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Saturday, April 11, 2026

 

Improving vaccine design for Ebola, HIV and more



Scripps Research scientists and colleagues develop a nanodisc platform that offers a clearer view of how key viral proteins interact with antibodies.



Scripps Research Institute

Improving vaccine design for Ebola, HIV and more 

image: 

A viral surface protein (blue and orange) is shown bound to multiple antibodies (pink, green and gray/white), with a region near the membrane (red).

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Credit: Scripps Research





LA JOLLA, CA—Viruses are masters at invading our cells thanks to specialized proteins that coat their surfaces. When scientists design vaccines, they often create versions of these viral surface proteins to study how our immune systems might respond. But those lab-made proteins typically lack key parts that sit within the virus’ membrane, so they don’t always behave the way they would on a real virus. This has made it difficult to understand how antibodies actually identify and neutralize these viral targets.

Now, scientists at Scripps Research, in collaboration with IAVI and other institutes, have created a platform that allows viral surface proteins to be studied in a form that more closely resembles how they appear naturally. The new approach utilizes nanodisc technology where these proteins are embedded into particles made of lipid molecules, preserving them in a membrane-like structure. This could help guide vaccine research by better revealing how antibodies and viral proteins interact.

Outlined in Nature Communications on February 10, 2026, the platform was tested using proteins from HIV and Ebola: two viruses that have long challenged vaccine developers because their surface proteins are difficult for the immune system to target effectively. However, the approach could be applied broadly to other viruses with similar membrane-embedded proteins, such as influenza and SARS-CoV-2.

“For many years, we’ve had to rely on versions of viral proteins that are missing important pieces,” says co-senior author William Schief, a professor at Scripps Research and executive director of vaccine design at IAVI’s Neutralizing Antibody Center. “Our platform lets us study these proteins in a setting that better reflects their natural environment, which is critical if we want to understand how protective antibodies recognize a virus.”

In real viruses, surface proteins aren’t free-floating, but rather embedded in a lipid membrane and arranged in specific shapes. Yet most lab studies remove the membrane-anchoring region to make the proteins easier to produce and analyze. While useful, those shortcuts can obscure important features, particularly for antibodies that target regions near the base of the protein, close to the viral membrane.

To address this, the research team assembled vaccine candidate viral proteins into nanodiscs, which are small and stable patches of membrane that hold the proteins in place. These lipid discs mimic the virus’ outer layer, helping preserve how antibodies would identify proteins in an actual virus. Their novel platform allowed the researchers to use a range of standard vaccine-development tools, including tests of antibody binding, sorting of immune cells and high-resolution imaging.

“Putting all of these components together into a single, reliable system was the key,” says first author Kimmo Rantalainen, a senior scientist in Schief’s lab. “The individual pieces already existed, but making them work together in a way that’s reproducible and scalable opens up new possibilities for how vaccines are analyzed and designed.”

Using HIV as a test case, the team focused on a conserved region of the virus’ surface protein that sits near the membrane. This region is targeted by a class of antibodies capable of blocking nearly all HIV variants. Such antibodies recognize viral parts that remain similar even as they mutate—an immune response scientists hope vaccines could eventually trigger.

With their nanodisc platform, the researchers were able to capture detailed structural snapshots of how these antibodies interact with the viral protein in its membrane context, revealing features that aren’t visible when the protein is studied on its own. Those insights also help explain how certain antibodies may neutralize a virus by destabilizing the protein structures it uses to infect cells, offering clues for how future vaccines might better engage similar immune responses.

“The structure gave us a level of detail we simply couldn’t access before,” notes Rantalainen. “It showed us new interactions at the membrane interface and suggested why those matter for antibody function.”

To demonstrate that the approach isn’t limited to HIV, the team also applied their nanodisc platform to Ebola proteins, confirming that antibodies could identify and bind to these proteins in the same membrane-like environment.

Beyond structural studies, this platform can be used to analyze immune responses to vaccine candidates. By using the nanodiscs as molecular “bait,” researchers can isolate and study cells that recognize viral proteins, providing a clearer picture of how the body responds to a given vaccine candidate. And because the system is scalable, what once took a month or longer to prepare can now be done in about a week, making it practical for comparing multiple candidate designs side by side.

Although the platform isn’t a vaccine itself, scientists can use it as a tool to inform and accelerate vaccine research, particularly for viruses where traditional approaches have fallen short.

“This gives the field a more realistic, accurate way to test ideas early on,” emphasizes Schief. “By improving how we study viral proteins and antibody responses, we hope this platform will help advance next-generation vaccines against some of the world’s most challenging viruses.”

In addition to Schief and Rantalainen, authors of the study “Virus glycoprotein nanodisc platform for vaccine analytics,” include Alessia Liguori, Gabriel Ozorowski, Claudia Flynn, Jon M. Steichen, Olivia M. Swanson, Patrick J. Madden, Sabyasachi Baboo, Swastik Phulera, Anant Gharpure, Danny Lu, Oleksandr Kalyuzhniy, Patrick Skog, Sierra Terada, Monolina Shil, Jolene K. Diedrich, Erik Georgeson, Ryan Tingle, Saman Eskandarzadeh, Wen-Hsin Lee, Nushin Alavi, Diana Goodwin, Michael Kubitz, Sonya Amirzehni, Devin Sok, Jeong Hyun Lee, John R. Yates III, James C. Paulson, Shane Crotty, Torben Schiffner and Andrew B. Ward of Scripps Research; and Sunny Himansu of Moderna Inc.

This work was supported by funding from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (grants UM1 AI144462, R01 AI147826, R56 AI192143 and 5F31AI179426-02); the Bill and Melinda Gates Foundation Collaboration for AIDS Vaccine Discovery (grants INV-007522, INV-008813 and INV-002916); the IAVI Neutralizing Antibody Center (INV-034657 and INV-064772); and the Alexander von Humboldt Foundation.

About Scripps Research

Scripps Research is an independent, nonprofit biomedical research institute ranked one of the most influential in the world for its impact on innovation by Nature Index. We are advancing human health through profound discoveries that address pressing medical concerns around the globe. Our drug discovery and development division, Calibr-Skaggs, works hand-in-hand with scientists across disciplines to bring new medicines to patients as quickly and efficiently as possible, while teams at Scripps Research Translational Institute harness genomics, digital medicine and cutting-edge informatics to understand individual health and render more effective healthcare. Scripps Research also trains the next generation of leading scientists at our Skaggs Graduate School, consistently named among the top 10 US programs for chemistry and biological sciences. Learn more at www.scripps.edu.

Friday, April 03, 2026

 

Global Virus Network meeting advances a science-driven agenda for pandemic preparedness



World-leading virologists highlight advances in antiviral therapeutics, artificial intelligence, immunology, and global surveillance shaping how future pandemics may be detected and controlled.




Global Virus Network





Global Virus Network Meeting Advances a Science-Driven Agenda for Pandemic Preparedness

World-leading virologists highlight advances in antiviral therapeutics, artificial intelligence, immunology, and global surveillance shaping how future pandemics may be detected and controlled.

TAMPA, FL (April 2, 2026): Artificial intelligence capable of predicting viral evolution months before dangerous variants emerge, next-generation antivirals designed to overcome limitations of current COVID-19 therapies, and advances in vaccine design and viral pathogenesis that could reshape how infectious and chronic viral diseases are understood and treated reflect the direction of current research emerging from the 2026 Global Virus Network (GVN) Annual International Scientific Meeting held March 4-6 at the University of South Florida (USF) in Tampa, Florida.

The meeting, in partnership with USF Health and Tampa General Hospital Cancer Institute, brought together leading virologists, clinicians, epidemiologists, and public health experts from around the world to examine lessons from COVID-19 and share cutting-edge research shaping the future of pandemic preparedness. Nearly 150 participants attended in person, with an additional 88 joining remotely, reflecting the GVN's global reach and scope.

Across discussions, a consistent theme emerged: the scientific tools needed to confront future pandemics, including genomic and wastewater surveillance, artificial intelligence, antiviral drugs, and immunological strategies, are advancing rapidly. The central challenge, aside from funding, is ensuring these advances translate into real-world preparedness, including surveillance systems, healthcare infrastructure, and public trust.

“The most important advances in pandemic preparedness come from basic science,” said Robert C. Gallo, MD, co-founder and chair of the scientific leadership committee of the GVN and director of the USF Institute for Translational Virology & Innovation. “The vaccines, antivirals, and genomic technologies we rely on today exist because of decades of basic scientific discovery. Sustaining that scientific foundation is essential to confront future pandemics.” Dr. Gallo is renowned for pioneering human retrovirology, including his discovery of Human T-cell Leukemia Virus Type 1 (HTLV-1), co-discovery of HIV as the cause of AIDS, development of the HIV blood test, and foundational work on interleukin-2 (IL-2), which enabled T-cell growth in culture, made the discovery of human retroviruses possible, and helped lay the foundation for modern immunotherapy.

Gallo also emphasized the broader role of science in guiding public understanding. “A scientist is ultimately a catalyst for truth. The scientific method remains our most powerful tool for understanding emerging diseases and developing the solutions needed to confront them. But there is also a great need for much stronger public education in science and for consistent engagement from the media, not only during active pandemics, to help counter false information and misleading theories that can spread rapidly through social media.”

Scientific Advances Shaping Pandemic Preparedness

Among the scientific highlights was breakthrough research on next-generation inhibitors targeting the SARS-CoV-2 main protease (Mpro) presented by Wuyuan Lu, PhD, a GVN Center of Excellence director at Fudan University in Shanghai, which could overcome limitations of existing COVID-19 therapies such as Paxlovid and represent a new generation of antiviral drugs against coronaviruses.

Researchers also showed how advances in artificial intelligence can predict viral evolution, using machine-learning models trained on large-scale genomic datasets to identify variants likely to emerge weeks or months before they become dominant.

“Artificial intelligence is giving us the ability to forecast viral evolution rather than simply react to it,” said Marco Salemi, PhD, a GVN Center of Excellence director at the Emerging Pathogens Institute at the University of Florida. “With the right genomic surveillance data, these tools could help identify variants of concern long before they become dominant in the population.”

Complementing these advances, leading coronavirus experts Robert Garry, PhD, a GVN Center of Excellence director at Tulane University with work in viral evolution and cross-species transmissionLinfa Wang, PhD, a GVN Center of Excellence director at Duke-NUS Singapore and internationally known as “Batman” for his renowned expertise on bat-borne viruses,  and Susan Weiss, PhD, a GVN Center of Excellence director at the University of Pennsylvania, a National Academy of Science member with expertise in coronavirus biology and pathogenesis, presented data-driven insights into how coronaviruses evolve, recombine, and adapt across species. These findings reinforce that viral diversity in animal reservoirs and ongoing genetic change remain central challenges for predicting and preventing future spillover events.

Together, these advances signal a shift toward earlier anticipation of viral threats, with immunological strategies aimed at slowing infection and next-generation vaccines designed to overcome the limitations of strain-specific approaches.

“A major goal in influenza research is the development of a universal vaccine that can provide broad, durable protection across multiple strains,” said renowned influenza virologist Peter Palese, PhD, a GVN Center of Excellence director at the Icahn School of Medicine at Mount Sinai and member of the National Academy of Sciences. “By targeting conserved regions of the virus that are far less prone to mutation, we can move beyond the need to update vaccines year to year and significantly improve our ability to control influenza.”

Antiviral strategies designed to provide longer-lasting protection were also discussed as an additional layer of defense against respiratory viruses.

Beyond acute infection, researchers presented emerging evidence that viral infections may contribute to chronic and neurodegenerative diseases.

Igor Koralnik, MD, chief of the division of neuroinfectious diseases and global neurology at Northwestern University, presented new data suggesting that certain viral infections may contribute to the development of neurodegenerative diseases, including Parkinson’s disease. His findings, based on analyses of patient samples and associated immune responses, point to a potential role for the human pegivirus in disease onset and progression, highlighting a new direction in understanding the long-term neurological impact of viral infections.

Brett Giroir, MD, CEO of Altesa BioSciences and the former U.S. Assistant Secretary for Health who helped lead the federal COVID-19 testing response, presented novel research on antiviral approaches for chronic obstructive pulmonary disease (COPD), showing how persistent viral activity may contribute to disease progression. The findings point to a growing recognition that viral infections can shape long-term chronic disease, opening new avenues for treatment.

Additional discussions underscored advances in the understanding of HTLV-1, a globally endemic virus associated with leukemia, neurological disease, and inflammatory disorders. Eduardo Gotuzzo, MD, a GVN Center of Excellence director at Universidad Peruana Cayetano Heredia in Peru, emphasized that HTLV-1 challenges conventional virology models, as a single virus can cause multiple distinct diseases, while most infected individuals remain asymptomatic. Why this occurs remains a central question in the field, with current research focusing on how subtle viral and host factors drive divergent outcomes.

Detecting Emerging Threats and Strengthening Preparedness

Experts emphasized strengthening early detection systems for emerging pathogens, including integrating genomic sequencing, wastewater monitoring, environmental surveillance, and advanced analytics to identify outbreaks earlier and respond more rapidly.

Participants also stressed that scientific advances must translate into operational readiness within healthcare systems. In collaboration with Tampa General Hospital, GVN is advancing a Hospital Pandemic Playbook designed to help hospitals rapidly mobilize diagnostics, clinical protocols, and surge capacity during future outbreaks.

The Playbook integrates lessons from COVID-19 with emerging scientific tools, including rapid diagnostics, genomic surveillance, and antiviral therapies, to help healthcare systems respond more effectively to new viral threats. 

“Preparedness in a hospital setting ultimately comes down to execution,” said Asa Oxner, MD, vice president and associate chief medical officer for Ambulatory Services, Tampa General Hospital, and associate professor of internal medicine at the USF Morsani College of Medicine. “Through our work with GVN on the Hospital Pandemic Playbook, we are building practical frameworks that enable hospitals to translate evolving science into coordinated clinical action during a crisis.”

GVN also announced Tampa General Hospital as the inaugural Hospital Virology Center of Excellence, recognizing the institution’s leadership in integrating clinical care, research, and preparedness for emerging viral threats.

The designation was established by the GVN to set a standard for hospitals that demonstrate excellence in translating virological science into clinical practice, integrating research, diagnostics, and patient care to strengthen preparedness and response to emerging viral threats.

Charles J. Lockwood, MD, MHCM, executive vice president of USF Health and dean of the Morsani College of Medicine, noted that partnerships between academic medicine, global research networks, and health systems are essential to strengthening pandemic preparedness. “Scientific discovery must move seamlessly from the laboratory to the bedside,” Lockwood said. “Collaborations like those between USF Health, Tampa General Hospital, and the Global Virus Network are critical to ensuring that breakthroughs in virology translate into real-world impact.”

Lessons from COVID-19: Bridging Science, Policy, and Public Trust

Discussions titled “Pandemics: Lessons Still Not Learned,” moderated by Andrew Jack of the Financial Times, who also serves as a member of the GVN board of directors, focused on how scientific knowledge can be better translated into policy and preparedness before the next global health crisis.

Speakers reflected on the scientific, political, and societal challenges exposed during the COVID-19 pandemic.

Brett Giroir, MD emphasized that the rapid development of COVID-19 vaccines was made possible by decades of prior investment in basic scientific research.  Giroir, who previously served as executive chairman of the GVN board of directors, highlighted the importance of strengthening connections between scientific expertise and policy leadership.

During my time in the White House, it became clear how critical it is to have direct, real-time access to leading virologists around the world,” Giroir said. “The Global Virus Network provides a unique platform to connect that expertise across borders and ensure policymakers are guided by the best available science when decisions must be made quickly. We know what works in pandemic response, but the challenge is ensuring those lessons are implemented before the next crisis forces us to relearn them.”

Sharon Lewin, MD, a member of the GVN board of directors and director of the Doherty Institute in Australia, stressed that pandemic preparedness must be built during the inter-pandemic period, when countries can strengthen surveillance systems, data sharing, and scientific capacity.

“The work of preparedness must happen between pandemics,” Lewin said. “That is when we have the opportunity to build the systems and partnerships needed to respond effectively when the next threat emerges.”

Speakers also addressed a growing challenge: declining public trust in health institutions.

Heidi Larson, PhD, one of the world’s leading experts on vaccine confidence and public trust and a member of the GVN board of directors, is the founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. She presented findings from one of the largest global studies of its kind, involving more than 72,000 participants across 70 countries examining public attitudes toward pandemic response and vaccination.

The research found that public trust in government pandemic response often did not correlate with epidemiological outcomes, indicating that perceptions of fairness, transparency, and inclusion in decision-making may shape trust more strongly than case numbers or mortality rates alone.

“Pandemic preparedness is not only about science and technology,” Larson said. “It is also about trust. Without public confidence in institutions and the information they provide, even the best scientific tools cannot achieve their full impact.”

Lessons from Emerging Outbreaks

Recent outbreaks, including the Mpox public health emergency in Africa, further illustrate how expanded laboratory capacity and community health worker networks helped strengthen surveillance and response.

“Emerging viruses do not remain confined to one region,” said Quarraisha Abdool Karim, PhD, associate scientific director of the Centre for the AIDS Programme of Research in South Africa and a member of the GVN board of directors. “Events like the Mpox epidemic remind us that outbreaks anywhere can quickly become global threats. Strengthening surveillance and scientific collaboration across regions is essential.”

Speakers also pointed to the resurgence of measles in several regions as a warning that even well-known viruses can re-emerge when vaccination coverage declines.

“Measles is biologically one of the simplest infectious diseases to prevent because we have a safe and highly effective vaccine,” said William Moss, MD, professor at Johns Hopkins Bloomberg School of Public Health and a leader at the GVN Center of Excellence. “But because the virus is so extraordinarily contagious, even small gaps in vaccination coverage can quickly lead to outbreaks.”

Looking Ahead

“The stakes for global virology communication and collaboration have never been higher,” said Mathew Evins, chief executive officer of the GVN. “By connecting leading virologists and research centers worldwide, GVN ensures that scientific knowledge moves faster than viruses and that expertise can be mobilized quickly when new outbreaks emerge.”

Speakers emphasized that while the world now has powerful tools, from genomic surveillance and artificial intelligence to next-generation antivirals and immunological strategies, sustained investment, global coordination, and workforce development will determine whether that progress translates into meaningful preparedness.

“Pandemic preparedness ultimately depends on people,” said Sten Vermund, MD, PhD, chief medical officer of the GVN and dean of the USF College of Public Health. “Strengthening the global virology workforce and supporting the next generation of scientists will be just as important as the scientific tools we develop.”

“We should not think of the period between pandemics as a time of rest,” said Christian Bréchot, MD, PhD, vice chair of the GVN board of directors and director of the USF Microbiomes Institute. “We are in a permanent training period, and the scientific work done today will determine how prepared the world is for the next pandemic.”

The next Global Virus Network Annual International Scientific Meeting will be held in Singapore, April 14-16, 2027.

The full agenda for the GVN 2026 Annual International Scientific Meeting is available here, and select presentations from the meeting are available here.

###


 

About the Global Virus Network

The Global Virus Network (GVN) is a worldwide coalition comprising 90+ Virology Centers of Excellence and Affiliates across 40+ countries, whose mission is to facilitate pandemic preparedness against viral pathogens and diseases that threaten public health globally. GVN advances knowledge of viruses through (i) data-driven research and solutions, (ii) fostering the next generation of virology leaders, and (iii) enhancing global resources for readiness and response to emerging viral threats. GVN provides the essential expertise required to discover and diagnose viruses that threaten public health, understand how such viruses spread illnesses, and facilitate the development of diagnostics, therapies, and treatments to combat them. GVN coordinates and collaborates with local, national, and international scientific institutions and government agencies to provide real-time virus informatics, surveillance, and response resources and strategies. GVN's pandemic preparedness mission is achieved by focusing on Education & Training, Qualitative & Quantitative Research, and Global Health Strategies & Solutions. The GVN is a non-profit 501(c)(3) organization. For more information, please visit www.gvn.org.

Wednesday, April 01, 2026

 

New vaccine strategy could help extend immunity against evolving viruses



UW–Madison research identifies a way to program longer-lasting T cells, a potential step toward broader, more durable protection against infections like the flu and COVID-19.



University of Wisconsin-Madison





Researchers at the University of Wisconsin School of Veterinary Medicine have identified a possible way to make longer lasting vaccines for respiratory viruses like influenza and the coronavirus that causes COVID-19.

The work, published March 25 in in the journal Cell Reports, focuses on T cells, a type of immune cell that helps control infections by killing virus-infected cells. Unlike antibodies — the basis of most current vaccines, which can lose effectiveness as viruses mutate — T cells recognize more stable parts of viruses, offering a path to broader protection.

A problem with designing vaccines around T cells, though, is their relatively short lifespan. The new research sheds light on a surprising potential workaround.

“We have discovered essentially a mechanism which we can target — a new clue to generating long-lived T cells,” says M. Suresh, a professor in the Department of Pathobiological Sciences who led the study. 

Rethinking how vaccines trigger immunity

Most vaccines are designed to stimulate antibodies that block infection. That approach works well for many infectious diseases, but it can fall short against viruses that evolve quickly.

“So, what do we do? We need a plan B,” says Suresh. 

For viruses like SARS-CoV-2 and seasonal influenza, that plan B has meant regularly updating vaccines to target newer virus variants and encouraging the public to get the latest flu and COVID shots each year. But that strategy has its pitfalls. 

“With the pandemic we went through, people are just tired of getting vaccinated,” Suresh says. Indeed, vaccination rates have been declining in the United States for years. 

The ability to harness T cells could offer a potentially more effective plan B. Rather than preventing infection outright, T cells help limit disease severity and promote early recovery by identifying and destroying infected cells.

“They go and hunt one infected cell at a time and eliminate them,” Suresh says.

Because T cells recognize internal viral proteins that don’t change much over time, they can remain effective even as viruses mutate. 

A key challenge, however, is the durability of protection offered by T cells, especially in the lungs, where respiratory infections take hold.

Suresh’s lab studies a specialized group of immune cells known as tissue-resident memory T cells, which remain in the lungs and airways as a first line of defense. These cells can respond quickly to infection.

“But the problem is they don’t stay very long,” Suresh says. “They die off, and we still don’t know why.”

A different early signal, a different immune outcome

In the new study, which was funded by the National Institutes of Health, Suresh and his colleagues looked at what happens in the first hours after vaccination, when the body’s innate immune system is activated.

Different types of pathogens trigger different early inflammatory signals that “program” memory T cells to recognize and go after infected cells. Suresh’s team asked whether changing those signals could reshape how T cells develop.

Using an experimental vaccine approach in mice, the researchers compared two types of early immune signals: one that mimics a viral infection and another that resembles a bacterial response. The difference was striking.

“When we had a virus-like inflammation, the memory T cells dropped off and we quickly lost protection,” Suresh says. “But when we created a bacterial-like inflammation, the mice developed a different kind of memory T cell which actually persisted longer and protected longer.”

Stem-like cells that adapt when needed

The longer-lasting cells had characteristics similar to stem cells, Suresh says, including the ability to persist and regenerate. 

Even more surprising, those cells were able to adapt when confronted with a virus. When the researchers exposed vaccinated mice to infection, the T cells shifted into a more typical virus-fighting mode.

“They just flipped,” Suresh says. 

That flexibility suggests the T cells could combine durability with the ability to effectively combat a viral infection.

Toward longer-lasting, broader vaccines

The findings offer a potential path toward vaccines that require fewer boosters and provide broader protection across variants.

“The duration of immunity is really, really important,” Suresh says. “Can we vaccinate fewer times, and can shots protect against new strains?”

The research also highlights the importance of delivering immunity where infections occur. For respiratory diseases, that may mean developing vaccines that work in the nose and lungs rather than through injection.

“The best way to immunize against all our respiratory infections is to give through the normal route of infection,” Suresh says.

What comes next

The current study was conducted in mice. The team plans to test the approach in nonhuman primates and in models that better reflect the diversity of human immune systems.

Future work will also explore ways to guide immune cells to the lungs after traditional vaccination — a strategy that could improve protection without requiring new delivery methods.

This research received funding from the National Institutes of Health (U01 AI124299 and R21 AI149793). 

Monday, March 30, 2026

 

Common antidepressant eases fatigue associated with long COVID, study finds





McMaster University





A global research team co‑led by McMaster University has identified one of the first medications shown to meaningfully reduce fatigue in people living with long COVID – a breakthrough for millions still struggling with persistent symptoms years after the pandemic began. 

The randomized, placebo‑controlled clinical trial found that fluvoxamine, a low‑cost and widely available antidepressant, significantly improved fatigue and quality of life among adults with long COVID. The findings were published March 31, 2026 in the Annals of Internal Medicine. 

Fatigue is the most common and debilitating symptom of long COVID, leaving many people unable to work, care for their families, or resume their normal lives. Despite its global impact, few proven treatments exist. 

“This is an important step forward for patients who have been desperate for evidence‑based options,” says Edward Mills, senior author, professor in McMaster’s Department of Health Research Methods, Evidence, and Impact, and co‑principal investigator of the trial. “Fluvoxamine showed consistent and meaningful benefits, and because it's already widely used and well understood, it has clear potential for clinical use.” 

The study was co‑led by researchers in Canada, Brazil, and the United States, with clinical sites in the city of Belo Horizonte and across Minas Gerais, Brazil. The REVIVE-TOGETHER trial team included partners from McMaster University, the University of British Columbia, Stanford University, the University of Pittsburgh, Duke University, Georgetown University, and multiple Brazilian institutions. 

The trial enrolled 399 adults in Brazil who continued to experience fatigue for at least 90 days after a confirmed SARS‑CoV‑2 infection. Participants were randomly assigned to receive fluvoxamine (sold under the brand name Luvox), metformin (a common diabetes medication), or placebo for 60 days. 

“We wanted to test whether two existing, widely available, and affordable medications could help. Both had biological reasons to think they might work against long COVID fatigue, but neither had been rigorously tested for this purpose in a proper clinical trial,” says Mills. 

The researchers found fluvoxamine reduced fatigue more than placebo, with evidence showing a 99 per cent probability the drug outperformed the placebo. The medication also produced improvements in overall quality of life across multiple measures. 

Previous research has showed metformin reduces the risk of developing long COVID when taken during the acute phase of infection, and this research showed it offers no meaningful benefit in helping people with fatigue symptoms of established long COVID. 

The study used a sophisticated Bayesian adaptive design, allowing researchers to stop treatment arms early when results became clear – a method that accelerates evidence generation while maintaining scientific rigour. 

“The trial used a sophisticated adaptive design that allowed it to reach conclusions more efficiently than traditional trials, stopping early when the evidence was clear enough – a design innovation as important as the findings themselves,” says Gilmar Reis, lead author, researcher with Cardresearch, a Brazilian clinical research center based in Belo Horizonte. Reis is also a part-time associate professor at McMaster. 

Long COVID remains a major public health challenge, affecting an estimated 65 million people worldwide. Yet most medical guidelines still offer only supportive care, such as pacing and symptom management, due to the lack of proven treatments. The researchers emphasize that while fluvoxamine offers a promising option for managing fatigue, long COVID is a complex condition with multiple symptoms and biological pathways. Further studies are needed to understand who benefits most, how the medication works, and how it might be combined with other emerging treatments. 

“This trial gives clinicians their first strong evidence for a medication that helps reduce long COVID fatigue. Patients want something they can try today – and this finding brings us closer to that reality,” says Jamie Forrest, corresponding author and postdoctoral research fellow at the University of British Columbia. 

The research was funded by The Latona Foundation. 

Available for interview: 

Edward Mills: millsej@mcmaster.ca  

  • Senior author of the study and co‑principal investigator of the trial 

  • Professor in McMaster’s Department of Health Research Methods, Evidence, and Impact 

 

Gilmar Reis: reisg1@mcmaster.ca    

  • Lead author of the study and co‑principal investigator of the trial 

  • Associate professor in McMaster’s Department of Health Research Methods, Evidence, and Impact 

Media contact: stranj4@mcmaster.ca  

Wednesday, March 25, 2026

 

Genetic breakthrough uncovers evolutionary limits of the COVID-19 virus




Oxford University Press USA




A new paper in Genome Biology and Evolution, published by Oxford University Press, indicates that while the COVID-19 virus has developed rapidly since 2019, it has done so within limited genetic channels. These genetic limits have remained unchanged. Despite scientists’ earlier fears about dramatic, rapid evolution of the COVID-19 virus, it appears recent changes in the virus were relatively constrained; the virus altered by combining pre-existing mutations. The virus has not expanded the number of genetic routes it can take to evolve.

SARS-CoV-2 underwent rapid evolution after first infecting humans in late 2019, resulting in new viral variants with properties that made them successful in human hosts. Previous work has shown how these variants were not closely related to the major circulating variants that preceded them, which led many scientists to believe that changes to the spike protein structure (the spikes or “crown” portion of the familiar COVID-19 microscopic image) drove SARS-CoV-2 variant evolution, enabling new mutations which had previously been impossible for the virus.

The SARS-CoV-2 pandemic was the worst pandemic of an infectious disease in recent decades, causing global mortality, economic damage, and social disruption. However, the response to the pandemic using contemporary technologies like affordable mass sequencing has resulted in a unique and significant scientific dataset.

Researchers here took advantage of the scale of global genome sequencing, protein structural determination, and targeted studies related to the virus. They used rich SARS-CoV-2 datasets to investigate the role of protein structural constraint in SARS-CoV-2 evolution and whether changes to spike protein structure made the virus stronger. They applied multiple computational predictors of structural constraint across different structural backgrounds and assessed how constraint has changed during SARS-CoV-2 variant evolution.

The investigation found that SARS-CoV-2 has undergone several distinct phases of evolution. An initial period of neutral diversification ended in late 2020 when multi-mutant variants began to arise. The World Health Organization classified variants with suspected phenotypic characteristics, such as increased transmissibility or immune escape properties, as variants of concern. But despite the unprecedentedly rich and granular dataset, the investigators find no evidence that structural constraints have changed substantially or played a role in SARS-CoV-2 S protein variant evolution. Despite high mutation rates and strong selective pressure, the SARS-CoV-2 S protein was under strong structural constraints after moving to human hosts.

It appears that while SARS-CoV-2 evolved rapidly during the pandemic, there were no substantial changes in the set of structurally viable mutations. The findings suggest that variant emergence came not from relaxation of structural constraints but by novel combinations of mutations with functional genetic interactions. But overall evolution remained tightly constrained by spike protein stability.

“Our research explores the dynamics of evolutionary change in SARS-CoV-2 in the period following its spillover into the human population. We found that strong constraints acting on the virus' spike protein limited what mutations could occur,” said the paper’s lead author, James Herzig. “This helps us understand how other coronaviruses might behave when they jump between species and could have important implications for the design of future vaccines and antiviral drugs.”

The paper, “Structural constraints acting on the SARS-CoV-2 spike protein reveal limited space for viral adaptation,” is available (at midnight on March 25 25th) at https://academic.oup.com/gbe/article-lookup/doi/10.1093/gbe/evag049.

Direct correspondence to: 
James C. Herzig
University of Glasgow Centre for Virus Research
464 Bearsden Rd
Glasgow G61 1QH, UNITED KINGDOM
james.c.herzig@glasgow.ac.uk

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com