The investigational metabolic modulator AXA1125 was associated with significantly less physical and cognitive fatigue compared with a placebo in long-COVID patients, according to a small randomized, controlled phase 2 pilot study trial led by researchers from the University of Oxford and AXA1125 maker Axcella Therapeutics, which also funded the study.

The double-blind, single-center study, published late last week in eClinicalMedicine, included 41 adults with fatigue-dominant long COVID who were randomly assigned in a 1:1 ratio to receive 33.9 grams of either AXA1125 or placebo orally in a liquid suspension twice daily for 4 weeks from December 15, 2021, to May 23, 2022. The follow-up period was 2 weeks.

Drug may boost energy production

Magnetic resonance spectroscopy of the patients' calf muscles didn't show significant differences between the 21 AXA1125 recipients versus the 20 placebo recipients, but AXA1125 was tied to a significant reduction in 28-day Chalder Fatigue Questionnaire score relative to placebo (least squares mean difference, -4.30).

Participants who reported less fatigue also showed better mitochondrial health and walked farther in the 6-minute walk test. Mitochondria are organelles that produce energy.

A total of 52.4% of AXA1125 recipients and 20.0% in the placebo group reported adverse events, but none were serious or led to treatment stoppage.

The authors noted that AXA1125 is composed of five amino acids and N-acetylcysteine, which may boost energy production and reduce inflammation. "These findings suggest that AXA1125 might offer therapeutic benefits in patients with Long COVID," the study authors wrote.

There is still some way to go in treating all patients with long COVID.

The researchers said they are planning a larger phase 3 multicenter clinical trial. "There is still some way to go in treating all patients with long COVID—our results focus specifically on fatigue, rather than the breathlessness and cardiovascular issues that other long COVID patients have reported," principal investigator Betty Raman, MBBS, DPhil, said in an Oxford news release. "We also selected patients who had clear signs of mitochondrial function being disturbed—effects of the medication on other symptoms remains to be evaluated in future studies."

In a new update on Equatorial Guinea's Marburg virus outbreak, the World Health Organization (WHO) said the outbreak has expanded to a fourth province and noted that epidemiologic links aren't clear for patients in multiple areas, which could be fueling undetected transmission chains.

The country's health ministry has picked up the pace with posting outbreak updates, and last week it put the number of confirmed cases at 15, of which 11 were fatal. Earlier in the outbreak, 20 probable cases were reported, all fatal. The WHO's new update said 3 more probable cases have been reported, all fatal. The case-fatality rate among the confirmed cases is 78.6%, though the WHO said the outcome for one isn't known.

Four of the lab-confirmed cases involve healthcare workers, two of whom died from their infections.

Of the 15 confirmed cases, 9—including the most recent case—are from Bata, Equatorial Guinea's most populated city and home to a port and international airport. In the most recent case from Bata, reported on Apr 7, an investigation is under way to determine transmission links and identify contacts.

The newly affected province is Wele-Nzas in the southeast corner of the country on the border with Gabon.

Several outbreak challenges

Equatorial Guinea is facing several challenges with the outbreak, its first involving Marburg virus. Cases in Bata raise the risk of further spread, infection prevention and control measures are insufficient, and diagnostic capacity to test samples is limited. The WHO also noted that the public's risk perception regarding the virus is low and that frequent population movements are common, with porous land borders with Cameroon and Gabon.

Marburg virus is similar to Ebola virus and spreads similarly, through contact with an infected patient's body fluids. There are no approved treatments or vaccines. The WHO said remdesivir is being used on a compassionate basis and other treatments are under evaluation.

A study of small veterinary practices in Portugal found multidrug-resistant (MDR) bacteria in nearly 20% of environmental samples, researchers reported at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

For the study, University of Lisbon researchers collected 182 samples from critical surfaces—such as surgical tables, examination tables, and weighing scales—at eight small veterinary practices in and around Lisbon. The researchers were specifically looking for the presence of methicillin-resistant Staphylococcus aureus (MRSA), MDR Acinetobacter, and extended-spectrum beta-lactamase and carbapenemase-producing Enterobacterales.

At least one resistant isolate was found in 34 (18.9%) of 182 samples; 41.2% of the resistant isolates were positive for MDR Acinetobacter, 38% for methicillin-resistant coagulase-negative Staphylococci, and 11.8% for methicillin-resistant Staphylococcus pseudointermedius. At one of the practices, 18.2% of samples were positive for OXA-23–producing Acinetobacter, which is resistant to carbapenems—a class of antibiotics not permitted for use in veterinary medicine by the European Medicines Agency.

The findings should not dissuade people from taking their pets to the veterinarian's office.

While none of the surfaces were positive for MRSA, 23% of veterinarians and staff at the practices who provided samples were found to carry MRSA.

"Our findings highlight the need to implement and monitor infection, prevention and control (IPC) guidelines in small animal veterinary practices," lead study author Joana Moreira da Silva, PhD, said in an ECCMID press release. She added, however, that the findings should not dissuade people from taking their pets to the veterinarian's office.

An analysis of meat sold at supermarkets in Spain found multidrug-resistant (MDR) Escherichia coli and Klebsiella pneumoniae in 40% of samples, Spanish researchers reported at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

Out of 100 randomly sampled retail meat products (25 each of turkey, chicken, beef, and pork) sold at supermarkets in Ovieda, a team led by researchers from the University of Santiago de Compostela-Lugo conducted molecular analysis of 82 E coli from 40 meat samples and 12 K pneumoniae isolates from 10 meat samples. Among the E coli isolates, 46 (56%) were extended-spectrum beta-lactamase (ESBL) producers, while 10 of the 12 K pneumoniae samples were ESBL producers. The recovery of ESBL-producing E coli was higher in turkey (68%) and chicken (56%) than in beef (16%) and pork (12%) products.

Fifty-six (68.3%) E coli isolates were determined to be MDR by antibiotic susceptibility testing. The highest prevalence of resistance was against ampicillin, aztreonam, nalidixic acid, ceftazidime, and cefuroxime.

Advice to consumers includes not breaking the cold chain from the supermarket to home, cooking meat thoroughly, storing it properly in the refrigerator, and disinfecting.

The analysis also revealed that 27% of the meat products contained potentially pathogenic extraintestinal E coli (including strains that are responsible for human infections), 6% contained uropathogenic E coli, and 1% contained E coli harboring the MCR-1 gene, which confers resistance to the last-resort antibiotic colistin.

Need for 'farm to fork' protections

The study authors say the findings highlight the need for "farm-to-fork" interventions to protect consumers, including increased surveillance for high-risk bacteria in farm animals and meat and development of vaccines to reduce the presence of specific MDR pathogens in food-producing animals.

"Advice to consumers includes not breaking the cold chain from the supermarket to home, cooking meat thoroughly, storing it properly in the refrigerator, and disinfecting knives, chopping boards and other cooking utensils used to prepare raw meat appropriately to avoid cross-contamination," study co-author Azucena Mora Gutierrez, PhD, said in an ECCMID press release.