Hi everyone,
In a landmark announcement, the U.S. Department of Health and Human Services (HHS) has formed the Office of Long COVID Research and Practice, demonstrating a much-needed focus on addressing the challenges posed by this debilitating condition. Furthermore, the HHS has launched Long Covid clinical trials through the RECOVER Initiative, offering hope for effective treatment options. In this edition of our newsletter, we delve into a range of topics, including the urgent need to prioritize Long Covid treatment, the role of antihistamines in improving cardiovascular manifestations, the long-term plasma metabolome of Long Covid patients, the association between VEGF-A plasma levels and respiratory impairments, and much more. Join us as we navigate the latest scientific findings and delve into the ongoing clinical trials that hold promise for our community.
Also important to note, the Patient-Led Research collaborative is seeking survey responses to better understand how COVID-19 infections and reinfections are impacting long-term health outcomes. If interested, please see here!
No article on this, but thought this was worth sharing as well, the Putrino Lab at Mount Sinai ‘will be formally announcing the launch of our new clinic: a center dedicated to recovery from complex chronic illnesses.’ In this clinic they will be treat people with conditions like EDS, LongCOVID, MECFS and LongLyme. For more info, please see this thread!
Media
DEFINITIONS:
RECOVER Initiative(Researching COVID to Enhance Recovery): A research program aimed at studying and finding treatments for Long COVID, with a focus on the long-term symptoms experienced by patients.
SUMMARY:
Current analysis estimates that 7.7 million to 23 million Americans have developed Long COVID.
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra released a statement applauding the formation of the Office of Long COVID Research and Practice to lead the Long COVID response and coordination across the federal government and the launch of the Long COVID clinical trials.
The Office of Long COVID Research and Practice will enhance efforts across the U.S. government to improve the lives of those living with Long COVID.
The NIH RECOVER Initiative is a $1.15 billion nationwide research program designed to understand, treat, and prevent long COVID.
My Take:
The establishment of the Office of Long COVID Research and Practice and the launch of the RECOVER Initiative clinical trials are significant steps in addressing the long-term effects of COVID-19.
I am glad that this has finally happened but this took almost 4 years(!)
SUMMARY:
In a world where most pandemic safety protocols have evaporated, where is the sense of urgency to treat, or at the very least support, people with Long COVID?
The response to Long COVID has been muted.
It is not acceptable.
Three years later, I have learned to manage Long COVID — which in my case includes extreme fatigue, near-constant headaches and the relentless need to restrict activities of daily living to avoid exacerbating symptoms.
Research
DEFINITIONS:
Mast cell activation (MCA): a process in which mast cells, a type of immune cell, release inflammatory mediators in response to various triggers.
Histamine receptor blockers: medications that block the action of histamine, a chemical released by mast cells that is involved in allergic reactions and inflammation.
SUMMARY:
Previous studies have suggested that mast cell activation (MCA) may play a role in the pathophysiology of long-COVID, including in its cardiovascular manifestations.
This study aimed to evaluate the effectiveness of histamine receptor blockers in treating long-COVID symptoms attributed to MCA.
The results showed that treating patients with fexofenadine and famotidine led to complete disappearance of long-COVID symptoms in 29% of treated patients, as well as significant improvement in each of the considered symptoms in all treated patients compared to controls.
My Take:
This study provides evidence that blocking histamine receptors may be an effective treatment for Long COVID symptoms attributed to mast cell activation.
The findings suggest that MCA may have a significant role in the pathophysiology of Long COVID.
Further research is needed to confirm these results and explore other potential treatment options for Long COVID.
Article: The plasma metabolome of long COVID patients two years after infection | Scientific Reports
SUMMARY:
A study conducted in Mexico evaluated the plasma metabolome of 100 samples collected from healthy controls, COVID-19 patients, and long COVID patients to assess long-term metabolic alterations.
Dysregulation of metabolites related to glucose metabolism, lipid metabolism, amino acid metabolism, and mitochondrial function was observed in long COVID patients, even after two years of the initial infection.
Different metabolic profiles were identified in patients with more complicated long COVID evolution, and IL-17 levels were significantly increased in these patients, suggesting chronic immune dysregulation.
My Take:
The dysregulation of metabolites related to various metabolic pathways suggests mitochondrial dysfunction, impaired energy metabolism, and chronic immune dysregulation as key hallmarks of Llong COVID.
[PAYWALLED]
DEFINITIONS:
DLCO: Diffusing capacity of the lungs for carbon monoxide, a measurement used to assess how well oxygen can transfer from the lungs to the bloodstream.
VEGF-A: Vascular endothelial growth factor A, a protein that promotes the formation of new blood vessels (angiogenesis) and is associated with endothelial dysfunction.
SUMMARY:
The study aimed to correlate biomarkers of endothelial dysfunction with persistent clinical symptoms and pulmonary function defects in long COVID patients.
The study included 137 patients with long COVID and found that angiogenesis-related biomarkers and von Willebrand factor levels were increased in these patients compared to healthy volunteers and acute hospitalized COVID-19 patients.
VEGF-A and von Willebrand factor were associated with persistent lung CT scan lesions and impaired diffusing capacity of the lungs for carbon monoxide (DLCO) measurement.
VEGF-A emerged as the most significant predictive factor for persistent lung CT scan lesions and impaired DLCO measurement.
DEFINITIONS:
Olfactory mucosa (OM): The olfactory mucosa is the tissue responsible for the sense of smell. It contains olfactory sensory neurons, supporting cells, and other cell types.
SUMMARY:
The study investigated the determinants of persistent olfactory symptoms in individuals with COVID-19.
RNA-Seq assays revealed that gene expression levels were altered in the olfactory mucosa for a long time after infection.
Patients with persistent olfactory deficits showed increased levels of expression of genes involved in the inflammatory response and zinc homeostasis.
DEFINITIONS:
Pulmonary embolism (PE): Refers to a condition in which a blood clot forms in the pulmonary arteries, blocking blood flow to the lungs.
SUMMARY:
Covid-19 infection is characterized by acute complications and long-term sequelae, often associated with endothelial dysfunction.
The aim of the study was to evaluate parameters in patients with pulmonary embolism (PE) after recent Covid-19 infection compared to PE patients without previous infection.
Patients with previous Covid-19 infection had a higher prevalence of diabetes mellitus and reduced levels of inflammatory markers.
The post-Covid-19 PE group had higher risk scores and severity indices compared to the Covid-19-free group.
My Take:
The findings suggest that patients with a previous Covid-19 infection have a unique prothrombotic state, characterized by persistent endothelial damage and increased thrombotic risk.
Hope
SUMMARY:
The National Institutes of Health launched and is opening enrollment for phase 2 clinical trials that will evaluate at least four potential treatments for long COVID, with additional clinical trials to test at least seven more treatments expected in the coming months.
Treatments will include drugs, biologics, medical devices and other therapies.
The trials are designed to evaluate multiple treatments simultaneously to identify more swiftly those that are effective.
My Take:
The launch of phase 2 clinical trials for potential treatments for long COVID is a significant development in the efforts to understand, treat, and prevent this condition.
Again, this took too long in my opinion. I see a common (fair) complaint that even with these clinical trials, there is not enough being done. However, the cost of clinical trials is massive, thus explaining why only four are being done. Although that begs the question, how can they be spending money more efficiently in other ways?
Article: NIH launches trials for long COVID treatments: what scientists think
SUMMARY:
The US National Institutes of Health (NIH) will launch its first trials to test the safety and efficacy of treatments for long COVID.
Researchers who spoke to Nature say that launching treatment trials is a crucial step, but that it will take tangible progress in these trials to assure those affected that US health officials are taking their concerns seriously.
It is great that the NIH has now launched some of these trials, says Ezekiel Emanuel, a bioethicist and oncologist at the University of Pennsylvania in Philadelphia, but he is watching whether they will meet their target enrolment.
Fingers crossed that HHS office does some good work!