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Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
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Feb 4 • 5 tweets • 3 min read
1. Acute COVID led to maximal levels of P-selectin dependent platelet-neutrophil aggregation. There was reduced phosphatidylserine exposure and integrin αIIbβ3 activation. It means less primary aggregation and more leukocyte-mediated thromboinflammatory signalling. @JTHjournal
2. #Microclots are typically positive on staining for P-selectin (also known as CD62P). Selective activation of platelet P-selectin may be a feature of acute COVID. Whether the same feature is found in #longCOVID remains unconfirmed. #TeamClots
3. P-selectin binds to PSGL-1 (P-selectin glycoprotein ligand). It is found on leukocytes eg neutrophils, macrophages and T-cells. PSGL-1 is a mediator of immunothrombosis. In chronic viral infection, PSGL-1 promotes T-cell exhaustion. @fitterhappierAJ cell.com/trends/immunol…
4. Another paper on the function of PSGL-1 as an immune checkpoint regulator that promotes T-cell exhaustion (free access). We are seeing a remarkable convergence in the COVID immunothrombosis story and the T-cell exhaustion story. Quite extraordinary! ncbi.nlm.nih.gov/pmc/articles/P…
5. If you follow the trail of thromboinflammatory signalling downstream, it leads straight into the endothelial and cardiac inflammation (myocarditis) story—mediated by angiotensin II. ⚡️💡 spandidos-publications.com/10.3892/mmr.20…

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More from @ToshiAkima

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Feb 5
Who wins the award for my dumbest professorial reply of 2022? 🥁 Semmelweis used “non-pharmacological” (sic) principles with calculations based on applied physics and engineering to recommend handwashing with chlorinated lime—calcium hypochlorite Ca(OCl)2 aricjournal.biomedcentral.com/articles/10.11… Image
Yes, ladies and gentlemen, handwashing is a mechanically engineered protective intervention like seatbelts, bulletproof vests, helmets, parachutes, and respirators. Semmelweis was an engineer. You read that correctly! 🤡 Image
If you really want to believe that the topical application of a corrosive chemical, 4% calcium hypochlorite, to the hands is a “non-pharmacological” mechanistic intervention based on applied physics and engineering, here is more info on caustic lime. en.wikipedia.org/wiki/Calcium_h… Image
Read 8 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Feb 3
It's true that masks do not protect you from airborne illnesses. A mask, surgical or woven, scores a Fit Factor of ~5 of the 100 points needed for an N95 to pass a fit test. There is too much leakage to protect the wearer from airborne inhalation. Wear respirators, not masks.🧵
Does this mean wearing a surgical mask is useless? No, because there is a ~2/3 reduction in aerosol dispersion on exhalation—as seen in this RIKEN modelling. It might not protect the wearer, but it acts as source control. If everyone wears one, it serves a public health function Yellow aerosol: leakage. Blue: aerosol escaping filtration.
Studies by RIKEN have shown that even a mouthguard can act as modest source control by reducing aerosol dispersion. Again, there is too much inward aerosol leakage for it to protect the wearer.
Read 10 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jan 26
Could PolyP be a key player in COVID contact-pathway thromboinflammation-driven microthrombi? Some thoughts from an emerging area of molecular wizardry. 🧵
#LongCOVID #TeamClots #PolyP
There is evidence in COVID of immunothrombosis being driven through the kallikrein-kinin-contact pathway—we'll just call it the “contact system”. It feeds into the renin-angiotensin system (SARS-CoV-2 binds to ACE2). @JTHjournal onlinelibrary.wiley.com/doi/10.1111/jt…
The still mysterious contact system, once mistaken for a haemostatic pathway, is now regarded as an immunothrombosis pathway. It may yet hold some secrets to how #longCOVID leads to #microclots. frontiersin.org/articles/10.33…
Read 13 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jan 24
As a clinician, I've seen young patients die of sepsis from atypical organisms with lymphopoenia weeks after acute COVID. I've seen deaths from TB and endocarditis. I've treated multidermatomal shingles. I routinely look out for post-COVID lymphopoenia 🧵nature.com/articles/s4159…
Our mortality and morbidity meetings are full of cases of young patients dying of sepsis shortly after a COVID infection. Irrespective of what the underlying mechanism is, post-COVID immunosuppression is a phenomenon readily observable to the clinician.
If not my patients, then friends spontaneously ask me why they get unrelenting non-COVID viral infections and UTIs etc they have never previously had soon after a COVID infection. Like other COVID-cautious people who have never had COVID, I do not experience this.
Read 9 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jan 23
This comes from the 2023 EIU global risk assessment. The trouble is, lifting China's #zeroCOVID policy is the very thing propelling the evolution of a “new, highly aggressive variant of COVID”🧵 mkto-ab220141.com/NzUzLVJJUS00Mz…
China is too dependent on the productivity of its factory workforce. Factories are ill-ventilated sardines cans ripe for COVID eruptions disrupting manufacturing. Mass death/injury means worker supply is less than demand, pushing up the cost of labour. axios.com/2022/12/16/the…
Mortality from pandemics has historically increased the value of labour. The plague probably helped to end serfdom in Europe. Chinese manufacturing depends on cheap labour, but with #infiniteCOVID, CCP serfdom will struggle, and this critical cogwheel in the economy will stutter. Thomas Piketty: Capital and Ideology. One of the factors tha
Read 7 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jan 20
Japan to downgrade COVID-19 from a level 2 to level 5 pathogen (the same level as seasonal influenza) as of spring to unleash restrictions on escalating death rates asia.nikkei.com/Spotlight/Coro…
Isolation periods will be abolished both for positive cases and close contacts. Masks to no longer be recommended indoors unless symptomatic or at risk. The downgrade to level 5 pathogen means the state no longer foots the medical bills
The reason for the shift is that Kishida has broken away from the neo-Keynesianism of his predecessors with its emphasis on investment in innovation and maximum employment. The ageing population and high population density will see death rates explode.
Read 5 tweets

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