This preprint (from April 5) is FASCINATING. Someone requested I have a look at it, and I'm glad they did, because it made SO MANY separate things suddenly make sense.

Here's a look at how a specific type of MICROCLOTS may be associated with LONG COVID pathology...

1/many Preprint posted April 5, 2024: "Increased fibrinaloid microclot counts in platelet-poor plasma are associated with Long COVID"  Abstract: "...The pathophysiology underlying Long COVID remains unclear but appears to involve multiple mechanisms including persistent inflammation, coagulopathy, autoimmunity, and organ damage. Studies suggest that microclots, also known as fibrinaloids, play a role in Long COVID. In this context, we developed a method to quantify microclots and investigated the relationship between microclot counts and Long COVID. We show that as a cohort, platele...
This thread will have three things:
- Takeaways of this study
- Breakdown of the method they developed
- How these findings connect with other known patterns

This is a study that looks at some rugged little blood clots that come courtesy of the SARS-CoV-2 spike protein.

2/ "Studies suggest that microclots, also known as fibrinaloids, play a role in Long COVID by blocking capillaries, limiting oxygen exchange, and potentially causing microvascular pulmonary thrombosis and multiple organ failure. Amyloid-containing deposits, resembling microclots, have also been observed in increased numbers in muscle tissue biopsies from people with Long COVID compared to samples from controls, and these numbers increase after exercise, an important observation as many people with Long COVID experience post-exertional symptom exacerbation after activity. However, the depo...
Some important background info:

- FIBRINOGEN is a protein that just kinda hangs out in the blood, waiting.

- FIBRIN is a fibrous protein that forms a mesh to hold platelets together to form a blood clot.

- THROMBIN is the enzyme that converts FIBRINOGEN into FIBRIN.

3/ Fibrinogen + Thrombin = Fibrin (monomer)  The fibrin monomers aggregate to form a mesh.  Fibrin mesh + clotting factor = cross-linked mesh that's much more stable, and which contracts tightly.  Image source: https://commons.wikimedia.org/wiki/File:Stabilisation_de_la_fibrine_par_le_factor_XIII.png
If you add thrombin to blood plasma "from people with various chronic inflammatory and neurodegenerative diseases," anomalous microclots can form that are "more resistant to breakdown than normal clots."

These can also be induced JUST by adding the spike protein to plasma.

4/ "Fibrinaloid microclots can be induced by adding thrombin in vitro to plasma samples from people with various chronic inflammatory and neurodegenerative diseases such as Alzheimer’s, Parkinson’s, type 2 diabetes and rheumatoid arthritis. Following considerable work using electron microscopy (that uncovered ‘dense matted deposits’), it was demonstrated that tiny amounts (1 molecule per 100,000,000 fibrinogen molecules) of bacterial lipopolysaccharide causes blood to clot into an anomalous ‘amyloid’ type form... These ‘microclots’ are significantly more resistant to breakdown than normal...
These microclots may impair oxygen exchange in various ways, which would lead to a cascade of issues, and it's a plausible explanation for why PEM occurs. If the virus directly enters pulmonary vasculature through the mouth, these spike protein clots could be a huge problem.

5/ "Studies suggest that microclots, also known as fibrinaloids, play a role in Long COVID by blocking capillaries, limiting oxygen exchange, and potentially causing microvascular pulmonary thrombosis and multiple organ failure. Amyloid-containing deposits, resembling microclots, have also been observed in increased numbers in muscle tissue biopsies from people with Long COVID compared to samples from controls, and these numbers increase after exercise,...  An alternative hypothesis based on the radiological evidence of lung changes in acute COVID suggests that the oral cavity may provide...
In this study, they developed a new method to measure the microclot counts for individuals, then demonstrated "that as a cohort, samples from people with Long COVID have a higher mean microclot count compared to samples from control groups."

6/ "The primary goal of this study was to investigate the relationship between the microclot count present in PPP, and the occurrence of Long COVID. To determine microclot counts for individuals, we have developed a robust, medium-throughput assay using automated image analysis. In addition, relationships between microclots counts and sex, age, body mass index (BMI), time since COVID-19 infection, and symptoms of Long COVID were investigated. We demonstrate that as a cohort, samples from people with Long COVID have a higher mean microclot count compared to samples from control groups. We ...
What are the takeaways?

- Microclot counts are raised in the LC cohort compared to controls
- SARS-CoV-2 infection raises microclot counts, which "take several months to return to control levels."
- Microclots may be a biomarker to screen, or even a treatment target.

7/ "... Significant differences were seen between the COVID controls and Long COVID individuals (** = p < 0.01), between the uninfected controls and Long COVID individuals (**** = p < 0.0001) and between both groups of controls and individuals who had tested positive for COVID in the previous three weeks (**** = p < 0.0001, *** = p < 0.001).  ... We discovered that microclot counts were raised in Long COVID samples compared to controls and that recent COVID-19 cases also had raised counts. However, we also observed that not all people with Long COVID have microclot counts above levels obs...
What is the new method they devloped? It's a way to screen for microclots, and it specifically addresses a few potential issues with past studies.

In particular, the type of slidse typically used often have specks of reflective material about the size of the microclots!

8/ "Fibrinaloid microclots are known to consist of amyloid-like material and, hence, can bind to the amyloid-specific dye ThT. This dye intercalates with the Beta-sheet structure of amyloid material with a resultant shift in excitation emission and quantum yield. Existing assays have used a blood smear approach .... During the development of our method, we identified several processing issues that affected the observed microclot counts with this method. Firstly, we noticed that auto-fluorescent material was visible on untreated glass slides, comparable in size to previously reported micro...
Critically, they also found that leaving the blood tubes sitting around for an hour before separating out the components affected the microclot count, as did repeated freeze-thaw cycles.

So, they designed a method that was quick and had as little handling as possible.

9/ "We also identified processing issues relating to the handling and storage of the blood samples. We established that when whole blood tubes were left standing for more than an hour before centrifugation, the resulting PPP showed reduced or no microclot count. After observing this effect, to ensure the accuracy of our analysis, we only used PPP samples that were processed within 30 minutes of collection. Additionally, repeated freeze-thaw cycles of the PPP following processing also resulted in alterations in microclot counts. As such, PPP was stored in aliquots, and analysis was carried...
In this method, they're able to keep the blood samples in little wells, rather than smearing them on a slide. An imaging module focuses at different depths to capture a multi-layered image, and the microclots are then automatically identified and counted.

10/ "To optimise the efficiency of our process and minimise manual handling, we used 15-well µ-Slides that come pre-sealed and were handled in a dust-free flow cabinet. We also used low protein binding plasticware at all stages. Each PPP sample was imaged directly in the well of the slide, allowing us to obtain 3D images within approximately 10 minutes per well. To minimise variability, we took triplicate technical repeats and analysis parameters were set to automatically identify the boundaries of the well to remove edge effects (Figure 1). Figure 1A shows the captured image, whereas Figu...
Importantly, they did repeat data collection and found that they got consistent results up to six hours after initial data collection, which means it can be done with an autosampler.

This method seems robust both for research and, potentially, diagnostics.

11/ "...obtain 3D images within approximately 10 minutes per well. To minimise variability, we took triplicate technical repeats and analysis parameters were set to automatically identify the boundaries of the well to remove edge effects (Figure 1). Figure 1A shows the captured image, whereas Figure 1B shows the processed image and associated microclot counts, automatically identified by the software. Control experiments and repeat data collection on the same slide gave consistent results up to six hours after sample handling, allowing the use of an autosampler for medium throughput. The r...
What was found, specifically?

LC group has significantly higher clot counts compared to both uninfected controls and infected-but-no-LC controls.

Interestingly, there was ALSO significant difference in clot counts between the "recent COVID" group and other control groups.

12/ "Microclots in Long COVID samples vs control samples  Having developed a robust assay for the quantification of microclots in PPP samples, we determined the distribution of microclot counts in each of the four groups. Figure 2 shows the average microclot count for each individual. Within the groups, mean microclot counts can be determined for each of the cohorts with the Uninfected Control (mean 13.6 ÷ S.D. 7.4), COVID Control (20.7 ÷ 10.1), Long COVID (40.1 ÷ 28.1) and Recent COVID (50.5 ÷ 20.4) groups. Significantly higher mean microclot counts were observed in the Long COVID group c...
It's very notable that "only one [control] had a microclot count >50 while approximately half the LC group had counts above this level."

Also very interesting: there was a statistically significant difference in LC vs. control for microclot counts for women, but not men.

13/ "Strikingly, within the data is that only one outlier in the control groups had a microclot count >50 while approximately half the Long COVID group had counts above this level. However, there is overlap between the groups; although microclots are detectable in all samples from people with Long COVID, in about half of the samples the counts are similar to the counts observed in samples from controls.  Pooling the data from the two control groups, Figure 3 shows that female Long COVID participants had a significantly higher mean microclot count than female controls p < 0.0001 whereas no ...
The difference in immune response seen between men and women may pattern with what has been observed elsewhere (including a stronger innate immune response in men, but a more robust adaptive response in women).

14/ "Our study also found that females had more microclots, which is consistent with the fact that females are more affected by Long COVID. Most Long COVID patients experience severe fatigue, with the female sex group as an independent risk factor in alignment with our symptom data Female COVID-19 patients exhibit more robust T cell activation, in contrast, male patients have higher levels of innate immune cytokines and a greater presence of non-classical monocytes, potentially accounting for the sex differences in disease outcomes. Males, but not females, who have recovered from COVID-19 ...
Very notably, the "Recent COVID samples have microclot counts comparable to" around the *top 25% of the LC group!*

"Together, these data indicate that exposure to SARS-CoV-2 initially increases the microclot count..., but these microclots are cleared over time."

15/ "Recent COVID samples have microclot counts comparable to the upper quartile of the Long COVID group, indicating that recent exposure to the virus leads to higher microclot counts (Figure 2). Within the control group where we have the dates of a confirmed infection from either lateral flow of PCR a significant time dependent decrease in microclot count was observed (Figure 4, r = -0.628, p < 0.0001). By ~450 days post-infection, all samples were within the same range as the COVID control group (20.7 + 10.1). This indicates that the control group have a decrease in microclot counts to b...
IMO, this finding is a really strong explanation as to why there seems to be an increased risk of cardiac incidents in the 3-6 months following a SARS-CoV-2 infection: The presence of the spike protein may be creating microclots throughout the cardiovascular system!

16/
"Recent COVID samples have microclot counts comparable to the upper quartile of the Long COVID group, indicating that recent exposure to the virus leads to higher microclot counts (Figure 2). Within the control group where we have the dates of a confirmed infection from either lateral flow of PCR a significant time dependent decrease in microclot count was observed (Figure 4, r = -0.628, p < 0.0001). By ~450 days post-infection, all samples were within the same range as the COVID control group (20.7 + 10.1). This indicates that the control group have a decrease in microclot counts to b...
Figure 4 - Microclot count as a function of time since infection within the COVID control and recent COVID groups combined. Participants reported the date that they first experienced symptoms during their most recent COVID infection. A Pearson rank correlation showed a significant inverse relationship between microclot count and date of previous COVID infection (r = -0.628 and p < 0.0001).
How did the microclots relate to symptoms? Their questionnaire was basic, but they generally found the symptoms you'd expect being prominent in the LC group: fatigue, post-exertional malaise, difficulties concentrating, etc.

However, high microclots didn't GUARANTEE LC!

17/
"The self-reported symptom scores indicate that over 93% of the group experienced "Feeling tired or having low energy", 84% experienced symptoms triggered by physical, mental, or emotional effort, 93% experienced symptoms that occur one or two days after physical, mental, or emotional effort, and 93% experienced difficulty concentrating. These symptoms were experienced at a higher rate than other symptoms (figure 5). These symptoms are typical of post-exertional symptom exacerbation (PESE) and persistent fatigue, which are strongly associated with Long COVID. Using this sympt...
Figure 5 – Relationship of microclot counts to symptoms. Long COVID participants rated how much they had been affected by a range of symptoms, and were then split by group based on their response from “not bothered” green, “bothered a little” blue to “bothered a lot” orange. Individuals’ microclot counts were then plotted against these groups. Figures are ordered based on the percentage of participants reporting to be ‘bothered a lot’ by a symptom. Comparative analyses across study groups were conducted employing the Kruskal-Wallis tests to ascertain statistical differences, utilising PRISM...
So, do microclots cause LC? I mean, they probably don't *help*.

One possible explanation is that LC may reflect a persistent dysregulated state (e.g. a "pro-coagulable state"), and external intervention would be required to shift things back to normal.

18/ "It is not fully understood how microclotting could relate to the development of Long COVID symptoms. One theory is that the balance of 'clotting vs anticlotting' (i.e. fibrin formation vs fibrinolysis) is shifted towards clotting by SARS-COV2 infection. The longitudinal data presented here suggests that this 'balance' can be restored within 6 months in those that recover. However, a subgroup of people may have persistent microclots due to ongoing inflammation e.g. due to viral persistence or abnormal immune response, possibly combined with ineffective fibrinolysis, leading to a pro-co...
I think the "potential role of the spike protein in inducing amyloid formation and seeding microclots" is a FASCINATING possibility—especially given that there seems to be the possibility of a runaway process of consistent clotting.

(It may also explain vCJD!)

19/ "The potential role of the spike protein in inducing amyloid formation and seeding microclots is intriguing. An in vitro study has shown that spike protein spontaneously forms amyloid in the presence of elastase, an enzyme released by activated phagocytes. Cross-seeding between amyloid proteins and peptides has been observed in other situations, and the spike protein amyloid could act to induce micro clot assembly in a similar manner. Proteomics analysis shows complement proteins in microclots, which are known to activate neutrophils and could thereby increase elastase release.  Once t...
The authors also note that, since this is a new line of research, we have no idea what role microclots may play in other conditions—but they're beginning by investigating whether pwME have similar microclot profiles to pwLC!

I'm also very curious how EBV impacts clotting!

20/ "We did not investigate samples from people with other acute viral infections, and it is possible that microclots may be raised in response to other infections. This has implications for other post-viral conditions such as myalgic encephalomyelitis (ME), often associated with infection by Epstein-Barr virus, and we are currently investigating whether people with ME have similar microclot profiles to people with Long COVID."
Of course, this isn't the only way that the SARS-CoV-2 spike protein has been shown to cause cardiac damage: It may also lead to fusion of uninfected cells!

21/
Overall, the implications are significant. At the very least, I think this is a plausible explanation for why there are often cardiac issues *in the time period shortly after infection,* even if it doesn't explain LC!

Source: (h/t @JPeaceJPeace)

22/22medrxiv.org/content/10.110…

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More from @NickAnderegg

Feb 1
Many people are asking for recommendations about what storage media to buy, so here's a buying guide from an experienced data hoarder (me)

The MOST IMPORTANT thing to know is that SOLID-STATE MEDIA IS NOT DURABLE. Flash drives, SSDs, SD cards, etc. are NOT long-term storage.

1/
That's not to say that it's impossible to use solid-state media for long-term storage. It's just that anything with durability guarantees gets prohibitively expensive quickly. Spinning hard drives—as well as DVDs and Blu-ray discs!—are your friend.

2/
- The way data is stored in solid-state media makes it much more susceptible to bit rot than other media.
- In a spinning hard drive, the moving parts are the most common point of failure.
- When you burn a DVD, that shit is fairly permanent.

3/
Read 42 tweets
Jan 9
I wish people would understand that insurance underwriters have armies of actuaries calculating risks, and if an insurance company drops you, it's because things have changed in such a way that insuring you will take more out of the financial pool than you're putting in

1/
It sucks, but it's a direct result of the fact that humans are widely inhabiting locations that are rapidly becoming impossible to inhabit safely. If you can't find insurance for your home, it means there's a high likelihood you'll need to move soon anyway.

2/
You get insurance so that you can replace all of your stuff in the event of a disaster. When the insurance company effectively says "the risk of disaster is so high that insuring you would almost certainly cause us to lose a lot of money," it ALSO means your life is in danger

3/
Read 7 tweets
Jan 5
So here’s the thing about some of the subtle neuro damage related to SARS-CoV-2 infection that I think a lot of people miss: some of the known deficits are correlated with things like impulsiveness and poor emotional control, so we might expect to see deficits there are well

1/
Consider how impatient people seem to be on the road in the last couple years relative to the 2010s, and I think we have a perfect example of where this is LIKELY already manifesting.

2/
This impact is particularly insidious for the person experiencing it, because poor impulse control, by definition, doesn’t really come on gradually. My biggest concern is how interactions under these circumstances will play out if this impact continues to become more common

3/
Read 15 tweets
Jan 3
Let's review some major points in the Nukit controversy, since some people are unclear:

- Someone criticized someone's use of Nukit lanterns.
- Nukit attacked the critic because, as noted, this is how they market
- Nukit now demands "mediation" with the community (how??)

1/ @marigoldglitter: "these tools should be used for people who must be in public despite the dangers, not for white men who want to eat in restaurants and maintain the status quo. if this is what you're gonna use these for, give them to a disabled person who can't go to the doctor b/c of risk."  Nukit: ""White man" in this case is buying those products from non-white small businesses who are focused on providing the community with effective, tested mitigations at far, far lower costs than anyone else."  OP: "Like why are you coming at me with this aggressive...
Nukit: "If you are in the US, and would like to purchase Far-UVC products, we cannot help you at this time. We tried to resolve the issues there, but the US COVID-Aware community was uninterested in mediation or intercession. As a result of that disinterest, a great deal of harm was done. When stock is finished, we will not be selling our products to the Us anymore. If you are in the US and want Nukit products, would like 333 million Americans, many disabled or immune compromised, to be able to access the most affordable Far-UVC on the market, kindly address the people who made it unsa...
So let's look at this a bit more critically. Here is the "evidence" Nukit provided that the didn't say anything racist. First of all, these aren't the comments in question, but it's worth a look anyway.

2/ Ok, I get that "evidence," "citations," and "personal accountability" are going to be called racist, but since people insist on just spewing lie after lie without any pushback- here's what actually happened. @marigoldglitter- a white woman attacked a Nukit customer who was supporting us by showing our products. This is something we rely on to fund research and donations. If our customers do not do this, that money goes to paid advertising. So yes, attacking our customers is attacking our company and directly harming marginalized folks who receive our products. ...
Seems to be framed this way because Nukit knows it's not an adequate explanation, so they're acting like anyone who criticizes them is in the wrong.  ---  A bigoted comment is a bigoted comment, even if it's not directed at someone who might be personally offended. Of course, Nukit didn't include the comments people actually call racist!  ---  Nukit is explicitly saying here that they view any criticism as an "attack," because criticisms can potentially hurt their business goals. Fundamentally, Nukit is angry that this usage of their products are being criticized.  ---  After Nuki...
Let's be clear about what happened here: Someone lamented the unequal access to protective measures and criticized someone who seems to be using a certain device to *maintain the status quo*, and the manufacturer of the device found it unacceptable.

3/
Read 16 tweets
Oct 9, 2024
NEW STUDY! This exploratory study identifies a SPECIFIC PHENOTYPE OF LONG COVID that appears related to NEUROMUSCULAR DISTURBANCE rather than lung damage—and they've termed it Complex Ventilatory Dysfunction!

Breakdown of the paper (thread written for a general audience!)...

1/ Published Oct 7, 2024: "A new phenotype of patients with post-COVID-19 condition is characterised by a pattern of complex ventilatory dysfunction, neuromuscular disturbance and fatigue symptoms"  Abstract:  Background Patients with post-COVID-19 condition frequently suffer from chronic dyspnoea. The causes and mechanism for dyspnoea in these patients without evidence of structural lung disease are unclear.  ...  Results ... A pattern of reduced forced vital capacity (FVC), but normal total lung capacity (TLC), termed complex ventilatory dysfunction ... was observed and occurred mo...
Broadly speaking, there are two groups of acute covid outcomes involving dyspnea (shortness of breath) as a long-term symptom:

- Severe cases that may have physical lung damage
- "Mild" cases that now have ME/CFS-like features, but who have no evidence of lung damage!

2/ "Current evidence suggests that cellular damage, a robust innate immune response with inflammatory cytokine production and a procoagulant state induced by SARS-CoV-2 infection are factors potentially contributing to post-COVID-19 sequelae such as dyspnoea, fatigue, and cognitive and mental disturbances... Dyspnoea has been well characterised as a major clinical symptom of post-COVID condition after severe and critical COVID-19 and is correlated with impaired lung function in terms of pulmonary restriction, and with reduced diffusion capacity as a possible consequence of pulmonary remod...
In this study, they explored this distinction further and identified a distinct subset of patients with a pattern of breathing abnormality that they have termed complex ventilatory dysfunction (CVD).

So how did they arrive at this conclusion? Let's dig in!

3/16 "We hypothesise that patients suffering from post-COVID-19 condition who have fatigue and exertional intolerance also have a reduction in respiratory muscle strength, causing a dysfunctional breathing pattern which is distinct from typical pulmonary sequelae after COVID-19 such as obstruction, restriction or impaired diffusion capacity. Based on clinical observations, we describe a new breathing abnormality termed complex ventilatory dysfunction (CVD), defined as total lung capacity (TLC) - forced vital capacity (FVC) >10% predicted value and absence of restriction (TLC ≥ lower limit o...
Read 16 tweets
Sep 22, 2024
NEW STUDY! It VERY thoroughly supports the hypothesis that SARS-CoV-2 emerged as a zoonotic spillover event in the Huanan Seafood Wholesale Market—using multiple methods!

Breakdown of the paper (written for a general audience!)...

1/many (but it's worth it, I promise!) Published Sep 19, 2024 in Cell: "Genetic tracing of market wildlife and viruses at the epicenter of the COVID-19 pandemic"  Highlights: - Common ancestor of SARS-CoV-2 linked to Huanan market matches the global common ancestor - Wildlife mitochondrial DNA identified in samples from stalls positive for SARS-CoV-2  Abstract:  "... We demonstrate that market-linked severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genetic diversity is consistent with market emergence and find increased SARS-CoV-2 positivity near and within a wildlife stall. We identify wildlife DNA in...
This paper reanalyzes the same data from the April 2023 paper in Nature that cast doubt on the Huanan Market hypothesis (pictured).

In the new paper published in Cell this week, another group conducted far more detailed (and statistically sound) analyses!

2/
Original paper that analyzed this same data: "Surveillance ofSARS-CoV-2 at the Huanan Seafood Market"  "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019, emerged in December 2019. Its origins remain uncertain. It has been reported that a number of the early human cases of coronavirus disease 2019 had a history of contact with the Huanan Seafood Market...."
"...It should be noted that the selection of shops for sampling was biased because shops selling wildlife as well as shops linked to early cases were prioritized for sampling. The origin of the virus cannot be determined from the analyses available so far. Although gene barcode analysis of animal species in the study suggested that Myotis, Nyctereutes and Melogale-species that have been recognized as potential host species of sarbecoviruses-were present at the market, these barcodes were mostly detected within the SARS-CoV-2 RT-qPCR-negative samples from the environment. It remains pos...
This new paper starts by reviewing the evidence supporting the Huanan Market hypothesis, and some of the details are FASCINATING!

To begin with, of the 174 COVID cases identified with an onset of December 2019, 32% had a link to the Huanan Market.

In a city of 12 million.

3/ "INTRODUCTION Many of the earliest known cases of COVID-19 worked at or visited the Huanan Seafood Wholesale Market ("Huanan market") in the city of Wuhan, a link first made by clinicians at different hospitals throughout the city. Retrospective review of early COVID-19 cases identified 174 patients with onset in December 2019, 32% of whom had an ascertained link to this location, within a city of over 12 million."
Read 24 tweets

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