Jan. 6, 2023 — Even though the causes of COVID have long remained puzzling, researchers are zeroing in on biomarkers — compounds that can be detected and measured — that could help them better diagnose and treat the condition can do. The end goal: a simple test to help determine who has had COVID for a long time and whether treatments are helping.
“The hope is that the specific markers discovered will inform how individual clusters[of the disease]should be treated and managed to reduce or eliminate symptoms,” says David WaltPh.D., Co-Director of Mass General Brigham Center for COVID Innovation in Boston.
Biomarkers are commonly used to identify and track diseases. They range from simple measurements such as blood pressure or blood sugar levels to autoantibodies that cause rheumatoid arthritis and enzymes that may indicate liver disease. While long-term COVID symptoms include fatigue, shortness of breath, chest pain and dizziness, having a biomarker or multiple biomarkers may help to better define and diagnose it.
Michael Peluso, MD, who has been treating COVID-19 and long-term COVID patients at San Francisco General Hospital since the start of the pandemic, says biomarkers are a “game changer.” Looking for something where you can make an intervention today, see a change in marker levels, and know that it will have a long-term effect.”
Researchers know that patients should not expect a single diagnostic test or research metric to emerge. Many things appear to be associated with different symptoms. Scientists and doctors anticipate that they will long establish different clinical subtypes of COVID.
Many research teams are working under the umbrella of recover initiative, a $1.15 billion National Institutes of Health Long COVID project. NIH funded 40 research projects Looking at the role of metabolism, genetics, obesity, antibodies, inflammation, diabetes, and more.
NIH team splits long COVID symptom cluster And looking at what drives the disease in each group. Clusters are:
- Viral persistence: when the COVID-19 virus stays in some people’s bodies
- Autonomic dysfunction: changes in the ability to control heart rate, body temperature, breathing, digestion, and sensation
- Sleep disturbances: changes in sleep patterns or ability to sleep
- cognitive dysfunction: trouble thinking clearly or brain fog
- exercise intolerance/fatigue: changes in a person’s activity and/or energy level
study recover The launch is expected in early 2023. The first clinical trial will test the antiviral paxlovid – which has shown something efficacy in early studies Against a placebo.
Many researchers are gathering evidence to show that the virus lurking in patients’ bodies is driving COVID for a long time. This could make the virus, or parts of it, a biomarker for long-lived COVID.
Mass General’s Vault Used sensitive test which can detect much smaller fragments of the virus than conventional tests. In a sample of about 50 patients, he 65% of tall COVID patients were found His blood contained fragments of the spike protein of the SARS-CoV-2 virus. Although the study was small and preliminary, he sees the presence of the spike protein in the blood as a clue.
“If there was no virus present, there would be no spike protein because the spike protein has a very short lifetime once someone has cleared a viral infection,” Walt says. “There must be continuous production of this spike protein from the active virus in order for this spike to be transmitted.”
A private research associate in California is looking for the persistent presence of the virus in the organ’s tissue. Researchers at the Polybio Research Foundation have studied complex chronic inflammatory diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and now chronic COVID, which often cause similar symptoms.
Michael Van Elzacker, PhD, co-founder of the group and a member of the Division of Neurotherapeutics at Massachusetts General Brigham Hospital in Boston, focused on the possibility of a viral reservoir — a place where the virus can hang out and evade the immune system . If it is, his team wants to find it and figure out what’s doing it, VanElzker says.
“All successful pathogens somehow evade the immune system,” he says. “They can’t find the small niche where they do very well.”
microclots – Small blood clots – are another sign of prolonged COVID. A group of researchers #teamclots On Twitter – studying them. One theory is that inflammation promotes clotting, which constricts small blood vessels and prevents oxygen delivery. One Possible Trigger: Spike Protein,
signs of inflammation itself can be used as a biomarker. Peluso and colleagues found in 2021 that COVID patients who lived longer had higher levels of inflammation Chemicals called cytokines. Measuring these cytokines helps explain the causes of prolonged COVID, Peluso said during a online recovery initiative Update in November.
Similarly, Yale researchers reported in August that cortisol – a stress hormone – was uniformly lower than normal among long-term Covid patients.
The continual emergence of new COVID variants has complicated research. Much early research was done before the rise of the Omicron variant. Walt said they found spike proteins in fewer Omicron long COVID samples — closer to 50% than 65% — and researchers have found fewer clots in Omicron patients, Who also had a mild illness.
Like some other scientists who have focused on COVID for a long time, Mohamed Abdel-Mohsen, PhD, began to look at another virus, in the case of HIV. This can sometimes lead to damage to the lining of the intestines, causing a condition known as leaky gut. Abdel-Mohsen, A Associate Professor in the Center for Vaccines and Immunotherapy At the Wistar Institute in Philadelphia, long-term COVID patients can also have leaky gut syndrome.
Abdel-Mohsen and his colleagues found There is evidence that the germs had migrated out of the intestines of Covid patients for a long time and caused inflammation elsewhere in the body, perhaps including the brain. But it is possible to treat the condition with medications, he says. Detection of evidence of such leakage may provide not only a biomarker, but also a target for treatment.
“There are many steps to intervene therapeutically and hopefully decrease symptoms and increase the quality of life of people experiencing (longer COVID),” he says.
While research on biomarkers is in its early stages, the hope is to find a biomarker that points to a treatment.
“TeaThe holy grail of biomarkers is really surrogate markers,” Peluso said during a November recovery briefing. “What surrogate markers mean is you identify the marker, you identify the level of the marker, and then you try to change that. do something for. And changing the level of the biomarker changes the clinical outcome.”
In other words, something similar to a statin drug that lowers bad cholesterol levels – something that in turn lowers the rate of stroke and heart attack.