Chemosensation and COVID-19

我们写了我们的临床方案，很快就会提交给IRB。然而，通过与其他内部和外部调查人员的合作，我们已经出版了一些关于这个主题的手稿。 新冠肺炎的多模式影响和没有感知到鼻塞表明，严重急性呼吸综合征冠状病毒2型感染可能扰乱感觉神经机制。鉴于我们在SARS-CoV-2大流行早期对其发病机制的了解有限，我们与全球化学感觉研究联盟(GCCR)的其他成员在《神经元》杂志上共同撰写了一篇综述，其中建议进行未来的实验以阐明疾病机制，并强调这项正在进行的工作与了解病毒如何更广泛地改变大脑功能的相关性。随着这些症状继续被报道，我们在过敏和鼻病学上写了一篇由Rosario Jaime-Lara博士(博士后研究员)领导的评论，描述了嗅觉在人类健康中的作用，重点是冠状病毒。到目前为止，多达80%或更多的感染SARS-CoV-2的患者报告有嗅觉障碍、营养不良、感觉障碍、动作障碍或化学成分改变。自我报告的化学感觉变化可以预测患者是否会被检测出SARS-CoV-2阳性。许多早期的化学感觉和新冠肺炎研究缺乏客观的化学感觉评估，这增加了化学感觉障碍甚至比目前所认识的更普遍的可能性。我们与Monell化学感官中心的Danielle Reed博士一起发表了一篇系统的综述和荟萃分析。在这项分析中，我们报告了客观措施是一种更敏感的方法来识别由于感染SARS-CoV-2而导致的气味损失。值得注意的是，虽然在大流行的早期阶段使用主观措施是权宜之计，但低估了气味丧失的真实流行率。在第二项预先登记的横断面研究中，我们使用了23种语言的众包问卷来评估自我报告最近呼吸道疾病的个人的症状，结果表明，气味丧失是有症状的新冠肺炎感染的最佳预测因子。我们发现，在单一特征模型和累积特征模型中，疾病期间的气味丧失都是有症状的新冠肺炎感染的最佳预测因子(ROC AUC=0.72)，而其他特征并未提供显著的模型改进。我们无法预测任何其他结果(例如，严重程度、住院情况、ICU住院情况)，因为我们在第一次调查中没有询问住院情况。有了这些数据，我们开发了OGOR-19工具，一个0-10的等级来筛选最近的嗅觉丧失，目前正在被其他人在临床人群中验证。考虑到实验室对化学感觉和肥胖的兴趣，以及肥胖者在嗅觉和味觉能力方面的变化，我们使用GCCR的数据进行了二次分析。我们比较了新冠肺炎实验室检测结果为阳性(C19+；n=5156)或阴性(C19-；n=659)的呼吸道疾病参与者的自我报告的化学感觉能力，这些参与者自我报告为肥胖(C19+；n=433，C19-；n=86)。我们发现，与C19-组相比，C19+在疾病期间表现出更大的嗅觉、味觉和化学作用的下降，尽管这些症状在肥胖和非肥胖者之间没有区别。在68%报告从呼吸道疾病症状中恢复的参与者中(n=3431 C19+和n=539 C19-)，康复后的化学感觉在C19+和C19诊断以及自我报告的肥胖方面没有区别。我们的结论是，尽管假设新冠肺炎患者对化学感觉刺激的敏感度较低，但肥胖者和非肥胖者自我报告的化学感觉丧失情况类似，而且在两组人中，自我报告的化学感觉症状对新冠肺炎的预测相似。 正如所讨论的那样，在内部，我们在新冠肺炎大流行期间建立了合作。患有澳大利亚大学硕士学位论文的患者患新冠肺炎的风险更高。我们开始评估由Ramchandani博士和Diazranados博士领导的自然历史新冠肺炎影响酒精研究中收集的数据。

We wrote our clinical protocol for submission to IRB soon. However, through collaborations with other investigators both intramural and extramural we have published a number of manuscripts regarding this topic. The multimodal impact of COVID-19 and the lack of perceived nasal obstruction suggest that severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) infection may disrupt sensory-neural mechanisms. Given our limited understanding of SARS-CoV-2 pathogenesis early in the pandemic, we co-authored a review in Neuron with other members of the Global Consortium for Chemosensory Research (GCCR), where future experiments were proposed to elucidate disease mechanisms, and highlighted the relevance of this ongoing work to understanding how the virus may alter brain function more broadly. As these symptoms continued to be reported, we wrote a commentary led by Dr. Rosario Jaime-Lara (postdoctoral fellow) in Allergy and Rhinology describing the role of olfaction in human health with a focus on coronaviruses. To date as many as 80% or more of patients infected with SARS-CoV-2 report anosmia, hyposmia, ageusia, dysgeusia, or changes in chemesthesis. Self-reported changes in chemosensory perception can predict whether a patient will test positive for SARS-CoV-2. Many of the early chemosensory and COVID-19 studies lacked objective chemosensory assessment, raising the possibility that chemosensory disturbances are even more prevalent than currently appreciated. Together with Dr. Danielle Reed (Monell Chemical Senses Center), we published a systematic review and meta-analysis. In this analysis, we reported that objective measures were a more sensitive method to identify smell loss because of infection with SARS-CoV-2. Of note, the use of subjective measures, while expedient during the early stages of the pandemic, underestimated the true prevalence of smell loss. In a second preregistered, cross-sectional study that used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness, we showed that smell loss is the best predictor of symptomatic COVID-19 infection. We found that smell loss during illness was the best predictor of symptomatic COVID-19 infection in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. We were not able to predict any other outcome (e.g., severity, hospitalization, ICU hospitalization) since we did not ask about hospitalization in that first survey. With this data in hand, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss currently being validated in clinical populations by others. Given the lab's interest in chemosensation and obesity as well as the knowledge that individuals with obesity show alterations in smell and taste abilities, we conducted a secondary analysis using data from the GCCR. We compared self-reported chemosensory ability in participants with a respiratory illness reporting a positive (C19+; n = 5156) or a negative (C19-; n = 659) COVID-19 laboratory test outcome, who self-reported to be obese (C19+; n = 433, C19-; n = 86) or non-obese. We found that compared to the C19- group, C19+ exhibited a greater decline in smell, taste, and chemesthesis during illness, though these symptoms did not differ between participants with obesity and without obesity. In 68% of participants who reported recovery from respiratory illness symptoms (n=3431 C19+ and n= 539 C19-), post-recovery chemosensory perception did not differ in C19+ and C19- diagnosis, and by self-reported obesity. We conclude that despite a presumed lower sensitivity to chemosensory stimuli, COVID-19 respondents with obesity experience a similar self-reported chemosensory loss as those without obesity, and in both groups self-reported chemosensory symptoms are similarly predictive of COVID-19. Intramurally, as discussed, We established collaborations during the COVID-19 pandemic. Patients with AUD are at higher risk of COVID-19. We began to evaluate the data collected in the natural history COVID-19 impact alcohol study led by Drs. Ramchandani and Diazgranados.