Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded positive-sense RNA virus causing respiratory, gastrointestinal, and central nervous system infections in humans, collectively referred to as coronavirus disease 2019 (COVID-19). The coronavirus disease 2019 (COVID-19) pandemic has affected populations worldwide, inducing severe health manifestations among the majority of the populace. The post-acute COVID-19 syndrome is characterized by persistent or prolonged symptoms for more than four weeks, imposing a significant healthcare challenge globally. Post-acute COVID-19 typically involves symptoms including severe fatigue, cognitive dysfunction, or pain. The pathophysiological mechanisms of acute COVID-19 involve viral toxicity, microvascular injury, immune dysregulation, and inflammation.

This cohort study is a COVID-19–related gastrointestinal endoscopic analysis investigating whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen persistence underlies the post-acute COVID-19 syndrome. Here, 46 patients with inflammatory bowel disease (IBD) with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection were scrutinized and evaluated. All patients underwent endoscopy by clinical means according to IBD guidelines and provided a negative SARS-CoV-2 PCR test on the day of endoscopic examination. Biopsy specimens and tissue samples of the under-trial patients were examined using SARS-CoV-2 PCR, immunofluorescence, and viral culture to analyze SARS-CoV-2 antigen persistence. The assessment of post-acute COVID-19 was done using a standardized questionnaire, and a systemic SARS-CoV-2 immune response was evaluated using flow cytometry and enzyme-linked immunosorbent assay at endoscopy. IBD activity was evaluated using clinical, biochemical, and endoscopic means.

It was reported that SARS-CoV-2 antigens persist in the gut mucosa for months after acute COVID-19 infection in the majority of patients with inflammatory bowel disease (IBD), irrespective of immunosuppressive therapy or gut inflammation. It was also observed that viral antigen persistence is associated with post-acute COVID-19 symptoms.

Collectively, the analysis and its outcome suggest that viral antigen persistence is a basis for post-acute sequelae of COVID-19, a rapidly emerging disorder across the globe.

Keywords: COVID-19; Post-acute COVID-19; SARS-CoV-2; Viral Antigen Persistence.

Source -Zollner A, Koch R, Jukic A, Pfister A, Meyer M, Rössler A, Kimpel J, Adolph TE, Tilg H; Postacute COVID-19 is Characterized by Gut Viral Antigen Persistence in Inflammatory Bowel Diseases; Gastroenterology; 2022 Aug;163(2):495-506.e8. doi: 10.1053/j.gastro.2022.04.037. Epub 2022 May 1. PMID: 35508284; PMCID: PMC9057012.