Department of Medical Microbiology, Lokman Hekim University, Ankara, Turkey.
Eur Rev Med Pharmacol Sci. 2020 Aug;24(16):8606-8620. doi: 10.26355/eurrev_202008_22660.
COVID-19 immune syndrome is a multi-systemic disorder induced by the COVID-19 infection. Pathobiological transitions and clinical stages of the COVID-19 syndrome following the attack of SARS-CoV-2 on the human body have not been fully explored. The aim of this review is to outline the three critical prominent phase regarding the clinicogenomics course of the COVID-19 immune syndrome.
In the clinical setting, the COVID-19 process presents as "asymptomatic/pre-symptomatic phase", "respiratory phase with mild/moderate/severe symptoms" and "multi-systemic clinical syndrome with impaired/disproportionate and/or defective immunity". The corresponding three genomic phases include the "ACE2, ANPEP transcripts in the initial phase", "EGFR and IGF2R transcripts in the propagating phase" and the "immune system related critical gene involvements of the complicating phase".
The separation of the phases is important since the genomic features of each phase are different from each other and these different mechanisms lead to distinct clinical multi-systemic features. Comprehensive genomic profiling with next generation sequencing may play an important role in defining and clarifying these three unique separate phases for COVID-19. From our point of view, it is important to understand these unique phases of the syndrome in order to approach a COVID-19 patient bedside.
This three-phase approach may be useful for future studies which will focus on the clinical management and development of the vaccines and/or specific drugs targeting the COVID-19 processes. ANPEP gene pathway may have a potential for the vaccine development. Regarding the specific disease treatments, MAS agonists, TXA127, Angiotensin (1-7) and soluble ACE2 could have therapeutic potential for the COVID-19 course. Moreover, future CRISPR technology can be utilized for the genomic editing and future management of the clinical course of the syndrome.
COVID-19 免疫综合征是由 COVID-19 感染引起的多系统疾病。SARS-CoV-2 攻击人体后，COVID-19 综合征的病理生物学转变和临床阶段尚未得到充分探索。本综述旨在概述 COVID-19 免疫综合征临床基因组学过程的三个关键突出阶段。
在临床环境中，COVID-19 过程表现为“无症状/前驱期”、“呼吸期有轻度/中度/重度症状”和“多系统临床综合征，免疫受损/失调和/或功能障碍”。相应的三个基因组阶段包括“初始阶段的 ACE2、ANPEP 转录本”、“传播阶段的 EGFR 和 IGF2R 转录本”和“并发症阶段涉及免疫系统相关关键基因”。
各阶段的分离很重要，因为每个阶段的基因组特征彼此不同，这些不同的机制导致不同的临床多系统特征。下一代测序的综合基因组分析可能在定义和阐明 COVID-19 的这三个独特的分离阶段方面发挥重要作用。从我们的角度来看，了解综合征的这些独特阶段对于接近 COVID-19 患者床边很重要。
这种三阶段方法可能对未来的研究有用，这些研究将侧重于 COVID-19 过程的临床管理和疫苗开发和/或针对特定药物的开发。ANPEP 基因途径可能具有疫苗开发的潜力。关于特定疾病的治疗，MAS 激动剂、TXA127、血管紧张素 (1-7) 和可溶性 ACE2 可能对 COVID-19 病程具有治疗潜力。此外，未来的 CRISPR 技术可用于基因组编辑和综合征临床病程的未来管理。
