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Researchers Uncover Key Cause of Lung-Related Long COVID at St. Paul’s Hospital

Prime Highlights:

  • St. Paul’s Hospital researchers identified inflammation in the smallest lung airways as an important cause of pulmonary long COVID.
  • With imaging and single-cell sequencing, research points to residual neutrophilic inflammation to explain persistent respiratory symptoms.

Key Facts:

  • Ordinary lung examinations tend to remain normal in cases of long COVID, necessitating sophisticated diagnostic approaches.
  • Hyperpolarized xenon gas MRI is able to detect gas exchange abnormalities in minute airways not picked up on by standard scanning.

Key Background:

Long COVID occurs in approximately 10% of people who have recovered from COVID-19, producing long-lasting symptoms such as tiredness, brain fog, and respiratory symptoms in the form of breathlessness and chronic cough. These long-term effects have a major effect on day-to-day life but are not detected by common diagnosis methods in these patients.

To bypass such diagnostic difficulties, scientists at the Centre for Heart Lung Innovation (HLI) at St. Paul’s Hospital used hyperpolarized xenon gas magnetic resonance imaging (xenon MRI). This technology allows researchers to visualize lung function at the microscopic level by following inhaled xenon gas, which replicates oxygen movement during gas exchange. Working in partnership with top institutions, the researchers compared xenon MRI scans of long COVID patients and determined four different subtypes of pulmonary long COVID, each of which was defined by particular gas exchange impairments in small airways. This finding highlights the limitations of conventional lung tests in the detection of long COVID-related damage.

Additional research included bronchoscopies to obtain lung tissue samples from sick patients. Single-cell RNA sequencing of these samples detected ongoing neutrophilic inflammation—an immune response normally observed during infections. Even after the virus had been cleared, these immune cells were active, leading to continued airway destruction and chronic respiratory symptoms.

These results present a key advance in the understanding of pulmonary long COVID, setting the stage for specific therapies to treat airway inflammation. Through the identification of the underlying cause of ongoing respiratory symptoms, this study holds out hope for better diagnosis and treatment, bringing relief to those afflicted with long-term post-COVID complications.