Writing Committee for the REMAP-CAP Investigators IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive.OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONSThe immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURESThe primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, −1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11...

Abstract-The HCN family of ion channel subunits underlies the currents I f in heart and I h and I q in the nervous system.In the present study, we demonstrate that minK-related peptide 1 (MiRP1) is a ␤ subunit for the HCN family. As such, it enhances protein and current expression as well as accelerating the kinetics of activation. Because MiRP1 also functions as a ␤ subunit for the cardiac delayed rectifier I Kr , these results suggest that this peptide may have the unique role of regulating both the inward and outward channels that underlie cardiac pacemaker activity. The full text of this article is available at http://www.circresaha.org. (Circ Res. 2001;88:e84-e87.)Key Words: HCN family Ⅲ MiRP1 Ⅲ KCNE family Ⅲ ␤ subunit T he HCN (hyperpolarization-activated cyclic nucleotidegated) family of ion channel subunits has been identified as the molecular correlate of the currents I f in heart and I h and I q in neurons. [1][2][3] However, several ion channels are heteromultimers of a large ␣ subunit (like the HCN family members) and smaller ␤ subunits. The cardiac delayed rectifiers I Kr 4 and I Ks 5 are examples of this basic principle. Their ␣ subunits derive from the ERG and KCNQ families, respectively, but both also contain ␤ subunits from the KCNE family of single transmembranespanning proteins called minK and minK-related peptides (MiRPs). In this study, we report that MiRP1 enhances the expression and speeds the kinetics of activation of the HCN family of channel subunits. From immunoprecipitation experiments, we show that it most probably forms a complex with HCN1. Using RNase protection assays (RPAs), we demonstrate that MiRP1 mRNA is prevalent in the primary cardiac pacemaking region, the sinoatrial (SA) node, and barely detectable in ventricle. Cardiac pacemaker activity is generated by a narrow balance of inward (I f ) and outward (I Kr ) currents. Our results demonstrate for the first time the potential importance of a single ␤ subunit in simultaneously regulating both the expression and gating of both inward and outward cardiac pacemaker channels. Materials and Methods Heterologous Expression in Xenopus OocytescRNA encoding mouse HCN1 or HCN2, rat MiRP1 with or without an HA tag at the carboxy-terminal, and rat minK were transcribed using the mMessage mMachine kit (Ambion). Xenopus laevis oocytes were isolated, injected with 2 to 5 ng (50 to 100 nL) of cRNA, and maintained in Barth medium at 18°C for 1 to 3 days. For experiments using both HCN1 or HCN2 and MiRP1 or minK, the respective cRNAs were injected in a 1:0.04 to 1 ratio. Electrophysiological studies on oocytes used the 2-microelectrode voltage clamp. The extracellular recording solution (OR2) contained, in mmol/L, NaCl 80, KCl 2, MgCl 2 1, and Na-HEPES 5 (pH 7.6). Group data are presented as meanϮSEM. Tests of statistical significance for midpoint and slope of activation curves were performed using unpaired Student's t tests. PϽ0.05 is considered significant. RNase Protection AssaysThe procedures for the preparation of total RNA from rabbit he...

Aim Extreme climatic events and large wildfires are predicted to increase as the world's climate warms. Understanding how they shape species’ distributions will be critical for conserving biodiversity. We used a 7‐year dataset of mammals collected during and after south‐east Australia's Millennium Drought to assess the roles of fire history, climatic extremes and their interactions in shaping mammal distributions. Location Grampians National Park, south‐eastern Australia. Methods We surveyed mammals at 36 sites along a ~50‐year post‐fire chronosequence in each of the 7 years. We modelled ten mammal species in relation to fire history, productivity and recent rainfall. Next, we examined the consistency of species’ fire response curves across each of three climatic phases relating to the Millennium Drought. Finally, we identified the optimal distribution of fire ages for small and medium‐sized mammal conservation in each of the three climatic phases. Results The majority of species were influenced by fire history, and all native species were negatively associated with recently burned vegetation. Seven of ten species responded positively to the end of the Millennium Drought, but six of these declined quickly thereafter. Species’ responses to fire history differed depending on the climatic conditions. However, the optimal distribution of fire‐age classes consistently emphasized the importance of older age classes, regardless of climatic phase. This distribution is in stark contrast to the current distribution of fire ages across the study region. Main conclusions Mammals in the study region face an uncertain future. The negative impact of drought, the short‐lived nature of post‐drought recovery and, now, the possibility of a new drought beginning forewarn of further declines. The stark contrast between the optimal and current fire‐age distributions means that reducing the incidence of further fires is critical to enhance the capacity of native mammal communities to weather an increasingly turbulent climate.

Bovines have evolved a subset of antibodies with ultra-long CDRH3 regions that harbour cysteine-rich knob domains. To produce high affinity peptides, we previously isolated autonomous 3-6 kDa knob domains from bovine antibodies. Here, we show that binding of four knob domain peptides elicits a range of effects on the clinically validated drug target complement C5. Allosteric mechanisms predominated, with one peptide selectively inhibiting C5 cleavage by the alternative pathway C5 convertase, revealing a targetable mechanistic difference between the classical and alternative pathway C5 convertases. Taking a hybrid biophysical approach, we present C5-knob domain co-crystal structures and, by solution methods, observed allosteric effects propagating >50 Å from the binding sites. This study expands the therapeutic scope of C5, presents new inhibitors and introduces knob domains as new, low molecular weight antibody fragments, with therapeutic potential.

Transcranial direct current stimulation (tDCS) has been shown to modulate neuroplasticity. Beneficial effects are observed in patients with psychiatric disorders and enhancement of brain performance in healthy individuals has been observed following tDCS. However, few studies have attempted to elucidate the underlying molecular mechanisms of tDCS in the brain. This study was conducted to assess the impact of tDCS on gene expression within the rat cerebral cortex. Anodal tDCS was applied at 3 different intensities followed by RNA-sequencing and analysis. In each current intensity, approximately 1,000 genes demonstrated statistically significant differences compared to the sham group. A variety of functional pathways, biological processes, and molecular categories were found to be modified by tDCS. The impact of tDCS on gene expression was dependent on current intensity. Results show that inflammatory pathways, antidepressant-related pathways (GTP signaling, calcium ion binding, and transmembrane/signal peptide pathways), and receptor signaling pathways (serotonergic, adrenergic, GABAergic, dopaminergic, and glutamate) were most affected. Of the gene expression profiles induced by tDCS, some changes were observed across multiple current intensities while other changes were unique to a single stimulation intensity. This study demonstrates that tDCS can modify the expression profile of various genes in the cerebral cortex and that these tDCS-induced alterations are dependent on the current intensity applied.