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10% of Early COVID-19 Patients in Korea Were Asymptomatic

Korean COVID-19 Research Published in World's Leading Medical Journal

Only 40% Patients Had Fever

Some Patients Exhibited No Respiratory Symptom

Non-specific Symptoms Pose Challenge to Quarantine Efforts

A study team led by Joon-Young Song, Hee-Jin Cheong, and Woo-Joo Kim, professors of infection at Korea University Guro Hospital confirmed that 10% of Patients With Coronavirus disease 2019 (COVID-19) had no symptoms in the early days of the epidemic in South Korea.

On April 7, 2020, findings made by the study team were published in the New England Journal of Medicine (NEJM), which made it the first Korean COVID-19 study appeared in the world's leading medical journal.

Out of the first 28 cases of laboratory-confirmed COVID-19 in South Korea, three were asymptomatic. Those three had almost no symptoms that the patients did not recognize that they were infected. Assessment of those first 28 cases revealed diverse initial manifestations, which were different from general respiratory diseases. This made it difficult for clinicians to diagnose COVID-19.

Major symptoms of the COVID-19 presented in early days of the COVID-19 outbreak in South Korea were fever, cough and sore throat. However, only 20 out of 28 presented those symptoms. Among 20 patients who reported specified symptoms initially, only eight (40%) presented with fever, and showed diverse respiratory symptoms. Contrary to influenza infections which have a pronounced symptom onset, COVID-19 vary in their initial symptoms and some might have mild manifestations with insidious onset, leading to unexpected early transmission.

The first author of the paper, professor Joon-Young Song said, “This study is of great significance as it confirmed that making an accurate clinical diagnosis of COVID-19 is quite difficult as its symptoms are similar to those of other respiratory infections. On top of this, the timing of the onset of the symptom is difficult to pinpoint, which poses greater challenge for doctors to make early diagnosis.”

Professor Hee-Jin Cheong pointed out, “Asymptomatic transmission has been suggested, and SARS-CoV-2 might be transmitted by those asymptomatic patients who do not show any symptoms. Nonspecific initial clinical features make it more difficult to control the spread of virus.”

Professor Woo-Joo Kim stressed, “COVID-19 virus is a stealth virus as it can infect others even when the patient exhibits no or mild symptoms only. Additional research needs to be done in order to understand to what extent it can infect other people through asymptomatic carriage. Such a feature of the virus urges us to remain on alert even when the spread of the disease seems to be under control.”

Korea University College of Medicine Dedicated to Caring Community in Times of Crisis Its Philanthropic and Humanitarian Services Underpin Society

The Korean University College of Medicine takes the full responsibility and fulfills its duty as an organization committed to training health care professionals who serve the community.

Founded at the end of the old Korean Empire as Korea’s first women’s medical college, the Korean University College of Medicine has established hospitals in the regions where people don’t have easy access to medical care. And it has come up with solutions to difficult problems in times of big changes or crises. Recently when Korea faced public health crises from novel influenza, MERS, and the disaster of the capsized ferry carrying high-school students on a school trip, the Korean University College of Medicine and its hospitals did its utmost in order to help the community overcome such crises and fulfilled its duties as an educational organization dedicated to supporting the social values of Korea, which enabled it to earn strong support from the Korean people.

Since January 20, 2020 when Korea had its first confirmed case of COVID-19, it has provided advice to the national institutions so that they could efficiently fight against the infection, and tried to provide science-based information to the general public in order to minimize the chance that the public is misguided by wrong information. Korea University Medicine has sent their medical teams to the regions where they are needed most and established a smart patient monitoring system. Among others, medical staff were swiftly dispatched along with medical supplies including 3 ventilators to the Daegu Dongsan Hospital located in Daegu, South Korea’s epicenter of the COVID-19 pandemic, in an attempt to save the severely ill patients. Besides, various efforts have been made to support the facilities overwhelmed by COVID-19 patients such as the Gyeonggi International Care Center Number 2, which was open to treat those patients who came from abroad with mild symptoms.

Most of all, Korea University College of Medicine faculty, the ‘Avengers,’ stand out most. Avengers refer to the professors who work around the clock in order to save the country by guiding relevant institutions into the right direction. To name a few, Woo-Ju Kim, professor of infectious diseases, played a pivotal role by making an accurate forecast of the progress of COVID-19 from the beginning. As a cool-headed leading scientist of infection in Korea, he wisely guided the general public out of confusion by informing them of what they should know in order to properly cope with challenges in daily life. He previously served as a special aid to the prime minister and a task force team leader of the Ministry of Welfare during the MERS crisis in 2015. Professor Jang-Wook Sohn is another hero. Since March 3, he frequently went down to the Daegu Gyeongbuk region in order to help establish a solid system of epidemic prevention and efficient operation of the Daegu Gyeongbuk Care Center Number 2, as well as setting up diagnostic guidelines and processes for them. He also runs training programs for the government personnel on site. It was said that he delivered balanced feedback for an effective and convenient smart monitoring system, which was installed for those living in the care center. In an effort to deliver the right COVID-19-related information to the general public, professor Won-Seok Choi gave a generous consent to requests for interviews with the mass media despite his busy schedule. There are also a number of graduates of KUCM who render their portion of outstanding services for the sake of community.

Jae-Wook Choi, chairman of the Science Verification Committee of the Korean Medical Association and professor of preventive medicine; and Byung-Chul Chun, professor of preventive medicine who did an outstanding job of controlling MERS years ago have been on the forefront of educating the general public on how to prevent further spread of COVID-19. A research team led by Man-Seong Park and Jin-Won Kim, professors of microbiology succeeded in separating the COVID-19 virus from the patients infected with COVID-19. Taking advantage of the high-performance next-generation sequencing approach that they established on their own, they completed the assessment of the whole sequencing of the virus and registered the virus name on the public data base as BetaCoV/South Korea/KUMC01/2020, BetaCoV/South Korea/KUMC02/2020. Besides, led by Chae-Seung Lim professor of laboratory medicine, Biogenetech (a subsidiary of the Korea University Guro Hospital) successfully developed a new technology of ‘COVID-19 High-Speed Multiple Molecular Diagnostics’ which enables very economical and fast detection of virus as well as diagnosis of various infectious diseases.

HSP90A inhibition promotes anti-tumor immunity by reversing multi-modal resistance and stem-like property of immune-refractory tumors

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A research team led by Dr. Tae Woo Kim, a professor of Biochemistry and Molecular biology / Biomedical Science department, Korea University College of Medicine, presents a new target for overcoming resistance to immunotherapy, which may shed new light on potential causes of therapeutic resistance.

Harnessing the immune system to detect and eliminate tumor cells, cancer immunotherapy has emerged as a potentially powerful approach to cancer treatment. Particularly, T cell-based therapeutic methods such as adoptive T cell transfer (ACT) and immune checkpoint blockades (ICB) have achieved tremendous progress in the field of cancer immunotherapy. However, despite the developing field’s potential to revolutionize cancer treatment, the presence of immunotherapeutic resistance limits its clinical application. Therefore, it is essential to identify optimal targets for overcoming immunotherapeutic resistance along with their mechanism of actions.

Among the diverse causes of resistance to immunotherapy, the cancer immunoediting theory has attracted attention as it can explain the emergence of resistance to anti-tumor immunity. Indeed, there is increasing evidence that cancer immunoediting drives the adaptation of tumor cells to host immune surveillance, thereby contributing to a generation of cancer cells with better survival advantages. In this regard, they found that immune selection by immunotherapy drives the evolution of tumors toward multi-modal resistant and stem-like phenotypes via transcription induction of AKT co-activator TCL1A by NANOG, previously.

In this study, they reported a crucial role of HSP90A at the crossroads between NANOG-TCL1A axis and multi-aggressive properties of immune-edited tumor cells by identifying HSP90AA1 as a NANOG transcriptional target. Furthermore, HSP90A potentiates AKT activation through TCL1A-stabilization, thereby contributing to the multi-aggressive properties in NANOGhigh tumor cells. Importantly, HSP90 inhibition sensitized immune-refractory tumor to adoptive T cell transfer as well as PD-1 blockade, and re-invigorated the immune cycle of tumor-reactive T cells. These findings implicate that the HSP90A-TCL1A-AKT pathway ignited by NANOG is a central molecular axis and a potential target for immune-refractory tumor.

The research results were published in Journal of Nature Communications under the title, HSP90A inhibition promotes anti-tumor immunity by reversing multi-modal resistance and stem-like property of immune-refractory tumors.

Comprehensive pharmacogenomic characterization of gastric cancer

Gastric cancer is among the most lethal human malignancies. Previous studies have identified potential genetic alterations that can be used as therapeutic targets in gastric cancer treatment. However, several challenges prevent clinical success of current targeted therapy. Notably, gastric cancer has multiple genetic alterations, making it difficult to decide which target is the most ideal choice.

Therefore, According to the team’s study led by Professor Jason Kyungha Sa of Cancer genomics / Biomedical Science department, Korea University College of Medicine, we generated patient-derived tumor cell models that have been tested with 60 different anticancer drugs and performed genetic analysis to explore gene-drug associations. Interestingly, we identified tumor-type specific drug sensitivity based on histological, pathological, and genetic classifications. For example, diffuse-type gastric tumors were more sensitive to VEGFR pathway targeting drugs, while signet ring-type gastric tumors were more sensitive to EGFR pathway targeting drugs.

We also found that tumors with ALK mutation could potential be more sensitive to WNT pathway targeting drugs. We also discovered that tumors with PIK3CA mutation, specifically with E542K amino acid change, were significantly more sensitive to AK targeting drug, AZD5363. Lastly, we found that RNF11 gene was significantly associated with drug response to EGFR pathway targeting drug, gefitinib. Collectively, our results show possibility of precision medical treatment through combining high-throughput drug screening with genetic analysis.

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