Coronavirus infects us silently, can also affect organs other than lungs: Virologist Peter Kolchinsky

A co-founder of Boston-based investment firm RA Capital Management, Peter Kolchinsky is a scientist and biotechnology investor. Peter has also authored two books, namely The Entrepreneur's Guide to a Biotech Startup and The Great American Drug Deal. He pursued a PhD in Virology from Harvard University after completing his BA from Cornell University and has served on the Board of Global Science and Technology for the National Academy of Sciences.,

Peter Kolchinsky joined India Today's Shiv Aroor for an exclusive interaction over the pandemic which has taken the world by storm.

Why did you call coronavirus an evil genius?
Peter Kolchinsky: Viruses are not good or evil, they are nature. I would emphasise the genius side of it. There's something that this virus did that made it more dangerous than SARS-1. This virus decided that it was going to silently infect us, go to the respiratory area and grow.

Has Covid-19 outsmarted us?

Peter Kolchinsky: We are only as effective as the dumbest of us.

How far are we from a vaccine?

Peter Kolchinsky: By the end of this year, vaccines will be made available for healthcare workers, those on the frontlines. The mass manufacturing of the vaccine is likely to begin in the first quarter of next year. This is when people will be vaccinated in schools, offices etc.

What is coronavirus, for a scientist?

Peter Kolchinsky: If you're a scientist, you're learning really quickly right now. You're discovering things about coronavirus that were never talked about as an industry. We will see this through, bring the treatment to patients.

We saw this kind of effort play out over 15 years to cure Hepatitis-C. We are now seeing healthcare developers drop a lot of precautions.

Recently, we spoke to diagnostic centres and asked them to share the level of antibodies that would come handy in the development of a vaccine.

As compared to SARS-1, it's a small change but it makes all the difference.

If things normalise, can Covid-19 strike back with the same strength?
Peter Kolchinsky: It won't strike back but rather stay with us. This will be the fifth coronavirus to stay with us. If it's not like the common cold and more like the flu, it will require a vaccine. This vaccine will be something that will be combined with a flu-vaccine, everyone will need to get it once in a lifetime or perhaps once a year.

Can this virus affect other organs?

Peter Kolchinsky: I believe it's affecting other organs like the respiratory system. It can affect the liver, kidneys or heart. Nobody should be focused only on how many people will be killed, but how many people are harmed by it. The question will be whether most of us who get infected by it in the future, will be asymptomatic or mildly infected.

This virus does not like to mutate. Unlike flu, this virus has a much more difficult time mutating. It tries not to make mistakes.

Does temperature play a role in the spread of Covid-19?
Peter Kolchinsky: It has infected people in different parts of the world. I don't believe that temperature plays a role in the spread of Covid-19.

How do you see re-infections?

Peter Kolchinsky: We need to see the difference between a true re-infection. You are looking for the virus through an RT-PCR test. But if the virus goes to the respiratory system and starts replicating less in the nose or throat, one might think that it is recovered. Sometimes, the person collecting a nasal swab might miss it while trying not to hurt the person.

If we're talking days or maybe a week, they never really recovered from the infection.

What are your thoughts about the lockdown in India?

Peter Kolchinsky: Someone recently analysed the public response during the Spanish Flu. Even at that time, people protested against social distancing. We have always been the same.

What's important is a safety net that would allow people to sit at home and not worry about the next paycheck.

What's going on about asymptomatic cases?

Peter Kolchinsky: Asymptomatic cases absolutely can transmit the virus. It can even spread through speaking. I think we have to be much more mindful of our role in transmitting the virus. You're doing it for everybody else. I think if 80% of people are asymptomatic, the death rate is 1%.

The problem is even if it's 0.2% globally, that's billions of deaths.

What went wrong in the US?

Peter Kolchinsky: When people think they are great at something, that's when they are most vulnerable. Our country and others lacked humility as well as cooperation. In the movie Contagion, they envisioned much of what is happening with us.

You learn as an investor, to hedge options. I hope in the future, we will study all different technologies or modalities. We will decide on a preferred diagnostic test but also have a few backup options.

If a virus like H1N1 becomes transmissible, it will not only kill elderly people but everyone.

 

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Gene testing for hereditary breast can be beneficial

More women may benefit from gene testing for hereditary breast or ovarian cancer, especially if they’ve already survived cancer once, an influential health group recommended Tuesday.

At issue are genes called BRCA1 and BRCA2. When they’re mutated, the body can’t repair damaged DNA as well, greatly increasing the chances of breast, ovarian and certain other cancers. Gene testing allows affected women to consider steps to lower their risk, such as when actress Angelina Jolie underwent a preventive mastectomy several years ago.

Most cancer isn’t caused by BRCA mutations — they account for 5 per cent to 10 per cent of breast cancers and 15 per cent of ovarian cancers — so the gene tests aren’t for everyone. But mutations cluster in families and the US Preventive Services Task Force has long recommended that doctors screen women who have relatives with BRCA-related cancers and refer those who might benefit from gene testing to a genetic counsellor to help them decide.

Tuesday, the task force expanded that advice, telling primary care doctors they should also assess women’s risk if:
—they previously were treated for breast or other BRCA-related cancers including ovarian, fallopian tube or peritoneal cancers, and now are considered cancer-free.

—their ancestry is prone to BRCA mutations, such as Ashkenazi Jewish women.

Why screen breast cancer survivors? After all, they already know there’s a risk of recurrence.

Take, for example, someone who had a tumour removed in one breast in their 40s a decade ago, when genetic testing wasn’t as common. Even this many years later, a BRCA test still could reveal if they’re at risk for ovarian cancer — or at higher than usual risk for another tumour in their remaining breast tissue, explained task force member. And it could alert their daughters or other relatives to potential shared risk.

“It’s important to test those people now,” the Dr. said. “We need to get the word out to primary care doctors to do this assessment and to make the referrals.” Private insurers follow task force recommendations on what preventive care to cover, some at no out-of-pocket cost under rules from former President Barack Obama’s health care law.

Cancer groups have similar recommendations for BRCA testing and increasingly urge that the newly diagnosed be tested, too, because the inherited risk can impact choices about surgery and other treatment.

Identifying BRCA mutation carriers “can be lifesaving, and should be a part of routine medical care,” Drs.  who weren’t involved with the new guidelines, wrote in an editorial accompanying them.

But too few high-risk women ever learn if they harbour BRCA mutations, they wrote. For example, cancer groups have long recommended that all ovarian cancer patients be tested, but several studies have found testing is done in less than a third.

Don’t skip the genetic counselling, said the task force’s Mangione. BRCA testing can cause anxiety and sometimes gives confusing results, finding mutations that might not be dangerous — things the counsellors are trained to interpret. There’s a shortage of genetic counsellors, particularly in rural areas, and she said counselling by phone can work.

There’s a wide array of gene tests, some that search just for BRCA mutations and others that test dozens of additional genes at the same time. There’s even a direct-to-consumer kit sold by 23and Me — but Domchek and Robson warned it only detects the three mutations found most in women of Ashkenazi Jewish descent, not dozens of other mutations.

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Researchers find way to make cancer cells self-destruct

In a new hope for cancer patients, researchers have found a way to cause some cancer cells to self-destruct. 

The research team has identified a new pathway that works as a partner to a gene called MYC which controls normal cell growth, but when it is mutated or amplified in cancer, it sets off a chain reaction that helps tumours grow uncontrollably. 

The pathway involves a protein called ATF4, and when it's blocked, it can cause cancer cells to produce too much protein and die. 

The study done on mice points the way towards a new therapeutic approach as inhibitors that can block synthesis of ATF4 already exist. 

"What we've learned is that we need to go further downstream to block tumour growth in a way that cancer cells can't easily escape, and our study identifies the target to do just that," said a Professor.

According to researchers, this finding shows the alternative approach is to target ATF4 itself, since it's the point where both signal pathways converge, meaning there's less redundancy built in to allow cancer to survive.

 It also shows that ATF4 turns on the genes MYC needs for growth and also controls the rate at which cells make specific proteins called 4E-BP. 

This study also found that when tumours in humans are driven by MYC, ATF4 and its protein partner 4E-BP are also overly expressed, which is further evidence that these findings may point to an approach that could work for humans. 

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