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Published on: Nov 13, 2020
1 minute read
By: Dr Rajan ( Medical Second Opinion Cell)

Using The Cellular Handshake Against The Virus

Using the cellular handshake against the virus

In early November an interesting study was published in The Lancet Respiratory Medicine, describing the treatment of a severe COVID-19 patient with human recombinant soluble angiotensin-converting enzyme-2. By using the treatment, it was possible to see the disappearance of the virus swiftly from the patient's serum, nose, and lungs, as well as a reduction in the patients’ inflammatory markers. How was this achieved? And why is this so intriguing.

When we look at treating viruses, there are several strategies at work. You can prevent its spread by the use of social distancing or masks, you can use medications that prevent its replication (such as Tamiflu). Or you can stop the virus from entering the cells, the first step in viral replication.

SARS-CoV-2 appears to enter human cells through the ACE2 receptor. ACE2 is a protein in the cell membrane found across the human body, especially the lungs, heart, kidney and small intestine. It function is related to the Renin-Angiotensin System, a mechanism by which the kidneys control your blood pressure.

Angiotensin-Converting Enzyme converts angiotensin 1 to angiotensin 2, a hormone that causes blood vessels to constrict. ACE 2 instead converts it to a protein that causes dilation of blood vessels. This likely protects these critical organs and ensure they receive sufficient blood to perform their tasks. ACE2 is being investigated as a possible target for blood pressure medications.

The study used a genetically modified soluble form of ACE2 that mimics the protein found on human cell membranes. By increasing its availability in the blood, the SARS-CoV-2 virus binds to this protein, resulting in its inactivation, rather than entering lung cells and causing lung injury. Lab studies have shown that it can reduce viral growth by as much as 1000 to 5000 times, and phase 1 studies show it to be safe to use in people.

The actual described case was in a 45-year-old woman, hospitalized with COVID, suffering from severe shortness of breath, cough and fatigue. She was first treated with hydroxychloroquine and anticoagulants, but this proved ineffective, and the virus was causing increasing damage to her lungs. Nine days after her symptoms started, she received the ACE2 treatment for a week, with no side effects. This resulted in an increase in ACE2 activity (seen from her blood results), but also a marked decrease in multiple inflammatory markers associated with COVID-19, as well as a sharp decrease in COVID 19 numbers. Indeed, the viral load dropped from 32,000 per mL to just 270 per mL two days after treatment started. She was also able to produce antibodies against the virus, so this did not impair her from getting immunity.

It is certainly a very interesting case, though questions remain on how feasible it would be (as well as how expensive) to manufacture large quantities of this protein receptor for treatment use, as well as how it fairs in clinical trials.

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Monkeypox Virus Symptoms: Early Signs, Disease Progression, and When to Seek Care

Monkeypox, now commonly referred to as mpox, is a viral infection that has gained global attention due to outbreaks beyond traditionally affected regions. Understanding monkeypox virus symptoms is essential for early detection, timely isolation and prevention of further spread.

According to the World Health Organization and Indian public health authorities, awareness of symptom patterns plays a critical role in controlling outbreaks and protecting vulnerable populations.

What Is the Monkeypox Virus?

Monkeypox is caused by the monkeypox virus, a member of the Orthopoxvirus family, which also includes smallpox. While generally less severe than smallpox, monkeypox can still cause significant illness and discomfort.

The virus spreads primarily through close physical contact.

Incubation Period of Monkeypox

After exposure, symptoms typically appear within:

5 to 21 days
most commonly 6 to 13 days

Individuals may feel well during this period but can become infectious once symptoms begin.

Early Monkeypox Virus Symptoms

Fever

Fever is usually the first symptom and may be:

sudden in onset
moderate to high grade
accompanied by chills

Fever signals the start of systemic infection.

Headache and Body Aches

Patients often experience:

severe headache
muscle aches
back pain

These symptoms resemble many viral illnesses.

Fatigue and Weakness

Marked tiredness and low energy levels are common and may limit daily activities.

Swollen Lymph Nodes

Swollen lymph nodes are a distinguishing feature of monkeypox.

Common sites include:

neck
armpits
groin

This helps differentiate monkeypox from chickenpox or smallpox.

Development of Monkeypox Rash

The skin rash usually appears:

1 to 3 days after fever onset

It may begin on the face or genital area and spread to other parts of the body.

Stages of Monkeypox Rash

The rash progresses through well-defined stages:

Macules

Flat red spots on the skin.

Papules

Raised, firm bumps.

Vesicles

Fluid-filled blisters.

Pustules

Pus-filled lesions that are painful.

Scabs

Lesions crust over and eventually fall off.

Complete healing occurs once scabs detach.

Distribution of Rash

Rash commonly affects:

face
hands and feet
mouth
genital and anal areas

The number of lesions can vary widely.

Pain and Discomfort

Rash lesions may be:

painful
itchy during healing

Pain severity differs between individuals.

Other Possible Symptoms

Additional symptoms may include:

sore throat
cough
nasal congestion

These reflect upper respiratory involvement.

Duration of Illness

Monkeypox symptoms typically last:

2 to 4 weeks

Recovery occurs gradually as lesions heal.

Who Is at Higher Risk of Severe Illness?

Higher risk groups include:

children
pregnant women
individuals with weakened immunity
people with chronic illness

Early care is crucial in these groups.

Complications of Monkeypox

Though uncommon, complications may include:

secondary bacterial skin infections
dehydration
pneumonia
eye involvement

Prompt medical guidance reduces risk.

How Monkeypox Is Transmitted

Transmission occurs through:

direct skin-to-skin contact
contact with lesions or bodily fluids
respiratory droplets during close contact
contaminated clothing or bedding

Understanding transmission helps prevent spread.

When to Seek Medical Care

Seek medical evaluation if:

fever is followed by rash
lymph nodes become swollen
rash appears in genital or facial areas

Early diagnosis supports isolation and care.

Diagnosis and Testing

Diagnosis may involve:

clinical examination
laboratory testing of lesion samples

Public health authorities guide testing protocols.

Prevention and Control Measures

Preventive steps include:

avoiding close contact with infected individuals
maintaining good hand hygiene
isolating during illness
following public health guidance

Vaccination may be recommended for high-risk groups.

Role of Public Awareness

Awareness of symptoms:

enables early detection
reduces stigma
supports timely care

WHO emphasises community education in outbreak control.

Conclusion

Monkeypox virus symptoms typically begin with fever, body aches and swollen lymph nodes, followed by a characteristic rash that progresses through defined stages. While most cases are self-limiting, early recognition, medical evaluation and isolation are essential to prevent complications and reduce transmission. Staying informed and acting promptly protects both individual and public health.

References

World Health Organization (WHO) – Mpox (Monkeypox) Clinical and Public Health Guidance
Indian Council of Medical Research (ICMR) – Emerging Viral Infections Reports
National Centre for Disease Control (NCDC), India – Monkeypox Advisories
Lancet – Clinical Features and Outcomes of Mpox
NITI Aayog – Public Health Preparedness and Infectious Disease Control

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