Studying severe long COVID to understand post-infectious disorders beyond COVID-19

Brodin, Petter; Casari, Giorgio; Townsend, Liam; O’Farrelly, Cliona; Tancevski, Ivan; Löffler‐Ragg, Judith; Mogensen, Trine H.; Lau, Yu Lung

doi:10.1038/s41591-022-01766-7

Cited by 103 publications

(91 citation statements)

References 11 publications

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“…Thus, SARS-CoV-2 infection might leave molecular remnants such as infected macrophages long after symptomatic recovery. Three potential mechanisms have been suggested recently to account for LCS: immune dysregulation, autoimmunity or viral persistence ( 53 ). Our data are fully compatible with immune dysregulation and viral persistence, but hardly support a general role of autoimmunity, as this should be expected to be associated with a pro-inflammatory pattern.…”

Section: Discussionmentioning

confidence: 99%

Multi-omics provide evidence for an anti-inflammatory immune signature and metabolic alterations in patients with Long COVID Syndrome – an exploratory study

Kovařík

Bileck

Hagn

et al. 2022

Preprint

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Despite the increasing prevalence of patients with Long Covid Syndrome (LCS), to date the pathophysiology of the disease is still unclear, and therefore diagnosis and therapy are a complex effort without any standardization. To address these issues, we performed a broad exploratory screening study applying state-of-the-art post-genomic profiling methods to blood plasma derived from three groups: 1) healthy individuals vaccinated against SARS-CoV-2 without exposure to the full virus, 2) asymptomatic fully recovered patients at least three months after SARS-CoV-2 infection, 3) symptomatic patients at least 3 months after a SARS-CoV-2 infection, here designated as Long Covid Syndrome (LCS) patients. Multiplex cytokine profiling indicated slightly elevated cytokine levels in recovered individuals in contrast to LCS patients, who displayed lowest levels of cytokines. Label-free proteome profiling corroborated an anti-inflammatory status in LCS characterized by low acute phase protein levels and a uniform down-regulation of macrophage-derived secreted proteins, a pattern also characteristic for chronic fatigue syndrome (CFS). Along those lines, eicosanoid and docosanoid analysis revealed high levels of omega-3 fatty acids and a prevalence of anti-inflammatory oxylipins in LCS patients compared to the other study groups. Targeted metabolic profiling indicated low amino acid and triglyceride levels and deregulated acylcarnithines, characteristic for CFS and indicating mitochondrial stress in LCS patients. The anti-inflammatory osmolytes taurine and hypaphorine were significantly up-regulated in LCS patients. In summary, here we present evidence for a specific anti-inflammatory and highly characteristic metabolic signature in LCS which could serve for future diagnostic purposes and help to establish rational therapeutic interventions in these patients.

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Section: Discussionmentioning

confidence: 99%

Multi-omics provide evidence for an anti-inflammatory immune signature and metabolic alterations in patients with Long COVID Syndrome – an exploratory study

Kovařík

Bileck

Hagn

et al. 2022

Preprint

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“…54 There are also increasing reports of prolonged or recurrent symptoms following the recovery of COVID-19, referred to as 'long-COVID' or 'post-COVID syndrome'. [56][57][58][59][60][61][62] Mechanisms including immune dysregulation, autoimmunity or potential viral persistence have been suggested to explain long-COVID; 62 however, data to test these hypotheses are needed. Long-COVID syndrome has mainly been characterised in adults 59,62 with less data available in children and adolescents 58,59 and all of these data pre-date Omicron predominance.…”

Section: Complications and Sequelae Of Covid-19 In Children-multisyst...mentioning

confidence: 99%

SARS-CoV-2 infection in children and implications for vaccination

Nathanielsz

Toh

et al. 2022

Pediatr Res

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The COVID-19 pandemic caused by novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for more than 500 million cases worldwide as of April 2022. Initial estimates in 2020 found that children were less likely to become infected with SARS-CoV-2 and more likely to be asymptomatic or display mild COVID-19 symptoms. Our early understanding of COVID-19 transmission and disease in children led to a range of public health measures including school closures that have indirectly impacted child health and wellbeing. The emergence of variants of concern (particularly Delta and Omicron) has raised new issues about transmissibility in children, as preliminary data suggest that children may be at increased risk of infection, especially if unvaccinated. Global national prevalence data show that SARS-CoV-2 infection in children and adolescents is rising due to COVID-19 vaccination among adults and increased circulation of Delta and Omicron variants. To mitigate this, childhood immunisation programmes are being implemented globally to prevent direct and indirect consequences of COVID-19 including severe complications (e.g., MIS-C), debilitating long-COVID symptoms, and the indirect impacts of prolonged community and school closures on childhood education, social and behavioural development and mental health. This review explores the current state of knowledge on COVID-19 in children including COVID-19 vaccination strategies. Impact Provides an up-to-date account of SARS-CoV-2 infections in children. Discusses the direct and indirect effects of COVID-19 in children. Provides the latest information on the current state of global COVID-19 vaccination in children.

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“…Moreover, SARS-COV-2 infection activates the coagulation cascade in addition to the endothelial dysfunction and hyper in ammation caused by a cytokine storm. These factors may be prolonged even after the acute phase of infection [20][21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Post-Acute COVID-19 syndrome (PACS) right atrioventricular and vena cava thrombus on top of a myxoma. A Case report

Alrifae¹,

almuqqudami²,

Etaleb³

et al. 2022

Preprint

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Post-Acute COVID-19 syndrome (PACS) is considered to be one of the least understood post-infectious syndromes. We report a case of a 21-year-old female who had a history of SARS-CoV-2 infection and presented with a right atrioventricular thrombus associated with pulmonary embolism and thrombocytopenia. At the time of admission, she was not vaccinated against SARS-CoV-2, and her serological tests for IgG and IgM antibodies against SARS-CoV-2 were positive. The size of the thrombus measured approximately 6×8×4 cm, which also led to tricuspid valve insufficiency due to mechanical dilatation of the valve’s ring. The right atrioventricular thrombus also extended up to the inferior vena cava, leading to mild congestive hepatomegaly. Moreover, during thrombectomy, the mass of the thrombus was attached to the interseptal right atrial wall. The histopathological assessment of the core mass revealed that it was a right atrial myxoma hidden inside that large thrombus. We suspect that the formation and propagation of the thrombus to that size occurs as a part of Post-Acute COVID-19 syndrome (PACS). This study reviews and discusses coronavirus disease 2019-relate to thrombus formation inside cardiac chambers in case of a cardiac tumor, like myxoma in the setting of post-acute phase COVID-19 syndrome.

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Studying severe long COVID to understand post-infectious disorders beyond COVID-19

Cited by 103 publications

References 11 publications

Multi-omics provide evidence for an anti-inflammatory immune signature and metabolic alterations in patients with Long COVID Syndrome – an exploratory study

Multi-omics provide evidence for an anti-inflammatory immune signature and metabolic alterations in patients with Long COVID Syndrome – an exploratory study

SARS-CoV-2 infection in children and implications for vaccination

Post-Acute COVID-19 syndrome (PACS) right atrioventricular and vena cava thrombus on top of a myxoma. A Case report

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