Yale School of Medicine immunologist, Professor Akiko Iwasaki, PhD, talks about a new way to combat the coronavirus.
Interview conducted by Ivanhoe Broadcast News in October 2022.
Is there any new research for COVID?
IWASAKI: Sure. We did discover things about long COVID where we found, for example, Epstein-Barr virus, which is a member of the herpes family, is reactivated in people with long COVID when we compared two people who’ve recovered from COVID. And we’re looking at what the mechanism is and what the potential impact of having such reactivation.
Will there be some surprising effects of people with long COVID?
IWASAKI: It’s genital. I mean there are other things we found other than just EBV, but I don’t know how long you have.
Can you talk to me about where you and your colleagues are in the pipeline in terms of developing more COVID nasal sprays?
IWASAKI: We are developing nasal vaccine booster as a strategy to combat COVID-19 and other respiratory viruses. The reason we’re focusing on the nasal cavity is because that’s where the virus first lands in our body. And if we can contain the virus within the nasal cavity before it spreads to other organs, we can not only prevent disease, but potentially something like long COVID, as well as reduce transmission going forward. And so that’s very important because current vaccines don’t do a great job of preventing transmission, although it’s very good at preventing severe disease.
You mentioned a booster. If someone has not had the shot before, would this not be an initial way to introduce that into the system?
IWASAKI: You could consider it as a primary series, but we are specifically developing a booster strategy because we know that majority of Americans have already had some vaccines or have had infection prior with an existing immune responses that we can leverage towards nasal immunity.
Could you describe how this would work? Is it something that could be over-the-counter that someone could do at home? How do you envisions this working?
IWASAKI: Right now, we envision this as a probably prescription type of vaccine that doesn’t really require a doctor to administer because it is a nasal spray. I’m sure many people have administered a nasal spray before. It’s not that hard. And essentially it’s a booster that contains the right vaccine antigen inside that bottle, but either administered by a health professional or potentially in the future, self-administration. But it has to be regulated somewhat because you don’t want to be boosting daily your immune system. So this has to be on a schedule.
Is it a one-time spray or is it once a week?
IWASAKI: Just like any other booster strategy, we want to minimize the number of boosters that one needs. So, I imagine this to be every six months or every four months or however the duration of the booster may be effective, but it won’t be a weekly spray.
Could you talk about where you and your colleagues are in the process? We imagined you’re in pre-clinical studies. What are you doing and then what is the next step?
IWASAKI: We’re currently developing this in a pre-clinical model, having shown effectiveness in rodent models and now we’re moving into a larger animal models to see whether we can see similar kind of prevention of infection and transmission. And our goal is to raise enough funds to be able to develop human quality vaccine that can be tried in Phase 1 clinical trial.
You said it was proven effective in rodent models in the lab. How effective was it?
IWASAKI: In the laboratory setting, we found that this booster strategy with the nasal spray is quite effective in preventing infection and transmission and completely preventing disease and so we’re very excited about this data.
One of the things I mentioned was that vaccine hesitancy. Do you and your colleagues see this as a way to work around some of that confusion and hesitancy?
IWASAKI: Vaccine hesitancy comes from many different places. One of the issues that I’ve heard is that some people are afraid of getting the needle shot. And it is known that people are really afraid to get the shot and therefore they don’t go to the vaccination site. So this will definitely alleviate that problem because it’s a simple spray that you would administer into the nose. There’s no pain associated with it. And the other issue is that it may have less side effects than having a shot. So people who are afraid of the side effect, hopefully, this will also alleviate such hesitation. And ultimately, when we develop these nasal immunity, the effect is much more potent because you’re capturing the virus right at the site of entry. So preventing the replication and the spread of the virus in the person and among the community. And that hopefully will make people more wanting to get such a vaccine to help the community, not just themselves. And that’s another goal of this vaccine strategy is to create that hard immunity that you can’t do with a conventional vaccine.
Are you are able to link it to COVID at this point?
IWASAKI: We’ve been very interested in understanding long COVID, which happens in a large fraction actually of people who even have milder COVID, who are not hospitalized, who are younger, people who have no co-morbidities. People can develop these types of long term symptoms even if you’ve boosted and vaccinated, you can still get long COVID. It’s a real problem that millions of Americans are suffering from right now. And we’re trying to understand the underlying cause of this disease. And recently we uploaded a pre-print study of our findings. And essentially what we found is that people with long COVID have features associated with reactivation of Epstein-Barr virus in this particular group of people whereas those who are infected with COVID but recover fully, we don’t find much evidence of reactivation of Epstein-Barr virus. This EBV reactivation is a feature associated with long COVID and whether that’s actually causing some of the symptoms or if just as the bystander effect of having long COVID, we don’t quite understand yet, but it’s definitely gives us something to work on, some hypothesis to test.
Can you tell me what EBV is?
IWASAKI: Epstein-Barr virus is a DNA virus that’s very common among humans. Ninety to 95% of adults carry this virus in a latent form. So the virus is hiding in the immune cells usually and it doesn’t really cause any disease until we get infection or some other immuno compromising state where this virus can reactivate and cause more replication and spread throughout the body. EBV is also known to cause mononucleosis or mono in people who get the virus for the first time in their teenage years or adolescence. And that can also carry long term consequences. Some people don’t recover from EBV infection for a long time. So there may be some link between having this EBV reactivation and some of the symptoms that may be either caused by that or triggered by that, that leads to long COVID.
What are some of the symptoms of EBV?
IWASAKI: So, when you get it as a very small child, it’sjust like a common cold. You get over it and you don’t even realize it. When you get it as a adolescent, you can get this fatigue, fever, malaise, the typical flu-like symptoms that’s followed by a long term disease in some people. And so that’s what happens during teenage years if you get it or in college. And then as an adult, when you get reactivation, you might again feel the same flu-like symptom, but it’s very hard to tell whether you have EBV or something else unless you get tested.
How do you characterize long COVID? Is there, now, a definition of someone who you could say that person suffers from long COVID? What kind of doctors to determine what long COVID is?
IWASAKI: Often, doctors determined by doing a lot of questions on the patients. For example, if you’ve not recovered for over four weeks after getting the acute COVID from variety of symptoms. Now, the long COVID comes with over 200 different symptoms so it’s really hard to define this all the symptoms, but the typical ones are fatigue, brain fog, post exertional malaise. These issues with cardiac issues and respiratory. There are multiple symptoms that are associated with long COVID. But essentially, if you can’t recover from an acute disease for over four weeks, that’s a defined as long COVID.
Is masking still in your mind to the number one way for us to prevent this?
IWASAKI: Well, masking is certainly one of the layers that we should employ to prevent infection with SARS-CoV-2 because this virus is very unpredictable. In some people, it will just cause some acute symptoms and recover. While in others, there is this debilitating condition that can last for months and months but some people have had it for over two years. And I study these people. I talk to these patients on a daily basis and they know what it can do. And so because of the possibility of long COVID, even though I had five mRNA vaccines thus far, I still keep wearing a mask because I need that extra security, extra layer to prevent the infection from happening. Going into the winter months, so I study respiratory infections and winter months is really the season for a lot of different respiratory viruses and COVID is no exception to that. So I’m especially careful in indoor settings especially making sure that of course I’m up-to-date on the boosters as well as wearing a mask and just trying to avoid circumstances that could trigger transmission.
When you talk to people about COVID fatugue, how do you counter that one?
IWASAKI: People are tired of talking or thinking about COVID. They’ve had this for over two years and I get the fatigue but the virus doesn’t care what we feel about the virus itself. And it’s doing it’s job very well. It’s mutating, it’s evolving. It’s becoming more transmissible and more invasive of immune responses. So I think it’s a formidable thing to just ignore and decide that it’s over in our head because it’s certainly isn’t.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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