Researchers unravel two mysteries of COVID-19

The Lawson Health Research Institute and Western University teams have taken an important step in understanding COVID-19 through two consecutive studies published this week. Critical Care Survey.. In one study, the team identified six molecules that could be used as biomarkers to predict patient severity. Another study is the first to reveal new mechanisms that cause blood clots in COVID-19 patients and potential ways to treat them.

Research was done by analysis Blood sample From critically ill patients at the London Health Sciences Center (LHSC). They build on a growing body of work from a team first in the world, profile another six to profile the body’s immune response to the virus molecule It may serve as a potential target for treating hyperinflammation in critically ill patients.

“We’ve begun to answer some of the biggest questions from clinicians and health researchers about COVID-19,” said Dr. Douglas Fraser, a senior researcher at LHSC’s Lawson and Western Schleich School of Medicine and Dentistry, and a critical care physician. Says. “The findings need to be validated in a larger group of patients, but could have important implications for treatment and research for this disease.”

Predict which COVID-19 patients will get worse

Many COVID-19 patients admitted to the intensive care unit (ICU) cannot survive because of lack of proven treatment.

“When patients are admitted to the ICU, we usually wait to see if they will get worse before considering risky interventions. Only new therapies can improve outcomes.” We also need a way to predict the prognosis and which patients progress,” said Fraser.

Researchers have identified six important molecules: CLM-1, IL12RB1, CD83, FAM3B, IGFR1R and OPTC. They found that these molecules were elevated in COVID-19 patients who became more seriously ill. 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 visited the emergency department.” Said Fraser. “These findings can be very important in determining how severe a patient will be.”

The team measured 1,161 plasma proteins blood Of the 30 participants, 10 patients with COVID-19 and 10 patients with other infections admitted to the ICU of LHSC, 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 notes that predicting the severity of a patient’s disease can help in several ways. This allows the medical team to have important conversations with family members and set goals for care based on the patient’s health and personal aspirations. Medical teams can use that knowledge to mobilize resources more quickly. If you know that a patient is at high risk of death, you may consider getting into the intervention earlier, despite the associated risks. The team also hopes that the results 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.

Understand why blood clots occur and how to treat them

The major complication of most severe patients with COVID-19 is the coagulation of small blood vessels in the lungs, which lowers oxygen levels in the body.

“The reason for this coagulation is unknown. In most cases, we suspect that the coagulation mechanism in our blood is excessive, and many clinicians are treating us with anticoagulant therapies such as the drug heparin.” Dr. Fraser says. “But we have 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 that there are two potential treatments for treating thrombosis 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 possible alternatives to anticoagulant therapy may improve patient outcomes,” says Fraser. “Through our combined findings, we want to provide tools to predict which patients will be the most ill and treatment for both hyperinflammation. Blood clot”