Dr. D’Silva
“New York City, where I practice, became the epicenter of COVID-19 by March 2020,” Dr. Haberman says. “We were overwhelmed by messages from patients all asking the same question: What do I do with my medications?”
The answer was unclear, so Dr. Haberman and her colleagues started investigating how COVID-19 was affecting their patients. They noticed these patients were more likely to have severe outcomes from COVID-19 if they were taking corticosteroids, but the same wasn’t true for biologics.
The present study, COVID-19 in Patients with Inflammatory Arthritis: A Prospective Study on the Effects of Immunomodulatory Therapy on Susceptibility and Clinical Outcomes, for which Dr. Haberman won a Scientist Development Award, is intended to give patients and practitioners confidence to make decisions about the medications used in rheumatology—specifically during the COVID-19 pandemic but also in the future, if another novel virus emerges.
Immune Response
The body’s immune response to COVID-19 is similar in some ways to the coagulopathy seen in antiphospholipid syndrome (APS), according to Jason Knight, MD, PhD, University of Michigan, who received an Innovative Research Award for his study, Antiphospholipid Antibodies in COVID-19.
Dr. Haberman
Early in the pandemic, Dr. Knight and his colleagues (including another Foundation-funded investigator, Ray Zuo, MD) used the study techniques from their APS research to identify high levels of neutrophil extracellular traps (NETs) in the blood of patients with COVID-19. In April 2020, this work was published online in JCI Insight and discussed further in Scientific American.1,2
NETs are essentially sticky, web-like remnants of an immune response to infection that, if unregulated, can propagate inflammation and microvascular thrombosis, including in the lungs of patients with acute respiratory distress syndrome (ARDS).
Also in April, Dr. Knight read a report in The New England Journal of Medicine that described antiphospholipid antibodies in three patients with COVID-19.3
Since then, Dr. Knight and his colleagues have been working to clarify how these antibodies change over time and if they persist after patients are released from the hospital. They’ve reported initial results in Science Translational Medicine and the preprint server MedRxiv (which is not peer-reviewed).4,5
In ongoing research, the team is investigating the mechanisms behind antiphospholipid antibodies to see why they form and how they regulate cells and trigger thrombosis.
Dr. Knight hopes the results of his research will effect better outcomes for patients during the pandemic and beyond. He notes that his team’s research into NETs and antiphospholipid antibodies in COVID-19 has already informed the design of several clinical trials.
“I think the pathways we are studying are actually likely to be more universal than has been realized to date. The intersection of autoantibodies, innate immunity, and thrombosis certainly has high relevance to APS, but I think, perhaps, also to other severe disease states, such as sepsis, ARDS, trauma and likely others,” Dr. Knight says. “Only time will tell, and there is still a lot of work to do, but I think we are going to save a lot of lives in the future based on all the hell we have gone through this year.”
