Long COVID: major findings, mechanisms and recommendations

Nature Reviews Microbiology, Journal Year: 2023, Volume and Issue: 21(3), P. 133 - 146

Published: Jan. 13, 2023

Language: Английский

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2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Journal of the American College of Cardiology, Journal Year: 2022, Volume and Issue: 79(17), P. 1717 - 1756

Published: March 16, 2022

Language: Английский

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Endothelial dysfunction and altered endothelial biomarkers in patients with post-COVID-19 syndrome and chronic fatigue syndrome (ME/CFS)

Journal of Translational Medicine, Journal Year: 2022, Volume and Issue: 20(1)

Published: March 22, 2022

Abstract Background Fatigue, exertion intolerance and post-exertional malaise are among the most frequent symptoms of Post-COVID Syndrome (PCS), with a subset patients fulfilling criteria for Myalgic Encephalomyelitis/Chronic Fatigue (ME/CFS). As SARS-CoV-2 infects endothelial cells, causing endotheliitis damaging endothelium, we investigated dysfunction (ED) biomarkers in PCS. Methods We studied function 30 PCS persistent fatigue as well 15 age- sex matched seronegative healthy controls (HCs). 14 fulfilled diagnostic ME/CFS. The other were considered to have Peripheral was assessed by reactive hyperaemia index (RHI) using peripheral arterial tonometry (PAT) HCs. In larger cohort HCs, including post-COVID reconvalescents (PCHCs), Endothelin-1 (ET-1), Angiopoietin-2 (Ang-2), Endocan (ESM-1), IL-8, Angiotensin-Converting Enzyme (ACE) ACE2 analysed biomarkers. Results Five ME/CFS five 16 showed ED defined diminished RHI (< 1.67), but none HCs exhibited this finding. A paradoxical positive correlation age, blood pressure BMI found not patients. ET-1 concentration significantly elevated both compared PCHCs. serum Ang-2 lower PCHCs Conclusion display evidence shown altered Different associations clinical parameters varying biomarker profiles may suggest distinct pathomechanisms patient subgroups.

Language: Английский

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Muscle abnormalities worsen after post-exertional malaise in long COVID

Nature Communications, Journal Year: 2024, Volume and Issue: 15(1)

Published: Jan. 4, 2024

A subgroup of patients infected with SARS-CoV-2 remain symptomatic over three months after infection. distinctive symptom long COVID is post-exertional malaise, which associated a worsening fatigue- and pain-related symptoms acute mental or physical exercise, but its underlying pathophysiology unclear. With this longitudinal case-control study (NCT05225688), we provide new insights into the malaise in COVID. We show that skeletal muscle structure lower exercise capacity patients, local systemic metabolic disturbances, severe exercise-induced myopathy tissue infiltration amyloid-containing deposits muscles worsen induction malaise. This highlights novel pathways help to understand suffering from other post-infectious diseases.

Language: Английский

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Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC)

eLife, Journal Year: 2023, Volume and Issue: 12

Published: March 22, 2023

COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, cognitive dysfunction that last for months impact everyday functioning, is referred to Long COVID under the general category post-acute sequelae SARS-CoV-2 infection (PASC). PASC highly heterogenous may be associated multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular neuropsychiatric disorders, pulmonary damage, renal failure, stroke, vascular endothelial dysregulation. A better understanding pathophysiologic mechanisms underlying essential guide prevention treatment. This review addresses potential hypotheses connect long-term health consequences. Comparisons between other virus-initiated chronic syndromes myalgic encephalomyelitis/chronic fatigue syndrome postural orthostatic tachycardia will addressed. Aligning identifying potentially regulated common underlining pathways necessary true nature PASC. The discussed contributors include from injury one or more organs, reservoirs replicating virus its remnants in several tissues, re-activation latent pathogens Epstein-Barr herpes viruses COVID-19 immune-dysregulated environment, interactions host microbiome/virome communities, clotting/coagulation dysfunctional brainstem/vagus nerve signaling, dysautonomia autonomic dysfunction, ongoing activity primed immune cells, autoimmunity due molecular mimicry pathogen proteins. individualized suggests different therapeutic approaches required best manage specific patients.

Language: Английский

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Long COVID: pathophysiological factors and abnormalities of coagulation

Trends in Endocrinology and Metabolism, Journal Year: 2023, Volume and Issue: 34(6), P. 321 - 344

Published: April 19, 2023

Acute COVID-19 infection is followed by prolonged symptoms in approximately one ten cases: known as Long COVID. The disease affects ~65 million individuals worldwide. Many pathophysiological processes appear to underlie COVID, including viral factors (persistence, reactivation, and bacteriophagic action of SARS CoV-2); host (chronic inflammation, metabolic endocrine dysregulation, immune autoimmunity); downstream impacts (tissue damage from the initial infection, tissue hypoxia, dysbiosis, autonomic nervous system dysfunction). These mechanisms culminate long-term persistence disorder characterized a thrombotic endothelialitis, endothelial hyperactivated platelets, fibrinaloid microclots. abnormalities blood vessels coagulation affect every organ represent unifying pathway for various

Language: Английский

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Long COVID and the cardiovascular system—elucidating causes and cellular mechanisms in order to develop targeted diagnostic and therapeutic strategies: a joint Scientific Statement of the ESC Working Groups on Cellular Biology of the Heart and Myocardial and Pericardial Diseases

Cardiovascular Research, Journal Year: 2022, Volume and Issue: 119(2), P. 336 - 356

Published: July 25, 2022

Abstract Long COVID has become a world-wide, non-communicable epidemic, caused by long-lasting multiorgan symptoms that endure for weeks or months after SARS-CoV-2 infection already subsided. This scientific document aims to provide insight into the possible causes and therapeutic options available cardiovascular manifestations of long COVID. In addition chronic fatigue, which is common symptom COVID, patients may present with chest pain, ECG abnormalities, postural orthostatic tachycardia, newly developed supraventricular ventricular arrhythmias. Imaging heart vessels provided evidence chronic, post-infectious perimyocarditis consequent left right failure, arterial wall inflammation, microthrombosis in certain patient populations. Better understanding underlying cellular molecular mechanisms will aid development effective treatment strategies its manifestations. A number have been proposed, including those involving direct effects on myocardium, microthrombotic damage endothelium, persistent inflammation. Unfortunately, existing circulating biomarkers, coagulation, inflammatory markers, are not highly predictive either presence outcome when measured 3 infection. Further studies needed understand mechanisms, identify specific guide future preventive treatments address sequelae.

Language: Английский

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Long COVID: The Nature of Thrombotic Sequelae Determines the Necessity of Early Anticoagulation

Frontiers in Cellular and Infection Microbiology, Journal Year: 2022, Volume and Issue: 12

Published: April 5, 2022

Many discharged COVID-19 patients affected by sequelae experience reduced quality of life leading to an increased burden on the healthcare system, their families and society at large. Possible pathophysiological mechanisms long COVID include: persistent viral replication, chronic hypoxia inflammation. Ongoing vascular endothelial damage promotes platelet adhesion coagulation, resulting in impairment various organ functions. Meanwhile, thrombosis will further aggravate vasculitis contributing deterioration. Thus, is essentially a thrombotic sequela. Unfortunately, there currently no effective treatment for COVID. This article summarizes evidence coagulation abnormalities COVID, with focus thrombosis. Extracellular vesicles (EVs) released types cells can carry SARS-CoV-2 through circulation attack distant tissues organs. Furthermore, EVs express tissue factor phosphatidylserine (PS) which Given persistence virus, inflammation are inevitable. Pulmonary structural changes such as hypertension, embolism fibrosis common The impaired lung function again aggravates abnormalities. In this article, we also summarize recent research antithrombotic therapy COVID-19. There increasing that early anticoagulation be improving outcomes. fact, systemic dysfunction caused key factors driving complications Early prophylactic prevent release or remove procoagulant substances, thereby protecting endothelium from damage, reducing sequelae, long-COVID patients.

Language: Английский

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Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study

The Lancet Regional Health - Europe, Journal Year: 2023, Volume and Issue: 28, P. 100595 - 100595

Published: Feb. 24, 2023

Few studies have reported the long-term health effects of COVID-19. The regional population-based Linköping COVID-19 study (LinCoS) included all patients hospitalised due to during first pandemic wave. Four months post-discharge, over 40% (185/433) experienced persisting symptoms and activity/participation limitations, indicating post-COVID-19 condition (PCC). present follow-up aimed determine recovery among these 24 post-admission. This prospective cohort from LinCoS with PCC at four post-discharge. We repeated same structured interview a 24-month identify their impact on daily life. Intercurrent issues were identified by reviewing medical records. Of 185 4 181 alive assessment 165 agreed participate. those, 21% (35/165) had been readmitted hospital for various causes in interim period. majority (139/165, 84%) problems affecting everyday life months. Significant improvements seen prevalence magnitude some symptoms/limitations compared Cognitive, sensorimotor, fatigue most common No clear difference was evident between individuals treated intensive care unit (ICU) non-ICU-treated individuals. Approximately half those who sick leave related after infection is one report 2-year outcomes following hospitalisation. Despite time, we found high need rehabilitation post infection. funded Region Östergötland.

Language: Английский

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Dysregulated autoantibodies targeting vaso- and immunoregulatory receptors in Post COVID Syndrome correlate with symptom severity

Frontiers in Immunology, Journal Year: 2022, Volume and Issue: 13

Published: Sept. 27, 2022

Most patients with Post COVID Syndrome (PCS) present a plethora of symptoms without clear evidence organ dysfunction. A subset them fulfills diagnostic criteria myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Symptom severity ME/CFS correlates natural regulatory autoantibody (AAB) levels targeting several G-protein coupled receptors (GPCR). In this exploratory study, we analyzed serum AAB against vaso- and immunoregulatory receptors, mostly GPCRs, in 80 PCS following mild-to-moderate COVID-19, 40 fulfilling ME/CFS. Healthy seronegative (n=38) asymptomatic post COVID-19 controls (n=40) were also included the study as control groups. We found lower for various AABs compared to at least one group, accompanied by alterations correlations among AABs. Classification using random forest indicated ADRB2, STAB1, ADRA2A strongest classifiers (AABs stratifying according disease outcomes) outcomes. Several correlated symptom Remarkably, vasomotor associated ADRB2 PCS/ME/CFS patients. Our identified dysregulation involved autonomous nervous system (ANS), vaso-, immunoregulation their correlation severity, pointing role pathogenesis PCS.

Language: Английский

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