Because, with the same symptoms, some Covid patients can be treated at home while others develop a clinical picture that requires hospitalization? What distinguishes one from the other, and how is it possible to quickly recognize them in order to adopt the best therapeutic strategy? Trying to answer these questions, a group of rHumanitas investigators identified three new ‘spy’ markers between saliva and blood useful for tracing a predictive identikit of the seriously ill Covid patient.
The study, published in ‘Gastro Hep Advances’, is coordinated by Maria Rescigno, head of the Humanitas Mucosal and Microbiota Immunology Laboratory and professor of general pathology at Humanitas University, who with her team supported Antonio Voza, head of the Emergency Department. aid from Humanitas, and Elena Azzolini, head of the Humanitas vaccination center. The work opens up to the development of new tests. Faced with the tsunami of the first pandemic waves, when thousands of patients poured into the emergency room and there was still little knowledge on the course of the disease – recall from Humanitas – the team of scholars made use of the expertise on the microbiota and mucous membranes to identify new severity markers that worked early. Rescigno and Chiara Pozzi, Humanitas immunologist researcher, focused on the microbiota of saliva and on the set of metabolites, that is, products that derive from a chemical process linked to the digestion or ingestion of food.
“Through a retrospective study – explains Rescigno – we analyzed the saliva and blood of hospitalized patients and those treated at home to find out what distinguished the two groups, comparing the data with those collected from healthy and healed subjects. machine learning approach: our data scientists, led by Riccardo Levi, helped us to eliminate confounding parameters and the age factor, by isolating two metabolites, myoinositol and acetic acid 2 pyrrolidine. These, together with a protein present in the blood (chitinase 3-L1), have been shown to be related to the severity of Covid, therefore to the need for hospitalization or not “.
“The combination of these three parameters of saliva and blood – the authors believe – would describe” in practice “the identikit of the seriously ill patient, and therefore would be able to distinguish Covid patients on the basis of the expectation of their clinical course”. “Subsequently – underlines Rescigno – we have seen that these two metabolites correlate with some groups of bacteria of the salivary microbiota. Those with altered metabolites also have altered bacteria. The result is not surprising: the microbiota plays an important role in infection because – recalls the expert – it prepares the immune system and can have anti-microbial activities. And saliva, where part of the microbiota is located, is one of the places where the virus enters. It is also important to underline that the protein identified in the blood is involved in the regulation of the Ace2 receptor, the receptor of the Sars-CoV-2 virus. This means that, if the protein is already high at the start, the person has more receptors and therefore could ‘let in’ more viruses “.
According to the Humanitas researchers, “the next step could be the development of a diagnostic test not currently available in the analysis laboratories. The methodology based on the analysis of metabolites (metabolomics) is a novelty that is gaining momentum in the diagnostic landscape. A revolution speeded up by Covid-19 – they remark – because during the pandemic it was possible to analyze the data of many patients very quickly “. Rescigno concludes: “The results of this study give us hope. In the future it will be possible to design these analyzes based on salivary tests and blood tests for other dangerous and difficult to predict pathologies, such as sepsis”.
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