Quiz 2 + Final Study Guide Flashcards
What caused COVID-19?
severe acute respiratory syndrome SARS-CoV-2
1. infects ACE-2 expressing nasal epithelial cells in the upper respiratory tract
2. infects ACE-2 expressing alveolar epithelial cells and patients exhibit pneumonitis
3. severe disease involves disruption of epithelial-endothelial barrier and hyperinflammation
Characteristics of SARS-CoV-2
enveloped, positive-sense (direct translation by host ribosome), single stranded RNA (+ssRNA) virus
Components
- S1: receptor binding domain
- S2: membrane fusion subunits
What are the general COVID-19 immunopathologies?
while most infections are mild, severe reactions include:
1. fatal systemic inflammation
2. tissue damage
3. cytokine storm: IL-6, IL-10
4. acute respiratory distress syndrome
Specific COVID-19 immunopathologies?
- lymphopenia: decrease WBC, more prone to infection
- T-cell activation
- lymphocyte dysfunction
- increased cytokine production, multiple organ dysfunction from inflammation
- increased antibodies
What do the most severe cases of COVID-19 exhibit?
extreme increase in inflammatory cytokines
- IL-6, IL-10
- TNF-alpha
initiates inflammation-induced organ dysfunction across multiple organs
- lung/kidney/liver injury, respiratory failure
What is the difference between alpha, delta, and omicron variants?
alpha: 10 changes in spike sequence; RBDs stay up; easier to enter
delta: 3 mutations in RBD that improve binding to ACE2 and evade immune response
omicron: 32 mutations in spike protein; increased infectivity and immune escape
Case fatality rate (CFR) was highest in beta
What is the life cycle of SARS-CoV-2?
- spike binds to host ACE2
- virus enters via endocytosis or direct fusion to plasma membrane
- viral genome is released and RNA is translated
- viral structural proteins produced and virus assembles
- exocytosis of virions
Describe fusion of SARS-CoV-2
- binds to ACE2
- Furin cleaves S1/S2 and TMPRSS2 cleaves S2’ of spike protein
- Activates S2 domain causes fusion of viral and host membranes
- viral capsid disassembles, releasing the viral RNA genome into the host cell’s cytoplasm
Describe endocytosis of SARS-CoV-2
absence of TMPRSS2
1. SARS-CoV-2 binds to ACE2
2. additional attachment factors (NRP-1)
3. Cathepsin L cleaves S protein and releases virus from the endosome
What is required for S binding to ACE2?
only one monomer needs to be in up/open position
- RBD in S1
Therapies for SARS-CoV-2
target several stages of the virus’s lifecycle: entry, replication, immune response
1. drugs targeting spike protein or binding to ACE2
2. antivirals that inhibit SARS-CoV-2 main protease, MPro
3. Vaccines: increase humoral response
differential receptor localization means that targeted therapies don’t work on all cell types
What is AD?
- A neurodegenerative disorder marked by cognitive and behavioral impairment
- Characterized by the deposition of amyloid-b (Ab) plaques and hyperphosphorylated tau neurofibrillary tangles
- 90% of cases are sporadic
- 10% of cases are hereditary (APP, PSEN1/2, APOE4)
What are the two subtypes of AD?
- Familial: usually early-onset, 5-10% of all cases; 5-10% of these involve mutations in APP, PSEN1/2, APOE4
- Sporadic: late-onset
How is AD identified?
- Psychological evaluations (short-term memory)
- Plasma levels of phosphorylated tau protein
- Amyloid beta and p-tau in CSF
- mutations in PSEN1/2, APOE4
- Neuroinflammation
What are the causes of AD?
- AB cascade hypothesis
- Neurofibrillary tau tangles
- Neuroinflammation: cytokine release, microglial dysfunction
- Genetics that cause AB clearance dysfunction
What is the amyloid-beta cascade hypothesis?
increase in AB with reduced clearance leads to oligomerization, inflammatory response (microglial/astrocyte), synaptic/neuronal injury, oxidative injury, hyperphosphorylation of tau, cell death, dementia with plaque and tangles
Where is APP found? How is amyloid precursor protein processed?
APP is found mostly on membranes of vesicles
APP is cleaved first by beta-secretase instead of alpha-secretase, leading to subsequent cleavage by gamma-secretase and formation of amyloid beta (AB) peptides
Alpha: good; cleaves transmembrane domain
Beta: bad (encoded by PSEN1/2)
Gamma: bad
Amyloid beta oligomers and plaques
damage neurons by neuroinflammation (activation of astrocytes/microglia), oxidative injury, and altered kinase/phosphatase activity (tau)
Neurofibrillary tangles (phosphorylated tau)
normal: binds and stabilizes microtubules
AD: MT depolymerization, aggregation, NFTs, neuron death
Neuroinflammation
activation of microglia and astrocytes by AB plaques leads to production of pro-inflammatory cytokines –> neuron damage + death
Theoretical Model for how Tau and AB converge?
- AB is produced by cleavage of APP
- AB forms oligomers that disrupt synapses
- fibrils of AB aggregate into plaques around neurons and activate microglia and release of inflammatory molecules
- misfolded tau aggregates into NFTs inside neurons
- NFTs can pass through synapses to other neurons
Genetics / AB clearance
- elevate AB production: APP, PSEN1, PSEN2 (gamma-secretase)
- cholesterol transport to neurons and AB clearance: APOE e4
- neuroinflammantion: TREM2, CD33
APOE e4
secreted by astrocytes, binds to AB then binds to TREM2 on microglia, phagocytosis + cleavage
- 3 isoforms: e2 is protective bc it binds AB and TREM2 with high affinity
- e4 has low affinity, bad clearance
How is AB cleared?
- APOE binds to AB
- TREM2 on microglia binds APOE/lipid complex with AB
- binding promotes phagocytosis and cleavage
CD33
inhibitor of microglial phagocytosis
during AD, CD33 levels increase
- AB can bind to CD33
What is the physiological role of AB?
protection against oxidation, regulation of cholesterol transport, antibiotic
3 therapeutic strategies for AD
- target neurotransmitters (acetylcholinesterase inhibitor drugs)
- target amyloid pathway
- tau aggregation
- secretase inhibitors
- antibodies targeting AB - target things not in the AB pathway
- CNS inflammation
- brain clearance with sonography
What is an AChe inhibitor?
Acetylcholinesterase (AChe) inhibitor prevents breakdown of acetylcholine
- treats symptoms, can’t reverse brain damage, but helps with cognition/behavior