Cynthia Tang

A Dual Focus: MU researcher earns $181,734 NIH grant and U.S. Public Health Service Award for COVID-19 research in the lab and on campus

June 20, 2022 By Penquite, Cara (MU-Student) in Research Tags: COVID-19, Excellence in Public Health Award, health disparities, infectious diseases, NIH

By Cara Penquite | Bond LSC

CynthiaProfile — Cynthia Tang is an M.D.-Ph.D. student in the Wan lab. Photo by Cara Penquite | Bond LSC

Cynthia Tang’s academic career is marked by her propensity to multitask. From earning a major and three minors during her undergrad to making a documentary while getting lab and clinical experience, she makes the most of her time.

Recently Tang received the Excellence in Public Health Award from the United States Public Health Service, and a $181.734 National Institutes of Health grant to be used over four years . . . all while getting an M.D. and Ph.D. simultaneously.

The funding from the grant goes towards Tang’s research on SARS-CoV-2, the virus responsible for the COVID-19 pandemic, and its effect in rural areas. By comparing DNA sequences of the virus from patients in rural and urban areas, Tang looks for differences in variants. Her goal is to understand how the virus has been evolving and why patients in rural areas experience more severe symptoms.

“I’ve always found infectious diseases really interesting,” Tang said. “This pandemic came up and it was exciting to be in the position to help contribute to the knowledge base of it.”

CynthiaCandid — Cynthia Tang creates protein structure models for the spike protein on the Sars-CoV-2 virus. Along with 3D models, Tang creates phylogenetic trees to compare the genetic makeup of variants of the virus. Photo by Cara Penquite | Bond LSC

In a family of immigrants, Tang saw the challenges in health literacy and cultural differences affecting patient care in the U.S first-hand, and she also caught a glimpse into a global view of healthcare.

“I had an opportunity to travel to Vietnam and actually see some of the health disparities of different health care structures in different countries,” Tang said. “We were visiting my grandfather who was in the hospital, and it was alarming to see the contrast between the quality of health care and availability of health care there compared to some of the hospitals that we have here.”

Tang recalls noticing lack of supplies, physicians and space for patients. She saw similar issues in the U.S., and shined light on public health disparities here by creating a documentary about the challenges immigrants face in the U.S. healthcare system. She also held competitions across Washington University’s campus to teach students more about public health issues while working as a clinical research coordinator.

“I wanted to help improve health equity,” Tang said.

A bachelor’s in chemistry and minors in philosophy, international development and pre-health professions at the College of Idaho may start to explain Tang’s public health focus and her path to bench and clinical research.

“My minor in international development was really useful for me because that gave me a lot more exposure to the different economies of different countries of the world, their health status and how politics, economics and health care all interrelate in different countries,” she said.

Her research at Washington University led Tang to an interest in its clinical applications.

“I really enjoyed the aspect of working with patients, actually getting to talk to patients and hearing their stories,” Tang said. “I felt like with clinical research, you can see … slightly quicker results from bench to bedside compared to bench research, and that was also when I decided I was interested in becoming a physician.”

Part of an eight-year joint M.D.-Ph.D. program at Mizzou, Tang started with two years of pre-clinical medical school before transitioning to Ph.D. research and then will return to finish the clinical years of medical training.

When she came to Mizzou, Tang continued fighting health disparities for immigrants.

“We organized a group of volunteers that were able to translate COVID-19 information to different non-English speaking communities in Boone County,” Tang said.

Always one to tackle several projects at once, Tang plans to pursue a career as a pediatric physician scientist interfacing with patients while continuing lab research.

“I like the idea of doing both. As a physician, you get that one-on-one contact and you get to make a very direct contribution to someone’s life,” Tang said. “And then with research, you don’t have as much contact with patients, but what you do can affect populations.”

Two SARS-CoV-2 strains cause independent infections only 19 days apart

August 5, 2021 By Suppes, Davis (MU-Student) in Research Tags: COVID-19, Mizzou Research

Increasing detection of reinfections and rediscovering brand new infections within days raises concerns for herd immunity and the durability of vaccine efficacy.

Cynthia Tang working to figure out how COVID-19 reinfections can bring us answers on how the virus is developing at Bond LSC. | photo by Davis Suppes, Bond LSC

By Davis Suppes | Bond LSC

Like many viruses, SARS-CoV-2 continues to develop and evolve with time. As the virus evolves it becomes more infectious and can produce worse symptoms and a higher fatality rate. While more people have been infected, we also learn more about it, including how different variants of the same virus can reinfect someone who already had SARS-CoV-2.

In a recent study led by Cynthia Tang, an MD-PhD student at the University of Missouri (MU) School of Medicine and Institute for Data Science and Informatics, her lab was able to identify a patient who got reinfected with a different strain of SARS-CoV-2 just 19 days after their initial infection. Her Systems Biology Laboratory is headed by Principal Investigator, Dr. Henry Wan, who directs the MU Center for Influenza and Emerging infectious Diseases.

“We found a case of reinfection that occurred during a shorter window of time than what we see in the current US Centers for Disease Control and Prevention (CDC) guidelines,” Tang said, “so we may be missing a subset of those reinfection cases.”

In October 2020, the CDC published investigative criteria for suspected SARS-CoV-2 reinfections. These criteria included: any individuals testing positive over 90 days after their first laboratory-confirmed SARS-CoV-2 infection, or symptomatic individuals testing positive 45–89 days after initial infection with paired respiratory specimens.

For this patient, nineteen days following her initial positive test in March of 2020, she returned for another SARS-CoV-2 test due to return-to-work requirements. Despite her symptoms fading to encompass only productive cough and fatigue she tested positive again. She continued to experience persistent cough, fatigue, and difficulty breathing until 55 days after her initial positive test.

Tang showed that the two samples contained two infectious variants of SARS-CoV-2 viruses. No diverse polymorphisms, or a mixture of different viruses, were identified among the sequences of the viruses from each clinical sample, suggesting true reinfection rather than a coinfection. One good news is that this case also suggests that reinfections may not be worse than the prior infection.

The CDC has encouraged symptom-based strategies for ending isolation rather than viral retesting for asymptomatic individuals or for individuals without new symptoms during 90 days after illness onset due to findings that detectable but noninfectious SARS-CoV-2 RNA can persist in respiratory samples. This means that even if you don’t exhibit symptoms there could still be traces of SARS-CoV-2 in your system, and those traces could be from an original infection or a reinfection.

This study suggested that reinfection could pose a challenge to infection control, especially as the Delta variants are surging around and new variants continue to emerge.

“People showing influenza-like illnesses are recommended to isolate themselves for ten days or wait for their symptoms to go away. We may not be catching cases where individuals contract another COVID-19 infection within a short amount of time,” Tang said.

“The COVID-19 vaccination has been proven to be effective in reducing the chances for people to become infected and reinfected”, Tang added.

This research was published in the Journal of Medical Virology in June 2021.

Higher Viral Load May Lead to Less Severe Symptoms

March 10, 2021 By Becca Wolf in Research Tags: COVID-19, virology

Cynthia Tang and Henry Wan | photos by Becca Wolf and Roger Meissen, Bond LSC

By Becca Wolf | Bond LSC

You would think that the less sick you are, the less contagious you are. That’s just logic.

However, science isn’t always logical. Especially with Covid-19.

Henry Wan, principal investigator at Bond Life Sciences Center, recently found that when a person has mild symptoms of Covid-19 they have a higher amount of viral shedding.

He also found that people with a higher amount of virus on their positive swab test are less likely to be hospitalized than those with a lesser amount.

“We are really interested in whether this may be causing more or less hospitalizations, and we found the opposite in the analysis,” Wan said. “We found that viruses that mutate a certain way can make the disease less severe. We then wondered if there are any [particular] mutations that cause this.”

Wan and his lab decided to look at different Covid-19 mutations. Using positive Covid-19 tests from throughout Missouri, they found four local lineages and several mutations. With this information, they analyzed patient data to see how people are reacting to each mutation.

“We need to understand how the community gets the mutation and how it spreads,” Wan said. “We want to understand this very dynamic process in Missouri. We’ve seen a lot of mutations introduced in the past several months. Some of them continue to spread and some of them die. We want to know what ecology factors cause this.”

Cynthia Tang, a M.D. Ph.D. student in Wan’s lab, helped with the research. She did work on the data collection and performed the analysis.

“Within the first eight months in Missouri alone we identified four new lineages, which shows just how quickly the virus can mutate and spread,” Tang said. “We also found that viral load was increasing over time. That in itself was very interesting.”

They then looked at if the specific lineages were associated with the increase in viral load but did not find any conclusive evidence. As a result, they speculated that there may be an overall selective advantage towards more viral load and viral shedding, but then found that an increase in viral load was associated with decreased severity.

Given how novel Covid-19 is, they knew they had to expect anything. From the past experience on influenza pandemics and throughout pandemic outbreaks, viruses typically evolve to adapt to the human population, to be less severe while spreading more readily to become seasonal.

“It was challenging going into the research without a lot of information,” Tang said. “There are a lot of publications out there, but our overall foundation of this virus and the disease itself isn’t that strong yet since the pandemic just started, so it’s challenging trying to figure out what the right questions are.”

Wan used this as a teaching moment.

“In the past, we are taught about pandemics in a textbook and that they are far away from us — like the 1918 flu. But now, we’re in it,” Wan said. “This is a good opportunity to lead them through real situations. I’m sure when the students grow up and maybe become a professor or a scientist in the future, they will be ready to fight the next pandemic when it comes.”

As a student, Tang has learned a lot; she has never worked on a project quite like this.

“It’s been a really interesting experience because this is my first time working on something that has a pressing timeline,” Tang said. “We need to get answers quickly because it’s causing so much damage. You’re learning about it, and you’re discovering new things with everybody else.”

Wan and Tang are grateful for the learning experience and the findings of this research.

“This study gives us a better understanding of how the virus is adapting,” Tang said. “But I think it’s good news that the pathogenesis is decreasing for disease severity.”

As with much Covid-19 research, this work has been shared to help advance an understanding of the disease prior to peer review. You can read more about Wan and Tang’s work in the article, “Increased SAR-CoV-2 shedding associated with reduced disease severity despite continually emerging genetic variants,” in medRxiv.