Michael Peluso, MD @MichaelPelusoMD Twitter profile

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Michael Peluso, MD

@MichaelPelusoMD

1 year

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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Michael Peluso, MD

@MichaelPelusoMD

1 year

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.

UCSF is trying a new tactic to eradicate long COVID symptoms. Here’s how it works

S.F. researchers are the first to try infusions of monoclonal antibodies to vanquish...

www.sfchronicle.com

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Michael Peluso, MD

@MichaelPelusoMD

2 months

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

Tissue-based T cell activation and viral RNA persist for up to 2 years after SARS-CoV-2 infection

Total-body PET imaging and microscopy analysis of rectosigmoid biopsies reveal prolonged T cell activation and SARS-CoV-2 RNA persistence following COVID-19.

www.science.org

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Michael Peluso, MD

@MichaelPelusoMD

3 months

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:

Nirmatrelvir-Ritonavir and Symptoms of Postacute Sequelae of SARS-CoV-2 Infection

This randomized clinical trial evaluates the efficacy of oral nirmatrelvir-ritonavir for treatment of moderate to severe postacute sequelae of SARS-CoV-2 infection of 3 months or longer duration.

jamanetwork.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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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Michael Peluso, MD

@MichaelPelusoMD

5 months

@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

Plasma-based antigen persistence in the post-acute phase of COVID-19

Persistent symptoms among some individuals who develop COVID-19 have led to the hypothesis that SARS-CoV-2 might, in some form or location, persist for long periods following acute infection.1,2...

www.thelancet.com

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Michael Peluso, MD

@MichaelPelusoMD

9 months

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!

Patient-Led Research Collaborative

@patientled

9 months

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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Michael Peluso, MD

@MichaelPelusoMD

11 months

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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Michael Peluso, MD

@MichaelPelusoMD

11 months

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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Michael Peluso, MD

@MichaelPelusoMD

1 year

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

Early Biological Markers of Post-Acute Sequelae of SARS-CoV-2 Infection

To understand the roles of acute phase viral dynamics and host immune responses in PASC, we enrolled 136 participants within 5 days of their first positive SARS-CoV-2 real-time PCR. Participants...

www.medrxiv.org

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Michael Peluso, MD

@MichaelPelusoMD

8 months

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.

Amy Proal, PhD

@microbeminded2

8 months

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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Michael Peluso, MD

@MichaelPelusoMD

8 months

@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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

6 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

1 year

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

3 months

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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Michael Peluso, MD

@MichaelPelusoMD

5 months

@LisaAMcCorkell @SenSanders @LCMoonshot This is a big deal! Grateful to @LisaAMcCorkell @SenSanders @LCMoonshot .

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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.

Autoantigen profiling reveals a shared post-COVID signature in fully recovered and Long COVID...

Some individuals do not return to baseline health following SARS-CoV-2 infection, leading to a condition known as Long COVID. The underlying pathophysiology of Long COVID remains unknown. Given that...

www.medrxiv.org

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Michael Peluso, MD

@MichaelPelusoMD

1 year

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.

Scientists gathered in New Mexico to address persistent symptoms of long COVID

Progress on long COVID may seem slow, but scientists say they're closing in on some potential explanations for the disease. That will hopefully point the way to treatments.

www.npr.org

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

1 year

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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Michael Peluso, MD

@MichaelPelusoMD

4 months

I spoke to @AEscalanteMD about our recent @TheLancetInfDis paper on antigen persistence. #LongCovid

Covid-19 Found in People’s Blood Months After Infection

Researchers provide an important clue to Long Covid, finding viral proteins in the blood of 25% of people more than a year after infection.

www.psychologytoday.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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

Persistent circulating SARS-CoV-2 spike is associated with post-acute COVID-19 sequelae

The diagnosis and management of post-acute sequelae of COVID-19 (PASC) poses an ongoing medical challenge. Identifying biomarkers associated with PASC would immensely improve the classification of...

www.medrxiv.org

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Michael Peluso, MD

@MichaelPelusoMD

2 years

I spoke recently at the RECOVER R3 seminar on biomarkers of Long COVID.

Understanding the Biomarkers of PASC

The seventeenth seminar of the Recover Research Review (R3) Seminar series, Understanding the Biomarkers of PASC, was held on November 8, 2022.Panelists for ...

www.youtube.com

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Michael Peluso, MD

@MichaelPelusoMD

11 months

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

The Long Covid Reader: The Book About Covid Long Haulers

An anthology amplifying the voices of 45 Long Haulers, sharing raw, powerful stories that shed light on the impact of Long Covid

www.kickstarter.com

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

5 months

@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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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.

Low Prevalence of Interferon α Autoantibodies in People Experiencing Symptoms of Post–Coronavirus...

Within a cohort of individuals with well-characterized post–coronavirus disease 2019 (COVID-19) conditions, or “long COVID,” the authors identified only 2

academic.oup.com

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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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Michael Peluso, MD

@MichaelPelusoMD

6 months

Great coverage of our @UCSF #hivcure work presented at CROI.

New Studies Advance HIV Cure Science

HIV cure researchers, including amfAR grantees, report findings on post-treatment control, HIV reservoirs, and early treatment in children at CROI.

www.amfar.org

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Michael Peluso, MD

@MichaelPelusoMD

2 years

Matt @durstenfeld gave a great cardiology grand rounds today on his work in understanding #LongCOVID at #UCSF .

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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

Evidence of recent Epstein-Barr virus reactivation in individuals experiencing Long COVID

Epstein-Barr virus (EBV) reactivation has been proposed as a driver of Long COVID (LC), but studies in well- characterized post-acute COVID-19 cohorts of individuals with and without Long COVID...

www.medrxiv.org

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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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Michael Peluso, MD

@MichaelPelusoMD

3 years

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.

Early clues regarding the pathogenesis of long-COVID

Intense investigation into the predictors and determinants of post-acute sequelae of SARS-CoV-2 infection (PASC), including ‘long COVID’, is underway. Recent studies provide clues to the mechanisms...

www.cell.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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 .

SARS‐CoV‐2 and Mitochondrial Proteins in Neural‐Derived Exosomes of COVID‐19

Objective As SARS-CoV-2 is known to invade neural cell mitochondria, a plasma system for quantifying central nervous system proteins in living humans was used to investigate neuropathogenic mechani...

onlinelibrary.wiley.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

A nice summary of the current state of Long COVID by @PamBelluck .

What We Know About Long Covid So Far (Published 2022)

There is no universal definition of the complex condition, but clues about causes and potential treatments are beginning to emerge.

www.nytimes.com

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

2 years

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

Effect of oral nirmatrelvir on Long COVID symptoms: a case series

As the SARS-CoV-2 pandemic continues to evolve, efforts to understand variability in COVID-19 recovery, as well as the impact of factors including viral variants, vaccine status, and COVID-19...

www.researchsquare.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

Coverage of our recent #UCSF #LongCOVID and #Paxlovid case series on #Reuters .

Evidence mounts for need to study Pfizer's Paxlovid for long COVID - researchers say

Additional reports of patients with long COVID who were helped by Pfizer Inc's oral antiviral treatment Paxlovid offer fresh impetus for conducting clinical trials to test the medicine for the...

www.reuters.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

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.

The Pandemic After the Pandemic

Long COVID isn’t going away, and we still do not have a way to fully prevent it, cure it, or really to quantify it.

www.theatlantic.com

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Michael Peluso, MD

@MichaelPelusoMD

2 years

San Francisco, San Mateo Co. Residents Urged to Share Long COVID Stories

UCSF, San Francisco Department of Public Health (SFDPH) and San Mateo County Health (SMC Health) are partnering with local community groups to learn about long COVID. Their project, Let’s Figure Out...

www.ucsf.edu

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Michael Peluso, MD

@MichaelPelusoMD

6 months

@seeksboston26mi @zalaly @BernieSanders This made my day…honored to be included among this group!

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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.

Post-Acute Sequelae of SARS-CoV-2...

This report describes identification of post-acute sequelae in recovered COVID-19 patients in Long Beach, California.

www.cdc.gov

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Michael Peluso, MD

@MichaelPelusoMD

3 years

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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Michael Peluso, MD

@MichaelPelusoMD

3 years

@FrancoChevalier @MonicaGandhi9 @BSchwartzinSF @carina_marquez @hymanscott @ooharrisphd @UCSF_ID This is great news! Congrats Franco!!

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