With the same symptoms, some people with Sars-CoV-2 end up in hospital while others can be treated at home. What distinguishes the two groups and how to identify them quickly to guide doctors ‘ therapeutic choices is the subject of a Humanitas Research, published in Gastro Hep Advances, which describes a new method based on the analysis of saliva and blood.
The coordinator of the study is Professor Maria Rescigno, head of the laboratory of mucosal immunology and microbiota of Humanitas and professor of General Pathology of Humanitas University, who with her team of researchers supported Dr. Antonio Voza, head of the Emergency Department of Humanitas, and Dr. Elena Azzolini, head of the vaccination center of Humanitas.
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Faced with the difficulties of the first pandemic waves, when thousands of patients poured into the emergency room and knowledge about the course of the disease was still few, the Humanitas team of researchers used microbiota and mucosal expertise to identify new markers of severity that worked early. Maria Rescigno and Chiara Pozzi, immunologist researcher at Humanitas, focused on the microbiota of saliva and on the set of metabolites, that is, products that derive from a chemical process related to the digestion or ingestion of food.
Differences in blood and saliva
“Through a retrospective study, we analyzed the saliva and blood of hospitalized patients and those treated at home to look for what distinguished the two groups, comparing the data with those collected from healthy and cured subjects – he explains Rescigno -. A machine learning approach was fundamental: our data scientists, led by Riccardo Levi, helped us eliminate the confounding parameters and the age factor, coming to isolate two metabolites, Myoinositol and acetic acid 2 pyrrolidine. These, along with a protein present in the blood (chitinase 3-L1), have been shown to be related to the severity of Covid, hence the need for hospitalization or not”.
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The combination of these 3 parameters of saliva and blood would describe the identikit of the seriously ill and thus be able to distinguish Covid patients based on the expectation of their clinical course. “Subsequently, we saw that these two metabolites correlate with certain groups of bacteria in the salivary microbiota – continues Rescigno – those who have altered metabolites also have altered bacteria. The result is not surprising: the microbiota has an important role in infection because 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 penetrates. It is also important to emphasize that the protein detected in the blood is involved in the regulation of the ACE2 receptor, the SARS-CoV-2 virus receptor. This means that if the protein is already high at the start, the person has more receptors and therefore could ‘bring in’ more viruses”.
Setting up a test
The next step could therefore be the development of a diagnostic test, which is currently not available in the analysis laboratories. The methodology based on the analysis of metabolites – metabolomics – is a novelty that is emerging in the diagnostic landscape. A revolution accelerated by Covid-19 because during the pandemic it was possible to analyze the data of many patients very quickly. “The results of this study give us hope – concludes Rescigno -. in the future, it will be possible to design these analyzes based on salivary tests and blood tests also for other dangerous and difficult to predict diseases, such as sepsis”.
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