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Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC)
INTRODUCTION: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. METHODS: We performed a prospective c...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Cold Spring Harbor Laboratory
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872384/ https://www.ncbi.nlm.nih.gov/pubmed/33564789 http://dx.doi.org/10.1101/2021.01.31.21250870 |
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author | Chun, Hyung J. Coutavas, Elias Pine, Alexander Lee, Alfred I. Yu, Vanessa Shallow, Marcus Giovacchini, Coral X. Mathews, Anne Stephenson, Brian Que, Loretta G. Lee, Patty J. Kraft, Bryan D. |
author_facet | Chun, Hyung J. Coutavas, Elias Pine, Alexander Lee, Alfred I. Yu, Vanessa Shallow, Marcus Giovacchini, Coral X. Mathews, Anne Stephenson, Brian Que, Loretta G. Lee, Patty J. Kraft, Bryan D. |
author_sort | Chun, Hyung J. |
collection | PubMed |
description | INTRODUCTION: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. METHODS: We performed a prospective cohort study of subjects with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors. RESULTS: Sixty-one subjects were enrolled across two academic medical centers at a median of 9 weeks (interquartile range 6–10) after COVID-19 illness: n=13 subjects (21%) mild/non-hospitalized, n=30 (49%) hospitalized/non-critical, and n=18 subjects (30%) hospitalized/intensive care (“ICU”). Fifty-three subjects (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P<0.05), but did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID-19 severity. Lipocalin 2 (LCN2), matrix metalloproteinase-7 (MMP-7), and hepatocyte growth factor (HGF) identified by the model were significantly higher in the ICU group (P<0.05) and inversely correlated with FVC and DLCO (P<0.05), and were confirmed in a separate validation cohort (n=53). CONCLUSIONS: Subjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets. FUNDING: The study was funded in part by the NHLBI (K08HL130557 to BDK and R01HL142818 to HJC), the DeLuca Foundation Award (AP), a donation from Jack Levin to the Benign Hematology Program at Yale, and Divisional/Departmental funds from Duke University. |
format | Online Article Text |
id | pubmed-7872384 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cold Spring Harbor Laboratory |
record_format | MEDLINE/PubMed |
spelling | pubmed-78723842021-02-10 Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) Chun, Hyung J. Coutavas, Elias Pine, Alexander Lee, Alfred I. Yu, Vanessa Shallow, Marcus Giovacchini, Coral X. Mathews, Anne Stephenson, Brian Que, Loretta G. Lee, Patty J. Kraft, Bryan D. medRxiv Article INTRODUCTION: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. METHODS: We performed a prospective cohort study of subjects with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors. RESULTS: Sixty-one subjects were enrolled across two academic medical centers at a median of 9 weeks (interquartile range 6–10) after COVID-19 illness: n=13 subjects (21%) mild/non-hospitalized, n=30 (49%) hospitalized/non-critical, and n=18 subjects (30%) hospitalized/intensive care (“ICU”). Fifty-three subjects (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P<0.05), but did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID-19 severity. Lipocalin 2 (LCN2), matrix metalloproteinase-7 (MMP-7), and hepatocyte growth factor (HGF) identified by the model were significantly higher in the ICU group (P<0.05) and inversely correlated with FVC and DLCO (P<0.05), and were confirmed in a separate validation cohort (n=53). CONCLUSIONS: Subjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets. FUNDING: The study was funded in part by the NHLBI (K08HL130557 to BDK and R01HL142818 to HJC), the DeLuca Foundation Award (AP), a donation from Jack Levin to the Benign Hematology Program at Yale, and Divisional/Departmental funds from Duke University. Cold Spring Harbor Laboratory 2021-04-21 /pmc/articles/PMC7872384/ /pubmed/33564789 http://dx.doi.org/10.1101/2021.01.31.21250870 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator. |
spellingShingle | Article Chun, Hyung J. Coutavas, Elias Pine, Alexander Lee, Alfred I. Yu, Vanessa Shallow, Marcus Giovacchini, Coral X. Mathews, Anne Stephenson, Brian Que, Loretta G. Lee, Patty J. Kraft, Bryan D. Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title | Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title_full | Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title_fullStr | Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title_full_unstemmed | Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title_short | Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC) |
title_sort | immuno-fibrotic drivers of impaired lung function in post-acute sequelae of sars-cov-2 infection (pasc) |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872384/ https://www.ncbi.nlm.nih.gov/pubmed/33564789 http://dx.doi.org/10.1101/2021.01.31.21250870 |
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