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Mechanisms of long COVID and the path toward therapeutics, 2024, Peluso et al

Discussion in 'Long Covid research' started by Nightsong, Sep 25, 2024.

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  1. Nightsong

    Nightsong Senior Member (Voting Rights)

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    585
    Summary
    Long COVID, a type of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) defined by medically unexplained symptoms following infection with SARS-CoV-2, is a newly recognized infection-associated chronic condition that causes disability in some people.

    Substantial progress has been made in defining its epidemiology, biology, and pathophysiology. However, there is no cure for the tens of millions of people believed to be experiencing long COVID, and industry engagement in developing therapeutics has been limited.

    Here, we review the current state of knowledge regarding the biology and pathophysiology of long COVID, focusing on how the proposed mechanisms explain the physiology of the syndrome and how they provide a rationale for the implementation of a broad experimental medicine and clinical trials agenda.

    Progress toward preventing and curing long COVID and other infection-associated chronic conditions will require deep and sustained investment by funders and industry.

    Link | PDF (Cell, open access)
     
    Last edited by a moderator: Sep 26, 2024
    Nightsong, Sep 25, 2024
    #1
    Kitty, Sean, Hutan and 2 others like this.
  2. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    London, UK
    I have read most of it It seems to be a very long list of things that might have been found but so far are inconclusive and probably insignificant. Most of it could have been written before Covid arrived, in the sense that it is just a rehash of popular memes about unexplained illnesses.

    I also disagree with the philosophy that everyone is partly right and it all works in a complex minestrone. In reality some ideas are right and others are wrong. I rather suspect that so far for LC they are all wrong.
     
    Jonathan Edwards, Sep 25, 2024
    #2
    bobbler, Jaybee00, wingate and 11 others like this.
  3. Hutan

    Hutan Moderator Staff Member

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    Location:
    Aotearoa New Zealand
    I do like Figure 1:

    Screen Shot 2024-09-26 at 1.37.53 pm.png

    "Fig. 1 Until the biology is better understood, we favor a framework using post-acute sequelae of SARS-CoV-2 infection (PASC), as an umbrella term comprising post- hospitalization syndromes, new or worsened medical conditions, and unexplained symptoms (long COVID). We use long COVID to refer specifically to unex- plained symptoms. While some biological mechanisms may turn out to overlap, such a framework ensures clarity of case definitions in research studies, limits heterogeneity and misclassification, and maximizes the chances of defining the underlying pathophysiology."
    ​
    The most basic thing to do to bring a bit of clarity to "Long Covid" is separate out all the other stuff that is often folded into it - and yet, so often, that doesn't happen.

    The only issue of course is that a significant subset of "New symptoms not explained by a known medical condition" is actually ME/CFS. Possibly fibromyalgia is another. I'm a bit surprised that Peluso did not acknowledge that in the Figure 1 categorisation.
     
    Hutan, Sep 26, 2024
    #3
    shak8, Nightsong, Kitty and 6 others like this.
  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    London, UK
    I am beginning to wonder if that is right. I am beginning to think that post-viral fatigue with EBV and Covid may be profound but distinct from ME/CFS. Buried within the category there may be a few per cent with ME/CFS but I suspect that most were never going to be ME/CFS and may be clinically different. I was going to open a thread on this and hope to today.

    I have had two bouts of unexplained post-Covid fatigue, which were exhausting, but I don't think I ever had ME/CFS. I remember having 'malaise' in the sense of feeling sweaty, unwell and feeble, after exertion with post-EBV fatigue but I am not sure that was ME/CFS PEM.
     
    Jonathan Edwards, Sep 26, 2024
    #4
    bobbler, shak8, Comet and 4 others like this.
  5. Jaybee00

    Jaybee00 Senior Member (Voting Rights)

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    2,159
    I think Peluso and Al-Aly are dueling to see who can make the longest and useless “Long Covid” review paper.

    This masterwork barely mentions ME/CFS.
     
    Jaybee00, Sep 30, 2024
    #5
    Peter Trewhitt likes this.

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