Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?

Bornstein, Stefan R.; Voit-Bak, Karin; Donate, Timo; Rodionov, Roman N.; Gainetdinov, Raul R.; Tselmin, Sergey; Kanczkowski, Waldemar; Müller, Gregor; Achleitner, Martin; Wang, Jun; Licinio, Júlio; Bauer, Michael; Young, Allan H.; Thuret, Sandrine; Bechmann, Nicole; Straube, Richard

doi:10.1038/s41380-021-01148-4

Cited by 67 publications

(58 citation statements)

References 20 publications

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“…From this point of view, we hypothesize that high cholesterol (and cholesterol ester) in certain VLDL and LDL subclasses (VLDL-4, -5, and LDL-1) favors membrane fusion events critical for viral infection. This would also explain recent successes with lipid apheresis as a treatment for long-COVID syndrome patients (Ärzteblatt DÄG Redaktion Deutsches, 2020; Bornstein et al, 2021).…”

Section: Discussionmentioning

confidence: 96%

Metabolic and Lipidomic Markers Differentiate COVID-19 From Non-Hospitalized and Other Intensive Care Patients

Schmelter

Föh

Mallagaray

et al. 2021

Front. Mol. Biosci.

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Coronavirus disease 2019 (COVID-19) is a viral infection affecting multiple organ systems of great significance for metabolic processes. Thus, there is increasing interest in metabolic and lipoprotein signatures of the disease, and early analyses have demonstrated a metabolic pattern typical for atherosclerotic and hepatic damage in COVID-19 patients. However, it remains unclear whether this is specific for COVID-19 and whether the observed signature is caused by the disease or rather represents an underlying risk factor. To answer this question, we have analyzed 482 serum samples using nuclear magnetic resonance metabolomics, including longitudinally collected samples from 12 COVID-19 and 20 cardiogenic shock intensive care patients, samples from 18 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody-positive individuals, and single time point samples from 58 healthy controls. COVID-19 patients showed a distinct metabolic serum profile, including changes typical for severe dyslipidemia and a deeply altered metabolic status compared with healthy controls. Specifically, very-low-density lipoprotein and intermediate-density lipoprotein particles and associated apolipoprotein B and intermediate-density lipoprotein cholesterol were significantly increased, whereas cholesterol and apolipoprotein A2 were decreased. Moreover, a similarly perturbed profile was apparent when compared with other patients with cardiogenic shock who are in the intensive care unit when looking at a 1-week time course, highlighting close links between COVID-19 and lipid metabolism. The metabolic profile of COVID-19 patients distinguishes those from healthy controls and also from patients with cardiogenic shock. In contrast, anti-SARS-CoV-2 antibody-positive individuals without acute COVID-19 did not show a significantly perturbed metabolic profile compared with age- and sex-matched healthy controls, but SARS-CoV-2 antibody-titers correlated significantly with metabolic parameters, including levels of glycine, ApoA2, and small-sized low- and high-density lipoprotein subfractions. Our data suggest that COVID-19 is associated with dyslipidemia, which is not observed in anti-SARS-CoV-2 antibody-positive individuals who have not developed severe courses of the disease. This suggests that lipoprotein profiles may represent a confounding risk factor for COVID-19 with potential for patient stratification.

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Section: Discussionmentioning

confidence: 96%

Metabolic and Lipidomic Markers Differentiate COVID-19 From Non-Hospitalized and Other Intensive Care Patients

Schmelter

Föh

Mallagaray

et al. 2021

Front. Mol. Biosci.

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“…115 Increasing evidence suggests that autoantibodies, whose concentrations exhibit also sex-specific Personal View differences, 116,117 play a crucial role in the extended multiorgan illness in patients with long COVID. 118,119 Pre-existing asthma, which is more prevalent in women than in men, has been reported to further increase the risk of developing long COVID. 114,120 Further characterisation of predictors for long COVID, such as sex and comorbidities, might help to identify patients at high risk of developing long COVID and allow early intervention to address their individual needs and improve outcomes.…”

Section: Sex-related Predisposition To Long Covidmentioning

confidence: 99%

Sexual dimorphism in COVID-19: potential clinical and public health implications

Bechmann

Barthel

Schedl

et al. 2022

The Lancet Diabetes & Endocrinology

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Current evidence suggests that severity and mortality of COVID-19 is higher in men than in women, whereas women might be at increased risk of COVID-19 reinfection and development of long COVID. Differences between sexes have been observed in other infectious diseases and in the response to vaccines. Sex-specific expression patterns of proteins mediating virus binding and entry, and divergent reactions of the immune and endocrine system, in particular the hypothalamic-pituitary-adrenal axis, in response to acute stress might explain the higher severity of COVID-19 in men. In this Personal View, we discuss how sex hormones, comorbidities, and the sex chromosome complement influence these mechanisms in the context of COVID-19. Due to its role in the severity and progression of SARS-CoV-2 infections, we argue that sexual dimorphism has potential implications for disease treatment, public health measures, and follow-up of patients predisposed to the development of long COVID. We suggest that sex differences could be considered in future pandemic surveillance and treatment of patients with COVID-19 to help to achieve better disease stratification and improved outcomes.

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“…According to the aforementioned definition of substitution versus supplementation, there is at present no scientific rationale for Se supplementation, but substitution is mandatory in case of suspected or diagnosed Se deficiency, both for avoiding health risks (e.g., AID) and for supporting the immune system of an already or not-yet diseased organism. [196] viral infection suppression [187] enhancement [197] cancer suppression [198] enhancement [199] (poly-)trauma suppression [200] enhancement [201] burn injury suppression [202] enhancement [203] smoking suppression [204] enhancement [205] surgery suppression [206] enhancement [207] transplantation suppression [190] enhancement [208] pregnancy suppression [82] enhancement [85] * out of many suitable references, one is chosen for reasons of space and clarity, with an apology to the authors of relevant studies not listed here. Admittedly, this overview is a biased selection intended to motivate and stimulate reflection.…”

Section: Se-deficiency As Potential Trigger Of Autoimmune Diseasementioning

confidence: 99%

Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease

Schomburg

2021

IJMS

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The trace element selenium (Se) is an essential part of the human diet; moreover, increased health risks have been observed with Se deficiency. A sufficiently high Se status is a prerequisite for adequate immune response, and preventable endemic diseases are known from areas with Se deficiency. Biomarkers of Se status decline strongly in pregnancy, severe illness, or COVID-19, reaching critically low concentrations. Notably, these conditions are associated with an increased risk for autoimmune disease (AID). Positive effects on the immune system are observed with Se supplementation in pregnancy, autoimmune thyroid disease, and recovery from severe illness. However, some studies reported null results; the database is small, and randomized trials are sparse. The current need for research on the link between AID and Se deficiency is particularly obvious for rheumatoid arthritis and type 1 diabetes mellitus. Despite these gaps in knowledge, it seems timely to realize that severe Se deficiency may trigger AID in susceptible subjects. Improved dietary choices or supplemental Se are efficient ways to avoid severe Se deficiency, thereby decreasing AID risk and improving disease course. A personalized approach is needed in clinics and during therapy, while population-wide measures should be considered for areas with habitual low Se intake. Finland has been adding Se to its food chain for more than 35 years—a wise and commendable decision, according to today’s knowledge. It is unfortunate that the health risks of Se deficiency are often neglected, while possible side effects of Se supplementation are exaggerated, leading to disregard for this safe and promising preventive and adjuvant treatment options. This is especially true in the follow-up situations of pregnancy, severe illness, or COVID-19, where massive Se deficiencies have developed and are associated with AID risk, long-lasting health impairments, and slow recovery.

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Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?

Cited by 67 publications

References 20 publications

Metabolic and Lipidomic Markers Differentiate COVID-19 From Non-Hospitalized and Other Intensive Care Patients

Metabolic and Lipidomic Markers Differentiate COVID-19 From Non-Hospitalized and Other Intensive Care Patients

Sexual dimorphism in COVID-19: potential clinical and public health implications

Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease

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