With the recent worldwide outbreak of the COVID-19 infection and the huge impact it has had upon lives in the UK, it is key to increase knowledge on the impact of the virus on the body. Certain aspects of the virus' characteristics are also poorly understood: The reason behind the variation in response between individuals, and the long-term impacts of infection upon the body. It is already known from previous research that muscle-health plays an important role in health, with other illnesses known to have an impact upon muscle health. A large number of studies have investigated the relationship between muscle and health, with an increasing focus upon the impact upon the mitochondria within the muscle cells. Mitochondria are the energy-producing component of a cell and are vital not just for the muscle-cells but for the body as a whole. The researchers hope that by investigating the impact of COVID-19 infection upon human skeletal muscle, the question of why individuals have different responses to the infection and the mechanism of the longer-term impact of infection can be answered. This added knowledge will then, hopefully, be able to guide therapy targets in the future.
Since the outbreak of the COVID-19 pandemic worldwide, there have been over 50,000 deaths and
over 1million infections in the UK alone. It has been widely reported that infection with
COVID-19 leads to large variation between individuals, a large number appear asymptomatic or
mild flu-like symptoms compared to a percentage requiring intensive care support and for
some, the infection is ultimately fatal. The reason behind this variation is not yet fully
understood.
With COVID-19 likely to have a lasting impact within the UK and on the NHS, any research that
improves our knowledge upon the effect of the infection has the possibility to improve
therapy targets and hopefully improve patient outcomes.
With how novel the COVID-19 pathogen is, little is currently known about the potential
long-term impacts of infection upon individuals. There are currently many reports of
longer-term syndromes following infection with COVID-19 including loss of smell and myalgia.
The researchers hope that investigating the impact upon patients over the 12-months following
their infection will gather information on the long-term impacts and potentially find
evidence of the reason for these longer-term symptoms.
With skeletal muscle being one of the largest components of the human body, any impact upon
its function is likely to have a significant impact upon an individual. With it being vital
for not only locomotion but also in energy production for the body. The researchers
hypothesize that changes within the skeletal muscle may account for some of the impacts of
COVID-19 infection. The investigators hope that by investigating changes in muscle structure,
muscle mitochondrial function, and neurological supply to the muscle they can identify a
future therapy target to improve outcomes from COVID-19 infection.
To investigate this, this study plans to recruit participants with confirmed COVID-19
infection requiring varying levels of oxygen support (Oxygen therapy only n=12, Non-invasive
ventilation n=12) and a control group of non-covid community-acquired pneumonia requiring
oxygen therapy (n=12).
All groups will undergo the same investigations, and no interventions will form part of the
study. Investigations will be carried out at 24-72hours of acute hospital admission, with
follow-up assessments at 6-months and 12-months post-discharge.
The assessments performed will include: muscle biopsy of the vastus lateralis muscle, an
ultrasound scan of the vastus lateralis muscle, voluntary and stimulated iEMG of VL, and
hand-grip strength analysis.
Other: No intervetion will be used
No intervention will be used
Inclusion Criteria:
- Confirmed COVID-19 infection as confirmed by PCR swab, or being treated for
non-COVID-19 community acquired pneumonia
- A minimum of oxygen treatment required for 24hours.
- Capacity to give informed and written consent
Exclusion Criteria:
- A BMI <16.5 or >35 kg/m2
- Active cardiovascular disease:
Significant arrhythmia
Recent acute coronary event
- Cerebrovascular disease:
Recent stroke
- Respiratory disease including:
Pulmonary hypertension
Significant COPD
Uncontrolled asthma
- Clotting dysfunction or current use of anticoagulants (eg Warfarin/Clopidogrel/
Rivaroxaban)
- Significant musculoskeletal or neurological disorders
Royal Derby Hospital
Derby, Derbyshire, United Kingdom
Beth Phillips, BSc PhD, Principal Investigator
University of Nottingham