Personalized treatment of COVID-19 disease as a major breakthrough in the quest for a cure
Personalized treatment of COVID-19 disease as a major breakthrough in the quest for a cure
Neda Golpar raboki,1,*Fatemeh Akbarian,2
1. Ale-Taha Institute of Higher Education, Tehran, Iran 2. Ale-Taha Institute of Higher Education, Tehran, Iran
Introduction: SARS-CoV-2 is one of the main subfamilies of coronaviruses with four known genera. The virus infection process is through binding to the ACE2 receptor on the cell surface through spike protein. Recently, large databases have been created to sequence and share different types of SARS-CoV-2; they show that some of these variations positively impact infection severity of the virus and the ability to escape from the immune system, leading to its further evolution. Subsequently, the evolution of the virus leads to the creation of new types with an increased level of infection, contagion, and even resistance to existing drugs. For example, SARS-CoV-2 spike P681R mutation transforms a proline residue into an arginine, resulting in a 40% increase in delta-type viral infectivity compared to other types. Therefore, it is necessary to create a platform for classifying the lineages based on their severity of the infection, contagion, etc. This platform should include effective treatments related to each lineage, as well as genetic profiles and medical records of each patient. As the most outstanding example of countries administrating personalized medicine for confronting the pandemics, Andalusia has collected the genetic profiles of its population since 2001 and analyzed the sequences of patients and the virus with the help of artificial intelligence. They discovered the natural history of the virus, the infectious process, response to treatments with antiviral drugs, and the body's response to the vaccination process. Thus, the spread of this disease might be urgently controlled through personalized medicine.
Methods: People are divided into different groups based on their genetic profiles and epigenetic factors to receive treatments and health care in personalized medicine. Thus, not only the quality of health care will increase, but the need for unnecessary tests and the cost of treatment will reduce. Employment of personalized medicine in the health system along with sequencing and categorizing microbiome sequences in different geographical areas mediate early identification of pandemics, such as COVID-19, and their transmission pattern in each region before the massive crisis.
Results: One of the largest databases recently gathered by the efforts of nineteen countries comprises the genomic sequences of patients with severe COVID-19 disease. The most effective variations related to SARS-CoV-2 can be identified utilizing this platform; researchers have found that the variant located at locus 3P21.31 has the highest association with the reproductive and severity of the infection, and people with this variant are more likely to develop the dangerous phenotype of COVID-19. This locus encodes various proteins that are not directly related to the infectivity of SARS-CoV-2 but may be indirectly influential. For example, ccl is a chemotaxis mediator for circulating monocytes, and its receptor is encoded by ccr9 gene located at this location. Research has shown that in patients with severe coronavirus phenotype, the expression of ccr9 and its ligand increases in monocytes and other body fluids. Therefore, it can be concluded that excessive expression of ccr9 can be one of the reasons for the various rates of inflammatory reactions in different people.
Conclusion: Furthermore, other studies have shown that loss of function in the TLR7 gene located on the X chromosome is strongly associated with the development of the acute SARS-CoV-2 phenotype. This gene plays an essential role in the production mechanism of interferon 1 (IFN1), which is produced by virus-infected cells and prevents propagation of the virus. Therefore, patients with impaired production of IFN1 are not able to fight against coronavirus infection. In addition, the tissue damage, inflammation, and functional disorders that result from infection vary in different hosts. Aside from genetics, epigenetic factors are also involved in developing the acute type of virus. Each individual has different reactions to the disease due to vaccination, conditions they have faced during their life, and the health status of the immune system. In primary infection of some patients, B and T lymphocyte counts rise sharply, while in others, they may not respond at all.
Therefore, diagnosing susceptible individuals at risk of exacerbation of disease and acute phenotype can help the health system, in which personalized medicine can play a very effective role. The necessary contexts for personal therapy include the establishment of microarray laboratories, the construction of bioinformatics platforms, the collection of mutation information, and, above all, the introduction of physicians to the concept of genetic profiling. It is crucial to create a strong link between the clinical department and the laboratory so that in case of an outbreak of the disease or discovering a solution for the treatment or control of the disease, the health system will immediately inform.
In conclusion, overcoming pandemics such as COVID-19 occurs only by the full cooperation of the clinical sectors, laboratories, and politicians worldwide. Thus, countries will be prepared to face this kind of viral attack in the future.