Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19.

BACKGROUND: COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS: A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS: The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS: SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.

Watching from a distance: A robotically controlled laser and real-time subject tracking software for the study of conditioned predator/prey-like interactions.

BACKGROUND: The physical distance between predator and prey is a primary determinant of behavior, yet few paradigms exist to study this reliably in rodents. NEW METHOD: The utility of a robotically controlled laser for use in a predator-prey-like (PPL) paradigm was explored for use in rats. This involved the construction of a robotic two-dimensional gimbal to dynamically position a laser beam in a behavioral test chamber. Custom software was used to control the trajectory and final laser position in response to user input on a console. The software also detected the location of the laser beam and the rodent continuously so that the dynamics of the distance between them could be analyzed. When the animal or laser beam came within a fixed distance the animal would either be rewarded with electrical brain stimulation or shocked subcutaneously. RESULTS: Animals that received rewarding electrical brain stimulation could learn to chase the laser beam, while animals that received aversive subcutaneous shock learned to actively avoid the laser beam in the PPL paradigm. Mathematical computations are presented which describe the dynamic interaction of the laser and rodent. COMPARISON WITH EXISTING METHODS: The robotic laser offers a neutral stimulus to train rodents in an open field and is the first device to be versatile enough to assess distance between predator and prey in real time. CONCLUSIONS: With ongoing behavioral testing this tool will permit the neurobiological investigation of predator/prey-like relationships in rodents, and may have future implications for prosthetic limb development through brain-machine interfaces.