Long COVID pathophysiology

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Long COVID, long tail covid, Post-Acute Sequelae of COVID-19 (PASC), post-acute COVID-19 and ongoing COVID are terms used to describe a group of long term health problems that are found in a significant minority of people who developed COVID-19 and remain ill a number of weeks or months later.

Overview[edit | edit source]

Main article: Long COVID

Pathophysiology[edit | edit source]

Infection and immunity[edit | edit source]

A range of antibodies have been found in patients with persistent post-acute COVID symptoms. Elevated G-protein coupled receptor autoantibodies have been found.[1] One study founded elevated antinuclear antibody (ANA) titles in 43.6% of long COVID patients twelve months after symptom onset.[2]

Long COVID may be associated herpesvirus reactivation such as Epstein-Barr Virus,[3] which has been shown to cause elevations of certain G-protein coupled receptor autoantibody types.[4][5][6][7]

Neurological and neuropsychiatric[edit | edit source]

Cardiovascular[edit | edit source]

Pulmonary[edit | edit source]

In a single cardiopulmonary exercise test, Post-COVID-19 patients exhibited markedly reduced peak exercise aerobic capacity (VO2) compared to controls and impaired oxygen extraction, even in those without cardiopulmonary disease.[8]

Comparison to other conditions[edit | edit source]

Findings Long COVID Post-acute SARS ME/CFS POTS MCAS
G-protein coupled receptor autoantibodies β2- and α1-adrenoceptors, angiotensin II AT1-, muscarinic M2-, MAS-, nociceptin- and ETA-receptors M3 and M4 muscarinic acetylcholine receptors, as well as ß2 adrenergic receptors α1, β1 and β2 adrenergic receptor autoantibodies

Post-SARS syndrome[edit | edit source]

Main article: Post-SARS syndrome

ME/CFS[edit | edit source]

Main article: Myalgic encephalomyelitis

Postviral fatigue syndrome[edit | edit source]

Main article: Postviral fatigue syndrome

Chronic fatigue and Idiopathic chronic fatigue[edit | edit source]

Main article: Idiopathic chronic fatigue

POTS[edit | edit source]

Main article: Postural orthostatic tachycardia syndrome

MCAS[edit | edit source]

Main article: Mast cell activation syndrome

Post-Ebola syndrome[edit | edit source]

Main article: Post-Ebola syndrome

Chronic Epstein-Barr virus[edit | edit source]

Main article: Chronic Epstein-Barr virus

Alzheimer's disease[edit | edit source]

Traumatic Brain Injury[edit | edit source]

Notable studies[edit | edit source]

  • 2021, 18F-FDG brain PET hypometabolism in patients with long COVID[9] (Full text)
  • 2021, Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients[10] (Full text)
  • 2021, Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID[11] (Full text)
  • 2021, Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19[12] (Full text) - Pre-print
  • 2021, Persistent clotting protein pathology in Long COVID/ Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin[13] (Full text) - Pre-print
  • 2021, Immunological dysfunction persists for 8 months following initial mild-moderate SARS-CoV-2 infection[14] (Full text) - Pre-print
  • 2021, Clinical characterization of dysautonomia in long COVID-19 patients[15] (Full text)
  • 2021, Persistent Exertional Intolerance after COVID-19: Insights from Invasive Cardiopulmonary Exercise Testing[16] (Full text)
  • 2021, Persistent Endotheliopathy in the Pathogenesis of Long COVID Syndrome[17] (Full text)
  • 2021, Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms[18] (Full text)
  • 2020, Long COVID-19: Challenges in the diagnosis and proposed diagnostic criteria[19] (Full text)
  • 2020, Multi-organ impairment in low-risk individuals with long COVID[20] (Full text) - Pre-print
  • 2020, Living with covid-19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid)[21] (Full text)

News and articles[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ "Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms". Journal of Translational Autoimmunity. 4: 100100. January 1, 2021. doi:10.1016/j.jtauto.2021.100100. ISSN 2589-9090.
  2. ↑ Seeßle, Jessica; Waterboer, Tim; Hippchen, Theresa; Simon, Julia; Kirchner, Marietta; Lim, Adeline; Müller, Barbara; Merle, Uta (July 5, 2021). "Persistent symptoms in adult patients one year after COVID-19: a prospective cohort study". Clinical Infectious Diseases (ciab611). doi:10.1093/cid/ciab611. ISSN 1058-4838.
  3. ↑ Gold, Jeffrey E.; Okyay, Ramazan A.; Licht, Warren E.; Hurley, David J. (2021/6). "Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation". Pathogens. 10 (6): 763. doi:10.3390/pathogens10060763. Check date values in: |date= (help)
  4. ↑ Angelini, Lucia; Bardare, Maria; Martini, Alberto (2002). Immune-mediated Disorders of the Central Nervous System in Children.
  5. ↑ Gebhardt, B. M. (June 26, 2000). "Evidence for antigenic cross-reactivity between herpesvirus and the acetylcholine receptor". Journal of Neuroimmunology. 105 (2): 145–153. ISSN 0165-5728. PMID 10742556.
  6. ↑ Brenner, T.; Timore, Y.; Wirguin, I.; Abramsky, O.; Steinitz, M. (October 1989). "In vitro synthesis of antibodies to acetylcholine receptor by Epstein-Barr virus-stimulated B-lymphocytes derived from patients with myasthenia gravis". Journal of Neuroimmunology. 24 (3): 217–222. ISSN 0165-5728. PMID 2553772.
  7. ↑ Kaminski, Henry J.; Janos, Minarovits. "Epstein-barr virus: Trigger for autoimmunity?". Annals of Neurology. ISSN 0364-5134.
  8. ↑ Singh, Inderjit; Joseph, Phillip; Heerdt, Paul M.; Cullinan, Marjorie; Lutchmansingh, Denyse D.; Gulati, Mridu; Possick, Jennifer D.; Systrom, David M.; Waxman, Aaron B. (August 10, 2021). "Persistent Exertional Intolerance after COVID-19: Insights from Invasive Cardiopulmonary Exercise Testing". CHEST. 0 (0). doi:10.1016/j.chest.2021.08.010. ISSN 0012-3692.
  9. ↑ https://link.springer.com/article/10.1007/s00259-021-05215-4
  10. ↑ https://link.springer.com/article/10.1007%2Fs12026-021-09185-5
  11. ↑ https://bjo.bmj.com/content/early/2021/07/08/bjophthalmol-2021-319450
  12. ↑ https://gut.bmj.com/content/70/4/698
  13. ↑ https://www.medrxiv.org/content/10.1101/2021.05.21.21257578v2
  14. ↑ https://www.medrxiv.org/content/10.1101/2021.06.01.21257759v1
  15. ↑ https://www.nature.com/articles/s41598-021-93546-5
  16. ↑ https://journal.chestnet.org/article/S0012-3692(21)03635-7/fulltext
  17. ↑ https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.15490
  18. ↑ Proal, Amy D.; VanElzakker, Michael B. (2021). "Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms". Frontiers in Microbiology. doi:10.3389/fmicb.2021.698169. ISSN 1664-302X. PMC 8260991. PMID 34248921.
  19. ↑ Raveendran, A.V. (2021). "Long COVID-19: Challenges in the diagnosis and proposed diagnostic criteria". Diabetes & Metabolic Syndrome. 15 (1): 145–146. doi:10.1016/j.dsx.2020.12.025. ISSN 1871-4021. PMC 7737559. PMID 33341598.
  20. ↑ Dennis, Andrea; Wamil, Malgorzata; Kapur, Sandeep; Alberts, Johann; Badley, Andrew D.; Decker, Gustav Anton; Rizza, Stacey A.; Banerjee, Rajarshi; Banerjee, Amitava (October 16, 2020). "Multi-organ impairment in low-risk individuals with long COVID". medRxiv: 2020.10.14.20212555. doi:10.1101/2020.10.14.20212555.
  21. ↑ NIHR (October 2020). "Living with covid-19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid)". evidence.nihr.ac.uk. doi:10.3310/themedreview_41169. Retrieved October 15, 2020.

autoantibody An antibody that works against the body's own antigens, a hallmark of autoimmune diseases. Autoantibodies are the opposite of an antibodies.

antinuclear antibodies (ANA) - "A circulating group of autoantibodies that are produced by the body when the immune system mistakenly recognizes normal components of its own cell nucleus as foreign."

antinuclear antibodies (ANA) - "A circulating group of autoantibodies that are produced by the body when the immune system mistakenly recognizes normal components of its own cell nucleus as foreign."

autoantibody An antibody that works against the body's own antigens, a hallmark of autoimmune diseases. Autoantibodies are the opposite of an antibodies.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

microbiome The full collection of microscopic organisms (especially bacteria and fungi) which are present in a particular environment, particularly inside the human body.

dysautonomia disorders of the autonomic nervous system that cause disturbances in all or some autonomic functions, may cause problems regulating autonomic functions, including heart rate, blood pressure, body temperature, and digestion. Can cause symptoms including lightheadedness, fainting, unstable blood pressure, and orthostatic intolerance.

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