New clues about who will develop the long Covid

crisis. Unhealthy gut bacteria. Presence of autoantibodies, which are commonly associated with autoimmune diseases.

These are among the risk factors identified in new studies as potentially making a person more susceptible to infection covid long, a condition in which widespread symptoms such as fatigue, brain fog and rapid heartbeat persist months after the initial infection with Covid-19.

Studies help advance scientists’ understanding of The biology behind the long Covid disease, provide evidence of Possible treatments. Patients with autoantibodies, for example, may get relief from current treatments for lupus, an autoimmune disease.

The variety of reasons why one person may prolong COVID-19, while others may not bolster the growing belief of scientists There will be no single cause or cure for the situation.

“This is really important because we really didn’t understand the exact biological risk factors for long-term Covid,” says Linda Jing, co-director of the Stanford Post-Act Covid-19 Clinic, who was not involved in any of the studies.

In a study published in the journal Cell, Scientists have identified four risk factors, which scientists tested based on the patient’s initial diagnosis. Most prevalent has been the presence of some autoantibodies, which are antibodies that mistakenly attack the body in autoimmune conditions such as lupus. The researchers found autoantibodies in about 60% of patients who developed long-term COVID-19.

Most patients have not been diagnosed with an autoimmune disease, but have very low levels of autoantibodies associated with various autoimmune diseases, says Jim Heath, senior study author and president and professor of the Institute for Systems Biology, a nonprofit biomedical research organization in Seattle.

was the second risk factor Epstein-Barr virus activation. Epstein-Barr is what causes mononucleosis and affects about 90% of people. Usually, the virus remains dormant after that. The study found that it was reactivated in some people who later developed long-term Covid.

“Your immune system will probably do a reasonable job of keeping EBV in check, and with SARS-CoV-2 infection you lose those brakes,” Dr. Heath says. “It seems to happen very early in the injury.”

Two other risk factors are type 2 diabetes and the discovery of SARS-CoV-2 genetic material in the blood, which means the virus escaped from the lungs and spread to other parts of the body.

Researchers collected and analyzed blood samples and swabs from more than 200 Covid-19 patients for two to three months after infection. The majority of patients were hospitalized with Covid, but tests were repeated on a separate group of about 100 patients with mostly mild Covid-19 infections. Tests were also conducted on about 460 healthy people in a control group.

Have you or someone you know battled Covid for a long time? Join the conversation below and share your experience.

The researchers hope to use their findings to determine Possible treatment options To prevent covid long. For example, people with the virus in their blood can be treated with one of the new antiviral drugs for Covid.

The researchers also found that some long-term Covid patients had very depleted levels of the hormone cortisol, which led to Addison’s disease, which has symptoms such as fatigue and muscle aches. Addison’s patients are often treated with cortisol replacement therapy.

The finding is important because doctors can test and treat the problem with current treatments, says Claire Steves, a geriatrician and clinical academic at King’s College London, who also studies long-time risk factors for Covid.

The cell study has been doing well, said Timothy Henrich, an assistant professor of medicine at the University of California at San Francisco who has also been studying Covid patients for a long time. But he noted that he examined patients only two to three months after the initial infection.

In a separate new study in Nature Communications, Researchers from Switzerland found five different factors The ones they concluded will help predict who will develop the long Covid.

Most notable: the low levels of two types of immunoglobulins, IgM and IgG3, which are two types of antibodies, says Onur Boyman, senior study author and professor and chair of clinical immunology and allergology at the University of Zurich.

Other indications included advanced age, history of asthma, symptoms of fever, fatigue, cough, difficulty breathing and gastrointestinal problems during acute Covid-19 infection. People who have developed prolonged illness Covid-19 experienced an average of three of these symptoms during the initial infection.

The researchers looked at 175 patients with Covid-19 and compared the results to about 40 healthy controls. They confirmed the findings in a separate group of 395 Covid-19 patients. Some people have all the risk factors while others have fewer, says Dr. Boyman.

The goal, says Dr. Boyman, is to find indicators in the body that are easy to test. He says the immunoglobulins they identified are fairly stable, and have nothing to do with SARS-CoV-2 infection.

A large number of Covid-19 patients develop symptoms long after the initial infection. The Wall Street Journal asked four patients to share their stories about the impact of the ongoing effects on their lives.

In the third study, published in the journal Gott, researchers in Hong Kong Analyze the gut microbiome of more than 100 Covid-19 patients at the time of the initial infection, one month later, and again six months later. They compared the results to a control group of 68 healthy people.

The gut microbiome is the bacteria and other microorganisms that live in the digestive system. The researchers found that Covid-19 patients with healthy gut bacteria were less likely to have had Covid for a long time and had a similar microbiome to people in the healthy control group. Patients who continued to develop Covid for a long time had a less diverse and abundant microbiome.

“It’s an interesting hypothesis that the gut microbiome may be involved in the prolonged Covid process,” said Dr. Steves, who was not involved in the study. She noted that in general when people get sick their microbiome changes, so more data is needed to see if changing the gut microbiome might work as a treatment.

Stephen Dix, MD, a professor of medicine at the University of California, San Francisco, who was not involved in the studies and heads a separate department, says that although results in all studies are promising, they need to be further tested in larger groups of people. A study on the long-term Covid disease.

“When you study a million things in a small number of people, you find a lot of things and not all of them are real,” says Dr. Dix.

write to sumathi reddy in sumathi.reddy@wsj.com

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