Michael Peluso, MD
@MichaelPelusoMD
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Infectious disease doctor @UCSF. #LongCOVID researcher. #HIV clinician and #HIVcure researcher.
San Francisco, California
Joined March 2022
Excited to be visiting @VirusesImmunity at the 2nd @YaleCII symposium today to talk about #LongCovid - Where we are, where we need to go, and how we can get there.
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Our new #UCSF preprint showing prolonged tissue-level immune activation and gut viral persistence for up to 2 years post-COVID. Does COVID-19 induce a new immunologic set-point and how is this related to PASC/Long COVID?.
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Our first @UCSF #LongCOVID clinical trial targeting viral persistence with monoclonal antibodies featured by @NanetteAsimov in the @sfchronicle today. I am grateful to @AeriumTx @patientled @polybioRF for supporting this effort.
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New @UCSF #LIINC paper: immune activation & viral persistence in tissue up to 2 years post-COVID. Found double-stranded RNA in #LongCOVID, suggesting active reservoir persists and evades immune clearance. Thanks @polybioRF, @NIH for support. @ScienceTM .
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Today, the #Stanford #Paxlovid trial for #LongCOVID (STOP-PASC) reported no difference in patient reported outcomes between drug vs placebo. Headlines say it's "negative," some are saying we should abandon the virus persistence hypothesis. My take:.
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Our new @UCSF #FindCOVID/#LIINC paper in @NatureComms showing SCV2 burden in first 3 weeks of COVID predicts future #LongCovid. In addition to LC treatment trials, we need investment in studies to prevent LC! Zero US-based trials on prevention so far.
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New #UCSF LIINC paper showing SARS-CoV-2-specific CD4 T cells with tissue homing markers and CD8 T cells with exhaustion. Dis-coordinated responses between antibodies and T cells. Also important differences in women. COVID Tissue persistence?.
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Our mechanistic review of #LongCovid - published in @CellCellPress - hopefully will be helpful coming out of the very inspiring RECOVER-Treating Long COVID meeting this week. Excited for the progress we will make together in the next year!.
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@UCSF #LIINC study on SCV2 protein persistence up to 14 mon post-COVID in @TheLancetInfDis . Now need to study this systematically in larger cohorts to pin down what it means. Does it have consequences? #LongCOVID?. Thanks @polybioRF @NIH for support.
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I am proud to have signed onto this letter to President Biden asking him to address the crisis of #LongCovid and other infection-associated chronic conditions in his FY25 budget! We need a robust response now!
Today a coalition of clinicians, researchers, RECOVER PIs, patient & disability orgs, and more sent an open letter to President Biden, urging him to address the crisis of #LongCovid & other infection-associated chronic conditions in his FY25 budget. 1/.
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The progress we have made on #LongCOVID so far is impressive. We need to keep it up. This means sustained investment in infection-associated chronic conditions research. @LisaAMcCorkell from @patientled and I wrote about this in @Nature today.
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Lots of attention on cortisol in #LongCovid lately. Here are results from a pilot project in the @UCSF #LIINC cohort. Similar levels between LC and recovered, but morning dynamics appear to differ, esp. in those with post-COVID ME/CFS. Detailed follow up project ongoing.
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Recent @UCSF #LIINC preprint finding SARS-CoV-2 antigen in plasma up to 14 months post-COVID. Samples prior to vaccine/reinfection. I now believe this is happening in at least some people. Major question - does this cause #LongCovid ? To be determined.
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Our recent #UCSF preprint showing how viral dynamics in the first 14 days can predict #LongCovid outcomes. May partially explain why early treatment seems to be protective. Early Biological Markers of Post-Acute Sequelae of SARS-CoV-2 Infection.
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New @UCSF #LIINC paper shows low mature/cytotoxic NK cells in #LongCovid compared to full recovery. Could reflect inability to clear infection. More interesting data showing immunologic differences in #LongCovid. Thanks to @polybioRF @NIH for funding.
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Proud to be an author of this paper and member of the Consortium! We definitely need more resources to move clinical trials forward! Currently there are way too few and we have hundreds of people on our waitlist.
Tell @ChrisCuomo that 33 scientists from 14 institutions joined forces to write this paper documenting evidence for #SARS-CoV-2 persistence as a potential driver of #LongCOVID. We call for more clinical trials of drugs capable of clearing persistent virus:
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@GladstoneInst @UCSF New #LIINC paper on immune dysfunction in #LongCovid. @UCSF + @GladstoneInst labs found SCV2-specific T cell tissue-homing and exhaustion supporting #LongCovid as a tissue-based disease with ongoing SCV2 stimulation. Supports targeting virus in trials.
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Excited to share this @ScienceTM viewpoint with @DrMaureenHanson on why #LongCOVID #MECFS and other infection-associated chronic conditions should be studied together as part of a coordinated research agenda.
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New @CMIJournal study showing association between post-acute SARS-CoV-2 protein in blood and #LongCOVID. Data from 4 cohorts, including #NIHRECOVER and @UCSF #LIINC. Need more research ASAP to see if useful as a biomarker for trials!
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6) Virus may not be replicating, in which case antivirals may not work, but viral persistence may still matter. We need studies of other types of interventions - monoclonals, immune modulators, combination therapies.
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Really enjoyed working on this review of #LongCOVID systems immunology with collaborators from @UCSF, @TheWistar, and @GladstoneInst. We did a deep dive into what's been done so far and laid out key questions for the next couple of years.
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To quote the paper: "The landscape of PASC research is dynamic. Smaller studies that are more focused and agile can scout the terrain ahead of larger and more definitive studies." . With each of these studies, the path will become a bit clearer. Let's keep up the momentum!.
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5) Duration of treatment may need to be longer, tissue penetration may need to be better, other antivirals (ensitrelvir) still need to be tested, studies need to focus on the biology.
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2) As the first RCT of an antiviral for #LongCOVID, this could not possibly have addressed all issues. We still don't know how to select participants most likely to benefit, what outcomes to measure, or when. Science is iterative.
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7) This was not a home run. But a great rally (and a big win) often starts with getting the leadoff hitter onto first - putting the rest of the lineup in position to build on that success. Science is the same way - early base hits eventually get you a win by building momentum.
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1) This was beautifully done and in many ways unprecedented. First and foremost the team and the participants should be commended for seeing It through. As a trialist, I am impressed and grateful.
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Excellent commentary from @patientled in Cell outlining priorities for #LongCOVID research.
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Important work from @patientled on lived experience with extended course Paxlovid for #LongCOVID. Some but not all benefit. Emphasizes need for ongoing randomized trials of antivirals to figure out who might benefit and how!.
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4) In #LIINC, ~10% have detectable antigen at any one time, and 25% have it ever. We don't have an assay that we can use to select these people for studies. Assay development for this eventual purpose is more important than ever.
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3) Given heterogeneity of #LongCOVID, we will need larger studies (like RECOVER-VITAL) to have the best chance of figuring out if a certain symptom subgroup benefits. VITAL (with 900 people) should be able to do that in a robust way. My enthusiasm for VITAL is unchanged.
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@LisaAMcCorkell @SenSanders @LCMoonshot This is a big deal! Grateful to @LisaAMcCorkell @SenSanders @LCMoonshot.
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Our new #UCSF LIINC study pre-print on post-COVID autoreactivity - clearly different from pre-pandemic controls, but no distinct signature of #LongCOVID. A lot more work to be done to figure this condition out.
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Story summarizing the #LongCovid meeting in Santa Fe featuring some comments from me, @DeeksSteven and @LisaAMcCorkell . It was inspiring to be together with so many great clinicians, scientists, and advocates focused on figuring out this huge problem.
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I spoke to @AEscalanteMD about our recent @TheLancetInfDis paper on antigen persistence. #LongCovid .
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Why is #LongCOVID so hard to study? 4 reasons. 1) So far, most effort has been focused on treatment and prevention of acute COVID. 2) There isn't an agreed upon definition. And Not everyone who has Long COVID has the same symptoms.
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New preprint shows immunologic link between COVID and development of MIS-C, a post-infectious inflammatory syndrome in kids. Molecular mimicry may underly some cases, with implications for understanding links between viral infection and autoimmunity.
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Really interesting pre-print from Harvard further suggesting that SARS-CoV-2 may persist in a viral reservoir - none of us thought this was true 2 years ago but the growing evidence (even if it is indirect) is harder and harder to ignore. #LongCovid .
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I spoke recently at the RECOVER R3 seminar on biomarkers of Long COVID.
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Amplifying this effort to share the stories of people experiencing #LongCOVID - The Long Covid Reader: The Book About Covid Long Haulers by Mary Ladd — Kickstarter
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3) Most studies look at people at a snapshot in time, but people's symptoms actually change over time. 4) The impact of the symptoms on everyday functioning and quality of life might matter more than their presence or absence. This is harder to measure.
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New paper on #LongCovid among people with #HIV in our #UCSF #LIINC study - surprising findings of more common Long Covid in this group need to be confirmed in larger cohorts but potentially informative .
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@WildNycgirl @BodyPROHIV Had a great discussion with Terri Wilder @WildNycgirl from @BodyPROHIV at CROI 2024! We discussed our recent work on antigen persistence post-COVID, part of which was published last week in LancetID.
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Our recent paper on anti-interferon antibodies, which are probably NOT part of the pathophysiology of #LongCOVID even though they are important in the risk of acute COVID. From the @UCSFMedicine LIINC study.
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New paper focused on those w Long COVID cardiac symptoms in @UCSF LIINC Study. Associated with inflammation, higher antibody levels, and pericardial effusions. #LongCovid.
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Here is how shortness of breath can change over 8 months. Some people always do or don't have it (YYY or NNN). Some have it, it goes away, and stays away (YNN). but in some it comes back (YNY). Some develop it later (NYY). Looking at one time doesn't give you the whole picture.
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Matt @durstenfeld gave a great cardiology grand rounds today on his work in understanding #LongCOVID at #UCSF.
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Some interesting findings from our recent study of EBV reactivation in those with Long COVID symptoms. Evidence of earlier activity but not ongoing EBV viremia. #LongCOVID.
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LongCOVID is real. But it is really hard to measure and to study. And there are currently no treatments. We need to be able to understand how to measure what people with Long COVID experience in order to come up with ways to treat and prevent it.
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Our #UCSF LIINC cardiology team has made some important discoveries about cardiopulmonary exercise capacity in people experiencing #LongCOVID. May explain why some people have reduced exercise capacity post-COVID.
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So excited that we finally launched our local site for the NIH's RECOVER Initiative today! We built UCSF's site on top of the LIINC infrastructure we created in March 2020, and it is great to see how much we've accomplished in the last 2 years! .
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Our commentary on some recent papers about #LongCOVID, including what we have learned about the biology and why it's so difficult to interpret some of the findings of these studies.
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Our latest study focused on people experiencing post-COVID neuropsychiatric symptoms. We detected abnormal levels of COVID proteins and mitochondrial proteins in extracellular vesicles. May be useful as markers for #LongCOVID.
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Long COVID is also called PASC (post-acute sequelae of COVID). Researchers think about Long COVID as physical or mental symptoms that are new (or worse) since a person had COVID-19, and which have lasted for about 3 months after their infection.
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I will use this account to post about my two areas of research - understanding Long COVID and the effort to cure HIV infection.
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Why is it hard to figure out how common #LongCOVID is from many studies?. People with long COVID may be more likely to seek out research, and people who feel fine may be less likely. So most studies (including ours can't answer the question.
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We really need studies of antivirals and Long COVID. Here are some cases we've seen recently:.(1) development of LC after symptomatic rebound from early treatment with antivirals .(2) improvement in LC after taking Paxlovid. #LongCovid #ucsf .
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Long COVID struggled to gain a toehold in the national consciousness. Now, as the world turns its attention away from the pandemic, the condition threatens to be the first major COVID impact to slip back into the margins, @KatherineJWu writes.
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Some of the best studies have been done in the UK, and show Long COVID on the order of 5-10%. A study by the CDC in the US showed about 30%. These numbers seem closer to what is right than many studies (like ours) where 50% or more have Long COVID.
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Instead, we really need studies that are as likely to enroll someone whether or not they have long COVID. This will make the study population look more like everyone who has had COVID, and makes it possible to answer the question. Only a few have done this so far.
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@FrancoChevalier @MonicaGandhi9 @BSchwartzinSF @carina_marquez @hymanscott @ooharrisphd @UCSF_ID This is great news! Congrats Franco!!.
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