Not all serious cases of SAR-CoV-2 infection are associated with other health problems of those affected.
In fact, very delicate situations have occurred in young people with no previous pathology who have even had to spend days in the intensive care unit.
It was completely inexplicable to both the scientific and medical communities.
But now, an international consortium of researchers (COVID Human Genetic Effort) points in a very specific direction: the antibodies that some people present and that are capable of blocking the body's defense against the coronavirus.
Apparently, this happens to 10% of people with severe pneumonia due to Covid-19, as revealed in a new article that has just been published in the journal 'Science' and in which several
Spanish centers
participate
such as the Can Ruti Campus, the Germans Trias i Pujol and IrsiCaixa Hospital or the Dr. Negrín University Hospital of Gran Canaria.
It is a kind of boycott created by certain immunoglobulins with the mission of besieging and immobilizing a molecule (interferon type 1 -IFN-) whose function is key in the defense of our body against SARS-CoV-2.
After
studying the blood samples of almost 3,000 people from different countries
(987 hospitalized for severe pneumonia due to Covid-19, 663 asymptomatic and 1127 healthy), the authors of the work - led by the National Institute of Health and Medical Research (INSERM) in France and the University of Rockefeller- observed that this happened precisely to 10.2% of hospitalized patients, for which they deduce that these antibodies would be responsible for aborting the functionality of their immune systems.
Three patients with severe coronavirus infection piqued the researchers' curiosity.
They had a previous disease for which we knew that they had antibodies that compromised their own immune system ", says Javier Martínez-Picado, ICREA researcher at IrsiCaixa, David Dalmau." We thought: it may not be isolated cases and that this situation is the trigger for severe symptoms in more people?
And that's why we started looking at whether more patients had these autoantibodies. "
Associated genetic alterations
In parallel, the journal 'Science' also publishes today a very revealing study by the same international group of researchers, in which the Bellvitge Biomedical Research Institute
(IDIBELL) and the Vall d'Hebron Research Institute (VHIR) have also participated. )
from Barcelona.
It turns out that "
3.5% of the population with serious symptoms and without reasons that could explain it present specific genetic mutations
that lead to the inability to generate type 1 interferons that defend us," Pere Soler-Palacín, chief, argues for this newspaper. of the Research Group on Infection in Immunosuppressed Pediatric Patients of the Vall d'Hebron.
Both the boycotting antibodies and the associated genetic alterations would justify why there are patients who develop the infection in a severe way without having other clinical reasons such as hypertension or other comorbidities.
Both explanations have in common a defect in the activity of type I interferons
, which demonstrates "the importance of the role of interferons in the fight against SARS-CoV-2".
In the words of Roger Colobran, researcher at the VHIR Diagnostic Immunology Research Group, "type I interferons are one of the main mechanisms that innate immunity has to fight viral infections".
In fact, during the last 15 years "
mutations in these 13 genes have already been described in specific and exceptionally severe cases of other viral infections such as influenza or herpesvirus encephalitis
. What has surprised us in this study is the high frequency of we have found these alterations in patients with severe COVID-19 ".
In influenza and herpetic encephalitis, the percentage is 1%.
Personalized medicine
Obviously, it is not feasible to carry out genetic studies on the entire population to identify the people most at risk, but both studies open the door to personalized medicine in the most vulnerable patients.
"If we validate the test to determine the antibodies that instead of attacking the virus attack our organism, the process would be simple, cheap and fast. In one day it would be possible to know if the patient has said antibodies and therefore, it could be apply a specific treatment to eliminate them and not aggravate their clinical situation ", argues Soler-Palacín.
A therapeutic option in this profile of affected people would be
plasmapheresis, a technique of "
extracorporeal
blood clearance
indicated in lupus or rheumatoid arthritis, for example," says the Vall d'Hebron specialist.
"There are already clinical trials that in several countries that are using this therapy in Covid patients, that is, it has not yet been proven that it works," but based on these new findings, the idea would be to be able to analyze whether those affected respond to treatment they did or did not have the boycotting antibodies.
"If everything goes well and being prudent with the time that this study requires, we would achieve that of 100 patients, 10 could benefit from plasma exchange and the rest (90) would not have to undergo this therapy" which, in their case, it wouldn't do any good.
In short, a window opens to personalized medicine in Covid patients.
Men more vulnerable
Another of the conclusions drawn from the studies echoed in the latest issue of 'Science' is that of 101 patients with antibodies that act against type I interferons, 95 were men.
"This gender bias suggests the presence of some genetic factor that somehow favors the appearance of this autoimmune phenomenon more in men than in women" and it is also observed that almost half of the patients with these antibodies were over 65 years old.
They were only found in 38% of those under 65, so "it seems that the frequency of these antibodies increases with age, says Soler-Palacín. It is precisely the population that has suffered the most in this pandemic.
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