Common coronavirus may prime immune system to develop long COVID

COVID-19
Woman blowing nose

Inside Creative House / iStock

Previous infection with an endemic coronavirus that causes the common cold may predispose COVID-19 patients with rheumatic disease to persistent symptoms, a Brigham and Women's Hospital-led study suggests.

Published yesterday in Science Translational Medicine, the study involved serologic testing for antibodies against SARS-CoV-2, a panel of endemic pathogens, and a panel of routine vaccine antigens in two groups of patients with pre-existing systemic autoimmune rheumatic disease (SARD) who either did or didn't develop long COVID, or post-acute sequelae of COVID-19 (PASC).

The team first analyzed a discovery cohort recruited before December 13, 2021, to identify potential antibody profiles tied to long COVID, then replicated the results in a validation cohort recruited from December 14, 2021, to September 16, 2022. 

SARD patients, who have illnesses such as rheumatoid arthritis or other inflammatory autoimmune diseases, are at increased risk for severe COVID-19.

Partial COVID immunity, control, clearance

Up to 45% of SARD patients experienced long COVID 28 days after infection. The researchers observed that long-COVID patients had weaker Fcγ receptor (FcγR)-binding anti–SARS-CoV-2 antibodies and stronger Fcγ receptor (FcγR)-binding pro-inflammatory antibody responses against the endemic coronavirus OC43 linked to cross-reactivity against SARS-CoV-2 and common coronaviruses.

"Rather than identifying an autoimmune marker of PASC, these results from two independent cohorts point to immunological imprinting by human endemic coronaviruses in patients with SARDs and PASC that may result in the generation of incomplete SARS-CoV-2 immunity, control, and clearance," the study authors wrote.

We know that, in the setting of influenza, previous exposure to a viral strain can influence a person's immune response to subsequent strains.

Galit Alter, PhD

In a Mass General Brigham news release, co-corresponding author Zachary Wallace, MD, of Massachusetts General Hospital, said, "Our study offers evidence and explanation for why some of our patients may be experiencing the persistent and wide-ranging symptoms of long COVID. Identifying a biomarker that helps us better understand current and previous infections could shed light on an inappropriate immune response that leads to some cases of long COVID."

Co-corresponding author Galit Alter, PhD, of Moderna Therapeutics, said that a first exposure to a virus can shape lifelong immunity. "We know that, in the setting of influenza, previous exposure to a viral strain can influence a person's immune response to subsequent strains," she said. "This concept—which we call 'original antigenic sin,' may be at play for coronaviruses, too, and may influence risk of long COVID, especially among individuals with rheumatic disease."

The authors called for further research into whether the results could be applied to long-COVID patients who don't have pre-existing autoimmune disease. "By starting with patients with rheumatic diseases, we may be able to develop biomarkers that help us understand who is at high risk for developing long COVID and strategically enroll individuals into clinical trials to either prevent long COVID or develop therapies to treat it," Wallace said.

This week's top reads

  1. 1 in 5 US retail milk samples test positive for H5N1 avian flu fragments

    The highest concentrations were in regions where the virus has been found in dairy herds.

    Lisa Schnirring
    grocery store milk

  2. Risk of uveitis recurrence higher in year after COVID vaccination

    The odds of the condition were increased among recipients of all 4 vaccines studied: Pfizer, Moderna, AstraZeneca, and J&J.

    Mary Van Beusekom

  3. USDA shares recent H5N1 avian flu sequences amid more dairy herd outbreaks

    In other developments, antiviral susceptibility testing shows that H5N1 is susceptible to neuraminidase inhibitor antiviral drugs.

    Lisa Schnirring
    woman in milking parlor

  4. Tazewell County, Virginia reports first CWD case

    The Virginia Department of Wildlife Resources confirmed the fatal prion disease in a buck harvested by a hunter in November 2023.

    Mary Van Beusekom

  5. Scientists find clues in early analysis of newly shared US H5N1 avian flu sequences

    Experts, with incomplete data, are quickly piecing together everything they can from the shared genetic sequences.

    Lisa Schnirring
    H5N1 particles

  6. H5N1 avian flu infects Colorado dairy cows as global experts weigh in on virus changes

    Global health groups say evolving developments, including a novel reassortant in Asia and increasing detections in mammals, require real-time monitoring.

    Lisa Schnirring
    dairy cow ear tags

  7. COVID may have eroded doctors' belief that they are obligated to treat infectious patients

    Reasons cited for accepting the option of refusing treatment included unreasonable risk to physicians and their families and labor rights and worker protection.

    Mary Van Beusekom
    Exhausted healthcare worker wearing N95

  8. US orders testing for certain dairy cows after H5N1 avian flu remnants found in retail milk

    The USDA says that lactating dairy cows must be tested before interstate transport.

    Lisa Schnirring
    Cows exiting truck

  9. FDA approves new treatment for uncomplicated urinary tract infections

    Pivya (pivmecillinam) is the first antibiotic approved by the FDA for uncomplicated UTIs in more than 2 decades.

    Chris Dall
    Treatment for urinary tract infections

  10. State COVID policies didn't translate into fewer cases, deaths, study suggests

    The researchers say that policy effectiveness may depend on policy implementation and compliance.

    Mary Van Beusekom
    Woman in wheelchair in nursing home room