The following first appeared on Substack by Eric Topol, MD. earthly truth.
In recent days, there have been several important new reports that help explain the pathophysiology of the long-lasting coronavirus. Coincidentally, we published an outlook article. science Today I’d like to summarize our progress so far and the important work ahead.
Here we summarize the new findings.
Leaky blood-brain barrier
A systematic study of long-term COVID-19 patients and their controls using MRI, brain-specific S100β protein, leukocyte RNA-seq, and cultured endothelial cell responses revealed that New insights into disruption of the blood-brain barrier (BBB). New coronavirus and brain fog symptoms. The study was well summarized by Professor Katerina Akasoglu of the Gladstone Institute, who was not involved in the study but is a highly regarded scientist in the field of neurovascular inflammation, who said: “This study… This is the first report of BBB disruption showing a correlation between brain fog and brain fog in patients.” The MRI findings are consistent with neuropathology reporting an accumulation of blood proteins in the brains of patients with COVID-19. We hope this will form the basis for future research at the blood-brain and immune interface. Discovery of mechanisms, biomarkers, and treatments for neurological symptoms in prolonged COVID-19 infection. ”
Although the number of participants in each group was small, the phenotypic analysis was very in-depth. Beyond the BBB, notable findings were dysregulation of the coagulation system and proinflammatory effects on endothelial cells.
Persistent infection of SARS-CoV-2 as a risk factor
A large-scale community surveillance project in the United Kingdom found that 381 participants had evidence of persistent SARS-CoV-2 infection for more than 30 days. It was much higher than expected.
1 to 3% remained infected for more than 30 days. Additionally, 0.1% to 0.5% remained infected for more than 60 days.
Serial assessments of viral loads showed many people had returned to high levels, indicating the virus was likely actively replicating.
The risk of long-term infection with COVID-19 increased by 55% in people who had been infected for more than 12 weeks and by 24% in people who had been infected for more than 26 weeks.
Interferon gamma as a potential biomarker for diagnosis and treatment
A new report analyzed interferon gamma, which is part of the innate immune system’s first line of defense against SARS-CoV-2 infection. Those with a longer duration of COVID-19 infection had a sustained increase after the acute phase, indicating resolution of symptoms among participants during follow-up serial evaluation of this biomarker. Although this requires further evaluation, it could be replicated and expanded to both confirm the diagnosis and provide an alternative measure to treatments being evaluated in prospective clinical trials, as well as an objective measure of correlation with symptoms. has the potential to fill a significant unmet need for
Deep phenotyping of myalgic encephalomyelitis (ME/CFS)
The results of a long-awaited eight-year NIH project have been published in a 70-page manuscript. Similar to the BBB study mentioned above, the number of participants in the study was small, but this was compensated for by extensive characterization and appropriate controls. The results are remarkable, as many of the symptoms of ME/CFS and long-term coronavirus overlap considerably: signs of persistent chronic antigen stimulation with immune system dysregulation (with T-cell depletion) , and disruption of multiple systems (some of which are central nervous system) systems are regulated and involve specific areas of the brain.
In association with, economist There were articles about post-infectious neurological syndromes that occur with coronavirus, ME/CFS, Lyme disease, and several other viruses. “Michelle Monger, a neuro-oncologist at the Stanford School of Medicine, pinpoints how the neurological damage caused by COVID-19 occurs, and explains how brain cells other than neurons are known to , with a particular focus on glial cells.”
Professor Monge just made a new recording. earthly truth A podcast on this topic will be posted soon.
Two new reports on protection from vaccination and long-lasting coronavirus
from the research of epidemiological chronicle, Michiganders have derived significant protection against the long-lasting coronavirus. The incidence of long-term COVID-19 infection was 40% to 60% lower in adults who were vaccinated before COVID-19 (compared to unvaccinated people). is. This level of protection is consistent with many recent reports, but the additional benefits of booster shots have not been emphasized enough.Data was previously reviewed earthly truth here.
Additionally, a new preprint report on Child and Adolescent Protection looked at the causal relationship between different variants (Delta and Omicron) and the direct benefits of vaccination. The protective effect was higher in teenagers than in children, with a range of 60% to 75%.
our science perspective
And finally, our essay scienceIn this, we have tried to summarize a lot of information about what we have learned so far and what is desperately needed now. Ziyad Al-Aly has put together a great thread reviewing the key points.
brief summary
Considerable progress has been made in understanding the causes of prolonged COVID-19 infection and the potential for alternative biomarker candidates, which will be of great help as randomized clinical trials move forward. Finding effective and safe treatments is clearly an urgent task, and despite a long list of potentially attractive interventions based on mechanistic insights, there is still insufficient research to pursue it. No efforts are being made. I hope that happens soon, but it’s not going to happen anytime soon.
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