A blood gene pattern linked to an increased chance of dying from a severe lung illness can also predict poor outcomes in COVID-19 patients, according to multicenter retrospective research headed by the South Florida Health University. The risk profile based on 50 genes might help tailor COVID-19 treatment, optimize the allocation of scarce healthcare resources like critical care beds and ventilators, and perhaps save lives.
For COVID-19 Individuals, A Gene Profile In Their Blood Indicates A Bad Prognosis And Mortality
Idiopathic pulmonary fibrosis (IPF), an unknown source of disease, damages the lung interstitium, or the area between the lung sacs and the bloodstream, causing severe lung scarring. Significant COVID-19 can potentially cause severe lung scarring by damaging the lung interstitium.
According to principal investigator Jose Herazo-Maya, MD, an associate professor and associate chief of pulmonary, critical care, and sleep medicine at the USF Health Morsani College of Medicine, their study recognized at the molecular position a gene risk profile that foresee worse COVID-19 outcomes before the patient becomes severely ill. That means that every COVID-19 patient may be given a blood test to determine whether they are at high or low risk of dying. And, if doctors know who is likely to end up in the ICU and who will likely recover well at home with adequate monitoring, they may customize their interventions to sole patients on the basis of their of risk.
The USF Health study was published online on June 20 in EBioMedicine, a journal of THE LANCET. Dr. Herazo-Maya and colleagues from Yale School of Medicine had previously conducted genetic studies. In 2017, they lead a multinational team that investigated and verified a gene expression profile in the blood that predicts the risk of IPF death with high accuracy. Certain individuals with lung scarring can live well for years, but others experience increasing illness and succumb to IPF soon.
The core issue they faced as the COVID-19 pandemic evolved was whether they could repurpose the gene signature known to predict mortality in fibrotic lung illness to predict death in people infected with a novel coronavirus that may also induce lung fibrosis. Brenda Juan-Guardela, MD, assistant professor of medicine at the USF Health Morsani College of Medicine and medical director of Respiratory Care Services at Tampa General Hospital, is the primary author of the EBioMedicine study (TGH). This is the initial research, to the best of their understanding, to examine overlapping immune gene profiles in COVID-19 and IPF, which were surprisingly comparable.
In three COVID-19 cohorts and two IPF cohorts, the team lead by USF Health examined gene expression patterns of 50 genes known to predict IPF mortality. In all five cohorts, the researchers utilized a molecular scoring method to discriminate between high-risk and low-risk gene profiles.
Dr. Herazo-Maya at TGH treats previously hospitalized COVID-19 patients who present to the Center for Advanced Lung Disease with significant lung fibrosis; some are being considered for lung transplantation. Even though coronavirus cases are decreasing, he cautioned that not all patients will recover without problems. The harmful, long-term consequences of COVID-19 are beginning to be shown in the lungs of some COVID-19 survivors.
While additional study is needed, Dr. Herazo-Maya believes that researchers and doctors will soon be able to use the gene risk profiles to assist enhance the management of COVID-19 and IPF patients. His group is presently working on a blood test based on these genes that may be used in clinical practice to predict bad illness outcomes.
Aside from outcome prediction, identifying 50-gene risk profiles may have substantial therapeutic promise. A 10-day treatment of the immunosuppressive steroid dexamethasone, for example, has been found to improve survival in individuals hospitalized with COVID-19.
Immunosuppressive medications have largely been abandoned for IPF therapy since they increase mortality when given in high dosages and combination for lengthy periods, according to Dr. Herazo-Maya. However, utilizing the precision or customized medicine approach, they might examine the use of dexamethasone or comparable steroid therapy for a short length of time in a subgroup of IPF patients with a 50-gene high-risk profile.
The 50-gene high-risk profile may further support the justification for further research into the use of tailored IPF antifibrotic medicines, which decrease the pace of lung scarring, to avoid COVID-19-related acute and long-term consequences, he noted.