Short Title: Gut Barrier Disruption in Post-COVID Fatigue
Authors:
Johanna Rohrhofer (ORCID: 0000-0002-2783-2099)1,
Viktoria Wolflehner (ORCID: 0009-0006-8762-0959)1,
Johannes Schweighardt 1, Larissa Koidl (ORCID:
0000-0001-9974-7929)1, Michael Stingl (ORCID:
0009-0004-7220-0658)2, Sonja Zehetmayer (ORCID:
0000-0001-6863-7997)3, Eva Untersmayr (ORCID:
0000-0002-1963-499X)1*
Author’s affiliation:
1 Institute of Pathophysiology and Allergy Research, Center for
Pathophysiology, Infectiology and Immunology, Medical University of
Vienna, 1090 Vienna, Austria
2 Facharztzentrum Votivpark, 1090 Vienna, Austria
3 Institute of Medical Statistics, Center for Medical Statistics,
Informatics and Intelligent Systems, Medical University of Vienna, 1090
Vienna, Austria
*Correspondence: eva.untersmayr@meduniwien.ac.at; Tel.: 0043 1 40400
51100
Abstract :
Background: Post-COVID-Syndrome (PCS) is the term for a
condition with persistent symptoms in a proportion of COVID-19 patient
after asymptomatic, mild or severe disease courses. Numbers vary but the
current estimate is that after COVID-19 approximately 10% develop PCS.
The aim of our study was to evaluate the impact of SARS-CoV-2 infection
on the gastrointestinal (GI) tract and associations with the development
of PCS with fatigue, post-exertional malaise (PEM), orthostatic
dysregulation, autonomous dysregulation and/or neurocognitive
dysregulation.
Methods: By combining medical record data from a prospective
observational study with symptom analysis before, during, and after
SARS-CoV-2 infection, we aimed to identify potential risk factors and
predictive markers for PCS. Additionally, we analyzed blood, saliva, and
stool samples from this well-characterized PCS patient cohort to
biologically validate our findings.
Results: We identified significant associations between
pre-existing GI complaints and the development of PCS Fatigue. PCS
patients showed higher LBP/sCD14 ratios, lower IL-33 levels, and higher
IL-6 levels compared to control groups. Our results highlight the
critical role of the GI tract in PCS development of post-viral Fatigue.
Conclusion: We propose that the viral infection disrupts
pathways related to the innate immune response and GI barrier function,
evidenced by intestinal low-grade inflammation and GI barrier leakage.
Monitoring GI symptoms and markers before, during and after SARS-CoV-2
infection is crucial for identifying predictive clinical phenotypes in
PCS. Understanding the interaction between viral infections, immune
responses, and gut integrity could lead to more effective diagnostic and
treatment strategies, ultimately reducing the burden on PCS patients.
Keywords (5/5): post-COVID syndrome, post-viral fatigue,
gastrointestinal barrier function, immune barrier, predictive phenotypes