Hi Everyone,
I am very happy to be back! I appreciate the patience everyone has, these newsletters take a lot of time to make and sometimes I need a short break to recharge my batteries. I do not foresee any more breaks this summer!
In this newsletter, we bring you articles that shed light on Long Covid from various perspectives, including immunology, neuroscience, microbiota, and more. These articles provide insights into the illness's mechanisms, treatment options, and strategies for managing its symptoms. Whether you are a Long Covid patient or a healthcare professional, we hope you find these articles informative and helpful in navigating this challenging illness.
Media
SUMMARY:
According to the most recent estimates, more than 65 million people worldwide may be living with some form of long Covid, a startling number that will only continue to increase, given the lack of available treatment options.
Akiko Iwasaki, an immunology professor at Yale School of Medicine, has been at the forefront of numerous research breakthroughs throughout the course of the pandemic, from understanding why men were more vulnerable to the Sars-CoV-2 virus, the autoimmunity that made some people unexpectedly susceptible, and why a small minority have experienced heart inflammation in response to the Covid-19 vaccines.
Iwasaki has been awarded the prestigious Else KrÃner Fresenius Prize for Medical Research, in part due to her ongoing work on long Covid.
One of the trials being conducted probes whether persistent virus infection may be causing long Covid in a subset of people.
Article: I Have Long COVID. It Upended My Life in Unimaginable Ways
SUMMARY:
Jemma Bella is a 24-year-old woman who is navigating the difficult journey of Long COVID.
She is sharing her story through a blog and on social media.
Her diagnosis of lingering fatigue, brain fog, heart palpitations, chest pains, joint aches, and muscle weakness have made working and simple tasks incredibly challenging.
My Take:
This is a harrowing experience and the skepticism and doubt surrounding the condition can be isolating.
It is important to appreciate the small blessings and celebrate every small victory.
It shows the importance of implementing multiple strategies to support one's recovery such as an anti-inflammatory diet, pacing, and meditation.
DEFINITIONS:
HHV-6/EBV activation: the reactivation or primary infection with human herpesvirus 6 and Epstein-Barr virus.
Fibronectin: a protein that plays a role in immune modulation and wound healing.
SUMMARY:
Bhupesh Prusty's research focuses on the role of herpesviruses in causing myalgic encephalitis/chronic fatigue syndrome (ME/CFS).
Prusty found evidence of widespread HHV-6/EBV activation across the brains of people with ME/CFS.
Prusty says he will be announcing a biomarker for ME/CFS and long COVID soon.
Prusty's recent study suggests that fibronectin-1 may be a biomarker for ME/CFS and that low levels of this protein could potentially constitute a type of immune "hole" in patients.
My Take:
The finding of widespread HHV-6/EBV activation in the brains of ME/CFS patients suggests that these viruses may be playing a significant role in the development of the condition.
The announcement of a biomarker for ME/CFS and long COVID could be a significant step forward in diagnosing and treating these conditions.
Article: CAMH study confirms ongoing brain inflammation associated with long COVID | CAMH
SUMMARY:
A new study found elevated levels of inflammation in the brain of patients with persistent symptoms of long COVID.
Inflammation in the brain was suspected of being the critical step in causing neurological and psychiatric symptoms of long COVID, so confirming this is vital to developing treatments for people experiencing symptoms.
The regions of the brain with the most inflammation are the ones involved in the capacity to enjoy things, motivational energy, and the ability to think and move quickly, symptoms of greatest concern among people with long COVID in the study.
Further study of the association between brain inflammation and depression, as well as further study on the short and long-term impacts of COVID-19 on the brain, could lead to new treatments for long COVID that would also be purposed for depression and other illnesses.
Research
SUMMARY:
Outpatient treatment with metformin can significantly reduce the incidence of long COVID by about 41% with an absolute reduction of 4.1% compared with placebo, according to a randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT).
The trial is one of the few COVID-19 treatment trials to include pregnant women.
Metformin was shown to reduce the incidence of long COVID and is safe, inexpensive, widely available, and has few contraindications or medication interactions.
There are few randomised trials for outpatient treatment of COVID-19 to assess the effects of early treatments on the incidence of post-COVID-19 condition (also known as long COVID).
My Take:
Governments should consider implementing the drug as a COVID-19 treatment to prevent long COVID quickly, given the urgent public health need.
DEFINITIONS:
Pacing strategies: adapting and adjusting patients' activities in terms of physical, cognitive and emotional effort within the limits imposed by the illness to prevent PEM occurrence and improve patients' quality of life.
SUMMARY:
Pacing is effective in managing patients with PCS, and high levels of adherence to pacing are associated with better outcomes.
PCS symptoms are similar to those encountered in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
The exact pathophysiology of both conditions remains unclear, but some mechanisms including mitochondrial dysfunction and inappropriate immune response were reported in both PCS and ME/CFS patients.
The Center for Disease Control (CDC) recommends pacing for PCS patients experiencing post-exertional malaise (PEM).
SUMMARY:
The study found that after two years, 69.1% of non-hospitalized individuals who had mild COVID-19 symptoms were classified as having Post-COVID Syndrome (PCS), i.e.
Symptoms persisted for at least 12 weeks.
A large proportion of individuals complained about lacking information on long-lasting COVID-19 symptoms and problems in finding competent healthcare providers.
The study identified a mismatch between the applied definition of PCS and the persons’ subjective perception of having PCS, highlighting the need for diagnosis and treatment to consider the individual’s psychosocial background.
The results highlight the need to optimize patient information on PCS, facilitate access to specialized healthcare providers and improve healthcare provider education on PCS.
SUMMARY:
The study conducted serum proteomic analysis on 55 unvaccinated adults with post-acute sequelae of SARS-CoV-2 infection (PASC) and found that 60% of PASC patients exhibited an inflammatory protein signature.
The identified inflammatory serum protein signature has the potential to be used to stratify patients for clinical trials of immunomodulatory drugs.
The study also proposed a serum diagnostic panel of three marker proteins (CCL7, CD40LG, S100A12) that may be helpful to differentiate inflammatory PASC from non-inflammatory PASC.
My Take:
The proposed serum diagnostic panel could also enable better differentiation and stratification of PASC patients in clinical trials and could potentially lead to improved outcomes.
Article: Mild SARS-CoV-2 infection results in long-lasting microbiota instability | mBio
DEFINITIONS:
Gut microbiota: the trillions of microorganisms colonizing the gastrointestinal tract.
K18-humanized angiotensin-converting enzyme 2 mouse model: a mouse model that expresses human ACE2 under the keratin-18 promoter, making it susceptible to SARS-CoV-2 infection.
SUMMARY:
Even mild SARS-CoV-2 infection can disrupt the gut microbiota, according to new research.
Longitudinal sampling of 14 SARS-CoV-2-positive outpatients and four household controls found that SARS-CoV-2 cases exhibited a significantly less stable gut microbiota than controls.
All tested SARS-CoV-2 variants, including Delta and Omicron, disrupted the mouse gut microbiota, according to experiments in K18-humanized angiotensin-converting enzyme 2 and wild-type C57BL/6J mice.
The results suggest that SARS-CoV-2 induces long-lasting microbiota instability, irrespective of disease severity.
The downstream consequences of microbiota instability for COVID-19 pathophysiology will be important to assess.
My Take:
This research highlights the potential impact of SARS-CoV-2 on gut microbial ecology, even in cases of mild infection.
The findings suggest that even if an individual has had a mild case of COVID-19, it could still have long-term consequences for their gut health.
The experiments in mice with different SARS-CoV-2 variants provide further evidence of the virus's ability to disrupt the gut microbiota, which could have implications for a wide range of host health and disease outcomes.
However, it is important to note that the causal relationship between SARS-CoV-2 infection and microbiota instability remains unclear and requires further investigation.
SUMMARY:
Higher cognitive impairment has been reported in post-COVID-19 survivors, and this impairment is not related to any pre-existing clinical or emotional disturbances.
A recent report has shown a potential link between a deficit in cognitive performance and chemosensory impairment in long COVID-19 patients.
Analysis between cognitive sub-dimensions suggested several cytokines that may be involved in cognitive function and may warrant further investigation. In particular, IL-1RA, IL-7, and G-CSF were associated with attention, language, episodic memory, and cognition dimensions.
One of the most robust findings in the present study was the observed relationship between different sociodemographic phenotypes and cognitive decline in long COVID. Older age, female sex, ethnicity endorsed as Brown, and a lower educational profile predicted lower cognitive performance, with educational profile having the greatest effect size.
Hope
Vitalik Buterin Donating $100 Million to Long Covid Research
https://open.substack.com/pub/hlahore/p/gut-bacteria-significantly-reduced?utm_source=share&utm_medium=android&r=24uvp2
Great newsletter! Always nice to see some good news about funding, too.