Showing posts with label disease. Show all posts
Showing posts with label disease. Show all posts

Friday, January 13, 2023

Smells Like Covid Part 2


It's been a couple years since the world learned the word "anosmia," so here's some updates:
(but don't forget this post about how parosmia worked with covid)

The first mass screening system for COVID cases has been developed with a sensitivity of 97%
Dec 2022, phys.org

Washing your hands with hydroalcoholic gel, smelling it and using a QR code to answer a short questionnaire. These very simple actions make up the world's first patented mass screening system for COVID cases.

Citrus fruits and apples are two of the first aromas that people with the SARS-CoV-2 virus stop detecting.

"Citrus" -- I don't remember seeing this at all, so I looked further into the report: "Based on the literature and habits of our Mediterranean study population, it was determined that the most suitable odoriferous substance was lemon." via Institute for Research in Fundamental Sciences in Iran and R DOty at U Penn: Moein, S. T. et al. Smell dysfunction: A biomarker for COVID-19. Int. Forum Allergy Rhinol. 10, 944–950 (2020). https://pubmed.ncbi.nlm.nih.gov/32301284/  -- This study used the University of Pennsylvania Smell Identification Test (UPSIT) which has 40 odorants; I can't read the paper because paywall, but I guess "citrus" or "lemon" is one of those odors. The paper wasn't meant to find the most prevalent non-detectable odor, but I guess it was just sitting there in the data?

"The antigen tests on the market have an average sensitivity of 80%, which means that the number of false negatives is 20%. What we have developed is not a diagnostic test, but a screening system that aims to detect the maximum possible number of positives and prevent false negatives," explained the researchers.

via Youcef Azeli et al, A machine learning COVID-19 mass screening based on symptoms and a simple olfactory test, Scientific Reports (2022). DOI: 10.1038/s41598-022-19817-x

Image credit: Stainless steel climate chamber at the Technical University of Denmark, Mikal Schlosser, 2022


Loss of smell following COVID linked to a person's immune reaction to the infection
Dec 2022, phys.org

They studied antibody levels in people infected during the early days of the pandemic—in all, they studied blood samples of 306 people who had donated blood for study after recovering from a COVID-19 infection. In comparing the antibody levels with other data provided by the donors and their doctors, the researchers determined that those people who had higher antibody levels tended to be the same people who had reported losing their sense of smell or taste. They found that such patients were twice as likely to lose one or the other sense as those who did not have higher-than-average levels of antibodies in their blood.

via Columbia University Irving Medical Center, the University of Pennsylvania, the National Institute of Alcohol Abuse and Alcoholism and the New York State Psychiatric Institute: Jonathan B. Overdevest et al, Chemosensory deficits are best predictor of serologic response among individuals infected with SARS-CoV-2, PLOS ONE (2022). DOI: 10.1371/journal.pone.0274611


Scientists find key reason why loss of smell occurs in long COVID-19
Dec 2022, phys.org

The reason some people fail to recover their sense of smell after COVID-19 is linked to an ongoing immune assault on olfactory nerve cells and an associated decline in the number of those cells, a team of scientists led by Duke Health report.

via Duke University Medical Center: John Finlay et al, Persistent post-COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium, Science Translational Medicine (2022). DOI: 10.1126/scitranslmed.add0484.

Post Script:
Nasal injections could treat long-term COVID-19–related smell loss
Jan 2023, phys.org

Using injections of platelet-rich plasma derived from a patient's own blood. In a trial of 26 participants, those who received the treatment were 12.5 times more likely to improve than patients who received placebo injections. 

"It's a nerve damage and nerve regeneration issue that we're dealing with," she said.

via Stanford: Carol H. Yan et al, Use of platelet‐rich plasma for COVID‐19–related olfactory loss: a randomized controlled trial, International Forum of Allergy & Rhinology (2022). DOI: 10.1002/alr.23116


Thursday, June 9, 2022

Covid's Parosmia Uncovered


Covid has a smell. Not that you can smell sick people, although you can actually. Dogs have proven that it's possible; only that humans have never been trained, and for obvious reasons.

Instead, we mean that things "smell like Covid." That's because everyone who got pre-Omicron Covid also got hit with a neuroplastic time bomb where their olfactory neurons got attacked and then reconfigured. Half the people who got Covid, and its anosmic introduction, knew they had it, and the other half didn't. (This according to a May 2022 study, linked here, and repasted below.)

Lost of people would argue with that stat. And I would have to argue back. The absolute worst source of data for testing anosmia etc is the subjective reporting of the people themselves. We don't even know we have a sense of smell in the first place, nevermind detecting that it's been removed. There are congential anosmics (can't smell from birth) who don't realize they're anosmic until they're teenagers! How do you not realize that? Because we don't talk about smells. They're outright lingua-phobic. And so when we lose it, especially in the midst of a respiratory infection that messes with our breathing, we don't even notice. We also think it's our sense of taste, so when someone asks "have you experienced any change in your sense of smell," you say no, but I did lose my sense of taste. In that study, they used Sniffin' Sticks, so an objective measure, and so they got the 100% stat. 

Next, things "smell like Covid" because after a bout of anosmia, your olfactory system needs to reboot, retrain, pick your computer analogy, and in the process, there's some bugs in the code. Eggs smell like Covid, coffee smells like Covid. Shit? Smells like biscuits. Wait, what? Yes, the Faeces Paradox, see below, it's all been explained for us. Thanks, Flavor Center at University of Reading:

Researchers find cause of disordered smell
May 2022, phys.org

Among the 29 volunteers with post-viral parosmia, scientists found 15 commonly identified compounds that triggered parosmia. They also found reduced sensitivity in some people, via lower TDI scores from Sniffin’ Sticks, although some who were considered functionally anosmic could still detect some of the trigger smells...

Some of the most cited food and drinks that set off parosmia in sufferers include:
  • Coffee
  • Onions
  • Garlic
  • Chicken
  • Green peppers

The most common trigger molecules are grouped into four distinct categories based on structure: 
  • thiols
  • trisubstituted pyrazines
  • methoxypyrazines
  • disulfides
  • (and as always with smell-things: some less common triggers did not fall into any one of these categories)
  • (these molecules tend to be potent, have very low olfactory detection thresholds and, in isolation, are neither distorted nor unpleasant for nonparosmics)

Trigger Molecules and their Parosmic Descriptions:
  • 2-furanmethanethiol ("coffee") is the most frequently reported trigger. Whereas NONPAR (non-parasmics) used a range of food-related terms to describe it (coffee, roasty, popcorn, smoky), PAR (parosmics) often struggled to find suitable descriptors, as they were unable to relate it to anything they had smelled before. PAR typically used words describing its hedonic quality (disgusting, repulsive, and dirty) or new coffee (relating to the altered smell of coffee since onset of parosmia) as described previously. Four PAR described it in the same way as NONPAR (biscuit, toasty or roasty) indicating that it is not universally parosmic, but certainly an important and frequent molecular trigger of parosmia.
  • 2-methyl-3-furanthiol and its corresponding methyl disulfide  ("meaty") were detected but reported less frequently as distorted. 
  • 2-Ethyl-3,6-dimethylpyrazine (also "coffee") was the second most frequent trigger in coffee; described with a variety of food terms by NONPAR, but by “new coffee”, “unpleasant” and “distorted” by PAR.
  • 2,3-diethyl-5-methylpyrazine, 2-ethyl-3,5-dimethylpyrazine and trimethylpyrazine (found in roasted, fried and baked goods) were common triggers. These compounds also triggered a parosmic response to cocoa, grilled chicken, and peanut butter
  • 2-Ethyl-3-methoxypyrazine, 2-isobutyl-3-methoxypyrazine and 2-isopropyl-3-methoxyprazine (green peppers) were common triggers in coffee.
  • 3-methyl-2-butene-1-thiol (pungent and weedy) was reported as a trigger 9/29 times.
  • 3-mercapto-3-methylbutanol and its formyl ester are potent aroma compounds in coffee, and were detected in half the cases, but only reported as distorted 5 or 6 times.

Exceptions:
  • The unknown compound has been tentatively identified as 4-methylthio-4-methyl-pentan-2-one, but this is yet unconfirmed. (What the heck is "the unknown compound?)
  • Although thiols and disulfides seem to effectively trigger a parosmic response, there are two notable exceptions.
  • Methanethiol, detected by some NONPAR, was not detected by any PAR. Likewise, dimethyl trisulfide is detected by 12/15 NONPAR but only by 4 PAR, and only reported once as a trigger.
  • A few compounds were detected but never reported as triggers.
  • 4-Ethylguaiacol was detected by 7 PAR and always described as spicy, sweet and smoky, but never parosmic.
  • Similarly, (E)-β-Damascenone, a key odour-active compounds in coffee, was detected by 6 PAR and always described as jammy and fruity.

The Faeces Paradox
  • Foods smell of faeces yet faeces smell of food (biscuity or pleasant)
  • Two parosmic researchers did not detect these compounds in a faecal slurry and were unaware of any foul smells.
  • However, they detected several other compounds, many of which they had also detected in coffee, and only some of which triggered parosmia.
  • In comparison, a normosmic scored the intensity of indole and skatole as close to the strongest imaginable. 
  • This provides a neat explanation as to why the changes in valence for faecal samples is reversed. 

How did they do it?
They GCMSd different sources, like coffee or onions, so that the individual molecules could be separated and presented one-at-a-time to the volunteers, so they could detect the specific molecules in the source that repulses them.

Why did they do it?
Prior to the global pandemic caused by COVID-19, parosmia was a rare condition known to occur after infections such as cold, flu or sinus infections, with very little awareness about the causes and treatments for the disease.

During the pandemic COVID-19 symptoms included loss of smell and taste in 50–60% of cases, of which about 10% developed parosmia. Since the omicron variant, loss of smell and taste has become a less common symptom (estimated to occur in about 10–20% of cases) and parosmia cases are likely to be fewer in number, parosmia is still estimated to affect 2 million people in Europe.
Not exactly. See below.

via the Flavor Center at University of Reading: Jane K. Parker et al, Insights into the molecular triggers of parosmia based on gas chromatography olfactometry, Communications Medicine (2022). DOI: 10.1038/s43856-022-00112-9


Study finds sensory loss in ~100% of active COVID infections, which is twice as high as self-reports
May 2022, phys.org

In participants with active infections during the delta surge, a majority (22 of 25) had been vaccinated. Objective screenings found that 100% were experiencing a diminished or lost sense of smell—but only 54.5% self-reported any problem with odor detection.

via Ohio State University: Kym Man et al, Chemosensory losses in past and active likely Delta variant break-through COVID-19 cases, Med (2022). DOI: 10.1016/j.medj.2022.05.004

Image credit: Free Photos at img freepic dot com [link]

Post Script:
Can 'smell' trigger tumors?
May 2022, phys.org
 
"Now that glioma preferentially emerges in the OB, will neuronal activity in the olfactory circuit affect the emergence of glioma?" the researchers wondered. This "mind-blowing" flash of inspiration became a turning point in this study. The research team attested to this hypothesis through a series of experiments.

In this study, they employed a cutting-edge chemogenetic technology to specifically manipulate the neuronal excitability of ORNs. They found that inhibiting the activity of ORNs reduced the size of the tumor significantly, whereas activating their activity increased the size of the tumor. It was therefore concluded that the neuronal excitability of ORNs was the root of gliomagenesis.

To further verify this conclusion, the researchers suppressed olfactory inputs through naris occlusion by using small plugs. They found that with naris occlusion, tumors were significantly hindered in the olfactory bulb, indicating that olfactory stimuli could regulate gliomagenesis.

via Zhejiang University: Pengxiang Chen et al, Olfactory sensory experience regulates gliomagenesis via neuronal IGF1, Nature (2022). DOI: 10.1038/s41586-022-04719-9

Post Post Script:
Clinical trial led by Thomas Jefferson University Hospital paves the way for innovative topical treatment
Mar 2022, Jefferson Hospital

Platelet-rich plasma (PRP) is a common restorative therapy used to regenerate cells, heal tissue, and address an array of medical conditions from healing injured muscles and tendons to increasing hair growth and reducing the appearance of scars. Animal studies have shown that PRP helps regenerate the olfactory epithelium, which may be the site affected in COVID-19 induced olfactory dysfunction (OD). As smell and taste are closely interrelated, improved sense of smell can help with sense of taste as well. Until now, PRP has been used as a nasal injectable in several small clinical trials for smell loss. Although the results were promising, nasal injections can be uncomfortable and invasive for patients.

A recent phase I clinical trial of eight patients who had at least six months of olfactory disturbance has shown preliminary success with 50 percent of participants (4 people) experiencing clinically significant improvements in smell and taste.

Also:
Autopsies suggest COVID’s smell loss is caused by inflammation, not virus
Apr 2022, Ars Technica

via Johns Hopkins: Ho C, Salimian M, Hegert J, et al. Postmortem Assessment of Olfactory Tissue Degeneration and Microvasculopathy in Patients With COVID-19. JAMA Neurol. Published online April 11, 2022. doi:10.1001/jamaneurol.2022.0154

Friday, March 11, 2022

Pan-Anosmia



Mechanism behind loss of smell with COVID-19 revealed
Feb 2022, phys.org

  • For more than 12 percent of COVID-19 patients, olfactory dysfunction persists 
  • SARS-CoV-2, indirectly dials down the action of olfactory receptors
  • The new study may also shed light on the effects of COVID-19 on other types of brain cells, and on other lingering neurological effects of COVID-19 like "brain fog," headaches, and depression
  • Presence of the virus near nerve cells in olfactory tissue brought an inrushing of immune cells, microglia, T cells, and cytokines that changed the genetic activity of olfactory nerve cells
  • They used infected golden hamsters and olfactory tissue from 23 human autopsies [hamsters are more susceptible to nasal cavity infections]

Reminder of why it's such a big deal when you start messing with smell:
"Other work posted by these authors suggests that olfactory neurons are wired into sensitive brain regions, and that ongoing immune cell reactions in the nasal cavity could influence emotions, and the ability to think clearly (cognition), consistent with long COVID."

The talk on gene behavior and downregulation of receptor building is lost on me (not a geneticist, not a neurologist), but one of the main points I am reminded of when reading this is -- for those who experienced a change in taste or smell, for any reason, but especially after a COVID infection, long-term brain damage is possibly ongoing, but it's the kind to go undetected for another 20-30 years, depending on how old you are, of course. 

They also seem to suggest that this is an explanation for why people experience brain fog, and even emotional disturbance, all of which makes a lot of sense, because your sense of smell is connected to the all those brain areas -- the hippocampus for memory and the amygdala for emotion, both integral parts of the limbic system. 

via NYU Langone Health Department of Microbiology, NYU Grossman School of Medicine and Columbia University: Marianna Zazhytska et al, Non-cell autonomous disruption of nuclear architecture as a potential cause of COVID-19 induced anosmia, Cell (2022). DOI: 10.1016/j.cell.2022.01.024


WHERE CAN I GET MORE INFORMATION ON SMELL LOSS?

Monell Anosmia Project - US Organization studying smell and taste

AbScent - UK Organization raising public awareness of smell loss

National Institute on Deafness and Other Communicable Disorders (NIDC) - Smell Disorders

ENT UK - Loss of Smell as Marker of Covid-19 Infection


Post Script:


Thursday, July 2, 2020

Healthy Brains


An interest in olfaction has me following the anosmic effects of this disease. A career as an industrial hygienist has me posting public health information on this olfactory awareness weblog:

Our sense of smell is a secret weapon in the fight against the 2019 novel coronavirus.

1. Loss of smell (anosmia) is a primary symptom of Covid-19.
2. Covid-19 may cause neurological damage.
3. This is not a coincidence.

Most people don't realize it but your sense of smell offers very sensitive diagnostics for complex brain activity, like how it can predict Alzheimer's decades in advance. This is because our sense of smell has special connections with the brain that other senses don't have. This also gives us an opportunity to monitor our own "brain health," and that's the main reason I'm sending this.

I'll let this recent BBC article on the topic fill-in the details; it's not long:
How Covid-19 can damage the brain - BBC Future


SEE UPDATE (7/25) ON NEW INFORMATION FROM HARVARD SPH BELOW


If you don't read that article, and if you're about to stop reading this, please:

  • Pay attention to changes in smell or taste, both for you and those around you.
  • Changes in smell and taste are a primary symptom for Covid-19.
  • Changes in smell and taste, in general and aside from a Covid infection, could be a sign of neurological issues and may warrant attention from a professional.
  • The sooner you recognize neurological issues the better.


WHERE CAN I GET MORE INFORMATION?

Monell Anosmia Project - US Organization studying smell and taste

AbScent - UK Organization raising public awareness of smell loss
https://abscent.org

National Institute on Deafness and Other Communicable Disorders (NIDC) - Smell Disorders
https://www.nidcd.nih.gov/health/smell-disorders

ENT UK - Loss of Smell as Marker of Covid-19 Infection
https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf

[x] image source link

Post Script:
The ability to detect smells predicts recovery and long-term survival in patients who have suffered severe brain injury, a new study has found. A simple, inexpensive 'sniff test' could help doctors to accurately diagnose and determine treatment plans for patients with disorders of consciousness.

Published in the journal Nature, ...

Simple sniff test reliably predicts recovery of severely brain injured patients
May 2020, phys.org
https://medicalxpress.com/news/2020-04-simple-reliably-recovery-severely-brain.html

Olfactory sniffing signals consciousness in unresponsive patients with brain injuries, Nature (2020). DOI: 10.1038/s41586-020-2245-5 , www.nature.com/articles/s41586-020-2245-5


UPDATE ON NEW INFORMATION
Eric Song et al. Neuroinvasion of SARS-CoV-2 in human and mouse brain, Journal of Experimental Medicine (2021). DOI: 10.1084/jem.20202135

David H. Brann et al. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia, Science Advances (2020). DOI: 10.1126/sciadv.abc5801

Trying to Make Sense of Long COVID Syndrome, Dr. Francis Collins. NIH Director's Blog, January 19th, 2021. https://directorsblog.nih.gov/

Harvard Medical School, coming with all the hot smell data these days, figures out what's going on with the covid smell loss problem.

I'm pretty sure you already know this, but just in case -- covid-19 can cause changes in smell or taste. It's a primary symptom, and the number one symptom for identifying infection (also the earliest; others may not show up until days later). The problem is that most people don't even know they have a sense of smell in the first place, so they don't notice that it's missing.

We thought it was the actual neurons themselves getting attacked and damaged by the virus. This is certainly possible, because your olfactory neurons, which are like little brain fingers with special neuron cells at the very tips, and are the only part of your brain that reach across the blood-brain barrier, outside the body envelope, and into the world. 

Imagine a piece of your brain reaching, creeping, crawling outside your skull to sniff the world firsthand. That's your olfactory neurons. That's where they stick the swab when taking your covid test sample. Sounds pretty vulnerable. I can see the line of reasoning here.

Well we were wrong (and when I say we, I mean them, because I'm not a scientist). It's not the neurons themselves being attacked, but their "supporting cells." These nonneuronal cells are described as sustentacular cells which wrap around the neurons for structural and metabolic support, and also basal cells which are regenerative stem cells responding to damage.

The thing is, I'm not sure of the implications here. Do we actually know what causes non-obstructive virus-induced anosmia prior to this? And what are the associations between people who have it and people who later develop neurodegenerative symptoms like Alzheimer's etc.? I don't think the new information from this study lets us put our guard down. Using the precautionary principle, I would say that your sense of smell is deeply connected to core areas of your brain, and any dysfunction there should prompt you to investigate potential neurological damage. With the brain, as plastic as it is, and important to quality of life, anything out of the ordinary should be taken seriously, and as quickly as possible. 

Notes:
David H. Brann et al. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia, Science Advances (2020). DOI: 10.1126/sciadv.abc5801

This lab also just released one of the more groundbreaking reports on how olfaction works,  basically in the same week: Stan L. Pashkovski et al, Structure and flexibility in cortical representations of odor space, Nature (2020). DOI: 10.1038/s41586-020-2451-1