The Lawson Health Research Institute and Western University teams have made great strides in understanding COVID-19 through two studies published in this week’s critical care study, including finding ways to predict patient illness.
To One studyThe team identified six molecules that could be used as biomarkers to predict patient severity. In Other studies, The team are the first to unveil new mechanisms that cause blood clots in COVID-19 patients and potential ways to treat them.
The study was conducted at the London Health Science Center (LHSC) by analyzing blood samples from critically ill patients. Based on the team’s growing body of work for the first time in the world, they identify six molecules that could act as potential targets for treating hyperinflammation in critically ill patients We have profiled the immune response of the body.
“We’ve begun to answer some of the biggest questions from clinicians and health researchers about COVID-19,” says Douglas Fraser, a senior researcher at Schulich School of Medicine & Dentistry at Lawson and Western, and a critical care physician at LHSC. Said the doctor. “While findings need to be validated in a larger patient group, they can have important implications for treatment and research for this disease.”
Many COVID-19 patients admitted to the intensive care unit (ICU) cannot survive because of lack of proven treatment.
Being able to predict the severity of a patient’s illness will allow health care teams to mobilize resources more quickly and, if the patient is known to be at higher risk of death, will be able to intervene faster, despite the associated risks. You can consider doing. Knowledge also allows the medical team to have important conversations with family members and can set goals of care based on the patient’s health and personal aspirations.
“When a patient is admitted to the ICU, we usually wait until we see if the patient gets worse before considering an at-risk intervention. Improving outcomes is not limited to new treatments, but also to prognosis and We also need a way to predict which patients will get worse,” Fraser explains.
The researchers identified six important molecules and found that these molecules were elevated in more severe COVID-19 patients. They found that when measured on the first day of ICU admission for COVID-19 patients, the molecule could be used to predict patients who will survive after standard ICU treatment.
“While further research is needed, we are confident in these biomarkers and suspect that these patterns may exist even before ICU admission, such as when the patient first came to the emergency department. “These findings can be very important in determining how severe a patient will be.”
The team measured 1,161 plasma proteins from the blood of 30 participants. There are 10 COVID-19 patients, 10 patients with other infections admitted to the ICU, and 10 healthy control participants. Blood was drawn on the set day of ICU admission, processed in the laboratory, and then analyzed using statistical methods and artificial intelligence.
The team also hopes that these findings can be used to better design COVID-19 clinical trials by grouping patients based on risk. This may have stronger results when considering potential treatments for the disease.
Dr. Douglas Fraser, Principal Investigator at Schulich School of Medicine and Dentistry at Lawson and Western, and critical care physician at LHSC.
The second study helps to understand how blood clots clot in small blood vessels in the lungs. It is a major complication in the most critically ill COVID-19 patients leading to low oxygen levels in the body.
“The reason for this coagulation is unclear. Many clinicians have taken anticoagulant therapies, such as the drug heparin, because it is almost suspected that the coagulation mechanism in our blood is overly affected. I’ve been treated,” Fraser says. “But it revealed a completely different mechanism.”
The team analyzed blood samples from an additional 30 participants and found evidence suggesting that the lining of small blood vessels was damaged and inflamed, creating a comfortable environment for platelets (small blood cells) to attach. did.
They found elevated levels of three molecules (hyaluronic acid, syndecan-1, P-selectin) in COVID-19 patients. The first two molecules are the products of blood vessels that are broken down from small hair-like structures (sugar coatings) lined inside. Their presence suggests that glycocalyx is damaged by its degradation products sent to the bloodstream. The presence of P-selectin is important because this molecule helps attach both platelets and the inner lining of blood vessels to each other.
“Glycocalyx keeps platelets from touching the inner walls of blood vessels and promotes the production of nitric oxide, which plays an important role in preventing platelet adhesion,” Fraser explains. To do. “We believe that the body’s immune response shears these tiny hair-like structures, inflames blood vessels, and produces enzymes that make platelets a comfortable environment for forming blood clots. I will.”
The team suggests two potential therapies for the treatment of blood clots in COVID-19 patients. Platelet inhibitors that prevent platelet adhesion and molecules that protect and restore the lining of blood vessels.
“Exploring these therapies as potential alternatives to anticoagulant therapy may improve patient outcomes,” Fraser said. “Through our combined findings, we want to provide tools to predict which patients will be the most severe and treatments for both hyperinflammation and thrombosis.”
