Blood test could identify COVID-19 patients at risk of 'cytokine storm' hyperinflammation

Date:
October 14, 2020
Source:
University of Southampton
Summary:
Researchers have identified a blood profile that could help identify
COVID-19 patients at greatest risk of deterioration and direct
them towards trials of specific treatments that could modify their
immune systems' responses.



FULL STORY ========================================================================== Southampton researchers have identified a blood profile that could help identify COVID-19 patients at greatest risk of deterioration and direct
them towards trials of specific treatments that could modify their immune systems' responses.


==========================================================================
A new study jointly led by Professor Tom Wilkinson and Dr Tristan Clark of
the University of Southampton, has shown a blood test for five cytokines
could help predict those at risk of life-threating overstimulation of
immune defences by COVID-19, and potentially tailor their treatment to
tackle this.

'Preventing a cytokine storm' Cytokines are cell signalling molecules
with many associated with inflammation released into the bloodstream
after an infection, helping to drive protective immune responses.

In patients with severe COVID-19, the immune system can overreact leading
to massively increased cytokine levels in the blood -- a 'cytokine
storm'. Instead of helping the body fight the virus, this overreaction
is extremely damaging to the cells and tissues of the body itself and
can be fatal.

Identifying those more prone to this response, and tackling the hyperinflammation could be a key route to reducing the severity of
COVID-19 and deaths.



========================================================================== 'Identifying patients most at risk' The study, published in Respiratory Research, analysed blood samples from 100 COVID-19 positive patients
admitted to University Hospital Southampton NHS Foundation Trust
(UHS) between 20 March and 29 April 2020, during the first phase of
the pandemic.

They found that high levels of cytokines IL-6, IL-8, TNF, IL-1b and IL-33
in the patients' blood on admission were associated with greater chance
of needing intensive care, artificial ventilation and of dying. IL-1b
and IL-33 showed the biggest effect.

This study formed part of the CoV-19POC study -- a trial led by Dr Clark looking at the clinical impact of molecular point-of-care testing in
patients at UHS with suspected COVID-19, including tests that dramatically
cut the time taken to diagnose COVID-19.

Combining this cytokine test with a clinical assessment of the patients' condition could help doctors identify and treat those most at risk of deteriorating.



==========================================================================
Dr Anna Freeman and Dr Hannah Burke, Respiratory Clinical Research Fellows
and joint first authors commented: "This project was a great opportunity
for collaboration within the Faculty of Medicine, using resource from
both the respiratory and infectious diseases teams.

"As early career researchers this study provided us with a valuable
learning opportunity about how to deliver academic impact within
the evolving COVID-19 pandemic." 'Investigating new treatments' Two
treatments for those hospitalised with COVID-19 have been found so far,
with the steroid dexamethasone shown to reduce deaths by up to a third,
in patients needing oxygen. The mechanism for Dexamethasone's protective effects isn't known, but as a non-specific anti-inflammatory it points
to the potential benefit of controlling the inflammatory immune response.

The Southampton team hope that by accurately identifying which cytokines
are driving hyperinflammation in each COVID-19 patient, doctors could
target them (such as with an IL-33 blocker current in UK trials),
yielding the biggest benefits for individual patients- an approach known
as 'precision medicine'.

Professor Tom Wilkinson said: "These findings, from the ongoing COVID
research programme in Southampton, have identified important inflammatory signals which will help steer the development of treatment strategies
for this new disease.

"It is increasingly apparent that COVID is highly heterogeneous. Only
by applying these techniques to stratify the condition will we be able
to target the key mechanisms of disease with the best treatment for that individual." Dr Tristan Clark said: "Our findings suggest that testing
for both COVID-19 and cytokines at the point-of-care is feasible and
in the future may identify infected patients and the most appropriate
treatment for them, in near real- time."

========================================================================== Story Source: Materials provided by University_of_Southampton. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. H. Burke, A. Freeman, D. C. Cellura, B. L. Stuart, N. J. Brendish,
S.

Poole, F. Borca, H. T. T. Phan, N. Sheard,
S. Williams, C. M. Spalluto, K. J. Staples, T. W. Clark,
T. M. A. Wilkinson. Inflammatory phenotyping predicts clinical
outcome in COVID-19. Respiratory Research, 2020; 21 (1) DOI:
10.1186/s12931-020-01511-z ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201014160518.htm

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