8 ms·

Biomarker predicts severity of Covid-19 infection early on

177 points by _Microft 5y ago

ddek 5y ago
As a relative layperson here, this feels retrospectively obvious, no? Per my shallow understanding (I only read the introduction to the paper), the marker hFwe-Lose is expressed by cells that are struggling, thus close to death. It's the precursor for apoptsis. It makes sense to me that COVID affecting lung tissue would cause more apoptsis, thus more hFwe-Lose pushed out either through breath or mucus. Is the 'news' here the discovery of the marker hFwe-Lose?
- wzdd 5y ago
  Per the paper (https://www.embopress.org/doi/full/10.15252/emmm.202013714 https://www.embopress.org/doi/full/10.15252/emmm.202013714) the importance of this finding appears to be the discovery that hFwe-Lose concentration has greater predictive power for patient risk stratification than other methods (which notably include analysis of other biomarkers in addition to things like patient age), at least for patients who will become seriously ill. In other words, working out who is likely to become seriously ill early on is important for physicians to provide the correct level of care; they have a number of tools to perform this asssessment already; the news is that hFwe-Lose concentration seems to be better than the rest at predicting severe outcomes. Personally I don't think it's blindingly obvious that biomarker levels early in the course of a disease should be so very highly predictive of patient outcomes late in the course of a disease, but I am also a layperson.
- radus 5y ago
  There are a lot of biomarkers expressed by “struggling” cells, most of which will not correlate to disease severity, so yes, the news is that this one in particular is predictive.
bborud 5y ago
Is there a service where you can have relevant parts of your genome sequenced without running the risk of the data being retained and shared against your will?
- f6v 5y ago
  How would you use the data?
  - bborud 5y ago
    Depends on what you are asking about. If you are asking about how I would technically go about looking up things: I have no idea. I don't know what the software space looks like around this. Anyone? If you are asking about the medical context, at least for me in particular, I have a close relationship with the local hospital and access to people who have the knowledge which would make this data useful. (In fact, the same people who advised me to be very careful about sending off my DNA overseas - advice I'm very glad I took)
_Microft 5y ago
"Flower lose, a cell fitness marker, predicts COVID-19 prognosis", by Michail Yekelchyk, Esha Madan, Jochen Wilhelm, Kirsty R Short, António M Palma,…, Rajan Gogna https://www.embopress.org/doi/full/10.15252/emmm.202013714 https://www.embopress.org/doi/full/10.15252/emmm.202013714 (Open Access)
- cblconfederate 5y ago
  Interesting that the biomarker does not interact specifically with SarsCov2, in fact it is a general stress biomarker. Therefore , even though this will be used to prognose higher-risk-patients, it's not clear if one could use it to treat covid by manipulating the marker.
  - Vecr 5y ago
    You can treat it with monoclonal antibodies (or even that and remdesivir, if you are willing to hospitalize the person right away, before they develop inflammatory symptoms), so I'm not sure why you would even want to pursue something like that even if you could.
  - _Microft 5y ago
    Such a test could be used to focus efforts on higher risk patients, e.g. by giving them risk reducing medication like Paxlovid.
    - est31 5y ago
      Yeah this medication is usually not available in large quantities, so you can't give it to everyone. So any type of marker is going to be very helpful to you because you can target it to those whose outcomes you can improve the most with it.
Lucasoato 5y ago
Do you think it would ever be possible to create cheap tests for this kind of cell fitness marker?
- deleted 5y ago
  [deleted]
- _Microft 5y ago
  They used a type of PCR to analyze nasal swabs for their prediction of severity test, so it's not as easy as doing a lateral flow test yet (that's the type of test we use as rapid Covid tests). Maybe it is not much more difficult or expensive than doing the PCR tests that we conduct for Covid though? There seem to be different types of PCR and I know little about that, so take that with a grain of salt. Maybe someone knowledgable can chime in?
  - Pyramus 5y ago
    Not knowledgeable but I do know there was a grad student (post doc?) who created their own PCR test for SARS-Cov-2 in their living room using frozen peas as their cooling medium. Obviously this guy was a specialist with access to the right materials but it goes to show that a lot is possible.
    - _Microft 5y ago
      It's absolutely astonishing how some scientific apparatuses started out. Here is an image of the first atomic force microscope (AFM) for example: https://en.wikipedia.org/wiki/Atomic_force_microscopy#/media/File:Atomic_Force_Microscope_Science_Museum_London.jpg https://en.wikipedia.org/wiki/Atomic_force_microscopy#/media...
      - baq 5y ago
        perfect. also a great example of why commercializing research is so difficult and expensive - to get something from looking like it's barely holding together with duct tape to being a sellable product is no small feat.
protoman3000 5y ago
It appears this provides a way to truly distinguish who should be protected from SARS-Cov-2 infection and who shouldn’t, given a cheap test can be manufactured. The problem then is, that we and the individuals affected know which group they are belonging to. This makes a very alienable experience. Imagine being one of these people, virtually every other person is radioactive to you. What would be the societal and political implications of this? Lockdowns only for people who have this marker? I can imagine people wouldn’t want to make this test as it makes them turn paranoid, could we force people to make this test?
- helge9210 5y ago
  > This makes a very alienable experience. Imagine being one of these people, virtually every other person is radioactive to you. Looks like a psychiatric condition that needs a separate treatment.
  - hdjjhhvvhga 5y ago
    On the contrary - looks like a reasonable reaction to me. You know the risk for you is very high, so you protect yourself better against the infection. The best tool we have is avoiding the infection by increasing physical distance from the aerosols in the air exhaled by others.
    - skocznymroczny 5y ago
      If you're vaccinated and believe in vaccines, it's safer than ever in this pandemic to go out, especially if you avoid indoor areas. I am concerned about some people who haven't really left their homes since March 2020. I know some of such people, and they are really paranoid. They are vaccinated, but even if they are outdoors, they say that "everyone around is spitting on them". It's very unhealthy and the more they stay in isolation, the harder it is for them to convince themselves it's relatively safe to go outside.
      - jonathanstrange 5y ago
pulkitsh1234 5y ago
Is there any research on how the "hFwe-Lose" marker is affected by breathing exercises ? or perhaps vitamin D ?
tremon 5y ago
> They could predict with a probability of around 90 percent that individual patients would later become seriously ill or die from the Covid-19 infection. The prediction of a less severe course was somewhat less precise. That is, in individual cases, a predicted severe course did not become evident. I wonder if this would correlate with date of infection vs date of testing. As in, a high expression of hFwe-Lose in the first N days after infection is a reliable indicator, but if the testing is done at a later stage, the baseline hFwe-Lose expression is higher in all patients and therefore no longer an adequate predictor. I wonder if there is a second biomarker that can provide an indication how long the infection has been progressing, and if they could correlate those two biomarkers? The linked paper (https://news.ycombinator.com/item?id=29263350 https://news.ycombinator.com/item?id=29263350) doesn't seem to mention this at all, perhaps because it's impossible to determine. Looking at the sensitivity-vs-selectivity charts, it may simply be that this biomarker by itself casts too wide a net.
todd3834 5y ago
Last night I was thinking about why some people are fine and others are not. I had a random thought that is probably nonsense but here it is: when I get a cold I noticed that if I sleep on my back the mucous all drips down my throat and I end up with a chest cold too. Once I determined that it could be related I never sleep on my back if I am sick. I have literally not had a cold move to my chest since. I started wondering if anyone had done studies on sleep position with sickness and maybe Covid to see if there is any correlation.
- gwbas1c 5y ago
  That was an early lesson in the pandemic: admitted patients sleeping on their bellies had a higher survival rate.
  - BoiledCabbage 5y ago
    Yes, but for very different reasons. Admitted patients were frequently at the point of difficulty breathing. When lying on your back, gravity makes your lung capacity smaller, when on your stomach, gravity makes it larger. The increased survival was simply due to getting more air at a critical time.
    - feb 5y ago
      When sleeping on your belly, doesn't your back "push" on your lungs? There's then more mass to compress your lungs than when sleeping on your back.
      - shardinator 5y ago
        That would make sense. I wonder if, laying on the stomach is actually freeing the phrenic nerve, allowing the diaphragm to work better, and therefore providing more oxygen.
- marvin 5y ago
  Do you sleep on your stomach, or does it work sleeping on your side too?
rob_c 5y ago
Yey, yet another reason to help people make informed decisions. Ignoring policy for the moment. It would be cool to know in advance if say whooping cough (for example) would hit me hard or not. If the price of detection could be driven down it would be better than having to store or produce expensive vaccines or treatments for people who won't significantly benefit from either. Hope that tech like this actually takes off :)

177 points by _Microft 5y ago

ddek 5y ago

As a relative layperson here, this feels retrospectively obvious, no? Per my shallow understanding (I only read the introduction to the paper), the marker hFwe-Lose is expressed by cells that are struggling, thus close to death. It's the precursor for apoptsis. It makes sense to me that COVID affecting lung tissue would cause more apoptsis, thus more hFwe-Lose pushed out either through breath or mucus. Is the 'news' here the discovery of the marker hFwe-Lose?

wzdd 5y ago
Per the paper (https://www.embopress.org/doi/full/10.15252/emmm.202013714 https://www.embopress.org/doi/full/10.15252/emmm.202013714) the importance of this finding appears to be the discovery that hFwe-Lose concentration has greater predictive power for patient risk stratification than other methods (which notably include analysis of other biomarkers in addition to things like patient age), at least for patients who will become seriously ill. In other words, working out who is likely to become seriously ill early on is important for physicians to provide the correct level of care; they have a number of tools to perform this asssessment already; the news is that hFwe-Lose concentration seems to be better than the rest at predicting severe outcomes. Personally I don't think it's blindingly obvious that biomarker levels early in the course of a disease should be so very highly predictive of patient outcomes late in the course of a disease, but I am also a layperson.
radus 5y ago
There are a lot of biomarkers expressed by “struggling” cells, most of which will not correlate to disease severity, so yes, the news is that this one in particular is predictive.

bborud 5y ago

Is there a service where you can have relevant parts of your genome sequenced without running the risk of the data being retained and shared against your will?

f6v 5y ago
How would you use the data?
- bborud 5y ago
  Depends on what you are asking about. If you are asking about how I would technically go about looking up things: I have no idea. I don't know what the software space looks like around this. Anyone? If you are asking about the medical context, at least for me in particular, I have a close relationship with the local hospital and access to people who have the knowledge which would make this data useful. (In fact, the same people who advised me to be very careful about sending off my DNA overseas - advice I'm very glad I took)

_Microft 5y ago

"Flower lose, a cell fitness marker, predicts COVID-19 prognosis", by Michail Yekelchyk, Esha Madan, Jochen Wilhelm, Kirsty R Short, António M Palma,…, Rajan Gogna https://www.embopress.org/doi/full/10.15252/emmm.202013714 https://www.embopress.org/doi/full/10.15252/emmm.202013714 (Open Access)

cblconfederate 5y ago
Interesting that the biomarker does not interact specifically with SarsCov2, in fact it is a general stress biomarker. Therefore , even though this will be used to prognose higher-risk-patients, it's not clear if one could use it to treat covid by manipulating the marker.
- Vecr 5y ago
  You can treat it with monoclonal antibodies (or even that and remdesivir, if you are willing to hospitalize the person right away, before they develop inflammatory symptoms), so I'm not sure why you would even want to pursue something like that even if you could.
- _Microft 5y ago
  Such a test could be used to focus efforts on higher risk patients, e.g. by giving them risk reducing medication like Paxlovid.
  - est31 5y ago
    Yeah this medication is usually not available in large quantities, so you can't give it to everyone. So any type of marker is going to be very helpful to you because you can target it to those whose outcomes you can improve the most with it.

Lucasoato 5y ago

Do you think it would ever be possible to create cheap tests for this kind of cell fitness marker?

deleted 5y ago
[deleted]
_Microft 5y ago
They used a type of PCR to analyze nasal swabs for their prediction of severity test, so it's not as easy as doing a lateral flow test yet (that's the type of test we use as rapid Covid tests). Maybe it is not much more difficult or expensive than doing the PCR tests that we conduct for Covid though? There seem to be different types of PCR and I know little about that, so take that with a grain of salt. Maybe someone knowledgable can chime in?
- Pyramus 5y ago
  Not knowledgeable but I do know there was a grad student (post doc?) who created their own PCR test for SARS-Cov-2 in their living room using frozen peas as their cooling medium. Obviously this guy was a specialist with access to the right materials but it goes to show that a lot is possible.
  - _Microft 5y ago
    It's absolutely astonishing how some scientific apparatuses started out. Here is an image of the first atomic force microscope (AFM) for example: https://en.wikipedia.org/wiki/Atomic_force_microscopy#/media/File:Atomic_Force_Microscope_Science_Museum_London.jpg https://en.wikipedia.org/wiki/Atomic_force_microscopy#/media...
    - baq 5y ago
      perfect. also a great example of why commercializing research is so difficult and expensive - to get something from looking like it's barely holding together with duct tape to being a sellable product is no small feat.

protoman3000 5y ago

It appears this provides a way to truly distinguish who should be protected from SARS-Cov-2 infection and who shouldn’t, given a cheap test can be manufactured. The problem then is, that we and the individuals affected know which group they are belonging to. This makes a very alienable experience. Imagine being one of these people, virtually every other person is radioactive to you. What would be the societal and political implications of this? Lockdowns only for people who have this marker? I can imagine people wouldn’t want to make this test as it makes them turn paranoid, could we force people to make this test?

helge9210 5y ago
> This makes a very alienable experience. Imagine being one of these people, virtually every other person is radioactive to you. Looks like a psychiatric condition that needs a separate treatment.
- hdjjhhvvhga 5y ago
  On the contrary - looks like a reasonable reaction to me. You know the risk for you is very high, so you protect yourself better against the infection. The best tool we have is avoiding the infection by increasing physical distance from the aerosols in the air exhaled by others.
  - skocznymroczny 5y ago
    If you're vaccinated and believe in vaccines, it's safer than ever in this pandemic to go out, especially if you avoid indoor areas. I am concerned about some people who haven't really left their homes since March 2020. I know some of such people, and they are really paranoid. They are vaccinated, but even if they are outdoors, they say that "everyone around is spitting on them". It's very unhealthy and the more they stay in isolation, the harder it is for them to convince themselves it's relatively safe to go outside.
    - jonathanstrange 5y ago

pulkitsh1234 5y ago

Is there any research on how the "hFwe-Lose" marker is affected by breathing exercises ? or perhaps vitamin D ?

tremon 5y ago

> They could predict with a probability of around 90 percent that individual patients would later become seriously ill or die from the Covid-19 infection. The prediction of a less severe course was somewhat less precise. That is, in individual cases, a predicted severe course did not become evident. I wonder if this would correlate with date of infection vs date of testing. As in, a high expression of hFwe-Lose in the first N days after infection is a reliable indicator, but if the testing is done at a later stage, the baseline hFwe-Lose expression is higher in all patients and therefore no longer an adequate predictor. I wonder if there is a second biomarker that can provide an indication how long the infection has been progressing, and if they could correlate those two biomarkers? The linked paper (https://news.ycombinator.com/item?id=29263350 https://news.ycombinator.com/item?id=29263350) doesn't seem to mention this at all, perhaps because it's impossible to determine. Looking at the sensitivity-vs-selectivity charts, it may simply be that this biomarker by itself casts too wide a net.

todd3834 5y ago

Last night I was thinking about why some people are fine and others are not. I had a random thought that is probably nonsense but here it is: when I get a cold I noticed that if I sleep on my back the mucous all drips down my throat and I end up with a chest cold too. Once I determined that it could be related I never sleep on my back if I am sick. I have literally not had a cold move to my chest since. I started wondering if anyone had done studies on sleep position with sickness and maybe Covid to see if there is any correlation.

gwbas1c 5y ago
That was an early lesson in the pandemic: admitted patients sleeping on their bellies had a higher survival rate.
- BoiledCabbage 5y ago
  Yes, but for very different reasons. Admitted patients were frequently at the point of difficulty breathing. When lying on your back, gravity makes your lung capacity smaller, when on your stomach, gravity makes it larger. The increased survival was simply due to getting more air at a critical time.
  - feb 5y ago
    When sleeping on your belly, doesn't your back "push" on your lungs? There's then more mass to compress your lungs than when sleeping on your back.
    - shardinator 5y ago
      That would make sense. I wonder if, laying on the stomach is actually freeing the phrenic nerve, allowing the diaphragm to work better, and therefore providing more oxygen.
marvin 5y ago
Do you sleep on your stomach, or does it work sleeping on your side too?

rob_c 5y ago

Yey, yet another reason to help people make informed decisions. Ignoring policy for the moment. It would be cool to know in advance if say whooping cough (for example) would hit me hard or not. If the price of detection could be driven down it would be better than having to store or produce expensive vaccines or treatments for people who won't significantly benefit from either. Hope that tech like this actually takes off :)