Possible long COVID biomarker: identification of SARC-CoV-2 related protein(s) in Serum Extracellular Vesicles, 2025, Abbasi et al

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Possible long COVID biomarker: identification of SARC-CoV-2 related protein(s) in Serum Extracellular Vesicles

Asghar Abbasi, Ritin Sharma, Nathaniel Hansen, Patrick Pirrotte & William W. Stringer

[Snippets from correspondence with no abstract, bolding added]


Blood samples were collected from 14 adults (aged ≥ 18 years) with a documented history of SARS-CoV-2 infection (confirmed via PCR or patient report) and persistent long COVID symptoms proposed by CDC and WHO (> 12 weeks since initial SARS-CoV-2 infection) including fatigue, dyspnea, exercise intolerance, or post-exertional malaise (PEM). The cohort was demographically and clinically diverse, including 43% women and 43% Hispanic/Latino participants. The majority (79%) were not hospitalized during their initial infection, and only one participant was unvaccinated at the time of study entry. Obesity was common (mean BMI 32.5 ± 8.4), and baseline physical activity levels were predominantly sedentary or limited to walking. The mean duration between initial SARS-CoV-2 infection and study enrollment was 17 ± 10 months. For further details about methods, see our previous publication [7].

Blood samples were collected from individuals with long COVID in response to an acute exercise test (both at rest and peak exercise), before (visit 2) and after (visit 24) completing an exercise training program.

Sequence analysis (pBLAST) confirmed that these peptides were specific to SARS-CoV-2 and did not overlap with human proteins. Importantly, each subject exhibited one or more SARS-CoV-2 peptides in their EV cargo, suggesting the persistence of viral components over time (Fig. 1B). Pp1ab is encoded by the ORF1ab gene and plays a crucial role in viral RNA transcription and replication.

To assess whether the peptides identified in long COVID EVs were also present in individuals without COVID-19 exposure (control group), we analyzed 20 serum EV samples collected prior to the COVID-19 pandemic (before 2019). These EV samples, obtained at rest and at peak incremental exercise from ex-smokers, showed no detectable viral peptide in any of the pre-pandemic specimens.

Overall, our targeted analysis confirmed the presence of the Pp1ab peptide in at least one sample in all long COVID subjects, while absent in controls.

Web | PDF | Infection | Open Access
 
I was probably being too hard on them. It is definitely necessary to verify these are SARS-CoV-2 peptides. And maybe they do plan on comparing to recovered controls. This is only a correspondence, not a full paper, so maybe they just wanted to get their initial results out quickly in case others want to look at EVs themselves.
 

News Release 11-Aug-2025

Researchers identify a potential biomarker for long COVID​

Extracellular vesicles in study participants contain SARS-CoV-2 peptides

Peer-Reviewed Publication
The Translational Genomics Research Institute


PHOENIX, Ariz. (August 11, 2025) — Researchers from the Translational Genomics Research Institute (TGen), part of City of Hope, and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center have identified a potential biomarker for long COVID.

If the findings of their study are confirmed by other research centers, the biomarker could be the first specific and quantifiable indicator for confirming long COVID. Currently, clinicians confer a diagnosis of long COVID based upon a collection of symptoms that patients develop after SARS-CoV-2 infection.

“If a patient arrives in clinic and they relate the persistence of typical signs and symptoms of long COVID, 12 weeks or more after COVID -19 infection, I give them a presumptive diagnosis, but I don’t have any blood tests or biomarkers to confirm this diagnosis,” said William Stringer, M.D., a Lundquist Institute investigator and senior author on the study.

The study results, reported in the journal Infection, detail the detection of SARS-CoV-2 protein fragments within extracellular vesicles (EVs) — tiny, naturally occurring packages that help cells share proteins, metabolites, and other materials. The researchers collected and analyzed blood samples from 14 patients over 12 weeks of aerobic exercise training (56 samples in all) in a clinical trial led by Stringer in long COVID.

The researchers found 65 distinct protein fragments from SARS-CoV-2 inside the EVs. These fragments come from the virus’s Pp1ab protein, an RNA Replicase enzyme which is key to how the virus copies itself and makes other viral particles. This protein is found uniquely in SARS-CoV-2, and not in uninfected human cells, noted Asghar Abbasi, Ph.D., a Lundquist Institute investigator and first author of the study.

Significantly, the researchers found that these viral peptides were demonstrated in each subject, but not each blood draw, in the EVs of Long COVID patients and were not detected in a separate control group of pre-pandemic EV samples.

These findings add to growing evidence that suggests that SARS-CoV-2 may persist in certain body tissues long after the initial infection. Some groups hypothesize these lingering viral reservoirs could play a role in Long COVID. How the virus reaches tissues without its usual entry points—such as the brain—remains an open question, and may be related to EV particles.

“We thought that maybe if the virus is circulating or moving in the body, we should try to see if EVs are carrying those viral fragments,” Abbasi explained.

This idea became part of an ongoing clinical trial led by Drs. Abbasi and Stringer, which was already studying EVs to see if they are linked to changes in immune function related to exercise and post-exertional malaise, a common symptom in these patients.

“While promising, the molecular signal of the viral peptides within the study samples was observed to be subtle and not consistently detected at every blood collection time point,” said Patrick Pirrotte, Ph.D., associate professor at TGen, director of the Integrated Mass Spectrometry Shared Resource at TGen and City of Hope, and co-senior author of the study. “There’s still a lot to unpack that we don’t know at this point.”

For instance, he added, the researchers don’t know if the exercise itself drives the expression of viral programs intracellularly, and then those viral programs result in proteins that are going to be shed, or if there is a permanent reservoir in those cells, and it’s just a matter of detecting it at a certain time point. Although the identified peptides originated from one of the virus’ largest proteins, the researchers did not detect other comparably large proteins indicative of active viral replication. It’s possible that the peptides contained in the EVs are just molecular “trash” leftover after the formation of new viral proteins.

“We haven’t run [our tests] on people without long COVID symptoms who are currently, or who were, infected with COVID,” said Stringer. “This raises the question: is this just continuing to take out the trash from the COVID infected cell or is this really ongoing replication someplace? I think that’s the mechanistic issue that needs to be resolved in future studies.”

The Pulmonary Education and Research Foundation (PERF) and the UCLA David Geffen School of Medicine (DGSoM)-Ventura County Community Foundation (VCCF) funded this research.


Journal​

Infection

DOI​

10.1007/s15010-025-02612-x

Method of Research​

Randomized controlled/clinical trial

Subject of Research​

People

Article Title​

Possible long COVID biomarker: identification of SARC-CoV-2 related protein(s) in Serum Extracellular Vesicles

Article Publication Date​

21-Jul-2025

COI Statement​

Declarations. Conflict of interest: Asghar Abbasi is supported by TRDRP (28FT-0017), NIH (R43HL167289, 2R44HL167289-02), and the Johnny Carson Foundation. William Stringer receives research foundation support from the Pulmonary Education and Research Foundation and the UCLA David Geffen School of Medicine (DGSoM)-Ventura County Community Foundation (VCCF) Long COVID 19 Research Award. He reports consulting fees from Verona, Genetech, and Vyaire. He is the co-author of a clinical exercise testing physiology textbook for Lippincott.

 
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