALUABLE 6057 04:03:40,400 --> 04:03:48,640 THAN OTHER MOUSE STRAINS. 6058 04:03:48,640 --> 04:03:49,240 AND THEN WE HAVE ALL THE 6059 04:03:49,240 --> 04:03:51,280 OTHER KNOCKOUT MODELS AND THE 6060 04:03:51,280 --> 04:03:51,920 RESEARCH COMMUNITY HAS PUT A 6061 04:03:51,920 --> 04:03:52,200 LOT OF 6062 04:03:52,200 --> 04:03:55,120 INVESTMENT IN THIS KNOCKOUT 6063 04:03:55,120 --> 04:03:55,760 MODELS AND WE SHOULD LOOK AT 6064 04:03:55,760 --> 04:03:59,440 WHAT GENES ARE PLAYING KEY 6065 04:03:59,440 --> 04:03:59,680 ROLES 6066 04:03:59,680 --> 04:04:01,480 PARTICULARLY SINCE THIS IS 6067 04:04:01,480 --> 04:04:05,040 SUCH A BIG ROLE, THE IMMUNE 6068 04:04:05,040 --> 04:04:05,600 SYSTEM, THERE ARE SO MANY 6069 04:04:05,600 --> 04:04:07,200 IMMUNE FACTOR 6070 04:04:07,200 --> 04:04:09,280 THAT WE COULD TAKE ADVANTAGE 6071 04:04:09,280 --> 04:04:11,560 OF. BUT THAT IS NOT TO SAY 6072 04:04:11,560 --> 04:04:12,200 THAT WE SHOULD FORGO OTHER 6073 04:04:12,200 --> 04:04:12,520 MODELS AND 6074 04:04:12,520 --> 04:04:14,960 OTHER ANIMAL MODELS AND THAT 6075 04:04:14,960 --> 04:04:16,480 INCLUDES THE HAMSTER, WHICH 6076 04:04:16,480 --> 04:04:20,480 DOES HAVE MORE SEVERE DISEASE 6077 04:04:20,480 --> 04:04:20,800 THAN MOST 6078 04:04:20,800 --> 04:04:22,520 OF THE MICE. 6079 04:04:22,520 --> 04:04:24,320 AND ALSO THE FERRET, ALTHOUGH 6080 04:04:24,320 --> 04:04:26,400 THAT IS MORE MILD THAN A 6081 04:04:26,400 --> 04:04:26,680 HAMSTER. 6082 04:04:26,680 --> 04:04:28,680 --- 6083 04:04:28,680 --> 04:04:30,120 AND THEN THERE IS A NONHUMAN 6084 04:04:30,120 --> 04:04:37,040 PRIMATES. AND 6085 04:04:37,040 --> 04:04:37,640 EVEN THOUGH WE ARE LIMITED 6086 04:04:37,640 --> 04:04:39,960 WITH THEM BECAUSE OF THE MANY 6087 04:04:39,960 --> 04:04:40,200 REASONS, 6088 04:04:40,200 --> 04:04:40,840 THERE'S NOT THAT MANY CENTERS 6089 04:04:40,840 --> 04:04:45,240 THAT CAN STUDY THESE ANIMALS. 6090 04:04:45,240 --> 04:04:47,920 AND YOU HAVE ISSUES NOT 6091 04:04:47,920 --> 04:04:48,520 HAVING MANY FEMALES BECAUSE 6092 04:04:48,520 --> 04:04:49,120 THEY ARE USED FOR BREEDING 6093 04:04:49,120 --> 04:04:49,560 BUT STILL WE NEED 6094 04:04:49,560 --> 04:04:51,200 TO DO SOME WORK WITH THIS 6095 04:04:51,200 --> 04:04:53,320 NONHUMAN PRIMATES SINCE WE 6096 04:04:53,320 --> 04:04:55,280 ARE INTERESTED IN THE EFFECTS 6097 04:04:55,280 --> 04:04:55,640 ON THE BRAIN 6098 04:04:55,640 --> 04:04:58,000 AND COGNITION AND THEY ARE A 6099 04:04:58,000 --> 04:04:59,360 MUCH BETTER MODEL, MUCH 6100 04:04:59,360 --> 04:05:01,000 CLOSER TO US. 6101 04:05:01,000 --> 04:05:01,880 LOOKING AT BRAIN FUNCTION. 6102 04:05:01,880 --> 04:05:03,880 --- 6103 04:05:03,880 --> 04:05:07,000 WE ALSO NEED TO CONSIDER THE 6104 04:05:07,000 --> 04:05:11,240 FACT THAT THE VARIANT THAT 6105 04:05:11,240 --> 04:05:11,880 WE'RE STANDING TODAY MAY NOT 6106 04:05:11,880 --> 04:05:12,560 BE THE VERY 6107 04:05:12,560 --> 04:05:14,400 END THAT IS INFECTING THE 6108 04:05:14,400 --> 04:05:17,600 POPULATION IN SEPTEMBER. 6109 04:05:17,600 --> 04:05:18,800 HOPEFULLY IT IS. 6110 04:05:18,800 --> 04:05:22,200 BUT IT MAY NOT BE. 6111 04:05:22,200 --> 04:05:25,440 WE GO BACK TO DOCTOR PERLMAN 6112 04:05:25,440 --> 04:05:25,960 WHO HAS BEEN STUDYING 6113 04:05:25,960 --> 04:05:31,280 CORONAVIRUSES FOREVER. 6114 04:05:31,280 --> 04:05:33,920 THEY'RE HERE TO STAY. WE HAVE 6115 04:05:33,920 --> 04:05:34,520 TAKE INTO ACCOUNT THE FACT 6116 04:05:34,520 --> 04:05:35,480 THAT THERE WILL BE MANY 6117 04:05:35,480 --> 04:05:35,880 VARIANTS AND WE 6118 04:05:35,880 --> 04:05:39,480 HAVE TO CONSIDER THAT ONE 6119 04:05:39,480 --> 04:05:40,040 VARIANT WILL GIVE US SOME 6120 04:05:40,040 --> 04:05:41,480 INFORMATION. 6121 04:05:41,480 --> 04:05:43,400 BUT WE CAN'T JUST IGNORE THE 6122 04:05:43,400 --> 04:05:43,960 FACT THAT THE VARIANCE OR 6123 04:05:43,960 --> 04:05:45,080 CHANGING. 6124 04:05:45,080 --> 04:05:46,600 --- AND WE ALSO NEED TO STUDY 6125 04:05:46,600 --> 04:05:50,480 THESE MODELS IN THE CONTEXT 6126 04:05:50,480 --> 04:05:59,920 OF WHAT ARE THE OTHER RISK 6127 04:05:59,920 --> 04:06:00,240 FACTORS, WE 6128 04:06:00,240 --> 04:06:00,840 NEED TO THINK ABOUT AGE, 6129 04:06:00,840 --> 04:06:01,320 OBESITY DIABETES AND 6130 04:06:01,320 --> 04:06:03,440 HYPERTENSION. 6131 04:06:03,440 --> 04:06:05,960 THESE ARE IMPORTANT VARIABLES. 6132 04:06:05,960 --> 04:06:08,640 IF THERE IS NOT THAT MUCH 6133 04:06:08,640 --> 04:06:10,200 DISEASE IN THE BASAL 6134 04:06:10,200 --> 04:06:10,840 CONDITION BUT ALL OF A SUDDEN 6135 04:06:10,840 --> 04:06:11,440 WHEN THE ANIMAL GETS 6136 04:06:11,440 --> 04:06:12,000 OLDER THEY ARE MUCH MORE 6137 04:06:12,000 --> 04:06:14,920 SUSCEPTIBLE LIKE IN HUMANS, 6138 04:06:14,920 --> 04:06:16,960 OR MORE SUSCEPTIBLE IF THEY 6139 04:06:16,960 --> 04:06:19,360 HAVE LIABILITIES 6140 04:06:19,360 --> 04:06:20,000 THEN WE NEED TO MODEL THAT IN 6141 04:06:20,000 --> 04:06:20,760 OUR ANIMALS. 6142 04:06:20,760 --> 04:06:26,280 --- AND THEN -- 6143 04:06:26,280 --> 04:06:31,280 NEXT SLIDE -- 6144 04:06:31,280 --> 04:06:31,920 WE NEED TO BE AWARE THE FACT 6145 04:06:31,920 --> 04:06:32,520 THAT IF WE ARE USING THESE 6146 04:06:32,520 --> 04:06:33,120 TRANSGENIC MOUSE MODELS, 6147 04:06:33,120 --> 04:06:34,160 WHERE WE GET THE 6148 04:06:34,160 --> 04:06:40,560 HUMAN GENE AND PUT IT INTO 6149 04:06:40,560 --> 04:06:41,160 THE MOUSE THE REGULATION OF 6150 04:06:41,160 --> 04:06:41,760 THIS GENE IS NOT UNDER THE 6151 04:06:41,760 --> 04:06:42,120 SAME HORMONAL 6152 04:06:42,120 --> 04:06:42,720 CONTROL THAN IF IT WERE THE 6153 04:06:42,720 --> 04:06:47,520 NORMAL MOUSE'S ACE 2, AND 6154 04:06:47,520 --> 04:06:48,120 THAT NEEDS TO BE IN THE BACK 6155 04:06:48,120 --> 04:06:58,400 OF OUR MINDS. 6156 04:06:59,480 --> 04:07:00,000 IT CAN BE A USEFUL MODEL BUT 6157 04:07:00,000 --> 04:07:02,000 WE NEED TO CONSIDER THE FACT 6158 04:07:02,000 --> 04:07:04,480 THAT IS NOT UNDER THE NORMAL 6159 04:07:04,480 --> 04:07:07,680 HORMONAL 6160 04:07:07,680 --> 04:07:08,320 REGULATIONS AND IF WE NEED TO 6161 04:07:08,320 --> 04:07:09,680 CONSIDER THE SEX, THAT IS 6162 04:07:09,680 --> 04:07:11,000 SOMETHING WE NEED TO CONSIDER. 6163 04:07:11,000 --> 04:07:17,480 --- 6164 04:07:17,480 --> 04:07:18,080 ALSO THE ORGANOIDS CAN BE A 6165 04:07:18,080 --> 04:07:20,680 VALUABLE MODEL. 6166 04:07:20,680 --> 04:07:22,760 THERE'S A LOT OF ADVANCES IN 6167 04:07:22,760 --> 04:07:23,440 ORGANOIDS, WE CAN STUDY LONG 6168 04:07:23,440 --> 04:07:27,360 AND MULTIPLE ORGANOID MODEL 6169 04:07:27,360 --> 04:07:27,720 AND THE ART 6170 04:07:27,720 --> 04:07:29,080 MULTIPLE SEX DIFFERENCES THAT 6171 04:07:29,080 --> 04:07:29,640 WE CAN LAY ON TOP OF THE 6172 04:07:29,640 --> 04:07:30,560 HORMONES. 6173 04:07:30,560 --> 04:07:31,960 IT WOULD BE VERY VALUABLE FOR 6174 04:07:31,960 --> 04:07:35,120 LOOKING AT SPECIFIC 6175 04:07:35,120 --> 04:07:37,040 MECHANISMS LIKE LOOKING AT 6176 04:07:37,040 --> 04:07:38,520 DRUG EFFECTS, 6177 04:07:38,520 --> 04:07:40,440 PHARMACEUTICAL EFFECTS, 6178 04:07:40,440 --> 04:07:41,200 ADVERSE EFFECTS ON THAT 6179 04:07:41,200 --> 04:07:42,720 ORGAN. 6180 04:07:42,720 --> 04:07:45,280 SO LET'S NOT FORGET ABOUT THE 6181 04:07:45,280 --> 04:07:49,480 VALUE OF ORGANOIDS. 6182 04:07:49,480 --> 04:07:53,320 NEXT SLIDE. 6183 04:07:53,320 --> 04:07:53,960 SO WE SPENT MOST OF THE TIME 6184 04:07:53,960 --> 04:07:57,160 TALKING ABOUT MODELS, AND 6185 04:07:57,160 --> 04:07:57,800 THEN WE SAID ONCE WE HAVE OUR 6186 04:07:57,800 --> 04:08:02,320 MODEL OR 6187 04:08:02,320 --> 04:08:02,960 MODELS THAN WHAT DO WE REALLY 6188 04:08:02,960 --> 04:08:04,360 NEED TO FOCUS ON NEXT? 6189 04:08:04,360 --> 04:08:05,360 AND THE IMMUNE SYSTEM CAME UP. 6190 04:08:05,360 --> 04:08:06,760 --- 6191 04:08:06,760 --> 04:08:07,400 I HAVE TO SAY THAT WE RAN OUT 6192 04:08:07,400 --> 04:08:08,560 OF TIME BECAUSE WE JUST RAN 6193 04:08:08,560 --> 04:08:11,400 OUT OF TIME. 6194 04:08:11,400 --> 04:08:11,960 DON'T FEEL THAT WE ARE 6195 04:08:11,960 --> 04:08:13,760 IGNORING THE OTHER GAPS AND 6196 04:08:13,760 --> 04:08:16,040 KNOWLEDGE SHARE. 6197 04:08:16,040 --> 04:08:16,640 THIS IS JUST BECAUSE WE DID 6198 04:08:16,640 --> 04:08:17,800 NOT HAVE ENOUGH TIME BUT WE 6199 04:08:17,800 --> 04:08:18,360 DID TALK ABOUT THE IMMUNE 6200 04:08:18,360 --> 04:08:18,840 SYSTEM. 6201 04:08:18,840 --> 04:08:27,040 IT IS INCREDIBLY IMPORTANT 6202 04:08:27,040 --> 04:08:27,520 ROLE AND WE NEED TO 6203 04:08:27,520 --> 04:08:29,720 UNDERSTAND THE SPECIFIC 6204 04:08:29,720 --> 04:08:30,160 MECHANISMS IN MANY 6205 04:08:30,160 --> 04:08:30,720 DIFFERENT CONDITIONS LIKE 6206 04:08:30,720 --> 04:08:32,560 VASCULAR DYSFUNCTION, BLOOD 6207 04:08:32,560 --> 04:08:35,560 DISORDERS AND WE NEED TO LOOK 6208 04:08:35,560 --> 04:08:39,200 AT DOCTOR -- 6209 04:08:39,200 --> 04:08:39,800 MADE THE POINT THAT IF WE 6210 04:08:39,800 --> 04:08:41,080 WANT TO LOOK AT PARTICULAR 6211 04:08:41,080 --> 04:08:41,720 CYTOKINES AND INHIBIT CERTAIN 6212 04:08:41,720 --> 04:08:43,520 CYTOKINES WE 6213 04:08:43,520 --> 04:08:44,160 NEED TO REALIZE THAT MAYBE WE 6214 04:08:44,160 --> 04:08:47,640 ARE INTERFERING WITH THE 6215 04:08:47,640 --> 04:08:50,520 PATHOLOGY. AND SO THAT MAY 6216 04:08:50,520 --> 04:08:55,080 NOT BE A VALUE. 6217 04:08:55,080 --> 04:09:05,600 SO WE SHOULD LOOK AT OTHER 6218 04:09:20,240 --> 04:09:20,760 WAYS IN MODULATING THE IMMUNE 6219 04:09:20,760 --> 04:09:30,920 SYSTEM. 6220 04:09:33,760 --> 04:09:34,280 WE NEED TO LOOK AT HOW THE 6221 04:09:34,280 --> 04:09:34,760 DISEASE IS CLEARED OR 6222 04:09:34,760 --> 04:09:37,640 DISRUPTED. 6223 04:09:37,640 --> 04:09:39,560 WE NEED TO FOCUS ON INNATE 6224 04:09:39,560 --> 04:09:41,360 IMMUNITY, ABSOLUTE CRITICALLY 6225 04:09:41,360 --> 04:09:42,000 IMPORTANT AND THE GREAT THING 6226 04:09:42,000 --> 04:09:42,960 ABOUT 6227 04:09:42,960 --> 04:09:43,560 STUDYING ANIMAL MODELS IS 6228 04:09:43,560 --> 04:09:49,160 THAT WE CAN GET, WE CAN START 6229 04:09:49,160 --> 04:09:52,600 AT THE VERY BEGINNING WHEN 6230 04:09:52,600 --> 04:09:53,160 THE DISEASE 6231 04:09:53,160 --> 04:09:53,760 STARTS AND WE CAN LOOK AT 6232 04:09:53,760 --> 04:09:54,320 THE VERY BEGINNING OF THE 6233 04:09:54,320 --> 04:09:54,920 INFECTION AND LOOK AND WHAT 6234 04:09:54,920 --> 04:09:55,320 IS HAPPENING IN 6235 04:09:55,320 --> 04:09:55,800 THE IMMUNE SYSTEM. 6236 04:09:55,800 --> 04:09:57,520 THIS IS NOT AS EASY IN HUMANS 6237 04:09:57,520 --> 04:09:59,280 SO WE WILL GET CLUES FROM 6238 04:09:59,280 --> 04:10:01,080 STUDYING THESE ANIMAL MODELS. 6239 04:10:01,080 --> 04:10:03,520 JUST THE VERY BEGINNING START 6240 04:10:03,520 --> 04:10:05,280 OF THIS. 6241 04:10:05,280 --> 04:10:08,200 THE IMMUNE RESPONSE. 6242 04:10:08,200 --> 04:10:10,920 --- WE ALSO WANT TO FOCUS ON 6243 04:10:10,920 --> 04:10:12,960 THE TIMING. 6244 04:10:12,960 --> 04:10:16,720 SO THAT WE CAN LOOK OBVIOUSLY 6245 04:10:16,720 --> 04:10:19,400 IN THE UPPER AIRWAVES IN THIS 6246 04:10:19,400 --> 04:10:21,200 RESPONSE. 6247 04:10:21,200 --> 04:10:25,280 WE ALSO WANT TO LOOK AT THE 6248 04:10:25,280 --> 04:10:25,840 BASELINE FOR THE IMMUNE 6249 04:10:25,840 --> 04:10:27,520 STATUS BECAUSE THIS CAN BE 6250 04:10:27,520 --> 04:10:28,440 AFFECTED BY 6251 04:10:28,440 --> 04:10:31,280 DIFFERENT CONDITIONS. 6252 04:10:31,280 --> 04:10:33,760 DOCTOR FAIRWEATHER MADE THE 6253 04:10:33,760 --> 04:10:34,880 POINT THAT WE NEED TO 6254 04:10:34,880 --> 04:10:36,720 CONSIDER THE BONE MARROW, THE 6255 04:10:36,720 --> 04:10:40,200 INNATE CELLS' BONE 6256 04:10:40,200 --> 04:10:44,360 MARROW, THE SET POINT AND WE 6257 04:10:44,360 --> 04:10:46,560 HAVE THE RIGHT MODEL FOR THIS? 6258 04:10:46,560 --> 04:10:50,800 DO WE HAVE ANOTHER SLIDE? 6259 04:10:50,800 --> 04:11:00,440 --- 6260 04:11:00,440 --> 04:11:04,440 WE HAVE ANOTHER DATA NOT A 6261 04:11:04,440 --> 04:11:05,080 WHOLE LOT. THERE ARE A LOT OF 6262 04:11:05,080 --> 04:11:06,000 STUDIES BUT NOT THAT MANY 6263 04:11:06,000 --> 04:11:07,920 HAVE SEX 6264 04:11:07,920 --> 04:11:08,480 DIFFERENCES. WE WANT TO 6265 04:11:08,480 --> 04:11:11,320 BRING ATTENTION TO THE FACT 6266 04:11:11,320 --> 04:11:11,880 THAT IT IS IMPORTANT TO 6267 04:11:11,880 --> 04:11:14,440 DISAGGREGATE YOUR 6268 04:11:14,440 --> 04:11:15,600 DATA BY SEX AS A BASIC 6269 04:11:15,600 --> 04:11:17,920 SCIENTIST. AND TO THINK ABOUT 6270 04:11:17,920 --> 04:11:18,400 WHEN LOOKING AT YOUR 6271 04:11:18,400 --> 04:11:20,320 MECHANISMS. 6272 04:11:20,320 --> 04:11:20,880 --- IT IS NOT TO SAY THAT 6273 04:11:20,880 --> 04:11:21,560 EVERYTHING IS GOING TO HAVE A 6274 04:11:21,560 --> 04:11:23,640 SEX DIFFERENCE. 6275 04:11:23,640 --> 04:11:26,320 THAT IS TOO SIMPLISTIC. 6276 04:11:26,320 --> 04:11:27,880 IT MAY BE THAT IT IS NOT A 6277 04:11:27,880 --> 04:11:38,440 MAJOR FACTOR ENOUGH ITSELF. 6278 04:11:38,440 --> 04:11:39,680 (CORRECTION) IN AND OF ITSELF 6279 04:11:39,680 --> 04:11:40,320 . AND IT IS ACTUALLY ON A 6280 04:11:40,320 --> 04:11:46,440 CONTINUUM. 6281 04:11:46,440 --> 04:11:47,000 AND DOCTOR REYNOLDS TALK 6282 04:11:47,000 --> 04:11:48,400 ABOUT HOW WE HAVE TO THINK 6283 04:11:48,400 --> 04:11:49,040 ABOUT SEX DIFFERENCES AND THE 6284 04:11:49,040 --> 04:11:52,080 IMPACT OF SEX 6285 04:11:52,080 --> 04:11:52,680 AND GENDER IS NOT JUST MEN 6286 04:11:52,680 --> 04:11:53,560 VERSUS WOMEN. 6287 04:11:53,560 --> 04:11:58,680 THERE ARE MANY DIFFERENCES. 6288 04:11:58,680 --> 04:12:03,640 THERE ARE TRANS INDIVIDUALS 6289 04:12:03,640 --> 04:12:04,520 AND INDIVIDUALS WHO HAVE 6290 04:12:04,520 --> 04:12:06,760 DIFFERENT HORMONAL STATES. 6291 04:12:06,760 --> 04:12:08,520 AND IT IS ALSO ON TOP OF THAT 6292 04:12:08,520 --> 04:12:12,040 WE HAVE TO THINK ABOUT 6293 04:12:12,040 --> 04:12:12,760 LAYERING THE SOCIAL 6294 04:12:12,760 --> 04:12:14,760 DETERMINANTS OF HEALTH IN 6295 04:12:14,760 --> 04:12:16,080 ANIMAL MODELS. 6296 04:12:16,080 --> 04:12:22,240 WE COULD LAYER PERHAPS STRESS. 6297 04:12:22,240 --> 04:12:26,960 WE HAVE NOT TALKED ABOUT THIS 6298 04:12:26,960 --> 04:12:27,600 IN OUR BREAKOUT SESSIONS BUT 6299 04:12:27,600 --> 04:12:28,200 I CAN IMAGINE THAT WE COULD 6300 04:12:28,200 --> 04:12:30,160 TALK ABOUT 6301 04:12:30,160 --> 04:12:31,960 SLEEP AND HOW SLEEP 6302 04:12:31,960 --> 04:12:35,560 DISTURBANCES CAN BE AFFECTED 6303 04:12:35,560 --> 04:12:36,160 BY SOCIAL DETERMINANTS OF 6304 04:12:36,160 --> 04:12:37,960 HEALTH. 6305 04:12:37,960 --> 04:12:38,400 THAT CAN IMPACT OUR 6306 04:12:38,400 --> 04:12:40,120 MECHANISMS AS WELL. 6307 04:12:40,120 --> 04:12:42,520 --- AND WE NEED TO LOOK AT 6308 04:12:42,520 --> 04:12:47,080 THE -- PRECEPTORS ANOTHER 6309 04:12:47,080 --> 04:12:47,680 INITIAL RECEPTORS IN IMMUNE 6310 04:12:47,680 --> 04:12:49,480 CELLS WHERE SEX 6311 04:12:49,480 --> 04:12:54,720 DIFFERENCES IN PHENOTYPES; 6312 04:12:54,720 --> 04:12:55,320 AND ANOTHER POINT THAT WAS 6313 04:12:55,320 --> 04:12:55,760 RAISED WAS THAT THE 6314 04:12:55,760 --> 04:12:58,120 MALE/FEMALE COMPARISONS COULD 6315 04:12:58,120 --> 04:12:58,640 BE MORE TRAUMATIC IN 6316 04:12:58,640 --> 04:13:00,560 THE ANIMAL MODELS THAN 6317 04:13:00,560 --> 04:13:01,160 INHUMAN CONDITIONS AND THAT 6318 04:13:01,160 --> 04:13:05,160 IS OKAY. 6319 04:13:05,160 --> 04:13:05,800 IN THAT IT BRINGS UP THESE 6320 04:13:05,800 --> 04:13:06,400 DIFFERENCES. BUT WE NEED TO 6321 04:13:06,400 --> 04:13:11,280 BE CAUTIOUS 6322 04:13:11,280 --> 04:13:11,840 IN OUR INTERPRETATION AND 6323 04:13:11,840 --> 04:13:12,440 AGAIN IT GOES BACK TO THE 6324 04:13:12,440 --> 04:13:12,960 FACT THAT THERE IS THIS 6325 04:13:12,960 --> 04:13:14,520 OVERLAP. 6326 04:13:14,520 --> 04:13:17,240 THERE IS NOT THIS 6327 04:13:17,240 --> 04:13:17,840 BLACK-AND-WHITE, AND WE HAVE 6328 04:13:17,840 --> 04:13:18,480 TO BE CAREFUL NOT TO SAY THAT 6329 04:13:18,480 --> 04:13:24,160 THE MALES ARE THIS 6330 04:13:24,160 --> 04:13:24,800 WAY AND THE FEMALES ARE THAT 6331 04:13:24,800 --> 04:13:25,360 WAY. BUT THERE ARE THESE 6332 04:13:25,360 --> 04:13:26,000 MECHANISMS THAT CAN BE 6333 04:13:26,000 --> 04:13:26,440 HAPPENING IN BOTH 6334 04:13:26,440 --> 04:13:27,920 SEXES. 6335 04:13:27,920 --> 04:13:29,480 IT MAY BE MORE THAT THIS 6336 04:13:29,480 --> 04:13:30,320 MECHANISM IS MORE PROMINENT 6337 04:13:30,320 --> 04:13:38,840 IN MALES WERE WHEREAS IT MAY 6338 04:13:38,840 --> 04:13:40,640 STILL BE THERE 6339 04:13:40,640 --> 04:13:41,040 IN THE FEMALES. 6340 04:13:41,040 --> 04:13:42,720 BUT IT IS NOT AS IMPORTANT. 6341 04:13:42,720 --> 04:13:43,960 THERE MAY BE A SECOND 6342 04:13:43,960 --> 04:13:44,480 MECHANISM THAT PLAYS A 6343 04:13:44,480 --> 04:13:46,120 GREATER ROLE IN THE OUTCOME 6344 04:13:46,120 --> 04:13:47,160 THAT WE ARE INTERESTED IN 6345 04:13:47,160 --> 04:13:49,120 STUDYING. 6346 04:13:49,120 --> 04:13:53,880 SO WE REALLY HAVE TO THINK 6347 04:13:53,880 --> 04:13:54,520 ABOUT BEING INCLUSIVE OF ALL 6348 04:13:54,520 --> 04:13:56,200 THE POPULATIONS. 6349 04:13:56,200 --> 04:13:56,840 TO MODEL SOCIAL DETERMINANTS 6350 04:13:56,840 --> 04:13:59,000 OF HEALTH AS A CHALLENGE FOR 6351 04:13:59,000 --> 04:14:01,120 BASIC SCIENTISTS. 6352 04:14:01,120 --> 04:14:02,720 BUT IT IS SOMETHING THAT WE 6353 04:14:02,720 --> 04:14:03,120 SHOULD CONSIDER. 6354 04:14:03,120 --> 04:14:04,440 WE CAN DO THAT BY LOOKING AT 6355 04:14:04,440 --> 04:14:06,000 DIFFERENT STRAINS. 6356 04:14:06,000 --> 04:14:08,160 WE CAN DO THAT BY LOOKING AT 6357 04:14:08,160 --> 04:14:13,640 DIFFERENT MODELS OF STRESS. 6358 04:14:13,640 --> 04:14:14,280 AND WE CAN DO THAT BY LOOKING 6359 04:14:14,280 --> 04:14:15,480 AT OTHER FACTORS THAT ARE 6360 04:14:15,480 --> 04:14:16,000 CAPTURED IN THE SOCIAL 6361 04:14:16,000 --> 04:14:16,400 DETERMINANTS OF 6362 04:14:16,400 --> 04:14:22,840 HEALTH. 6363 04:14:22,840 --> 04:14:25,560 --- HOW AM I DOING FOR TIME? 6364 04:14:25,560 --> 04:14:26,200 JASMINA? 6365 04:14:26,200 --> 04:14:27,960 >> JASMINA VARAGIC: 6366 04:14:27,960 --> 04:14:30,480 I THINK YOU ARE OKAY. IT 6367 04:14:30,480 --> 04:14:31,080 WOULD BE GOOD IF YOU COULD GO 6368 04:14:31,080 --> 04:14:32,800 THROUGH IT. 6369 04:14:32,800 --> 04:14:38,560 >> I WANT TO MAKE SURE. 6370 04:14:38,560 --> 04:14:39,160 SO THE ANIMAL MODELS CAN 6371 04:14:39,160 --> 04:14:46,800 POINT TO POTENTIAL SIGNALS, 6372 04:14:46,800 --> 04:14:47,400 REGULATED PATHWAYS IN FUTURE 6373 04:14:47,400 --> 04:14:47,800 STUDY AND THIS 6374 04:14:47,800 --> 04:14:48,400 IS WHAT WE REALLY HOPE, OUR 6375 04:14:48,400 --> 04:14:51,400 BASIC SCIENCE WILL DO, INFORM 6376 04:14:51,400 --> 04:14:53,240 HUMAN SUBJECT STUDIES. 6377 04:14:53,240 --> 04:14:55,680 --- AND WE ALSO THINK-- AND 6378 04:14:55,680 --> 04:14:56,960 THESE ARE BEING TIED IN 6379 04:14:56,960 --> 04:15:04,920 REAL-TIME-- IT'S NOT THE 6380 04:15:04,920 --> 04:15:08,720 CLEANEST ENGLISH 6381 04:15:08,720 --> 04:15:11,440 HERE. BUT WE DO WANT TO LOOK 6382 04:15:11,440 --> 04:15:12,000 AT THE RAPID VIRAL 6383 04:15:12,000 --> 04:15:15,600 REPLICATION MECHANISMS. 6384 04:15:15,600 --> 04:15:16,680 THE FACT THAT THE INTERFERON 6385 04:15:16,680 --> 04:15:17,320 RESPONSE IS LACKING AND THAT 6386 04:15:17,320 --> 04:15:20,480 WE HAVE IN SOME CASES AN 6387 04:15:20,480 --> 04:15:23,040 EXAGGERATED 6388 04:15:23,040 --> 04:15:23,680 CYTOKINE RESPONSE ASSOCIATED 6389 04:15:23,680 --> 04:15:24,240 IN SOME CASES WITH SEVERE 6390 04:15:24,240 --> 04:15:24,720 OUTCOMES. 6391 04:15:24,720 --> 04:15:26,840 WE WANT TO LOOK AT THAT. 6392 04:15:26,840 --> 04:15:30,120 THAT IS AN IMPORTANT 6393 04:15:30,120 --> 04:15:31,280 MECHANISM THAT WE REALLY 6394 04:15:31,280 --> 04:15:33,280 DON'T FULLY UNDERSTAND YET. 6395 04:15:33,280 --> 04:15:37,560 AND IT COULD VERY WELL BE 6396 04:15:37,560 --> 04:15:39,520 WHAT IS UNDERLINING SOME OF 6397 04:15:39,520 --> 04:15:41,720 THIS COVID PHENOMENA. 6398 04:15:41,720 --> 04:15:46,240 IT COULD ALSO UNDERLINED LONG 6399 04:15:46,240 --> 04:15:46,840 COVID AND IF I HAVE NOT SAY 6400 04:15:46,840 --> 04:15:47,840 IT BEFORE WE NEED A MODEL FOR 6401 04:15:47,840 --> 04:15:48,160 LONG 6402 04:15:48,160 --> 04:15:49,400 COVID. 6403 04:15:49,400 --> 04:15:52,320 WE DO NOT HAVE THAT. 6404 04:15:52,320 --> 04:15:52,920 WE NEED TO BE ABLE TO MODEL 6405 04:15:52,920 --> 04:15:54,280 WHAT IS HAPPENING WAY AFTER 6406 04:15:54,280 --> 04:15:57,520 THE VIRUS IS NO LONGER 6407 04:15:57,520 --> 04:15:58,000 PRESENT AND WE JUST 6408 04:15:58,000 --> 04:16:01,080 DON'T HAVE THAT MODEL YET. 6409 04:16:01,080 --> 04:16:05,160 WE NEED TO LOOK AT SPECIFIC 6410 04:16:05,160 --> 04:16:07,400 PROGNOSTIC MARKERS. 6411 04:16:07,400 --> 04:16:08,520 WE NEED TO IDENTIFY THEM SO 6412 04:16:08,520 --> 04:16:15,720 WE CAN THEN IN OUR ANIMAL 6413 04:16:15,720 --> 04:16:16,320 MODELS-- TAKE THEM AND SEE 6414 04:16:16,320 --> 04:16:16,720 IF THEY ARE ALSO 6415 04:16:16,720 --> 04:16:21,920 OCCURRING HUMANS. 6416 04:16:21,920 --> 04:16:22,560 THAT WOULD BE VERY USEFUL FOR 6417 04:16:22,560 --> 04:16:25,960 HUMAN SUBJECT STUDIES. 6418 04:16:25,960 --> 04:16:26,480 --- AND I EMPHASIZE THE 6419 04:16:26,480 --> 04:16:26,920 DIVERSITY IN THE 6420 04:16:26,920 --> 04:16:37,240 SUBPOPULATIONS. 6421 04:16:38,240 --> 04:16:41,680 WE HAVE TO CONSIDER OTHER 6422 04:16:41,680 --> 04:16:43,920 MODELS 6423 04:16:43,920 --> 04:16:44,560 AND WE ARE GOING TO CONCLUDE 6424 04:16:44,560 --> 04:16:45,160 THAT SOMETHING IS PLAYING A 6425 04:16:45,160 --> 04:16:46,360 BIG ROLE ON THE MECHANISM OF 6426 04:16:46,360 --> 04:16:48,680 DISEASE. 6427 04:16:48,680 --> 04:16:51,680 AND THEN LASTLY, I WOULD SAY 6428 04:16:51,680 --> 04:16:52,560 THAT IT IS IMPORTANT THAT WE 6429 04:16:52,560 --> 04:16:57,160 FIND WAYS TO STANDARDIZE OUR 6430 04:16:57,160 --> 04:16:57,520 DESCRIPTION 6431 04:16:57,520 --> 04:17:04,600 OF SEX AND GENDER. 6432 04:17:04,600 --> 04:17:05,160 I KNOW SOME JOURNALS ARE 6433 04:17:05,160 --> 04:17:07,840 REQUIRING YOU TO STATE THE 6434 04:17:07,840 --> 04:17:08,480 SIX OF YOUR ANIMAL BUT IT IS 6435 04:17:08,480 --> 04:17:08,920 NOT JUST THE SEX 6436 04:17:08,920 --> 04:17:11,120 OF THE ANIMAL. IT IS ALSO THE 6437 04:17:11,120 --> 04:17:12,720 AGE AND HORMONAL STATUS AND 6438 04:17:12,720 --> 04:17:21,560 THAT IS AN IMPORTANT 6439 04:17:21,560 --> 04:17:23,240 CONSIDERATION, 6440 04:17:23,240 --> 04:17:24,760 COMPARING OUR LAB WITH OTHER 6441 04:17:24,760 --> 04:17:25,360 LABORATORIES AND THAT IS AN 6442 04:17:25,360 --> 04:17:26,680 IMPORTANT COMPONENT. 6443 04:17:26,680 --> 04:17:28,080 IF WE ARE INTERESTED IN 6444 04:17:28,080 --> 04:17:29,760 GETTING TO THE BOTTOM OF WHY 6445 04:17:29,760 --> 04:17:31,640 SEX DIFFERENCES EXIST. 6446 04:17:31,640 --> 04:17:33,640 AND THE SUSCEPTIBILITY AND 6447 04:17:33,640 --> 04:17:35,880 THE PROGRESSION OF DISEASE 6448 04:17:35,880 --> 04:17:39,360 AND POSSIBLY RESPONSE TO 6449 04:17:39,360 --> 04:17:39,840 TREATMENT ALTHOUGH 6450 04:17:39,840 --> 04:17:40,440 WE DON'T HAVE A GOOD FEELING 6451 04:17:40,440 --> 04:17:41,360 FOR THAT YET AND THEN 6452 04:17:41,360 --> 04:17:43,360 OUTCOMES. 6453 04:17:43,360 --> 04:17:46,880 SO I THINK YOU CAN SEE THAT 6454 04:17:46,880 --> 04:17:48,800 THERE IS A TREMENDOUS AMOUNT 6455 04:17:48,800 --> 04:17:50,080 THAT WE STILL NEED TO LEARN 6456 04:17:50,080 --> 04:17:52,640 AND THIS IS 6457 04:17:52,640 --> 04:18:03,160 NO WAY I THE MOST IMPORTANT 6458 04:18:09,400 --> 04:18:11,640 NECESSARY. 6459 04:18:11,640 --> 04:18:15,360 DR. VARAGIC WILL ASK YOU FOR 6460 04:18:15,360 --> 04:18:16,000 INPUT TO MAKE SURE WE DO NOT 6461 04:18:16,000 --> 04:18:17,960 LEAVE ANYTHING OUT. 6462 04:18:17,960 --> 04:18:20,880 >> DO YOU WANT TO TAKE OVER? 6463 04:18:20,880 --> 04:18:21,520 >> THANK YOU VERY MUCH DOCTOR 6464 04:18:21,520 --> 04:18:31,720 SANDBERG. 6465 04:18:41,440 --> 04:18:51,760 IF YOU STOP SHARING. 6466 04:18:53,720 --> 04:18:55,720 >> DR. KANTHI: 6467 04:18:55,720 --> 04:18:58,160 WE MADE A FEW MODIFICATIONS. 6468 04:18:58,160 --> 04:19:02,160 >> WE HAD A BROAD DISCUSSION. 6469 04:19:02,160 --> 04:19:02,800 WOULD YOU LIKE TO START WITH 6470 04:19:02,800 --> 04:19:04,520 THIS ONE WHICH IS MORE ON THE 6471 04:19:04,520 --> 04:19:04,920 TECHNICAL SIDE? 6472 04:19:04,920 --> 04:19:05,520 I DIVIDED THEM A LITTLE BIT 6473 04:19:05,520 --> 04:19:06,400 INTO THE MEDICAL AND SOCIAL 6474 04:19:06,400 --> 04:19:06,960 ECONOMIC ASPECTS. 6475 04:19:06,960 --> 04:19:10,680 >> DR. KANTHI: 6476 04:19:10,680 --> 04:19:11,280 WONDERFUL KNOW WILL BE GLAD 6477 04:19:11,280 --> 04:19:11,880 TO START SO THE DISCUSSION 6478 04:19:11,880 --> 04:19:12,640 WAS WIDE-RANGING AS IT SEEMS 6479 04:19:12,640 --> 04:19:13,120 LIKE BREAKOUT 6480 04:19:13,120 --> 04:19:16,160 ROOM 1 WAS. 6481 04:19:16,160 --> 04:19:19,120 CLEARLY THERE IS A LOT OF 6482 04:19:19,120 --> 04:19:20,320 IMPORTANT INTEREST AND INPUT 6483 04:19:20,320 --> 04:19:22,200 AND WE TRY TO CAPTURE -- WE 6484 04:19:22,200 --> 04:19:27,480 KNOW WE MISSED 6485 04:19:27,480 --> 04:19:28,080 SOME, AND WE WILL LOOK AT THE 6486 04:19:28,080 --> 04:19:29,120 NOTES TO PULL THOSE OUT AND 6487 04:19:29,120 --> 04:19:31,760 IF AT ANY POINT YOU FEEL THAT 6488 04:19:31,760 --> 04:19:31,960 THE 6489 04:19:31,960 --> 04:19:35,320 SUMMARY DOES NOT CAPTURE SOME 6490 04:19:35,320 --> 04:19:35,920 OF THE THOUGHTS AND OPINIONS 6491 04:19:35,920 --> 04:19:38,680 THAT CAME OUT AS LEAD 6492 04:19:38,680 --> 04:19:39,040 INITIATIVE TO 6493 04:19:39,040 --> 04:19:41,600 CONSIDER, PLEASE SEND THOSE 6494 04:19:41,600 --> 04:19:43,960 TO THE CHAT BOX FOR THE 6495 04:19:43,960 --> 04:19:44,560 DISCUSSION THAT FOLLOWS HER 6496 04:19:44,560 --> 04:19:45,320 LATER ON BY EMAIL. 6497 04:19:45,320 --> 04:19:46,960 AND WE WILL DO OUR BEST TO 6498 04:19:46,960 --> 04:19:47,960 MAKE SURE THAT WE INCORPORATE 6499 04:19:47,960 --> 04:19:49,880 YOUR FEEDBACK. 6500 04:19:49,880 --> 04:19:51,520 --- SO THE CLINICAL TRIAL 6501 04:19:51,520 --> 04:19:52,080 DISCUSSION WAS QUITE 6502 04:19:52,080 --> 04:19:52,960 INTERESTING. 6503 04:19:52,960 --> 04:19:56,280 THERE WAS A THOUGHT THAT WE 6504 04:19:56,280 --> 04:19:59,280 NEED TO BE ABLE TO IMPROVE 6505 04:19:59,280 --> 04:20:01,160 CLINICAL TRIAL ENROLLMENT AND 6506 04:20:01,160 --> 04:20:02,920 ARE 6507 04:20:02,920 --> 04:20:03,520 DIFFERENT ASPECTS THAT WILL 6508 04:20:03,520 --> 04:20:04,800 COVER SHORTLY AS WELL BUT ONE 6509 04:20:04,800 --> 04:20:06,600 OF THE CHALLENGES THAT CAME 6510 04:20:06,600 --> 04:20:09,080 UP IN ACUTE 6511 04:20:09,080 --> 04:20:11,120 COVID WAS THE DIFFICULTY OF 6512 04:20:11,120 --> 04:20:13,200 BEING ABLE TO START TRIALS 6513 04:20:13,200 --> 04:20:15,000 AND ENROLL PATIENTS IN THOSE. 6514 04:20:15,000 --> 04:20:23,480 ONCE PATIENTS WERE BEING 6515 04:20:23,480 --> 04:20:24,120 ENROLLED THERE WERE A LOT OF 6516 04:20:24,120 --> 04:20:24,760 DIFFERENT TRIALS AT THE SAME 6517 04:20:24,760 --> 04:20:25,120 AS ADDITIONAL 6518 04:20:25,120 --> 04:20:25,760 FUNDING WAY TO HARMONIZE 6519 04:20:25,760 --> 04:20:28,440 THAT-- AND IT'S ADDITION CAN 6520 04:20:28,440 --> 04:20:33,480 HAVE MULTIPLE TRIALS GOING 6521 04:20:33,480 --> 04:20:33,800 BUT IT IS 6522 04:20:33,800 --> 04:20:35,080 IMPORTANT THAT PATIENTS ARE 6523 04:20:35,080 --> 04:20:35,560 PRESENTED WITH THE 6524 04:20:35,560 --> 04:20:41,520 OPPORTUNITY TO PARTICIPATE IN 6525 04:20:41,520 --> 04:20:42,000 MULTIPLE TRIALS SO 6526 04:20:42,000 --> 04:20:42,600 GIVING PATIENTS THE OPTION 6527 04:20:42,600 --> 04:20:43,400 SEEMS IMPORTANT. 6528 04:20:43,400 --> 04:20:45,640 SO WE WILL COVER THIS LATER. 6529 04:20:45,640 --> 04:20:49,160 --- THE GROUP FELT THAT AS 6530 04:20:49,160 --> 04:20:50,720 THE SHIFTING LANDSCAPE OF 6531 04:20:50,720 --> 04:20:52,160 WHAT IS CONSIDERED STANDARD 6532 04:20:52,160 --> 04:20:53,760 THERAPIES FOR 6533 04:20:53,760 --> 04:20:56,600 COVID CHANGES, AND WE START 6534 04:20:56,600 --> 04:20:57,640 LOOKING TOWARDS WHAT IT MIGHT 6535 04:20:57,640 --> 04:21:00,840 LOOK LIKE IN LONG COVID, 6536 04:21:00,840 --> 04:21:02,240 TRYING TO 6537 04:21:02,240 --> 04:21:03,800 UNDERSTAND HOW TO SET THE 6538 04:21:03,800 --> 04:21:05,560 STAGE FOR MULTIPLE DIFFERENT 6539 04:21:05,560 --> 04:21:07,200 THERAPIES AND THINKING ABOUT 6540 04:21:07,200 --> 04:21:07,520 COMBINATION 6541 04:21:07,520 --> 04:21:09,040 THERAPIES. 6542 04:21:09,040 --> 04:21:11,160 IN TRYING TO UNDERSTAND HOW 6543 04:21:11,160 --> 04:21:12,280 THOSE MIGHT BE PUT TOGETHER 6544 04:21:12,280 --> 04:21:13,600 IN SOME SORT OF AN 6545 04:21:13,600 --> 04:21:14,120 ARCHITECTURE TO BE ABLE 6546 04:21:14,120 --> 04:21:17,320 TO PRESENT THE PATIENTS 6547 04:21:17,320 --> 04:21:19,040 EITHER AS COMBINATION 6548 04:21:19,040 --> 04:21:21,880 THERAPIES, OR THERAPIES THAT 6549 04:21:21,880 --> 04:21:26,400 ARE GUIDED MORE BY IN A 6550 04:21:26,400 --> 04:21:29,880 PERSONALIZED MANNER TO 6551 04:21:29,880 --> 04:21:31,480 PROVIDE PATIENTS THAT WOULD 6552 04:21:31,480 --> 04:21:32,040 BE MUCH MORE RELEVANT TO 6553 04:21:32,040 --> 04:21:33,680 THEIR BIOLOGY. 6554 04:21:33,680 --> 04:21:35,040 OR THEIR NONBIOLOGICAL 6555 04:21:35,040 --> 04:21:40,560 FACTORS. AND THIS 6556 04:21:40,560 --> 04:21:42,040 WOULD INCLUDE SEX AND GENDER 6557 04:21:42,040 --> 04:21:42,480 AS PART OF IT. 6558 04:21:42,480 --> 04:21:44,520 --- YOU HAVE SEEN THAT MANY 6559 04:21:44,520 --> 04:21:45,160 OF OUR CLINICAL TRIALS DON'T 6560 04:21:45,160 --> 04:21:46,600 SINCERELY INCORPORATE SEX AND 6561 04:21:46,600 --> 04:21:46,920 GENDER AS 6562 04:21:46,920 --> 04:21:50,240 CONSIDERATIONS. 6563 04:21:50,240 --> 04:21:50,800 AND SO FINDING WAYS TO BE 6564 04:21:50,800 --> 04:21:53,160 ABLE TO DO THIS AND OFFER 6565 04:21:53,160 --> 04:22:02,760 THIS IN AN EQUITABLE MANNER 6566 04:22:02,760 --> 04:22:03,080 AND OFFERED 6567 04:22:03,080 --> 04:22:03,720 TAILORED TRIALS IS IMPORTANT 6568 04:22:03,720 --> 04:22:04,320 AND THERE WAS A DISCUSSION 6569 04:22:04,320 --> 04:22:04,920 ABOUT HAVING AN INTENTIONAL 6570 04:22:04,920 --> 04:22:05,800 DESIGN THAT 6571 04:22:05,800 --> 04:22:08,040 INCORPORATES BAYSIAN ANALYSIS 6572 04:22:08,040 --> 04:22:10,440 THAT INCLUDES WOMEN WOULD BE 6573 04:22:10,440 --> 04:22:12,080 IMPORTANT TO BE ABLE TO HAVE 6574 04:22:12,080 --> 04:22:12,360 TRIALS 6575 04:22:12,360 --> 04:22:22,920 THAT CAN BE DESIGNED QUICKLY, 6576 04:22:24,400 --> 04:22:24,920 BEING POWERED UP EASILY AND 6577 04:22:24,920 --> 04:22:26,800 BE USEFUL, AND THEN TAKING 6578 04:22:26,800 --> 04:22:28,680 THESE TRIALS 6579 04:22:28,680 --> 04:22:30,320 AND INTERPRET AND APPLY TO 6580 04:22:30,320 --> 04:22:30,920 PATIENTS WHEREVER THEY ARE. 6581 04:22:30,920 --> 04:22:33,200 --- 6582 04:22:33,200 --> 04:22:33,800 THE THOUGHT ABOUT USING SOME 6583 04:22:33,800 --> 04:22:35,280 OF THESE NEWER APPROACHES-- 6584 04:22:35,280 --> 04:22:36,920 WHICH CAN SOMETIMES INCLUDE 6585 04:22:36,920 --> 04:22:39,080 THIS BAYSIAN 6586 04:22:39,080 --> 04:22:40,600 DESIGN BUT ALSO BEING ABLE TO 6587 04:22:40,600 --> 04:22:44,440 USE MULTIPLE AGENTS IN AN 6588 04:22:44,440 --> 04:22:45,040 ADAPTIVE PLATFORM APPROACH 6589 04:22:45,040 --> 04:22:45,440 WOULD ALLOW US 6590 04:22:45,440 --> 04:22:47,360 TO TRY AND REACH SOME OF 6591 04:22:47,360 --> 04:22:48,800 THESE GOALS. 6592 04:22:48,800 --> 04:22:50,640 --- AND ALSO THINKING ABOUT 6593 04:22:50,640 --> 04:22:53,040 HOW WE LOOK AT SUBGROUPS, 6594 04:22:53,040 --> 04:22:58,080 AND THINK ABOUT ANALYZING 6595 04:22:58,080 --> 04:22:58,640 THEM BEFORE WE START THE 6596 04:22:58,640 --> 04:23:01,040 TRIAL. 6597 04:23:01,040 --> 04:23:03,080 AND SO INCORPORATING THAT AS 6598 04:23:03,080 --> 04:23:03,480 A DESIGN FACTOR. 6599 04:23:03,480 --> 04:23:04,000 AND THE SUBGROUPS WOULD 6600 04:23:04,000 --> 04:23:06,880 INCLUDE SEX, GENDER, 6601 04:23:06,880 --> 04:23:09,440 SOCIOECONOMIC STATUS AS WELL. 6602 04:23:09,440 --> 04:23:11,120 SO THE IMPORTANCE OF BRINGING 6603 04:23:11,120 --> 04:23:12,560 THAT IN, IN A VERY 6604 04:23:12,560 --> 04:23:14,040 PURPOSEFUL, INTENTIONAL WAY 6605 04:23:14,040 --> 04:23:15,640 WOULD PROBABLY ALTER 6606 04:23:15,640 --> 04:23:18,440 THE CLINICAL TRIAL DESIGN. 6607 04:23:18,440 --> 04:23:20,360 AND ALSO ITS EXECUTION. 6608 04:23:20,360 --> 04:23:22,520 --- SO LOOKING BEYOND WHAT 6609 04:23:22,520 --> 04:23:27,160 ARE LARGE CLINICAL CENTER 6610 04:23:27,160 --> 04:23:27,720 SITES AND MOVING THIS OUT 6611 04:23:27,720 --> 04:23:28,200 INTO COMMUNITIES TO 6612 04:23:28,200 --> 04:23:28,800 ESSENTIALLY GO WHERE THE 6613 04:23:28,800 --> 04:23:29,760 PATIENTS ARE. 6614 04:23:29,760 --> 04:23:33,160 --- 6615 04:23:33,160 --> 04:23:33,800 THERE WAS A DISCUSSION ABOUT 6616 04:23:33,800 --> 04:23:36,440 IDENTIFYING BIOMARKERS SINCE 6617 04:23:36,440 --> 04:23:37,040 THEY MIGHT BE IMPORTANT FOR 6618 04:23:37,040 --> 04:23:38,960 PROGNOSTICATION. 6619 04:23:38,960 --> 04:23:39,520 THE BIOMARKERS COULD BE 6620 04:23:39,520 --> 04:23:40,800 IMPORTANT FOR BEING ABLE TO 6621 04:23:40,800 --> 04:23:41,920 GET TO MORE PRECISE 6622 04:23:41,920 --> 04:23:44,400 TREATMENTS. 6623 04:23:44,400 --> 04:23:45,000 AND FOR A TAILORED APPROACH 6624 04:23:45,000 --> 04:23:45,600 TO BE ABLE TO TREAT PATIENTS 6625 04:23:45,600 --> 04:23:46,920 WITH. 6626 04:23:46,920 --> 04:23:47,480 AND PERHAPS TO THINK MORE 6627 04:23:47,480 --> 04:23:48,440 ABOUT PERSONALIZED MEDICINE 6628 04:23:48,440 --> 04:23:50,640 ON THE BACK END. 6629 04:23:50,640 --> 04:23:52,080 SO WE WILL BE ABLE TO REACH 6630 04:23:52,080 --> 04:23:53,880 THAT GOAL. 6631 04:23:53,880 --> 04:23:55,400 --- IN ORDER TO DO THAT, WE 6632 04:23:55,400 --> 04:23:58,680 DO NEED TO HAVE STUDIES THAT 6633 04:23:58,680 --> 04:24:00,360 INCORPORATE BIO REPOSITORIES 6634 04:24:00,360 --> 04:24:02,920 AND SO THAT 6635 04:24:02,920 --> 04:24:08,960 BECOMES A CENTRAL PORTION. 6636 04:24:08,960 --> 04:24:09,560 AND THIS BIO REPOSITORIES 6637 04:24:09,560 --> 04:24:11,160 WOULD NOT BE THE STEPCHILD 6638 04:24:11,160 --> 04:24:11,560 BUT AN IMPORTANT 6639 04:24:11,560 --> 04:24:17,880 PART OF THE INITIAL DESIGN. 6640 04:24:17,880 --> 04:24:18,400 BIOMARKERS NEED TO BE 6641 04:24:18,400 --> 04:24:19,000 ACCESSIBLE MUCH IN THE WAY 6642 04:24:19,000 --> 04:24:20,600 THAT WE HEARD THE ACTIVE 4A 6643 04:24:20,600 --> 04:24:26,840 TRIAL AND THE 3CPO 6644 04:24:26,840 --> 04:24:27,480 TRIAL AND BEING ABLE TO PAIR 6645 04:24:27,480 --> 04:24:28,280 THAT WITH CLINICAL DATA TO BE 6646 04:24:28,280 --> 04:24:30,280 ABLE TO REALLY TRY AND DRILL 6647 04:24:30,280 --> 04:24:32,120 DOWN TO 6648 04:24:32,120 --> 04:24:35,360 UNDERSTANDING WHY A 6649 04:24:35,360 --> 04:24:35,920 PARTICULAR INTERVENTION 6650 04:24:35,920 --> 04:24:37,480 WORKED. 6651 04:24:37,480 --> 04:24:40,040 OR WHY IT DID NOT WORKED. 6652 04:24:40,040 --> 04:24:40,520 AND HOW WE USE THAT 6653 04:24:40,520 --> 04:24:41,320 INFORMATION TO BE ABLE TO 6654 04:24:41,320 --> 04:24:41,920 DESIGN BETTER TRIALS IN THE 6655 04:24:41,920 --> 04:24:42,240 FUTURE. 6656 04:24:42,240 --> 04:24:43,240 --- 6657 04:24:43,240 --> 04:24:45,680 THERE WAS DISCUSSION ABOUT 6658 04:24:45,680 --> 04:24:50,360 NIH POLICIES. 6659 04:24:50,360 --> 04:24:50,920 I THINK THE SPECIFICALLY 6660 04:24:50,920 --> 04:24:51,640 REFERRED TO THE CONVERSATION 6661 04:24:51,640 --> 04:25:01,720 ABOUT HOW WE WILL ENROLL 6662 04:25:01,720 --> 04:25:02,200 PATIENTS AND MAKING 6663 04:25:02,200 --> 04:25:06,480 SURE THAT ALL POPULATIONS ARE 6664 04:25:06,480 --> 04:25:07,120 REPRESENTATED APPROPRIATELY 6665 04:25:07,120 --> 04:25:07,680 IN CLINICAL TRIALS UNDER 6666 04:25:07,680 --> 04:25:07,960 RULES AND 6667 04:25:07,960 --> 04:25:08,560 REGULATION SURROUNDING THIS 6668 04:25:08,560 --> 04:25:09,120 AND THERE WAS DISCUSSION 6669 04:25:09,120 --> 04:25:11,520 ABOUT THERE NEEDING TO BE 6670 04:25:11,520 --> 04:25:11,960 SOME WAY TO BETTER 6671 04:25:11,960 --> 04:25:12,480 ENFORCE OR ASSESS IT. 6672 04:25:12,480 --> 04:25:15,840 ANDDOCTOR-- MENTIONED THAT 6673 04:25:15,840 --> 04:25:18,040 THIS IS PART OF CLINICAL 6674 04:25:18,040 --> 04:25:18,680 TRIALS AND THIS IS WHY WE SEE 6675 04:25:18,680 --> 04:25:20,440 MORE WOMEN 6676 04:25:20,440 --> 04:25:21,040 ENROLLED IN CLINICAL TRIALS 6677 04:25:21,040 --> 04:25:23,800 NOW THAN WE DID 20-25 YEARS 6678 04:25:23,800 --> 04:25:27,400 AGO. 6679 04:25:27,400 --> 04:25:32,080 >> I WILL TAKE OVER FROM HERE. 6680 04:25:32,080 --> 04:25:32,680 WE FOCUSED A LOT ON HOW TO 6681 04:25:32,680 --> 04:25:34,080 MAKE SURE THAT THE PUBLISHERS 6682 04:25:34,080 --> 04:25:36,280 IN THE TRAILER MUCH MORE 6683 04:25:36,280 --> 04:25:39,720 PRESENTATIVE. 6684 04:25:39,720 --> 04:25:40,320 THAT WE SHOULD FOCUS ON CROSS 6685 04:25:40,320 --> 04:25:44,600 DISCIPLINARY SETUPS. 6686 04:25:44,600 --> 04:25:45,240 THAT COMMUNITY ENGAGEMENT IS 6687 04:25:45,240 --> 04:25:48,440 ESSENTIAL IN ACTUALLY 6688 04:25:48,440 --> 04:25:49,080 ACHIEVING REPRESENTATION NOT 6689 04:25:49,080 --> 04:25:49,520 JUST IN TERMS OF 6690 04:25:49,520 --> 04:25:51,160 SEX AND GENDER BUT IN BROADER 6691 04:25:51,160 --> 04:25:55,000 TERMS OF DIVERSITY. AND THIS 6692 04:25:55,000 --> 04:25:56,240 NEEDS TO BE CONSIDERED 6693 04:25:56,240 --> 04:25:56,640 BROADLY IN THE 6694 04:25:56,640 --> 04:25:56,960 STUDIES. 6695 04:25:56,960 --> 04:26:00,200 --- 6696 04:26:00,200 --> 04:26:00,840 IT WAS POINTED OUT THAT THERE 6697 04:26:00,840 --> 04:26:02,120 IS SOME CODIFICATION BETWEEN 6698 04:26:02,120 --> 04:26:06,640 SEX AND GENDER AND WE HAD 6699 04:26:06,640 --> 04:26:06,880 BINARY 6700 04:26:06,880 --> 04:26:08,880 DISCUSSIONS AND THIS WAS NOT 6701 04:26:08,880 --> 04:26:09,640 REPRESENTATIVE OF THE FULL 6702 04:26:09,640 --> 04:26:14,320 RANGE OF SEX AND GENDER. 6703 04:26:14,320 --> 04:26:14,920 SO WE NEED TO BE MORE PRECISE 6704 04:26:14,920 --> 04:26:17,160 IN THE METHODOLOGY WE ARE 6705 04:26:17,160 --> 04:26:19,440 APPLYING AND THAT ALSO MEANS 6706 04:26:19,440 --> 04:26:19,800 THAT WE MIGHT 6707 04:26:19,800 --> 04:26:20,760 NEED TO BETTER HARMONIZE 6708 04:26:20,760 --> 04:26:23,120 TERMS FOR THE FUTURE. 6709 04:26:23,120 --> 04:26:24,000 CREATE SOME SORT OF DATA 6710 04:26:24,000 --> 04:26:25,080 DICTIONARY. 6711 04:26:25,080 --> 04:26:26,800 AND MAKE SURE THAT WHEN 6712 04:26:26,800 --> 04:26:28,040 PEOPLE ARE ENROLLED THAT WE 6713 04:26:28,040 --> 04:26:29,760 HAVE THE WORDS TO ADDRESS 6714 04:26:29,760 --> 04:26:34,560 THIS. 6715 04:26:34,560 --> 04:26:35,160 AND MAKE SURE THAT THIS IS 6716 04:26:35,160 --> 04:26:36,960 DONE IN AN INCLUSIVE WAY 6717 04:26:36,960 --> 04:26:37,600 DEVELOPED WITH THE COMMUNITY 6718 04:26:37,600 --> 04:26:40,040 BECAUSE NOT ALL 6719 04:26:40,040 --> 04:26:40,600 TERMINOLOGY WORKS FOR OUR 6720 04:26:40,600 --> 04:26:41,200 COMMUNITIES AS YOU PROBABLY 6721 04:26:41,200 --> 04:26:41,680 ALL KNOW. 6722 04:26:41,680 --> 04:26:44,560 --- WE HAD SEVERAL POINTERS 6723 04:26:44,560 --> 04:26:46,640 TO THE FACT THAT THE 6724 04:26:46,640 --> 04:26:47,720 COMMUNITIES NEED TO BE 6725 04:26:47,720 --> 04:26:48,320 INVOLVED, THAT YOU SHOULD 6726 04:26:48,320 --> 04:26:53,160 BE INTENTIONAL FROM THE START 6727 04:26:53,160 --> 04:26:53,800 IF YOU WANT TO WORK WITH THE 6728 04:26:53,800 --> 04:26:54,400 COMMUNITY. AND THIS SHOULD 6729 04:26:54,400 --> 04:26:58,520 NOT BE AN 6730 04:26:58,520 --> 04:27:00,000 ADD-ON LATER BECAUSE YOU WILL 6731 04:27:00,000 --> 04:27:01,600 NOT BE ABLE TO RECRUIT THE 6732 04:27:01,600 --> 04:27:02,160 POPULATION THAT YOU WOULD 6733 04:27:02,160 --> 04:27:03,200 LIKE AND IT 6734 04:27:03,200 --> 04:27:03,680 WOULD FEEL SOMEWHAT 6735 04:27:03,680 --> 04:27:06,000 INADEQUATE AND NOT AUTHENTIC 6736 04:27:06,000 --> 04:27:08,240 AND IT PROBABLY ISN'T. 6737 04:27:08,240 --> 04:27:08,840 IT IS A RELEVANT POINT IN THE 6738 04:27:08,840 --> 04:27:10,240 BEGINNING. 6739 04:27:10,240 --> 04:27:14,280 --- AND AS DOCTOR CONTI 6740 04:27:14,280 --> 04:27:16,600 (PHONETIC) ALREADY POINTED 6741 04:27:16,600 --> 04:27:17,680 OUT WE SHOULD OFFER TRIALS 6742 04:27:17,680 --> 04:27:18,040 ACTIVELY TO 6743 04:27:18,040 --> 04:27:18,680 DIFFERENT POPULATIONS AS WAS 6744 04:27:18,680 --> 04:27:19,280 MENTIONED YESTERDAY AS WELL. 6745 04:27:19,280 --> 04:27:22,520 BY SOME OF THE PATIENT 6746 04:27:22,520 --> 04:27:23,120 PARTICIPANTS THAT SHARED 6747 04:27:23,120 --> 04:27:25,440 THEIR STORIES WITH US. 6748 04:27:25,440 --> 04:27:26,080 NOT EVERYBODY FELT THAT THEY 6749 04:27:26,080 --> 04:27:32,720 WERE BEING OFFERED TO 6750 04:27:32,720 --> 04:27:33,320 PARTICIPATE IN TRIALS IN WE 6751 04:27:33,320 --> 04:27:35,400 SHOULD BE MORE 6752 04:27:35,400 --> 04:27:35,920 INTENTIONAL TO INCLUDE 6753 04:27:35,920 --> 04:27:36,200 EVERYBODY. 6754 04:27:36,200 --> 04:27:36,840 --- THERE WAS ALSO DISCUSSION 6755 04:27:36,840 --> 04:27:37,480 ABOUT THE IMPACT OF 6756 04:27:37,480 --> 04:27:43,840 SOCIOECONOMIC FACTORS. 6757 04:27:43,840 --> 04:27:44,400 AND THAT THIS SHOULD BE 6758 04:27:44,400 --> 04:27:52,000 COLLECTED IN ADDITION TO 6759 04:27:52,000 --> 04:27:52,600 BIOLOGICAL FACTORS BECAUSE 6760 04:27:52,600 --> 04:27:53,120 THEY PLAY A CRITICAL 6761 04:27:53,120 --> 04:27:53,720 ROLE TO ACCESS OF HEALTHCARE 6762 04:27:53,720 --> 04:27:54,200 AND RISK MODIFIERS. 6763 04:27:54,200 --> 04:27:54,680 IT IS ESSENTIAL TO 6764 04:27:54,680 --> 04:27:57,720 COLLABORATE WITH GROUPS THAT 6765 04:27:57,720 --> 04:27:58,320 ARE THE ONE HAND SIGN HAVE 6766 04:27:58,320 --> 04:27:58,880 THIS EXPERTISE AND ALSO 6767 04:27:58,880 --> 04:28:03,800 COLLECTED DATA SO WE MAY 6768 04:28:03,800 --> 04:28:04,560 TRIANGULATE LIGHT SOME OF 6769 04:28:04,560 --> 04:28:07,000 THIS INFORMATION AND SET UP 6770 04:28:07,000 --> 04:28:08,720 AN INTERSECTIONAL 6771 04:28:08,720 --> 04:28:09,440 ANALYSIS. 6772 04:28:09,440 --> 04:28:10,080 --- WE ALSO TALK A LITTLE BIT 6773 04:28:10,080 --> 04:28:10,720 ABOUT THE FACT THAT IT MIGHT 6774 04:28:10,720 --> 04:28:12,800 BE NECESSARY TO LOOK AT 6775 04:28:12,800 --> 04:28:13,200 COMMUNITY LEVEL 6776 04:28:13,200 --> 04:28:14,160 FACTORS. 6777 04:28:14,160 --> 04:28:16,160 TO MAKE SURE THAT WE RECRUIT 6778 04:28:16,160 --> 04:28:19,000 OUR POPULATIONS FROM 6779 04:28:19,000 --> 04:28:21,640 DIFFERENT SETTINGS AND THAT 6780 04:28:21,640 --> 04:28:23,920 THIS MIGHT NOT JUST 6781 04:28:23,920 --> 04:28:24,560 BE IN ACADEMIC HOSPITALS BUT 6782 04:28:24,560 --> 04:28:25,440 TO MAKE SURE THAT WE INCLUDE 6783 04:28:25,440 --> 04:28:31,520 COMMUNITY LEVEL HEALTHCARE 6784 04:28:31,520 --> 04:28:31,840 PROVIDERS 6785 04:28:31,840 --> 04:28:32,480 AND CAST A BROADER NET IN 6786 04:28:32,480 --> 04:28:33,000 ORDER TO REALLY ACCESS 6787 04:28:33,000 --> 04:28:34,480 EVERYBODY. 6788 04:28:34,480 --> 04:28:37,120 --- THERE WAS A POINT THAT 6789 04:28:37,120 --> 04:28:37,760 DIVERSE POPULATION SHOULD BE 6790 04:28:37,760 --> 04:28:41,560 FOLLOWED LONGITUDINALLY SO IT 6791 04:28:41,560 --> 04:28:41,880 IS NOT JUST 6792 04:28:41,880 --> 04:28:44,000 A CROSS-SECTIONAL MOMENT. AND 6793 04:28:44,000 --> 04:28:46,160 AS I SAID AT MULTIPLE SITES. 6794 04:28:46,160 --> 04:28:49,720 --- AND IT SHOULD REALLY BE 6795 04:28:49,720 --> 04:28:51,480 POINTED OUT THAT 6796 04:28:51,480 --> 04:28:52,440 DECENTRALIZED DESIGNS 6797 04:28:52,440 --> 04:28:53,880 INCLUDING REMOTE AREAS ARE 6798 04:28:53,880 --> 04:28:54,120 MORE 6799 04:28:54,120 --> 04:28:56,520 DIFFICULT TO ACCESS SHOULD BE 6800 04:28:56,520 --> 04:28:57,480 SPECIFICALLY TARGETED AS WELL 6801 04:28:57,480 --> 04:28:59,680 IF WE ARE TRYING TO GET 6802 04:28:59,680 --> 04:29:00,080 REPRESENTATION 6803 04:29:00,080 --> 04:29:06,400 AND INCREASE DIVERSITY. 6804 04:29:06,400 --> 04:29:07,040 --- ANOTHER IMPORTANT POINT, 6805 04:29:07,040 --> 04:29:07,640 INCLUDING PREGNANT WOMEN IN 6806 04:29:07,640 --> 04:29:09,560 CLINICAL TRIALS AND 6807 04:29:09,560 --> 04:29:10,000 INDIVIDUALS WITH 6808 04:29:10,000 --> 04:29:11,160 SPECIFIC DISEASES. 6809 04:29:11,160 --> 04:29:12,520 AND OF COURSE WE CAN LEARN 6810 04:29:12,520 --> 04:29:17,160 FROM THE HIV STUDIES WHICH 6811 04:29:17,160 --> 04:29:17,800 HAVE DONE A GREAT JOB IN THE 6812 04:29:17,800 --> 04:29:20,400 PAST IN 6813 04:29:20,400 --> 04:29:21,040 RECRUITING A DIVERSE GROUP OF 6814 04:29:21,040 --> 04:29:22,160 INDIVIDUALS HIGHLY INVOLVED 6815 04:29:22,160 --> 04:29:31,360 IN THE DESIGN OF RESEARCH AND 6816 04:29:31,360 --> 04:29:31,680 THESE ARE 6817 04:29:31,680 --> 04:29:32,280 DEFINITELY COMMUNITIES AND 6818 04:29:32,280 --> 04:29:32,600 EXPERTISES. 6819 04:29:32,600 --> 04:29:33,760 --- 6820 04:29:33,760 --> 04:29:37,000 DOCTOR CONTI MENTIONED SOME 6821 04:29:37,000 --> 04:29:43,760 OF THESE TRIALS AND WE MOVED 6822 04:29:43,760 --> 04:29:47,200 THROUGH SEVERAL EXAMPLES. 6823 04:29:47,200 --> 04:29:54,600 AND THE ECHO 6824 04:29:54,600 --> 04:29:55,200 TRIALS AS MENTIONED NOT TO 6825 04:29:55,200 --> 04:29:56,880 INCLUDE PATIENTS WITH FATIGUE. 6826 04:29:56,880 --> 04:29:58,240 THERE WAS AN ACTIVE CALL TO 6827 04:29:58,240 --> 04:30:00,320 POTENTIALLY SUPPORT AND 6828 04:30:00,320 --> 04:30:02,480 MAKING SURE THAT YOU HAVE A 6829 04:30:02,480 --> 04:30:02,760 DIVERSE 6830 04:30:02,760 --> 04:30:05,280 POPULATION, 70 SITES, 6831 04:30:05,280 --> 04:30:09,000 RECRUITING ACROSS THE UNITED 6832 04:30:09,000 --> 04:30:09,600 STATES AND IF YOU HAVE THE 6833 04:30:09,600 --> 04:30:12,200 OPPORTUNITY TO GET 6834 04:30:12,200 --> 04:30:12,840 POTENTIALLY WITH THE SITES IN 6835 04:30:12,840 --> 04:30:14,960 ORDER TO MAKE SURE THAT A 6836 04:30:14,960 --> 04:30:16,920 DIVERSE POPULATION WILL BE 6837 04:30:16,920 --> 04:30:17,280 PARTICIPATED. 6838 04:30:17,280 --> 04:30:20,280 IT IS A CROSS DISCIPLINARY 6839 04:30:20,280 --> 04:30:20,880 TRIALS AND IT WILL COLLECT 6840 04:30:20,880 --> 04:30:21,360 ENTER INFORMATION. 6841 04:30:21,360 --> 04:30:22,200 --- 6842 04:30:22,200 --> 04:30:28,480 THEN WE HAD THE C4R TRIAL 6843 04:30:28,480 --> 04:30:32,440 ALREADY MENTIONED, THE PLUS 6844 04:30:32,440 --> 04:30:35,440 THIS CASE WAS THAT THERE WAS 6845 04:30:35,440 --> 04:30:37,480 GREAT DIVERSITY 6846 04:30:37,480 --> 04:30:38,000 AND INFORMATION IN THE 6847 04:30:38,000 --> 04:30:39,480 COMMITTEE BUT NO DETAILED 6848 04:30:39,480 --> 04:30:41,120 INFORMATION ABOUT GENDER SO 6849 04:30:41,120 --> 04:30:41,840 FOCUSING ON ANOTHER 6850 04:30:41,840 --> 04:30:45,040 ASPECT OF DIVERSITY IS NOT A 6851 04:30:45,040 --> 04:30:47,360 GIVEN THAT WE WILL HAVE 6852 04:30:47,360 --> 04:30:47,960 INFORMATION ABOUT GENDER. 6853 04:30:47,960 --> 04:30:48,560 AND AS SAID BEFORE THIS NEEDS 6854 04:30:48,560 --> 04:30:50,840 TO BE DONE DELIBERATELY IN 6855 04:30:50,840 --> 04:30:51,200 THE BEGINNING. 6856 04:30:51,200 --> 04:30:51,800 --- IT WAS ALSO POINTED OUT 6857 04:30:51,800 --> 04:30:55,320 THAT ESPECIALLY WHEN ASKING 6858 04:30:55,320 --> 04:30:55,960 INDIVIDUALS FROM MARGINALIZED 6859 04:30:55,960 --> 04:30:56,400 COMMUNITIES 6860 04:30:56,400 --> 04:30:57,600 THAT MAYBE DO NOT HAVE ACCESS 6861 04:30:57,600 --> 04:31:01,520 TO HEALTHCARE. 6862 04:31:01,520 --> 04:31:03,680 ASKING ABOUT POSITIVE TESTS 6863 04:31:03,680 --> 04:31:04,240 MIGHT BE A MECHANISM OF 6864 04:31:04,240 --> 04:31:04,720 EXCLUSION BECAUSE NOT 6865 04:31:04,720 --> 04:31:05,440 EVERYBODY HAS ACCESS TO 6866 04:31:05,440 --> 04:31:06,040 THESE COMMUNITIES. 6867 04:31:06,040 --> 04:31:11,400 AND ASKING ABOUT LONG COVID 6868 04:31:11,400 --> 04:31:11,920 IT MIGHT BE POTENTIALLY 6869 04:31:11,920 --> 04:31:13,440 CHALLENGING AND POTENTIALLY 6870 04:31:13,440 --> 04:31:13,880 EXCLUSIONARY FOR 6871 04:31:13,880 --> 04:31:14,480 CERTAIN COMMUNITIES BECAUSE 6872 04:31:14,480 --> 04:31:18,680 OF COURSE, IT MIGHT BE 6873 04:31:18,680 --> 04:31:19,280 STIGMATIZED AS WELL AND IT 6874 04:31:19,280 --> 04:31:19,760 COULD HAVE 6875 04:31:19,760 --> 04:31:20,160 CONSEQUENCES. 6876 04:31:20,160 --> 04:31:22,440 --- THE LAST EXAMPLE 6877 04:31:22,440 --> 04:31:25,000 MENTIONED BY DOCTOR BARRY 6878 04:31:25,000 --> 04:31:25,960 MERZ, WE WANTED TO KNOW WHAT 6879 04:31:25,960 --> 04:31:28,440 THEY DID WELL AT 6880 04:31:28,440 --> 04:31:29,080 CEDARS AND WHAT WE CAN LEARN 6881 04:31:29,080 --> 04:31:31,200 HERE. 6882 04:31:31,200 --> 04:31:31,760 AND SHE MADE A POINT THAT 6883 04:31:31,760 --> 04:31:33,600 THEY ARE DOING GREAT BUT THEY 6884 04:31:33,600 --> 04:31:36,240 ALSO HAVE A SOMEWHAT 6885 04:31:36,240 --> 04:31:36,680 ADVANTAGE GIVEN BY 6886 04:31:36,680 --> 04:31:38,040 THE COMMUNITY WHERE THEY ARE 6887 04:31:38,040 --> 04:31:44,560 LOCATED, BEING A DIVERSE AREA 6888 04:31:44,560 --> 04:31:45,160 IN A LARGE INSTITUTION THAT 6889 04:31:45,160 --> 04:31:45,480 TAKES CARE 6890 04:31:45,480 --> 04:31:50,840 OF EVERYONE AND ONE HAS TO BE 6891 04:31:50,840 --> 04:31:51,480 DELIBERATE IN RECRUITING THIS 6892 04:31:51,480 --> 04:31:53,480 MAKES IT SOMEWHAT EASIER THAN 6893 04:31:53,480 --> 04:31:53,760 IN OTHER 6894 04:31:53,760 --> 04:31:56,360 INSTITUTIONS THAT MIGHT LACK 6895 04:31:56,360 --> 04:31:56,920 SUCH AN INFRASTRUCTURE OR 6896 04:31:56,920 --> 04:31:58,760 CATCHMENT AREA. 6897 04:31:58,760 --> 04:31:59,400 --- THAT IS PRETTY MUCH WHAT 6898 04:31:59,400 --> 04:32:02,600 WE TALKED ABOUT. 6899 04:32:02,600 --> 04:32:04,400 IF ANY OF THE PARTICIPANTS IN 6900 04:32:04,400 --> 04:32:05,840 THE BREAKOUT ROOMS STILL HAVE 6901 04:32:05,840 --> 04:32:06,440 POINTS TO ADDRESS THAT WE 6902 04:32:06,440 --> 04:32:06,800 HAVE MISSED 6903 04:32:06,800 --> 04:32:08,520 HERE PLEASE FEEL FREE TO CHIP 6904 04:32:08,520 --> 04:32:09,360 IN. 6905 04:32:09,360 --> 04:32:10,200 OTHERWISE I THINK THAT IS IT 6906 04:32:10,200 --> 04:32:15,280 FORM OUR SIDE NOW. 6907 04:32:15,280 --> 04:32:17,160 >> DR. KANTHI: 6908 04:32:17,160 --> 04:32:19,440 WONDERFUL THANK YOU. 6909 04:32:19,440 --> 04:32:23,920 THE NEXT PHASE HERE IS FOR US 6910 04:32:23,920 --> 04:32:24,440 TO HAVE MORE OF AN OPEN 6911 04:32:24,440 --> 04:32:29,640 CONVERSATION AND THINK ABOUT 6912 04:32:29,640 --> 04:32:30,040 WHETHER YOU AS 6913 04:32:30,040 --> 04:32:35,480 THE AUDIENCE HAVE COMMENTS. 6914 04:32:35,480 --> 04:32:36,000 HOW MIGHT YOU INFORM 6915 04:32:36,000 --> 04:32:36,560 DIFFERENT ASPECT OF THE 6916 04:32:36,560 --> 04:32:38,480 REPORT? FOR THE ONES YOU WERE 6917 04:32:38,480 --> 04:32:39,000 IN OR PERHAPS YOU ARE 6918 04:32:39,000 --> 04:32:40,440 NOT IN, AND HOW YOU WOULD 6919 04:32:40,440 --> 04:32:43,080 MAKE MORE BROAD, MORE 6920 04:32:43,080 --> 04:32:44,720 INCLUSIVE, MORE THOROUGH 6921 04:32:44,720 --> 04:32:45,200 ALIGNMENT WITH THE 6922 04:32:45,200 --> 04:32:55,680 MISSION OF THIS WORKSHOP. 6923 04:33:00,640 --> 04:33:05,680 >> DR. SANDBERG: 6924 04:33:05,680 --> 04:33:13,880 EVERYBODY HAD SO MANY IDEAS 6925 04:33:13,880 --> 04:33:14,480 BUT WE DID NOT HAVE ENOUGH 6926 04:33:14,480 --> 04:33:24,520 TIME. 6927 04:33:24,520 --> 04:33:26,200 WE JUST TALKED ABOUT TWO 6928 04:33:26,200 --> 04:33:27,640 TOPICS AND THERE WERE ANOTHER 6929 04:33:27,640 --> 04:33:29,360 20, AND WE COULD SPEND THE 6930 04:33:29,360 --> 04:33:30,280 WHOLE TIME AT 6931 04:33:30,280 --> 04:33:32,400 THE BAR TALKING ON THIS. 6932 04:33:32,400 --> 04:33:35,160 >> DR. KANTHI: 6933 04:33:35,160 --> 04:33:35,760 I AGREE THAT WE CAN USE ALL 6934 04:33:35,760 --> 04:33:37,080 TIME BUT WE ONLY HAVE A FIXED 6935 04:33:37,080 --> 04:33:37,880 AMOUNT OF TIME SO WE HAVE TO 6936 04:33:37,880 --> 04:33:38,120 MOVE 6937 04:33:38,120 --> 04:33:41,000 SOMETHING FORWARD. 6938 04:33:41,000 --> 04:33:41,640 --- PERHAPS I CAN START WITH 6939 04:33:41,640 --> 04:33:45,760 ONE IDEA. 6940 04:33:45,760 --> 04:33:46,360 I WAS STRUCK WITH THE TALKS 6941 04:33:46,360 --> 04:33:47,320 BOTH YESTERDAY AND TODAY. 6942 04:33:47,320 --> 04:33:48,880 AND CAME AWAY WITH A BIT OF A 6943 04:33:48,880 --> 04:33:52,400 MESSAGE IS I THOUGHT ABOUT 6944 04:33:52,400 --> 04:33:53,440 THE COLLECTIVE EXPERIENCE OF 6945 04:33:53,440 --> 04:33:56,280 THIS GROUP. 6946 04:33:56,280 --> 04:33:56,920 AND THERE WERE COMMENTS FROM 6947 04:33:56,920 --> 04:33:59,560 SEVERAL OF THE SPEAKERS. 6948 04:33:59,560 --> 04:34:02,600 WE HAVE WHAT IS LIKELY A 6949 04:34:02,600 --> 04:34:03,880 ONCE-IN-A-LIFETIME 6950 04:34:03,880 --> 04:34:05,480 OPPORTUNITY TO BE ABLE TO 6951 04:34:05,480 --> 04:34:09,600 STUDY HOW OUR ORGAN SYSTEMS 6952 04:34:09,600 --> 04:34:12,200 INTERACT WITH ONE ANOTHER. 6953 04:34:12,200 --> 04:34:16,880 AND SO WE HOPE WE WOULD NOT 6954 04:34:16,880 --> 04:34:17,520 HAVE THIS OPPORTUNITY BUT IT 6955 04:34:17,520 --> 04:34:18,880 IS HERE. 6956 04:34:18,880 --> 04:34:20,800 IT IS IMPORTANT TO ENSURE 6957 04:34:20,800 --> 04:34:22,200 THAT WE ARE LEVERAGING IT AS 6958 04:34:22,200 --> 04:34:24,880 MUCH AS POSSIBLE TO BE ABLE 6959 04:34:24,880 --> 04:34:26,640 TO THINK ABOUT 6960 04:34:26,640 --> 04:34:28,480 NOT JUST ACUTE ILLNESSES BUT 6961 04:34:28,480 --> 04:34:30,280 CHRONIC ILLNESSES AS WELL. 6962 04:34:30,280 --> 04:34:30,800 THINGS LIKE AUTOIMMUNE 6963 04:34:30,800 --> 04:34:40,960 DISEASE. 6964 04:34:46,000 --> 04:34:46,520 SO TO THAT END, ONE EXAMPLE 6965 04:34:46,520 --> 04:34:47,080 THAT WAS PRESENTED BY THE 6966 04:34:47,080 --> 04:34:47,720 GROUP IN YALE THERE ARE AUTO 6967 04:34:47,720 --> 04:34:48,040 ANTIBODIES 6968 04:34:48,040 --> 04:34:48,360 FORMED. 6969 04:34:48,360 --> 04:34:49,680 IN THE GROUP DESCRIBE SOME OF 6970 04:34:49,680 --> 04:34:54,080 THE -- ONES. 6971 04:34:54,080 --> 04:34:54,720 IT IS A BROAD REPERTOIRE AND 6972 04:34:54,720 --> 04:34:56,200 WE DON'T KNOW WHAT THIS MEANS. 6973 04:34:56,200 --> 04:34:57,440 --- AS WE THINK FORWARD MAYBE 6974 04:34:57,440 --> 04:34:58,640 THERE IS A TERM THAT CAN BE 6975 04:34:58,640 --> 04:35:00,280 COINED HERE. 6976 04:35:00,280 --> 04:35:02,520 THAT BRINGS TOGETHER SOME OF 6977 04:35:02,520 --> 04:35:06,080 THESE OTHER DISCIPLINES. 6978 04:35:06,080 --> 04:35:06,680 MAYBE SOMETHING LIKE VASCULAR 6979 04:35:06,680 --> 04:35:08,480 IMMUNO BIOLOGY. 6980 04:35:08,480 --> 04:35:10,560 I MENTIONED THAT IN OUR LAST 6981 04:35:10,560 --> 04:35:13,800 DISCUSSION SESSION. 6982 04:35:13,800 --> 04:35:14,400 THAT IS SOMETHING TO THINK 6983 04:35:14,400 --> 04:35:15,240 ABOUT AND I AM INTERESTED TO 6984 04:35:15,240 --> 04:35:15,880 HEAR FROM THOSE WHO HAVE BEEN 6985 04:35:15,880 --> 04:35:16,200 DOING THIS 6986 04:35:16,200 --> 04:35:26,600 LONGER THAN I HAVE, . 6987 04:35:31,840 --> 04:35:34,120 >> WE HAVE KNOWN THAT THERE 6988 04:35:34,120 --> 04:35:34,680 IS A RELATIONSHIP BETWEEN 6989 04:35:34,680 --> 04:35:36,320 VIRAL INFECTIONS AND 6990 04:35:36,320 --> 04:35:36,880 AUTOIMMUNE DISEASES BUT 6991 04:35:36,880 --> 04:35:39,480 IT IS DIFFICULT TO PROVE 6992 04:35:39,480 --> 04:35:41,560 BECAUSE CLINICAL DISEASES 6993 04:35:41,560 --> 04:35:42,120 PRESENTS A MUCH LATER AND 6994 04:35:42,120 --> 04:35:43,160 VIRAL INFECTIONS SO 6995 04:35:43,160 --> 04:35:44,960 MUCH SOONER. 6996 04:35:44,960 --> 04:35:46,200 MANY OF THEM ARE COMMON 6997 04:35:46,200 --> 04:35:46,840 INFECTIONS THAT ARE DIFFICULT 6998 04:35:46,840 --> 04:35:47,280 TO DISTINGUISH. 6999 04:35:47,280 --> 04:35:50,760 I THINK COVID HAS SHOWN US 7000 04:35:50,760 --> 04:35:53,680 THAT VIRUSES CAN CAUSE 7001 04:35:53,680 --> 04:35:55,520 AUTOIMMUNE DISEASE REALLY 7002 04:35:55,520 --> 04:35:58,080 WITHOUT ANY DOUBT. 7003 04:35:58,080 --> 04:36:00,080 AND VIRUSES ARE VERY GOOD AT 7004 04:36:00,080 --> 04:36:01,920 INDUCING THIS BY CAUSING THE 7005 04:36:01,920 --> 04:36:02,520 TYPE OF DAMAGE THAT THEY DO. 7006 04:36:02,520 --> 04:36:07,240 BUT ALSO HAVE AN IN, AND 7007 04:36:07,240 --> 04:36:09,880 INTEGRATE WITH MITOCHONDRIA 7008 04:36:09,880 --> 04:36:14,120 AND THE CELLS. 7009 04:36:14,120 --> 04:36:14,760 AND PRODUCE DAMAGING PROFILE 7010 04:36:14,760 --> 04:36:15,400 TO PRODUCE STRONG AUTOIMMUNE 7011 04:36:15,400 --> 04:36:16,400 RESPONSES. 7012 04:36:16,400 --> 04:36:18,120 WE HAVE AN OPPORTUNITY TO 7013 04:36:18,120 --> 04:36:19,440 UNDERSTAND MANY THINGS. 7014 04:36:19,440 --> 04:36:25,360 AUTO VIRUSES CAN CAUSE POTS, 7015 04:36:25,360 --> 04:36:25,960 WE DID NOT THOUGHT THAT WAS 7016 04:36:25,960 --> 04:36:28,600 POSSIBLE BEFORE SEEING THIS. 7017 04:36:28,600 --> 04:36:31,240 THIS IS 7018 04:36:31,240 --> 04:36:31,800 BROUGHT VIRUSES TO THE 7019 04:36:31,800 --> 04:36:32,360 FOREFRONT WHERE THEY HAVE 7020 04:36:32,360 --> 04:36:32,960 BEEN IGNORED QUITE A WHILE 7021 04:36:32,960 --> 04:36:34,480 FOR WHAT THEY CAN DO 7022 04:36:34,480 --> 04:36:35,120 IN THEIR ROLE IN DISEASE AND 7023 04:36:35,120 --> 04:36:41,680 THERE ARE STRONG SEX 7024 04:36:41,680 --> 04:36:42,280 DIFFERENCES IN ALL OF THE 7025 04:36:42,280 --> 04:36:42,760 AUTO IMMUNE DISEASES 7026 04:36:42,760 --> 04:36:44,040 AND THE PATHOLOGY DIFFERENCES 7027 04:36:44,040 --> 04:36:48,120 IN MALES AND FEMALES IF YOU 7028 04:36:48,120 --> 04:36:48,760 ARE A SMALL NUMBER OF MALES 7029 04:36:48,760 --> 04:36:49,120 GETTING IT 7030 04:36:49,120 --> 04:36:49,720 AND HIGHER NUMBER FEMALES AND 7031 04:36:49,720 --> 04:36:50,680 VICE A VERSA. 7032 04:36:50,680 --> 04:36:51,320 WE HAVE ALL OF THESE FACTORS 7033 04:36:51,320 --> 04:36:52,400 PLAYING OUT SO WE DON'T HAVE 7034 04:36:52,400 --> 04:36:54,920 A MORE REMARKABLY STRONG SEX 7035 04:36:54,920 --> 04:36:55,240 DIFFERENCE 7036 04:36:55,240 --> 04:36:57,840 IN MALES. 7037 04:36:57,840 --> 04:37:02,400 THE IMMUNE RESPONSE SUGGEST 7038 04:37:02,400 --> 04:37:02,840 WE SHOULD HAVE AN 7039 04:37:02,840 --> 04:37:03,400 OVERWHELMING RESPONSE IN 7040 04:37:03,400 --> 04:37:03,840 MALES WITH TISSUE 7041 04:37:03,840 --> 04:37:04,360 PATHOLOGY BUT ALL THE 7042 04:37:04,360 --> 04:37:04,960 AUTOIMMUNE RESPONSES SHOWS 7043 04:37:04,960 --> 04:37:07,120 THAT WE HAVE FACTORS GOING UP 7044 04:37:07,120 --> 04:37:09,960 IN MALES THAT ARE 7045 04:37:09,960 --> 04:37:10,560 BAD, AND UP IN FEMALES THAT 7046 04:37:10,560 --> 04:37:14,760 ARE BAD. AND THEY ARE 7047 04:37:14,760 --> 04:37:16,400 COUNTERACTING IN SOME SENSES 7048 04:37:16,400 --> 04:37:16,720 OUR OLD SEX 7049 04:37:16,720 --> 04:37:17,880 DIFFERENCES SO WE HAVE A 7050 04:37:17,880 --> 04:37:18,440 WONDERFUL OPPORTUNITY TO 7051 04:37:18,440 --> 04:37:18,960 UNDERSTAND THESE THINGS 7052 04:37:18,960 --> 04:37:27,960 BETTER. 7053 04:37:27,960 --> 04:37:32,000 >> DR. KANTHI: 7054 04:37:32,000 --> 04:37:35,960 DR. DELA CRUZ FEEL FREE. 7055 04:37:35,960 --> 04:37:36,920 THIS IS AN OPEN CONVERSATION. 7056 04:37:36,920 --> 04:37:38,600 >> DR. DELA CRUZ: 7057 04:37:38,600 --> 04:37:39,600 I AGREE WITH WHAT HAS BEEN 7058 04:37:39,600 --> 04:37:43,440 COMMENTED BY DR. KHANTI IN 7059 04:37:43,440 --> 04:37:46,480 THE PREVIOUS SPEAKER. 7060 04:37:46,480 --> 04:37:47,080 THIS IS AN OPPORTUNITY TO 7061 04:37:47,080 --> 04:37:48,960 UNDERSTAND WHAT THIS ONE 7062 04:37:48,960 --> 04:37:49,520 VIRUS CAN CAUSE AND IT IS 7063 04:37:49,520 --> 04:37:49,960 OBVIOUSLY REALLY 7064 04:37:49,960 --> 04:37:50,960 COMPLICATED. 7065 04:37:50,960 --> 04:37:52,640 WE HAVE BEEN STUDYING THE 7066 04:37:52,640 --> 04:37:54,760 ROLE OF RESPIRATORY VIRUSES 7067 04:37:54,760 --> 04:37:58,440 AND LONG-TERM OUTCOMES IN 7068 04:37:58,440 --> 04:38:00,000 LUNG DISEASES BUT 7069 04:38:00,000 --> 04:38:00,640 THE PROBLEM IS THAT WE NEVER 7070 04:38:00,640 --> 04:38:04,360 HAD AN INITIATING EVENT IN 7071 04:38:04,360 --> 04:38:04,960 LARGE NUMBERS. WE WANTED TO 7072 04:38:04,960 --> 04:38:06,400 INFER FROM 7073 04:38:06,400 --> 04:38:06,960 HISTORY AND HISTORICAL 7074 04:38:06,960 --> 04:38:08,320 EFFECTS. 7075 04:38:08,320 --> 04:38:08,920 AND THIS IS THE TIME TO DO 7076 04:38:08,920 --> 04:38:10,800 THIS. 7077 04:38:10,800 --> 04:38:12,880 WE KNOW WHO ARE INFECTED. 7078 04:38:12,880 --> 04:38:17,040 WE KNOW WHO THEY ARE. 7079 04:38:17,040 --> 04:38:17,600 THERE'S TONS OF CLINICAL 7080 04:38:17,600 --> 04:38:18,160 TRIALS DONE CURRENTLY AND 7081 04:38:18,160 --> 04:38:18,920 SOME OF THE SEX AND GENDER 7082 04:38:18,920 --> 04:38:21,280 FACTOR DISCUSSED 7083 04:38:21,280 --> 04:38:23,240 OVER THE PAST TWO DAYS CAN BE 7084 04:38:23,240 --> 04:38:23,880 MOBILIZED AND USE THOSE DATA 7085 04:38:23,880 --> 04:38:25,800 IN BIO SPECIMENS TO ADDRESS 7086 04:38:25,800 --> 04:38:26,640 THESE 7087 04:38:26,640 --> 04:38:27,000 COMPLICATIONS. 7088 04:38:27,000 --> 04:38:28,520 --- 7089 04:38:28,520 --> 04:38:29,120 AND I DON'T THINK THIS IS ONE 7090 04:38:29,120 --> 04:38:30,320 THING CAUSING ANOTHER GENE, 7091 04:38:30,320 --> 04:38:32,040 ANOTHER RECEPTOR. 7092 04:38:32,040 --> 04:38:32,640 I THINK IT IS A COMPETITION 7093 04:38:32,640 --> 04:38:34,640 ISSUE. 7094 04:38:34,640 --> 04:38:35,200 THE OTHER THING WE REALLY 7095 04:38:35,200 --> 04:38:36,440 NEED TO DISSECT ARE THE 7096 04:38:36,440 --> 04:38:37,760 DIFFERENT PHENOTYPES, PASSED 7097 04:38:37,760 --> 04:38:38,360 PHENOTYPES. 7098 04:38:38,360 --> 04:38:42,520 AND EVEN ERDS FROM FLU OR 7099 04:38:42,520 --> 04:38:46,040 FROM COVID. 7100 04:38:46,040 --> 04:38:48,960 WE KNOW THERE ARE DIFFERENT 7101 04:38:48,960 --> 04:38:49,520 PHENOTYPES, INFLAMMATORY 7102 04:38:49,520 --> 04:38:52,400 VERSUS NON-INFLAMMATORY. THIS 7103 04:38:52,400 --> 04:38:52,800 IS ALL REALLY 7104 04:38:52,800 --> 04:38:54,520 IMPORTANT DISCUSSIONS. 7105 04:38:54,520 --> 04:38:55,160 AND ACTUALLY HIGHLIGHTED THAT 7106 04:38:55,160 --> 04:38:56,880 WE NEED TO DO A LOT MORE FOR 7107 04:38:56,880 --> 04:38:58,280 THIS KIND OF WORK. 7108 04:38:58,280 --> 04:39:04,480 AND GENDER AND SEX THAT HAS 7109 04:39:04,480 --> 04:39:06,040 BEEN DISCUSSED IS ONE OF THE 7110 04:39:06,040 --> 04:39:06,520 ONLY FEW FACTORS THAT 7111 04:39:06,520 --> 04:39:07,240 CONTRIBUTE TO THIS 7112 04:39:07,240 --> 04:39:09,000 HETEROGENEITY. 7113 04:39:09,000 --> 04:39:12,560 IT IS AN IMPORTANT ONE. 7114 04:39:12,560 --> 04:39:13,160 WE DO NOT KNOW WHAT IS GOING 7115 04:39:13,160 --> 04:39:20,440 ON IN HUMANS TO BE HONEST. 7116 04:39:20,440 --> 04:39:21,080 IN SOME OF THE HUMAN STUDIES 7117 04:39:21,080 --> 04:39:23,440 I PRESENTED THE EFFECTS WERE 7118 04:39:23,440 --> 04:39:23,920 SMALL COMPARED TO THE 7119 04:39:23,920 --> 04:39:26,200 MILLIONS OF PEOPLE 7120 04:39:26,200 --> 04:39:26,840 COMPARED TO WE NEED TO THINK 7121 04:39:26,840 --> 04:39:27,800 ABOUT LARGE-SCALE APPROACHES 7122 04:39:27,800 --> 04:39:30,720 TO SEE THE EFFECTS AND BETTER 7123 04:39:30,720 --> 04:39:33,040 PHENOTYPING TO REALLY 7124 04:39:33,040 --> 04:39:33,680 UNDERSTAND THE MECHANISM THAT 7125 04:39:33,680 --> 04:39:35,480 TIES THIS TOGETHER. 7126 04:39:35,480 --> 04:39:36,040 THANK YOU FOR GIVING THIS 7127 04:39:36,040 --> 04:39:39,200 EVENT. 7128 04:39:39,200 --> 04:39:41,000 >> AND WOULD MAKE THE POINT A 7129 04:39:41,000 --> 04:39:43,120 LITTLE MORE SPECIFICALLY THAT 7130 04:39:43,120 --> 04:39:44,760 I MADE IN MY PRESENTATION. 7131 04:39:44,760 --> 04:39:48,040 THAT WE HAVE BEEN RECOGNIZING 7132 04:39:48,040 --> 04:39:48,920 THE ROLE OF INFLAMMATION, 7133 04:39:48,920 --> 04:39:53,840 TRIGGERED BY X, Y AND Z IN 7134 04:39:53,840 --> 04:39:54,960 CARDIOVASCULAR 7135 04:39:54,960 --> 04:39:58,440 DISEASE FOR THREE DECADES. 7136 04:39:58,440 --> 04:39:59,000 WE HAVE THREE RANDOMIZED 7137 04:39:59,000 --> 04:40:02,520 CONTROLLED TRIALS, AND TWO 7138 04:40:02,520 --> 04:40:06,280 OUT OF THE THREE WERE 7139 04:40:06,280 --> 04:40:07,960 POSITIVE TRIALS 7140 04:40:07,960 --> 04:40:09,160 ENDORSING THAT THIS IS A 7141 04:40:09,160 --> 04:40:09,760 CONCEPT THAT WE CAN ADDRESS 7142 04:40:09,760 --> 04:40:11,720 CARDIOVASCULAR DISEASE IN 7143 04:40:11,720 --> 04:40:15,280 WOMEN AND MEN, BY 7144 04:40:15,280 --> 04:40:17,200 ADDRESSING IMMUNE FUNCTION 7145 04:40:17,200 --> 04:40:21,920 AND VASCULAR INFORMATION. 7146 04:40:21,920 --> 04:40:22,800 (CORRECTION) INFLAMMATION. 7147 04:40:22,800 --> 04:40:24,800 --- 7148 04:40:24,800 --> 04:40:29,920 I WOULD SAY THAT WE SHOULD BE 7149 04:40:29,920 --> 04:40:30,520 DOING PILOT PHARMACOLOGICAL 7150 04:40:30,520 --> 04:40:33,040 TRIALS AND USING BIOMARKERS, 7151 04:40:33,040 --> 04:40:33,360 AND MAYBE 7152 04:40:33,360 --> 04:40:37,920 CARDIAC MRI AS A BIOMARKER. 7153 04:40:37,920 --> 04:40:38,440 I DON'T THINK THAT IS 7154 04:40:38,440 --> 04:40:40,680 PREMATURE TO LOOK AT THIS 7155 04:40:40,680 --> 04:40:43,000 BECAUSE A) WE HAVE IT; B) WE 7156 04:40:43,000 --> 04:40:44,600 KNOW HOW IT WORKS, 7157 04:40:44,600 --> 04:40:45,760 KIND OF. 7158 04:40:45,760 --> 04:40:46,440 AND THERE'S PLENTY OF PEOPLE 7159 04:40:46,440 --> 04:40:49,240 AS DR. DELA CRUZ SAID, THAT 7160 04:40:49,240 --> 04:40:52,440 THERE ARE PLENTY OF FOLKS AT 7161 04:40:52,440 --> 04:40:54,360 RISK FOR CPT 7162 04:40:54,360 --> 04:40:55,720 BECAUSE OF THEIR COVID 7163 04:40:55,720 --> 04:40:58,560 STATUS. 7164 04:40:58,560 --> 04:41:02,440 >> I AGREE HUNDRED PERCENT. 7165 04:41:02,440 --> 04:41:03,040 HE SAID A LOT OF THE THINGS 7166 04:41:03,040 --> 04:41:03,600 AND WANTED TO REITERATE 7167 04:41:03,600 --> 04:41:06,160 FOLLOWING TODAY'S DISCUSSION 7168 04:41:06,160 --> 04:41:06,560 AND YESTERDAY'S 7169 04:41:06,560 --> 04:41:09,360 AS WELL. 7170 04:41:09,360 --> 04:41:09,960 AND I THINK THIS IS THE USE 7171 04:41:09,960 --> 04:41:13,840 OF ANIMAL MODELS IN STUDYING 7172 04:41:13,840 --> 04:41:15,600 THE DIFFERENCES IN THE 7173 04:41:15,600 --> 04:41:17,560 PATHOLOGY AND LONG 7174 04:41:17,560 --> 04:41:19,120 COVID SYNDROME WILL HELP US 7175 04:41:19,120 --> 04:41:20,560 DECIPHER WHICH MECHANISMS 7176 04:41:20,560 --> 04:41:22,680 MIGHT PLAY A ROLE BETWEEN THE 7177 04:41:22,680 --> 04:41:22,960 DIFFERENT 7178 04:41:22,960 --> 04:41:25,000 SEXES. 7179 04:41:25,000 --> 04:41:25,520 AND WHICH MAY BE MORE 7180 04:41:25,520 --> 04:41:28,360 PERTINENT AND ACUTE VERSUS 7181 04:41:28,360 --> 04:41:30,920 LONG COVID. 7182 04:41:30,920 --> 04:41:32,360 --- I THINK THIS IS A GOOD 7183 04:41:32,360 --> 04:41:34,000 OPPORTUNITY TO CONTINUE 7184 04:41:34,000 --> 04:41:34,480 STUDYING THE ROLE OF 7185 04:41:34,480 --> 04:41:36,920 INFLAMMATION IN CAUSING 7186 04:41:36,920 --> 04:41:39,880 CARDIOVASCULAR EVENTS AND 7187 04:41:39,880 --> 04:41:42,120 LONG COVID CARDIOVASCULAR 7188 04:41:42,120 --> 04:41:44,320 EVENTS AND NEUROVASCULAR 7189 04:41:44,320 --> 04:41:45,280 EVENTS. 7190 04:41:45,280 --> 04:41:46,880 SO THAT WE CAN LEARN MORE 7191 04:41:46,880 --> 04:41:50,240 ABOUT HOW PREVENTING SOME OF 7192 04:41:50,240 --> 04:41:51,920 THAT CHRONIC INFLAMMATION CAN 7193 04:41:51,920 --> 04:41:52,200 IMPROVE 7194 04:41:52,200 --> 04:41:53,560 LONG-TERM HEALTH OUTCOMES FOR 7195 04:41:53,560 --> 04:41:58,360 MEN AND WOMEN. 7196 04:41:58,360 --> 04:41:59,840 AND WOMEN POST PREGNANCY AS 7197 04:41:59,840 --> 04:42:00,920 WELL. 7198 04:42:00,920 --> 04:42:01,440 DO NOT FORGET ABOUT OUR 7199 04:42:01,440 --> 04:42:04,240 PREGNANT WOMEN. 7200 04:42:04,240 --> 04:42:08,000 DELTA HAD A DEVASTATING 7201 04:42:08,000 --> 04:42:08,560 EFFECT WORLDWIDE ON THESE 7202 04:42:08,560 --> 04:42:13,040 WOMEN AND -- AS WELL AS SO IT 7203 04:42:13,040 --> 04:42:13,480 OPEN OUR EYES WITH 7204 04:42:13,480 --> 04:42:14,160 DELTA. 7205 04:42:14,160 --> 04:42:16,400 AND SO WHEN YOU SEE WOMEN 7206 04:42:16,400 --> 04:42:18,040 THAT HAD COVID DURING THEIR 7207 04:42:18,040 --> 04:42:21,560 PREGNANCY IN YOUR CLINICS AND 7208 04:42:21,560 --> 04:42:21,880 THEY ARE 7209 04:42:21,880 --> 04:42:23,640 SUFFERING FROM SOME OF THESE 7210 04:42:23,640 --> 04:42:25,000 LONG COVID SYMPTOMS, KEEP 7211 04:42:25,000 --> 04:42:27,040 THAT IN MIND. 7212 04:42:27,040 --> 04:42:28,440 IF YOU WANT TO YOU CAN 7213 04:42:28,440 --> 04:42:30,280 ACTUALLY MAY BE COLLECT SOME 7214 04:42:30,280 --> 04:42:33,200 BLOOD AND SENT IT TO US AND 7215 04:42:33,200 --> 04:42:33,640 LET'S SEE IF THEY 7216 04:42:33,640 --> 04:42:34,480 ARE PRODUCING AND 7217 04:42:34,480 --> 04:42:35,040 AUTOANTIBODY OR SOMETHING 7218 04:42:35,040 --> 04:42:36,720 LIKE THAT AND WE CAN START 7219 04:42:36,720 --> 04:42:39,080 SOME CROSS-COUNTRY 7220 04:42:39,080 --> 04:42:40,440 COLLABORATIONS SO THAT WE CAN 7221 04:42:40,440 --> 04:42:41,080 ALL LEARN A LITTLE BIT MORE 7222 04:42:41,080 --> 04:42:42,440 ABOUT HOW LONG THESE PEOPLE 7223 04:42:42,440 --> 04:42:44,400 ARE GOING TO 7224 04:42:44,400 --> 04:42:45,000 SUFFER AND HOW DEVASTATING 7225 04:42:45,000 --> 04:42:45,600 THEIR LONG-TERM EFFECTS CAN 7226 04:42:45,600 --> 04:42:48,920 BE. 7227 04:42:48,920 --> 04:42:51,400 >> 7228 04:42:51,400 --> 04:42:53,880 -- -- 7229 04:42:53,880 --> 04:42:55,400 >> DR. KANTHI: 7230 04:42:55,400 --> 04:42:58,000 THANK YOU. 7231 04:42:58,000 --> 04:42:58,640 ARE THERE OTHER THOUGHTS FROM 7232 04:42:58,640 --> 04:43:00,720 THE GROUP? 7233 04:43:00,720 --> 04:43:03,440 PLEASE FEEL FREE TO TURN YOUR 7234 04:43:03,440 --> 04:43:04,920 CAMERA ON IF YOU WISH. 7235 04:43:04,920 --> 04:43:05,960 BUT UNMUTE YOURSELF, AND 7236 04:43:05,960 --> 04:43:07,360 SHRE. 7237 04:43:07,360 --> 04:43:10,880 I KNOW IT'S BEEN A BIT OF A 7238 04:43:10,880 --> 04:43:15,440 LONG DAY, WITH A LARGE VOLUME 7239 04:43:15,440 --> 04:43:16,040 OF INFORMATION AND A LOT OF 7240 04:43:16,040 --> 04:43:16,280 ENERGY 7241 04:43:16,280 --> 04:43:19,240 EXPENDED. 7242 04:43:19,240 --> 04:43:19,760 I WAS SHARING THAT MY 7243 04:43:19,760 --> 04:43:20,400 CAFFEINE LEVELS HAVE DROPPED 7244 04:43:20,400 --> 04:43:21,760 PRETTY LOW. 7245 04:43:21,760 --> 04:43:22,440 I WILL NEED TO SPIKED THAT UP 7246 04:43:22,440 --> 04:43:24,520 AGAIN SOON. 7247 04:43:24,520 --> 04:43:28,280 --- SOMETHING THAT STOOD OUT 7248 04:43:28,280 --> 04:43:28,520 TO ME. 7249 04:43:28,520 --> 04:43:31,360 I WILL MAKE A COMMENT HERE. 7250 04:43:31,360 --> 04:43:33,360 THIS DISEASE SEEMS TO AFFECT 7251 04:43:33,360 --> 04:43:35,920 ALL ORGAN SYSTEMS AND ACROSS 7252 04:43:35,920 --> 04:43:37,560 TISSUES. 7253 04:43:37,560 --> 04:43:38,160 IT MIGHT BE IMPORTANT FOR US 7254 04:43:38,160 --> 04:43:42,400 TO THINK ABOUT ENSURING THAT 7255 04:43:42,400 --> 04:43:43,840 WE-- WE CREATE A FINAL REPORT 7256 04:43:43,840 --> 04:43:44,080 FROM 7257 04:43:44,080 --> 04:43:44,720 THIS-- THAT WE HAVE INCLUDED 7258 04:43:44,720 --> 04:43:48,440 REFERENCES TO VASCULAR, 7259 04:43:48,440 --> 04:43:49,640 IMMUNE, EPITHELIAL CONNECTING 7260 04:43:49,640 --> 04:43:51,440 TISSUE, MUSCLE 7261 04:43:51,440 --> 04:43:55,280 TISSUE, NEUROLOGICAL TISSUE, 7262 04:43:55,280 --> 04:43:55,920 THESE ARE ALL DIFFERENT WAYS 7263 04:43:55,920 --> 04:43:56,560 THAT PATIENTS ARE MANIFESTING 7264 04:43:56,560 --> 04:43:56,800 WITH 7265 04:43:56,800 --> 04:43:58,440 COMPLICATIONS BOTH ACUTE AND 7266 04:43:58,440 --> 04:43:58,680 CHRONIC. 7267 04:43:58,680 --> 04:44:03,760 AND THERE SEEMS TO BE SOME 7268 04:44:03,760 --> 04:44:04,400 DIFFERENCES THAT ARE BASED ON 7269 04:44:04,400 --> 04:44:06,320 SEX AND GENDER AND THE 7270 04:44:06,320 --> 04:44:06,840 HETEROGENEITY OF 7271 04:44:06,840 --> 04:44:10,600 THESE MANIFESTATIONS. 7272 04:44:10,600 --> 04:44:14,240 DR. -- YOU ARE WELCOME TO 7273 04:44:14,240 --> 04:44:15,280 UNMUTE YOURSELF IF YOU WISH. 7274 04:44:15,280 --> 04:44:16,400 >> DR. MULLINGTON: 7275 04:44:16,400 --> 04:44:18,240 THANK YOU. 7276 04:44:18,240 --> 04:44:20,320 I WANTED TO SAY THAT IT IS 7277 04:44:20,320 --> 04:44:23,480 ALSO A GREAT OPPORTUNITY TO 7278 04:44:23,480 --> 04:44:26,280 UNDERSTAND STRESS BETTER. 7279 04:44:26,280 --> 04:44:30,360 AND THE MIND/BODY CONNECTION. 7280 04:44:30,360 --> 04:44:32,760 WHAT CAN WE DO TO TURN THIS 7281 04:44:32,760 --> 04:44:34,520 AROUND? 7282 04:44:34,520 --> 04:44:37,960 WHAT KIND OF STRESS REDUCTION 7283 04:44:37,960 --> 04:44:38,560 APPROACHES MIGHT WE BE ABLE 7284 04:44:38,560 --> 04:44:41,800 TO DEVELOP? 7285 04:44:41,800 --> 04:44:42,440 HOW WILL OUR UNDERSTANDING OF 7286 04:44:42,440 --> 04:44:47,880 THE PATHOBIOLOGY HELP US 7287 04:44:47,880 --> 04:44:48,800 BETTER UNDERSTAND HOW 7288 04:44:48,800 --> 04:44:50,720 COGNITIVE STRATEGIES 7289 04:44:50,720 --> 04:44:53,760 AND BEHAVIORAL MANIPULATIONS 7290 04:44:53,760 --> 04:44:56,400 TO IMPROVE SLEEP AND 7291 04:44:56,400 --> 04:44:59,440 COGNITIVE BEHAVIORAL THERAPY 7292 04:44:59,440 --> 04:44:59,880 APPROACHES AND HOW 7293 04:44:59,880 --> 04:45:01,680 THEY CAN POTENTIALLY TURN 7294 04:45:01,680 --> 04:45:03,480 SOME OF THE BIOLOGY. 7295 04:45:03,480 --> 04:45:04,480 THIS IS A GREAT OPPORTUNITY 7296 04:45:04,480 --> 04:45:05,480 TO DO SOME OF THAT. 7297 04:45:05,480 --> 04:45:06,720 THANKS. 7298 04:45:06,720 --> 04:45:10,120 >> ABSOLUTELY. 7299 04:45:10,120 --> 04:45:12,320 DR. OERTELT-PRIGIONE: 7300 04:45:12,320 --> 04:45:15,560 IT IS I THINK A VERY RELEVANT 7301 04:45:15,560 --> 04:45:15,800 POINT. 7302 04:45:15,800 --> 04:45:17,440 WE HAVE HAD SOME INTERESTING 7303 04:45:17,440 --> 04:45:18,560 DATA COMING OUT OF THE UNITED 7304 04:45:18,560 --> 04:45:22,120 KINGDOM LAST WEEK, LOOKING AT 7305 04:45:22,120 --> 04:45:23,200 THE 7306 04:45:23,200 --> 04:45:29,240 PEOPLE MOSTLY AFFECTED BY 7307 04:45:29,240 --> 04:45:38,880 LONG COVID AT THIS TIME. 7308 04:45:38,880 --> 04:45:39,480 PREMENOPAUSAL WOMEN ARE MORE 7309 04:45:39,480 --> 04:45:41,280 AFFECTED WE DO NOT KNOW WHY. 7310 04:45:41,280 --> 04:45:42,960 AND DATA AROUND PROFESSIONS. 7311 04:45:42,960 --> 04:45:44,400 THEY FOUND THAT A RELATIVELY 7312 04:45:44,400 --> 04:45:45,960 HIGH INCIDENCE IN TEACHERS, 7313 04:45:45,960 --> 04:45:47,640 HEALTHCARE WORKERS; I WOULD 7314 04:45:47,640 --> 04:45:49,160 SAY A NUMBER 7315 04:45:49,160 --> 04:45:50,760 OF PROFESSIONS WHICH HAVE 7316 04:45:50,760 --> 04:45:55,000 BEEN UNDER A HIGH-LEVEL 7317 04:45:55,000 --> 04:45:55,520 STRESS THROUGHOUT THE 7318 04:45:55,520 --> 04:45:56,040 PANDEMIC AND STILL ARE 7319 04:45:56,040 --> 04:45:57,400 NOW. YOU KNOW THE MANAGEMENT 7320 04:45:57,400 --> 04:45:59,920 IN THE UK IS ALSO QUITE OPEN 7321 04:45:59,920 --> 04:46:00,520 AS IS IN THE NETHERLANDS, 7322 04:46:00,520 --> 04:46:01,080 ASSUMING THAT 7323 04:46:01,080 --> 04:46:04,280 COVID IS OVER. 7324 04:46:04,280 --> 04:46:06,880 EXPOSURE MEAN STRESS. 7325 04:46:06,880 --> 04:46:07,680 --- I WAS WONDERING LOOKING 7326 04:46:07,680 --> 04:46:15,240 AT THE DATA IS, IS BASELINE 7327 04:46:15,240 --> 04:46:16,400 STRESS DUE TO EXPOSURE TO 7328 04:46:16,400 --> 04:46:17,920 MULTIPLE DUTIES, 7329 04:46:17,920 --> 04:46:20,520 CONVERGENCE OF CARE AND WORK 7330 04:46:20,520 --> 04:46:22,760 AND SO FORTH. 7331 04:46:22,760 --> 04:46:24,360 IF THIS LEVEL OF STRESS IS 7332 04:46:24,360 --> 04:46:25,600 ALREADY HEIGHTENED BEFORE AND 7333 04:46:25,600 --> 04:46:27,800 THEN YOU HAVE A COVID 7334 04:46:27,800 --> 04:46:29,800 INFECTION ON TOP OF 7335 04:46:29,800 --> 04:46:31,800 THAT IF THAT DOES NOT SOMEHOW 7336 04:46:31,800 --> 04:46:33,000 INCREASE YOUR RISK POTENTIAL 7337 04:46:33,000 --> 04:46:36,160 OF DEVELOPING LONG COVID. 7338 04:46:36,160 --> 04:46:36,760 THERE IS AN INTERACTION AT 7339 04:46:36,760 --> 04:46:38,240 THAT LEVEL AND GOES IN THE 7340 04:46:38,240 --> 04:46:38,960 DIRECTION OF WHAT YOU WERE 7341 04:46:38,960 --> 04:46:39,280 MENTIONING, 7342 04:46:39,280 --> 04:46:42,600 STRESS AND PRIMING. 7343 04:46:42,600 --> 04:46:44,720 AND HOW FAR THIS COULD PLAY A 7344 04:46:44,720 --> 04:46:46,240 ROLE IN POTENTIAL PREVENTION 7345 04:46:46,240 --> 04:46:46,800 STRATEGIES GOING IN THAT 7346 04:46:46,800 --> 04:46:49,640 DIRECTION. 7347 04:46:49,640 --> 04:46:53,160 >> AND BECAUSE YOU MENTIONED 7348 04:46:53,160 --> 04:46:55,160 THAT, I WOULD MENTION ALSO 7349 04:46:55,160 --> 04:46:56,920 THAT IN RELATION TO THAT AND 7350 04:46:56,920 --> 04:46:57,200 PUT IT IN 7351 04:46:57,200 --> 04:47:01,000 CHAT BUT ENDOCRINE 7352 04:47:01,000 --> 04:47:01,560 DISRUPTORS, WE HAVE NOT 7353 04:47:01,560 --> 04:47:02,880 DESCRIBED THAT IN THE TARGET 7354 04:47:02,880 --> 04:47:03,600 ESTROGEN REFLECTORS ALPHA 7355 04:47:03,600 --> 04:47:08,680 AND BETA UBIQUITOUS IN OUR 7356 04:47:08,680 --> 04:47:10,840 ENVIRONMENT AND THEY SHOW AN 7357 04:47:10,840 --> 04:47:11,280 INCREASINGLY STRONG 7358 04:47:11,280 --> 04:47:11,720 RELATIONSHIP WITH 7359 04:47:11,720 --> 04:47:18,120 MANY DISEASES INCLUDING 7360 04:47:18,120 --> 04:47:18,760 CARDIOVASCULAR DISEASE AND IN 7361 04:47:18,760 --> 04:47:19,360 ANIMAL MODELS AFFECTING THE 7362 04:47:19,360 --> 04:47:19,760 ANIMALS AND THE 7363 04:47:19,760 --> 04:47:22,120 TISSUE CULTURE STUDIES. 7364 04:47:22,120 --> 04:47:24,120 AND THE INTERACT WITH A VIRAL 7365 04:47:24,120 --> 04:47:24,400 INFECTION. 7366 04:47:24,400 --> 04:47:24,920 AND PUBLISHED ON THAT 7367 04:47:24,920 --> 04:47:28,160 RECENTLY. 7368 04:47:28,160 --> 04:47:28,800 WE DID NOT SEE ANY EFFECT ON 7369 04:47:28,800 --> 04:47:30,200 THE IMMUNE SYSTEM WITHOUT THE 7370 04:47:30,200 --> 04:47:34,920 VIRAL INFECTION THERE. 7371 04:47:34,920 --> 04:47:35,440 BUT WHEN YOU CHANGE THE 7372 04:47:35,440 --> 04:47:39,760 ESTROGEN RECEPTOR EXPRESSION, 7373 04:47:39,760 --> 04:47:40,360 IT HAS A BIG EFFECT ON THE 7374 04:47:40,360 --> 04:47:40,760 IMMUNE RESPONSE 7375 04:47:40,760 --> 04:47:41,280 SO IT COULD BE ALTERING 7376 04:47:41,280 --> 04:47:42,000 PARTICULAR FEMALES BUT ALSO 7377 04:47:42,000 --> 04:47:42,640 ALTERING WHAT IS HAPPENING IN 7378 04:47:42,640 --> 04:47:44,480 MALES. 7379 04:47:44,480 --> 04:47:45,080 BECAUSE OF COURSE THEY ALSO 7380 04:47:45,080 --> 04:47:47,320 HAVE ESTROGEN RECEPTORS. 7381 04:47:47,320 --> 04:47:47,920 --- AND ONE OTHER THING WE 7382 04:47:47,920 --> 04:47:48,920 DID NOT DESCRIBE HERE WHICH I 7383 04:47:48,920 --> 04:47:49,560 BELIEVE HAS BEEN SHOWN TO BE 7384 04:47:49,560 --> 04:47:49,880 SOMETHING 7385 04:47:49,880 --> 04:47:52,040 IMPORTANT IN COVID IS ALSO 7386 04:47:52,040 --> 04:48:00,080 VITAMIN D AND THE ELEMENT D 7387 04:48:00,080 --> 04:48:00,720 RECEPTOR. VITAMIN D IS NOT A 7388 04:48:00,720 --> 04:48:01,080 VITAMIN BUT A 7389 04:48:01,080 --> 04:48:02,440 STEROID. 7390 04:48:02,440 --> 04:48:04,440 IT STRONGLY INFLUENCES THE 7391 04:48:04,440 --> 04:48:05,040 NATIVE IMMUNE RESPONSE IN A 7392 04:48:05,040 --> 04:48:06,840 SEX SPECIFIC MANNER. 7393 04:48:06,840 --> 04:48:07,480 IT IS IMPORTANT TO LOOK AT IN 7394 04:48:07,480 --> 04:48:12,320 THE FUTURE FOR COVID. 7395 04:48:12,320 --> 04:48:14,960 --- 7396 04:48:14,960 --> 04:48:16,120 >> DR. KANTHI: 7397 04:48:16,120 --> 04:48:20,120 THANK YOU. I WAS ALSO VERY 7398 04:48:20,120 --> 04:48:25,000 EXCITED ABOUT-- WE'VE 7399 04:48:25,000 --> 04:48:25,600 DISCUSSED ABOUT HOW THIS IS 7400 04:48:25,600 --> 04:48:26,080 AN OPPORTUNITY FOR 7401 04:48:26,080 --> 04:48:28,400 US TO BE ABLE TO STUDY HUMAN 7402 04:48:28,400 --> 04:48:28,720 PHYSIOLOGY. 7403 04:48:28,720 --> 04:48:29,960 AND UNDERSTAND HOW WE MIGHT 7404 04:48:29,960 --> 04:48:32,720 BE ABLE TO BETTER MANAGE AND 7405 04:48:32,720 --> 04:48:35,880 TREAT DISEASE IN THE FUTURE. 7406 04:48:35,880 --> 04:48:36,520 BUT ANOTHER LARGE REVOLUTION 7407 04:48:36,520 --> 04:48:37,720 I THINK-- AND I THINK IT IS A 7408 04:48:37,720 --> 04:48:41,040 FAIR TERM TO USE-- THAT IS, 7409 04:48:41,040 --> 04:48:41,280 AS A 7410 04:48:41,280 --> 04:48:42,080 RESULT OF THE PANDEMIC IS 7411 04:48:42,080 --> 04:48:47,840 RAPIDLY ADVANCING HOW WE 7412 04:48:47,840 --> 04:48:48,480 THINK ABOUT CLINICAL TRIALS; 7413 04:48:48,480 --> 04:48:48,760 WE HAVE 7414 04:48:48,760 --> 04:48:49,320 TRADITIONALLY LOOKED AT A 7415 04:48:49,320 --> 04:48:50,000 SINGLE INTERVENTION, 7416 04:48:50,000 --> 04:48:54,240 RANDOMIZED 7417 04:48:54,240 --> 04:48:56,480 PLACEBO-CONTROLLED. AND IN 7418 04:48:56,480 --> 04:48:56,880 THIS CASE, 7419 04:48:56,880 --> 04:48:58,800 THE PANDEMIC AND FACILITATED, 7420 04:48:58,800 --> 04:49:01,240 PERHAPS FORCED THE COMMUNITY 7421 04:49:01,240 --> 04:49:04,520 TO BE ABLE TO COME TOGETHER. 7422 04:49:04,520 --> 04:49:05,040 AND DESIGN THIS LARGER 7423 04:49:05,040 --> 04:49:06,960 PLATFORM TRIALS THAT ALLOW US 7424 04:49:06,960 --> 04:49:08,960 TO GENERATE RESULTS MUCH MORE 7425 04:49:08,960 --> 04:49:09,360 QUICKLY EVEN IF 7426 04:49:09,360 --> 04:49:10,800 THEY ARE NOT AS CLEAN AS WE 7427 04:49:10,800 --> 04:49:11,960 WOULD LIKE. 7428 04:49:11,960 --> 04:49:16,080 THE SIGNALS DO REALLY STAND 7429 04:49:16,080 --> 04:49:16,640 OUT WHEN WE LOOK AT THIS 7430 04:49:16,640 --> 04:49:17,880 LARGE DATA SETS. 7431 04:49:17,880 --> 04:49:18,440 ARE THE COMMENTS FROM THE 7432 04:49:18,440 --> 04:49:20,000 GROUP ON THIS? 7433 04:49:20,000 --> 04:49:21,960 WHERE COULD WE GO FROM THIS? 7434 04:49:21,960 --> 04:49:25,440 IS THE NEW NORM FOR US? 7435 04:49:25,440 --> 04:49:26,040 >> AGAIN I WOULD TAKE LESSONS 7436 04:49:26,040 --> 04:49:26,440 FROM CANCER. 7437 04:49:26,440 --> 04:49:30,880 THEY DO A LOT OF 7438 04:49:30,880 --> 04:49:33,680 BAYSIAN-STAGE TRIALS. 7439 04:49:33,680 --> 04:49:35,360 THEY STARTED WITH 10 ARMS, 7440 04:49:35,360 --> 04:49:35,880 DIFFERENT DOSING AND 7441 04:49:35,880 --> 04:49:37,320 DIFFERENT MEDICATIONS AND 7442 04:49:37,320 --> 04:49:38,480 THEY CAN DO THIS BECAUSE 7443 04:49:38,480 --> 04:49:41,560 CANCER IS SO PREVALENT. 7444 04:49:41,560 --> 04:49:42,800 SO WE SHOULD BE ABLE TO DO 7445 04:49:42,800 --> 04:49:44,840 THIS. BAYSIAN DESIGN. 7446 04:49:44,840 --> 04:49:49,880 AND YOU LEARN WITH EACH PHASE. 7447 04:49:49,880 --> 04:49:52,120 IT BECOMES EFFICIENT. 7448 04:49:52,120 --> 04:49:53,320 YOU DROP ARMS THAT ARE NOT 7449 04:49:53,320 --> 04:49:54,960 PROMISING WITH THE BAYESIAN 7450 04:49:54,960 --> 04:50:00,960 ANALYSIS. 7451 04:50:00,960 --> 04:50:01,800 >> DR. KANTHI: 7452 04:50:01,800 --> 04:50:07,440 THANK YOU. 7453 04:50:07,440 --> 04:50:11,320 >> DR. KANTHI: 7454 04:50:11,320 --> 04:50:12,280 OTHER ADDITIONAL COMMENTS OR 7455 04:50:12,280 --> 04:50:12,800 THOUGHTS? THAT YOU ARE 7456 04:50:12,800 --> 04:50:18,120 ITCHING TO GET IN? 7457 04:50:18,120 --> 04:50:20,160 WONDERFUL. 7458 04:50:20,160 --> 04:50:28,840 ON BEHALF OF DR. SANDBERG, 7459 04:50:28,840 --> 04:50:32,640 SABINE OERTELT -PRIGIONE AND 7460 04:50:32,640 --> 04:50:37,320 DR. -- I WILL HANDED BACK TO 7461 04:50:37,320 --> 04:50:37,920 JASMINA. 7462 04:50:37,920 --> 04:50:40,320 >> JASMINA VARAGIC: 7463 04:50:40,320 --> 04:50:43,240 I AM HERE TAKING NOTES. 7464 04:50:43,240 --> 04:50:45,720 WE WILL BE IN TOUCH OF COURSE 7465 04:50:45,720 --> 04:50:50,160 TO ADVANCE THIS DISCUSSION. 7466 04:50:50,160 --> 04:50:50,760 WE ARE REALLY THINKING ABOUT, 7467 04:50:50,760 --> 04:50:53,000 FIRST WE WILL HAVE AN 7468 04:50:53,000 --> 04:50:54,160 EXECUTIVE SUMMARY AND THEN 7469 04:50:54,160 --> 04:50:55,320 THINKING ABOUT 7470 04:50:55,320 --> 04:50:55,960 APPLICATION SO WE WILL BE IN 7471 04:50:55,960 --> 04:50:56,760 TOUCH FOR SURE. 7472 04:50:56,760 --> 04:50:59,200 AND WOULD LIKE TO GIVE LIKE A 7473 04:50:59,200 --> 04:51:00,560 CLOSING COMMENT. 7474 04:51:00,560 --> 04:51:04,040 IF I CAN HAVE MY SLIDES ON. 7475 04:51:04,040 --> 04:51:05,560 THAT WOULD BE REALLY NICE. I 7476 04:51:05,560 --> 04:51:07,760 APPRECIATE IT. 7477 04:51:07,760 --> 04:51:09,840 --- AND OF COURSE TAKING THIS 7478 04:51:09,840 --> 04:51:12,000 OPPORTUNITY TO THANK AGAIN 7479 04:51:12,000 --> 04:51:18,680 OUR WONDERFUL COCHAIRS -- DR. 7480 04:51:18,680 --> 04:51:18,920 KHANTI, 7481 04:51:18,920 --> 04:51:21,040 DOCTOR SANDBERG. 7482 04:51:21,040 --> 04:51:23,560 I WOULD ALSO LIKE TO THANK 7483 04:51:23,560 --> 04:51:26,040 ALL PHENOMENAL PRESENTERS AND 7484 04:51:26,040 --> 04:51:26,640 MODERATORS AND EVERYONE WHO 7485 04:51:26,640 --> 04:51:27,720 JOINED US AND 7486 04:51:27,720 --> 04:51:30,920 CONTRIBUTED TO THE GREAT 7487 04:51:30,920 --> 04:51:33,480 DISCUSSION IN THE WORKSHOP. 7488 04:51:33,480 --> 04:51:35,000 THANKS FOR THE COMMUNITY 7489 04:51:35,000 --> 04:51:35,640 REPRESENTATIVES. MR. 7490 04:51:35,640 --> 04:51:42,680 SIEVS, MR. KUSIC, MS. -- 7491 04:51:42,680 --> 04:51:45,000 AND FOR SHARING THE PERSONAL 7492 04:51:45,000 --> 04:51:46,440 JOURNEYS AND REMINDING US HOW 7493 04:51:46,440 --> 04:51:46,800 MUCH WE HAVE 7494 04:51:46,800 --> 04:51:48,840 TO DO AND MANY THANKS TO THE 7495 04:51:48,840 --> 04:51:53,080 NIH, MY COLLEAGUES FROM THE 7496 04:51:53,080 --> 04:51:53,680 NHLBI, NATIONAL HEART, LUNG 7497 04:51:53,680 --> 04:51:53,960 AND BLOOD 7498 04:51:53,960 --> 04:52:03,000 INSTITUTE. 7499 04:52:03,000 --> 04:52:08,800 AND THE EUNICE SHRIVER 7500 04:52:08,800 --> 04:52:09,440 INSTITUTE-- AND INSTITUTE FOR 7501 04:52:09,440 --> 04:52:14,440 MINORITY HEALTH DISPARITIES. 7502 04:52:14,440 --> 04:52:14,880 THEIR ENTHUSIASM 7503 04:52:14,880 --> 04:52:15,480 AND EXEMPLARY DEDICATION MADE 7504 04:52:15,480 --> 04:52:19,640 THE WORKSHOP A SUCCESS. AND 7505 04:52:19,640 --> 04:52:20,200 THE NIH FOR THE TECHNICAL 7506 04:52:20,200 --> 04:52:20,480 SUPPORT. 7507 04:52:20,480 --> 04:52:22,080 --- 7508 04:52:22,080 --> 04:52:23,520 I WOULD LIKE TO CLOSE ON OUR 7509 04:52:23,520 --> 04:52:26,520 VIEW, OUR PLANS ON HOW TO 7510 04:52:26,520 --> 04:52:28,360 LEVERAGE THIS WORKSHOP AND 7511 04:52:28,360 --> 04:52:30,240 IDEAS WE HAVE 7512 04:52:30,240 --> 04:52:30,760 GATHERED THROUGH THE 7513 04:52:30,760 --> 04:52:34,360 STIMULATING DISCUSSIONS. 7514 04:52:34,360 --> 04:52:36,240 AND MENTIONED WE WILL PUBLISH 7515 04:52:36,240 --> 04:52:40,760 AN EXECUTIVE SUMMARY ON THE 7516 04:52:40,760 --> 04:52:41,360 NIH WEBSITE AND I HOPE THAT 7517 04:52:41,360 --> 04:52:41,640 THIS IS A 7518 04:52:41,640 --> 04:52:42,160 GOOD RESOURCE FOR ALL 7519 04:52:42,160 --> 04:52:45,200 ATTENDING AND FOR ANYONE WHO 7520 04:52:45,200 --> 04:52:47,040 DID NOT ATTEND. AND IN 7521 04:52:47,040 --> 04:52:56,960 ADDITION THE WORKSHOP IS 7522 04:52:56,960 --> 04:52:57,560 RECORDED AND THE RECORDING 7523 04:52:57,560 --> 04:52:58,160 WILL BE IN THE ARCHIVES AND 7524 04:52:58,160 --> 04:52:58,800 ACCESSIBLE THROUGH THE LINKS 7525 04:52:58,800 --> 04:52:59,160 ON THE SLIDE 7526 04:52:59,160 --> 04:52:59,760 AND IN THE BOOKLET AND WITH 7527 04:52:59,760 --> 04:53:07,960 PLAN LANDSCAPE ANALYSIS OF 7528 04:53:07,960 --> 04:53:08,600 NHLBI GRANTS WITH RESPECT TO 7529 04:53:08,600 --> 04:53:11,560 SECTION THE 7530 04:53:11,560 --> 04:53:12,200 RESEARCH, AND PUBLICATIONS IN 7531 04:53:12,200 --> 04:53:14,000 PEER-REVIEWED JOURNALS. AND 7532 04:53:14,000 --> 04:53:14,640 WE SEE THIS AS AN OPPORTUNITY 7533 04:53:14,640 --> 04:53:14,880 TO TO 7534 04:53:14,880 --> 04:53:18,640 SHARE MORE BROADLY DETAILS 7535 04:53:18,640 --> 04:53:19,240 IDENTIFY CRITICAL RESEARCH 7536 04:53:19,240 --> 04:53:19,840 GAPS AND OPPORTUNITIES TO 7537 04:53:19,840 --> 04:53:20,200 ADDRESS THIS. 7538 04:53:20,200 --> 04:53:24,800 --- 7539 04:53:24,800 --> 04:53:25,240 WILL ALSO EXPLORE 7540 04:53:25,240 --> 04:53:25,880 OPPORTUNITIES TO DEVELOP OUR 7541 04:53:25,880 --> 04:53:26,520 YOUTH INITIATIVE AS MENTIONED 7542 04:53:26,520 --> 04:53:28,320 ON THE SEX AND GENDER 7543 04:53:28,320 --> 04:53:30,920 EMPHASIS ON COVID-RELATED 7544 04:53:30,920 --> 04:53:35,320 HEART, LUNG AND BLOOD 7545 04:53:35,320 --> 04:53:38,920 DISORDERS. AND WILL INDICATE 7546 04:53:38,920 --> 04:53:39,320 TO THE RESEARCH 7547 04:53:39,320 --> 04:53:39,840 COMMUNITIES THAT WE ARE 7548 04:53:39,840 --> 04:53:42,920 INTERESTED IN THIS TYPE OF 7549 04:53:42,920 --> 04:53:44,560 RESEARCH QUESTIONS AND THEY 7550 04:53:44,560 --> 04:53:44,920 STRATEGICALLY 7551 04:53:44,920 --> 04:53:45,520 ALIGNED WITH THE INSTITUTE 7552 04:53:45,520 --> 04:53:45,840 PRIORITIES. 7553 04:53:45,840 --> 04:53:47,840 --- 7554 04:53:47,840 --> 04:53:48,520 FINALLY DURING THESE TWO DAYS 7555 04:53:48,520 --> 04:53:50,080 OF THE WORKSHOP WE FREQUENTLY 7556 04:53:50,080 --> 04:53:52,120 HEARD ABOUT LACK OF SEX AND 7557 04:53:52,120 --> 04:53:52,400 GENDER 7558 04:53:52,400 --> 04:53:53,960 SPECIFIC DATA IN CVOID-19 7559 04:53:53,960 --> 04:53:57,600 RESEARCH AND UNFORTUNATELY, 7560 04:53:57,600 --> 04:54:03,080 CVOID-19 IS NOT AN ISOLATED 7561 04:54:03,080 --> 04:54:03,360 EXAMPLE, 7562 04:54:03,360 --> 04:54:03,960 REPORTING SEGREGATED DATA 7563 04:54:03,960 --> 04:54:08,840 BISECTS AND GENDER IS NOT , 7564 04:54:08,840 --> 04:54:09,480 AND OTHER RESEARCH AREAS BUT 7565 04:54:09,480 --> 04:54:11,320 WE HOPE THAT 7566 04:54:11,320 --> 04:54:11,960 THIS WORKSHOP REFLECTED WHAT 7567 04:54:11,960 --> 04:54:13,920 HAS BEEN ACCOMPLISHED IN 7568 04:54:13,920 --> 04:54:17,200 CVOID-19 RELATED HEART, LUNG 7569 04:54:17,200 --> 04:54:19,960 AND BLOOD 7570 04:54:19,960 --> 04:54:20,560 RESEARCH INCORPORATING SEX 7571 04:54:20,560 --> 04:54:21,840 AND GENDER. 7572 04:54:21,840 --> 04:54:22,440 --- AND MOST IMPORTANTLY WE 7573 04:54:22,440 --> 04:54:24,400 HOPE WE UNDERLINE AND WE CAN 7574 04:54:24,400 --> 04:54:25,000 DO BETTER IN UNDERSTANDING 7575 04:54:25,000 --> 04:54:25,360 THE IMPACT OF 7576 04:54:25,360 --> 04:54:29,320 BOTH SEX AND GENDER IN HEALTH 7577 04:54:29,320 --> 04:54:29,880 AND DISEASE IN ORDER TO 7578 04:54:29,880 --> 04:54:30,880 PROMOTE DISCOVERY, INNOVATION 7579 04:54:30,880 --> 04:54:33,200 AND EQUITY IN 7580 04:54:33,200 --> 04:54:34,480 CVOID-19 RESEARCH BECAUSE THE 7581 04:54:34,480 --> 04:54:35,960 ULTIMATE GOAL IS TO IMPROVE 7582 04:54:35,960 --> 04:54:39,200 HEALTH, AND REDUCE HEALTH 7583 04:54:39,200 --> 04:54:40,360 DISPARITIES IN 7584 04:54:40,360 --> 04:54:46,560 ALL AFFECTED. 7585 04:54:46,560 --> 04:54:47,160 WITHOUT THANK YOU VERY MUCH 7586 04:54:47,160 --> 04:54:47,720 AGAIN AND HAVE A GREAT 7587 04:54:47,720 --> 00:00:00,000 EVENING.