Long COVID: Pathophysiology, current concepts, and future directions

Chrysanthi Skevaki1, Charalampos D Moschopoulos2, Paraskevi C Fragkou3

  • 1Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, University of Marburg, Marburg, Germany; German Center for Lung Research (DZL), University of Giessen, Marburg Lung Center (UGMLC), Giessen, Germany; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland.

Insights

Long COVID, a complex condition following SARS-CoV-2 infection, significantly impacts quality of life and healthcare systems. Understanding its pathophysiology through various mechanisms and biomarkers is crucial for developing effective treatments.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Pathophysiology

Background:

  • Long COVID presents diverse symptoms post-SARS-CoV-2 infection, affecting patient quality of life and straining global healthcare resources.
  • The underlying mechanisms of Long COVID are not fully understood, necessitating further research into its complex nature.

Purpose of the Study:

  • To explore the multifaceted pathophysiology of Long COVID.
  • To highlight ongoing research into potential biomarkers and therapeutic strategies for Long COVID.

Main Methods:

  • Review of proposed hypotheses for Long COVID mechanisms, including viral persistence, immune dysregulation, and autoimmunity.
  • Discussion of active investigations into biomarkers such as inflammatory mediators, immunophenotyping, and multiomics.

Main Results:

  • Several key areas are being investigated for Long COVID's evolution and complexity: SARS-CoV-2 persistence, organ damage, immune system perturbation, autoimmunity, latent virus reactivation, endothelial dysfunction, and microbiome disturbances.
  • Biomarker research is actively exploring inflammatory mediators, immunophenotyping, and multiomics to identify Long COVID endotypes.

Conclusions:

  • A comprehensive understanding of Long COVID's pathophysiology is essential for developing targeted therapeutics.
  • Continued research into biomarkers and mechanisms is critical for advancing Long COVID patient care and management.

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