The genes of people who live to be over the age of 100 could one day help others stay heart-healthy for longer, according to some exciting new research.
A team of British and Italian researchers has found that a specific mutated gene in so-called “superagers” who make it into their centenarian years could be used to help those with heart failure turn back the clock by ten years, as detailed in a groundbreaking study published in the journal Cardiovascular Research.
Building on the discovery of the longevity-associated gene variant known as BPIFB4 in 2018, the researchers conducted experiments on human cells in test tubes and later on mice to see if the genes were still able to turn back the biological clock when introduced in a lab instead of being inherited.
Incredibly, they found that its introduction to damaged cells can both halt and even reverse heart aging. “The cells of the elderly patients, in particular those that support the construction of new blood vessels, called ‘pericytes’, were found to be less performing and more aged,” said Monica Cattaneo, a researcher at the MultiMedica Group in Italy and co-author, in a press release.
“By adding the longevity gene/protein to the test tube, we observed a process of cardiac rejuvenation: the cardiac cells of elderly heart failure patients have resumed functioning properly, proving to be more efficient in building new blood vessels,” Cattaneo added.
The researchers also found that those same cells seemed to have reduced expression of BPIFB4 as well. In other words, people who tend to develop heart problems may actually be missing this key longevity protein.
As University of Bristol professor and co-author Paolo Madedu notes, these findings suggest that introducing a protein to the cells of patients with heart problems may be an alternative to gene therapy, which, in spite of being a promising branch of medical treatment, still carries a number of associated risks, including the potential of developing cancer.
“Our findings confirm the healthy mutant gene can reverse the decline of heart performance in older people,” Madedu said in the press release. “We are now interested in determining if giving the protein instead of the gene can also work.”
Obviously, this kind of potential treatment will take many years to perfect — but regardless, this could be a huge win in the war against heart disease.
Sick Woman Lying In Bed With Tissues (Getty Images/Obradovic)
SARS-CoV-2, the virus that causes COVID, is devastating precisely because it can worm its way into so many different organs and systems in the body. That manifests as different symptoms, from fever to trouble breathing, although an infection can be asymptomatic, too — that is, no symptoms at all.
Throughout the pandemic, there have been a few telltale signs of COVID infection. The loss of sense of smell and taste were chief among them. But as the virus has mutated again and again, creating new strains like Typhon (BQ.1) and Gryphon (XBB) which can evade some of our tools to fight it, it seem that the symptoms of COVID may have changed as well.
Recent estimates published by the Centers for Disease Control and Prevention on Friday pegged Typhon and its close relative Cerberus (BQ.1.1) as making up 27 percent of cases, an 11 percent increase from last week. Meanwhile, cases of BA.5, the strain that has dominated cases for the majority of summer, dipped below 50 percent for the first time in months.
Indeed, emerging data suggests the symptoms of COVID are changing with new variants. And, they can differ regardless of whether you’ve been vaccinated or not, or previously infected. Newly released data from the ZOE Health Study, which maintains the COVID Symptom Tracker app, finds that the dominant symptoms have shifted.
The app was originally launched in March 2020. It quickly logged one million users, who typed in how COVID was making them feel, allowing researchers to pin down some of the most common COVID symptoms. It was part of the reason why it became well-known that anosmia (loss of smell and taste) is a key symptom of the original COVID strain.
More recently, ZOE crunched the data from over 4.8 million users and found that after two vaccinations, the top-ranking symptoms were sore throat, runny nose, blocked nose, persistent cough, headache, in that order. (Vaccines can protect against severe disease, which generally means hospitalization or death, but breakthrough infections are not unheard of, although far less severe than infections in the unvaccinated.)
Loss of smell has slipped to the number nine slot, while shortness of breath is down at number 30 for this group. ZOE says this indicates “the symptoms as recorded previously are changing with the evolving variants of the virus.”
Just one dose of a vaccine can shift the order of most common symptoms to headache, runny nose, sore throat, sneezing and then persistent cough. For those who haven’t received a vaccine at all, the symptoms are generally closer to the original ranking from 2020: headache, sore throat, runny nose, fever and persistent cough.
However, loss of smell has slipped to the number nine slot, while shortness of breath is down at number 30 for this group. ZOE says this indicates “the symptoms as recorded previously are changing with the evolving variants of the virus.”
Just because SARS-2 appears to be evolving does not mean that it will become more “mild” — and it’s definitely nothing like the flu or a regular cold. The virus indiscriminately attacks the inner lining of blood vessels, causing injuries to the heart and lungs, and can cause literal brain damage. Given the broad range of debilitating symptoms known as long COVID, it doesn’t really make sense to call this “mild.”
Additionally, repeat infections could have unknown consequences — experts aren’t entirely sure what happens when you get COVID two, three or more times. That’s why watching out for new symptoms are so important. COVID may manifest differently because different viral strains sometimes impact different parts of the body. The delta strain, for example, found its niche in the lower respiratory tract, while omicron BA.2 tends to prefer the upper airway.
But it’s also critical to note that the data from ZOE is self-reported and doesn’t take into account demographic information or which variant caused the infection. It’s also using averages to report the most common symptoms — everyone is different and there is no guarantee here the disease will follow a certain course.
Nonetheless, the data gives a good idea of what to expect and people should be aware of these changes in order to best protect themselves. And the tools to fight COVID haven’t really changed: testing, masking, indoor ventilation, drugs like Paxlovid and, of course, the vaccines are all powerful strategies we should be using more to prevent this winter wave from becoming extremely deadly.
The Biden Administration warned this week that an estimated 30–70,000 Americans could die from the virus this winter. But even a small wave could cause supply chain disruptions and sicken millions. One thing that could make this winter worse than previous COVID waves is the rise of a “variant soup,” meaning multiple new strains of the virus surging at once.
In previous fall and winter waves, only one type of the virus (i.e. delta or the original “wild type” strain) has really dominated. Public health experts are also warning of a “twindemic” or even “tripledemic” in which COVID surges along with flu and respiratory syncytial virus (RSV). Most people may have never heard of RSV, but it was first discovered in chimpanzees in 1956, and the virus regularly causes outbreaks in humans.
It’s usually only serious in babies and older people, but it’s still not a fun illness. Even though the fall is just beginning, both flu and RSV are returning with a vengeance after relatively few cases the previous two years. On Friday, the Washington Post reported that this flu season is early and more severe than it has been in 13 years, “with at least 880,000 cases of influenza illness, 6,900 hospitalizations and 360 flu-related deaths nationally.”
Meanwhile, pediatric hospital beds across the U.S. are filling up with RSV cases, many of them completely full for weeks. Symptoms of flu and RSV may overlap (cold-like symptoms like fever, runny nose, coughing), making it somewhat confusing for sick people to know what illness they really have. That underscores the importance of testing for COVID and visiting a doctor when ill, if you have access to medical care. It also serves as a reminder to stay home when sick and mask up when possible.
Masking prevents the spread of all three of these viruses: flu, RSV and COVID. That’s one theory as to why the last two winters have been mostly free of diseases other than COVID, which has dominated due to its novelty and severe contagiousness. But as restrictions loosen, some of these more familiar viruses are coming roaring back. Keeping track of new and old symptoms is really only part of the equation. Masks, vaccines and social distancing continue to be some of the best tools at our disposal.
It’s hard to get through a winter without suffering sore throat, but luckily they normally get better within a few days. Sore throat is a common symptom of COVID and its newer variants. And of course, many sore throats are caused by viral colds or flu, so they can be treated at home. The most common treatment is probably throat lozenges – but do they really work any better than sucking on a hard lolly?
Why does my throat hurt so much?
A sore throat can fall anywhere between slight discomfort to a sensation of “swallowing razor blades”. Occasionally it hurts so much to swallow that people dribble saliva from their mouths, rather than swallowing it.Bacteria and viruses can invade the thin moist skin (mucosa) lining the throat. This kills many lining cells and triggers inflammation, which appears as redness, swelling and increased secretions.
Infections in the nose also cause thick mucus to travel down the back of the throat and cause further irritation. This is referred to as “post-nasal drip”. A blocked nose causes reliance on mouth breathing, which tends to dehydrate the already inflamed throat. Ouch.
What do lozenges do?
Lozenges are a solid medication intended to be dissolved or disintegrated slowly in the mouth. They consist of one or more active ingredients and are flavoured and sweetened to make them pleasant tasting. Hard lozenges are generally formed using sucrose or other sugars similar to the process for hard candy confections.
There are many active ingredients added to lozenges, including antiseptics; pain relievers; menthol and eucalyptus oil; cough suppressants such as dextromethorphan and soothing compounds. “Cough drops” and sore throat lozenges are almost identical but may contain different proportions of these ingredients.
Different brands of lozenges advertise a confusing choice of formulations. It is more common now to see brands with “triple action” ingredients that promise to be anaesthetic (to numb pain), antiseptic (to kill germs) and anti-inflammatory (to reduce redness).Unfortunately, clinical trials directly comparing the benefit of different medication types for most common conditions (head to head trials) are rarely undertaken.
This is likely due to the added complexity of such trials compared with placebo controlled trials, and medication research often being funded by the pharmaceutical manufacturer of the products. So, we have to rely on indirect comparisons instead. The traditional approach to treating sore throat is to assume lozenges or gargling with antiseptics will reduce sore throat by treating the infection causing it.
However, a limited number of trials of antiseptic lozenges (such as Strepsils and Betadine lozenges) produced only a small reduction in sore throat pain (a difference of one unit in a ten-point pain scale compared with placebo). So they do seem to provide a small degree of relief, and continue to be sold. More and more brands are including other medications beyond antiseptics in their range of throat lozenges
Checking the effects
There are some other explanations for the apparent effectiveness of any treatment for a self-limiting infection. How do we know if the symptom or infection would have lasted longer if we hadn’t used that treatment? To tell, we’d need a control group who didn’t receive the treatment, and a large sample size to overcome the role of chance causing the difference.
Relief might come from something other than the active ingredient. After all, sucking on a sweet, hard lozenge could soothe a dry throat by increasing saliva release. To test this effect, we’d need a true placebo medication – identical in every respect apart from the active ingredient.
Several well-designed and well-conducted controlled clinical trials show some active ingredients provide significantly better pain relief than placebo lozenges. These medications fall into two main groups: local anaesthetics (such as benzocaine) and anti-inflammatory agents (flurbiprofen).
A study comparing benzocaine lozenges, (now offered in many brands of lozenges) to placebo lozenges found quicker pain relief (20 minutes for benzocaine compared to more than 45 minutes for the placebo). More study participants felt relief using the medication, though very few reported complete pain relief.
A systematic research review found nine studies that supported the benefit of flurbiprofen lozenges (available in Australia in Strepfen Intensive lozenges) for a range of sore throat conditions. In one of the reviewed studies, flurbiprofen produced greater reductions in sore throat pain (47%) as well as difficulty swallowing (66%) and swollen throat (40%) over the first 24 hours compared with placebo.
One of the common sore throat treatments sold in Australia is Difflam, which contains the anti-inflammatory medication benzydamine. One clinical trial found a greater than two point reduction in the ten point pain scale by day three in those using benzydamine versus placebo.
Are lozenges better than sore throat sprays?
A study using radioactive labelled medication demonstrated more prolonged and complete delivery of medication in the mouth for lozenges compared to spray and gargle. This seems to be the basis for the claim that sprays are less effective than lozenges.
However, drawing conclusions from such evidence is less accurate than a study that directly compares the effectiveness of the various modes of delivery on actual pain. One study compared flurbiprofen and found similar pain relief benefit between lozenges and spray.
So the choice of delivery method can be based on personal preference, including the taste of the product.
Sore throat lozenges and sprays provide some additional relief for the pain of sore throat, particularly those with anti-inflammatory or local anaesthetic ingredients. They are often combined with an antiseptic agent, which may or may not add any significant benefit.
Used as directed, these agents seem safe and have negligible adverse effects. They are also affordable and readily available. But this shouldn’t stop us using other treatments we know also soothe sore throats, such as a small spoonful of honey.
By: David King Senior Lecturer in General Practice, The University of Queensland
Throat lozenges generally contain painkillers, antibacterial agents, antitussives, pectin, menthol and/or eucalyptus. We take a closer look at each ingredient to see how effective it is in reducing sore throat symptoms. Benzydamine hydrochloride and flurbiprofen are painkillers that belong to the group known as NSAIDs (non-steroidal anti-inflammatory drugs) that help reduce swelling.
A number of good-quality studies have shown that flurbiprofen lozenges and benzydamine hydrochloride given as a spray or gargle provide effective relief from sore throat symptoms, including difficulty in swallowing. Amylmetacresol, cetylpyridinium chloride, dichlorobenzyl alcohol and hexylresorcinol are antibacterial agents that help fight against disease-causing bacteria.
But the majority of sore throats are caused by viral infections rather than bacterial, so for the most part antibacterial agents in lozenges aren’t going to help. Local anaesthetics numb the area they’re in contact with and provide temporary relief from soreness. Lignocaine hydrochloride and benzocaine are used widely in medical and dental practice for numbing the mouth and throat during minor surgical procedures, or when a tube must be inserted into the windpipe.
Benzocaine, lignocaine hydrochloride, benzydamine hydrochloride and hexylresorcinol also have local anaesthetic properties. Pholcodine and dextromethorphan hydrobromide are antitussives that are intended to help suppress dry, unproductive (non-phlegmy) coughs, which can contribute to making your throat sore. But a wide-scale review of trials testing antitussives (mainly dextromethorphan) found that they were no more effective than a placebo for treating coughs in most cases. And a much higher concentration of dextromethorphan was used in the trials than is found in throat lozenges.
Menthol is made synthetically or obtained from mint oils. It’s the component of peppermint oil that’s thought to be responsible for most of its therapeutic properties. It gives a cooling and soothing sensation when you inhale or eat it, thanks to its ability to chemically trigger cold-sensitive receptors in the skin. But the effect of nasal decongestion from menthol is subjective – studies show that although people feel decongested after inhaling menthol vapour, there’s no actual improvement in the nasal airway when airflow is measured.
Just like menthol, eucalyptus is thought to act as a nasal decongestant. However, there’s a lack of controlled, clinical studies to support its effectiveness. Pectin is commonly used as a thickening agent in foods like jam and jelly. In throat lozenges it’s used to coat the throat, and in doing so has a soothing effect in much the same way as a teaspoon of honey would.
For more than a year now, the original COVID-19 vaccines have held up remarkably well — even miraculously so — against a Greek alphabet of new variants: Alpha, Beta, Gamma, Delta.
But now experts say something is changing. Since the start of 2022, the initial version of Omicron, known as BA.1, has been spinning off new sublineages — BA.2, BA.2.12.1, BA.4, BA.5 — at an alarming pace.
Earlier variants did this too. But it never really mattered, because their offshoots “had no functional consequence,” according to Eric Topol, founder of Scripps Research Translational Institute. “They did not increase transmissibility or pathogenicity.”
Today’s rapidly proliferating Omicron mutants are different, however. They all have one worrisome trait in common: They’re getting better and better at sidestepping immunity and sickening people who were previously shielded by vaccination or prior infection.
The virus, in other words, is now evolving faster — and in a more consequential way — than ever before. Given the increasing speed of immune evasion, and what this pattern portends for the future, experts warn that the time has come to rethink our reliance on the vaccine status quo and double down on next-generation vaccines that can actually stop infection.
“As difficult [as] it is to mentally confront, we must plan on something worse than Omicron in the months ahead,” Topol wrote on May 15. “We absolutely need an aggressive stance to get ahead of the virus — for the first time since the pandemic began — instead of surrendering.”
The brewing storm of BA sublineages isn’t all bad news. COVID cases have been rising nationwide since the beginning of April, nearly quadrupling over the last six weeks to more than 90,000 per day on average. Yet both COVID deaths (about 300 per day) and ICU patients (about 2,000 total) are still at or approaching record lows — even though other countries with bigger gaps in previous exposure or vaccination have been hit hard, and even though new research shows that Omicron and its spinoffs are not, in fact, intrinsically less severe or deadly than prior variants, contrary to early assumptions.
The new variants have not altered the fundamental usefulness of the Covid vaccines. Most people who have received three or even just two doses will not become sick enough to need medical care if they test positive for the coronavirus. And a booster dose, like aprevious bout with the virus, does seem to decrease the chance of reinfection — but not by much.
At the pandemic’s outset, many experts based their expectations of the coronavirus on influenza, the viral foe most familiar to them. They predicted that, as with the flu, there might be one big outbreak each year, most likely in the fall. The way to minimize its spread would be to vaccinate people before its arrival.
Instead, the coronavirus is behaving more like four of its closely related cousins, which circulate and cause colds year round. While studying common-cold coronaviruses, “we saw people with multiple infections within the space of a year,” said Jeffrey Shaman, an epidemiologist at Columbia University in New York.
If reinfection turns out to be the norm, the coronavirus is “not going to simply be this wintertime once-a-year thing,” he said, “and it’s not going to be a mild nuisance in terms of the amount of morbidity and mortality it causes.”
Reinfections with earlier variants, including Delta, did occur but were relatively infrequent. But in September, the pace of reinfections in South Africa seemed to pick up and was markedly high by November, when the Omicron variant was identified, Dr. Pulliam said.
Reinfections in South Africa, as in the United States, may seem even more noticeable because so many have been immunized or infected at least once by now.
Although the federal government does not collect data on COVID reinfections, and nor do health authorities in WA and Queensland, Victoria recorded almost 10,000 reinfections between late December 2021 and late March 2022. This compares with just 108 known reinfections in Victoria during the previous two years. NSW plans to release state reinfection data soon.
As the Omicron sub-variant BA.2 continues to fuel more infections, the spectre of repeat infections is well and truly upon us. Current vaccines were designed to protect against the original strain of SARS-CoV-2, and while the shots are crucial in shielding us from severe illness and death, they are less effective in preventing infection by newer variants.
Unfortunately, natural immunity gained from a Delta infection also won’t stop us getting infected with Omicron. We learnt this with the rise of Omicron in South Africa late last year, when a population with relatively high natural immunity from previous coronavirus infections still fell victim to the merciless Omicron wave.
Reinfections have become something of a hallmark of Omicron. Since the rise of this highly transmissible strain, the number of people reinfected with coronavirus has spiked, in a pattern that is unique to the strain. Imperial College London researchers estimate a reinfection with Omicron is 5.4 times greater than with the Delta variant.
A letter published in The New England Journal of Medicine indicated that a previous COVID-19 infection was 90 per cent effective at preventing an infection with the Alpha, Beta or Delta variants, but only 56 per cent effective against Omicron.
The data shows that the number of weekly reinfections jumped from 20,000 to 50,000 in just one month, with reinfections occurring across all age groups, despite high vaccination levels. (A reinfection was counted when someone tested positive on two tests taken more than 90 days apart.)
Waning immunity is playing a part, along with the easing of restrictions. But the potent variable here is the rise of the BA.2 variant of Omicron, which is rapidly becoming the dominant strain globally.
The good news as far as reinfections go, is that catching the same variant twice is fairly unlikely. So if you got sick with Omicron BA.1, you’re probably in the clear when it comes to catching BA.2.
A more likely scenario is being reinfected after having Delta or an earlier strain. You’re more likely again to get infected if you’ve had no prior COVID infection at all, and that likelihood increases further if you’re unvaccinated.
While reinfection is no fun, the plus side is that it gives you excellent immunity when coupled with vaccination. The combination triggers a broader range of antibody and white cell responses in your system, meaning you are less likely to suffer serious illness on reinfection.
A preprint study from Qatar confirms that the best defence against Omicron BA.1 or BA.2 infections is a prior infection plus two vaccinations and a booster shot. This reduces the risk of infection by 77 per cent, compared with 52 per cent if you got three doses but had no prior infection, the study found.
Senior research fellow at the Kirby Institute’s infection analytics program Dr Deborah Cromer says COVID-19 may follow the trajectory of other respiratory viruses, such as the flu, when it comes to reinfection.
“People will get the flu once, but that doesn’t mean they won’t get the flu again,” she says. “They probably won’t get the flu twice in one season, but obviously, there are people who do. And if you’ve had the flu vaccine, it doesn’t mean you won’t get the flu, but your symptoms will probably be less severe.
“I think what we’re talking about is a respiratory virus that will keep changing, but if people’s immunity levels keep being maintained at a high level, then it should hopefully not be too severe.”
That’s pretty much how the 1918 Spanish flu petered out. The first couple of years of that pandemic were the worst in terms of severe sickness and death, but as the virus changed and spread over the following decades, it continued to infect people but was far less dangerous.
The key problem in Australia, though, is a lack of good data. As more people rely on rapid-antigen tests, there are fewer samples available for sequencing. ANU infectious diseases physician Peter Collignon says we need systematic surveillance to monitor infections and genomic sequencing to better understand how reinfections will impact us.
“Instead of having a one in 1000 chance of dying, is there one in 10,000 if you’re reinfected? What’s your chance of getting into hospital? And how is it proportionate to your socio-economic condition and your age? We need that sort of data to be able to plan for the future.”