Scientists from St Petersburg University, together with colleagues from Qatar University, have won a research grant that will support a large-scale international project to study post-COVID-19 complications in patients with diabetes and long Covid.

The project team is comprised of: scientists from St Petersburg University including staff members of the Laboratory of the Mosaic of Autoimmunity, the Faculty of Medicine, and the Pirogov Clinic of High Medical Technologies; and experts from Qatar University and a Qatar affiliate of the Weill Cornell Graduate School of Medical Sciences. The research objectives are to: identify and study neurological complications of long Covid and the role of concomitant diabetes; and develop recommendations for the early detection of the autonomic nervous system disorders and neuroimmune complications. The findings of the study are to be reported by the end of 2021.

It has been reported that COVID-19 patients with diabetes require a prolonged recovery period after the disease. Moreover, it could be complicated by neurological, autonomic and immunopathological disorders that reduce patients’ work ability and quality of life. The spectrum of clinical manifestations and complaints of patients suffering from the long-term effects of COVID-19 does not allow excluding an autoimmune component in the pathogenesis of post-COVID-19 disorders.

The Russian members of the research team are: Professor Leonid Churilov, the Project Manager, Head of the Department of Pathology at St Petersburg University; Ivan Pchelin, Acting Dean of the Faculty of Medicine at St Petersburg University; Dr Nataliia Gavrilova, Assistant Lecturer in the Department of Faculty Therapy and neurologist at the Pirogov Clinic of High Medical Technologies, St Petersburg University; Dr Lidiia Soprun, Assistant Lecturer in the Health Management and Medical Law Department and epidemiologist at the Pirogov Clinic of High Medical Technologies, St Petersburg University; Dr Varvara Riabkova, Assistant Researcher in the Laboratory of the Mosaic of Autoimmunity at St Petersburg University; and Dr Tamara Fedotkina, Leading Research Associate in the Laboratory of the Mosaic of Autoimmunity at St Petersburg University.

According to the researchers, neuropathy of small nerve fibres in the skin, mucous membranes and internal organs can play a prominent role in the course of the so-called long Covid, or post-COVID-19 syndrome. The researchers’ hypothesis is that the peripheral nerve damage occurs as a result of an immune response, causing neurological and somatic symptoms such as: tachycardia; memory impairment; weakness; fatigue; and various pain sensations.

The issue is that diagnosing peripheral neuropathy can be difficult. Usually it requires a skin biopsy. However, it is technically impossible to repeat the procedure at the same biopsy site, which is necessary to assess the efficacy of the therapy and disease dynamics. Furthermore, biopsy is labour-intensive, time-consuming, and expensive, because a histological laboratory is required to process the samples. Occasionally, biopsy can lead to the development of complications. Besides, doctors do not recommend performing skin biopsy in immunocompromised patients. These include patients with diabetes mellitus, who comprise over half of the total number of patients with small fibre neuropathy.

The researchers from St Petersburg University and Qatar University propose using an alternative procedure – confocal microscopy of the cornea. It is a rapid, non-invasive, reproducible clinical technique that does not have the aforementioned drawbacks of skin biopsy. Corneal confocal microscopy (CCM) allows for repeated monitoring of the same area. The CCM results can be compared and interpreted using artificial intelligence (AI) software.

Scientists from the Laboratory of the Mosaic of Autoimmunity at St Petersburg University began studying small fibre neuropathy in 2018. Since then, we have developed and patented a few original clinical, laboratory and instrumental techniques for diagnosis and monitoring of this disorder.

Leonid Churilov, Project Manager, Full Member of the International Academy of Sciences (Health and Ecology), Head of the Department of Pathology, Deputy Head of the Laboratory of the Mosaic of Autoimmunity at St Petersburg University

‘In 2020, we commenced studying long Covid with a hypothesis that it can be an immune-neuroendocrine dysfunction. We have a patient database, records of clinical and instrumental examinations, a biobank of blood serum and skin biopsies. Corneal confocal microscopy is an extremely valuable tool for both research and diagnostics because it enables monitoring the condition of the patients with small fibre neuropathy without causing inconvenience and breaking the skin,’ explained Professor Churilov, Project Manager, Full Member of the International Academy of Sciences (Health and Ecology), Head of the Department of Pathology, and Deputy Head of the Laboratory of the Mosaic of Autoimmunity at St Petersburg University.

The Laboratory of the Mosaic of Autoimmunity at St Petersburg University will serve as the main base for research. Additionally, the Resource Centres working in the area of Biomedicine and Human Health at the St Petersburg University Research Park will be instrumental in the successful implementation of the project.

 

Upon completion of the project, doctors in our country will finally be given access to AI software that analyse the CCM results to detect and monitor neuropathy. This, indeed, will help improve and speed up the diagnosis of long Covid and, consequently, improve the patients’ quality of life.

In September 2021, the world’s first Centre for the Study of Autoimmune Diseases and the Effects of the New Coronavirus Disease was opened at the Pirogov Clinic of High Medical Technologies at St Petersburg University. The Centre is headed by Professor Yehuda Shoenfeld, Head of the Laboratory of the Mosaic of Autoimmunity at St Petersburg University, founder and Head of the Zabludowicz Center for Autoimmune Diseases, President of Ariel University and a Member of Israel Academy of Sciences and Humanities of Israel. The new research unit enabled us to combine the newest breakthroughs in autoimmunity research with the therapeutic and diagnostic potential of the University’s Clinic of High Medical Technologies.

It is worthy of note that the Pirogov Clinic for High Medical Technologies became part of St Petersburg University in 2018. Since then, it has established itself not only as a high-level healthcare organisation, but also as a well-regarded research institution. In 2020, almost one in every ten biomedical publications by St Petersburg University researchers was co-authored by doctors from the University’s Pirogov Clinic. And the number of publications is continuously growing. This proves the effectiveness of work in a university clinic format, which allows for providing better conditions for translating the acquired scientific knowledge into medical practice.