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Research problem and overall purpose

COVID-19 has affected more than 2.4 million persons in Sweden. Some have a prolonged course after initial disease with debilitating symptoms

Post-Acute COVID-19 Syndrome (PACS). The overall purpose of the research project is to characterise PACS patients regarding severity of residual symptoms, objectively analyse functional and patophysiological impairment in affected organs and explore underlying immunomechanistic causes.Relevance Investigating longterm PACS effects and increase the understanding of the various phenotypes and underlying mechanisms will generate effective ways to inform on novel treatment strategies and better protocols for clinical follow-up and design interventions for prevention. Data and methods In-depth phenotyping is generated from our post-COVID outpatient clinic with regular monitoring of previously hospitalized patients with initial severe Covid-19 and non-hospitalized PACS patients. A cohort of age and sex matched  COVID-19 patients without PACS  constitute a control group. We will perform systems-level analyses of blood immune cells, plasma proteins and bio-energetic measurements of blood cells in combination with whole genome sequencing from patients with severe PACS.Plan for project realization Abundant phenotypic patient data is now available for analysis as well as blood samples for immuno-mechanistic analysis. In depth studies of pulmonary, cardiovascular and other long term complications are ongoing.

Post covid condition (PCC) affects approximately 10% of people infected with SARS-CoV-2. With half a billion confirmed COVID-19 cases globally, the magnitude of the expected Post COVID healthcare problem is enormous. No treatment options to date have shown efficacy.We hypothesize that part of PCC is a chronic inflammation involving the endothelium started by COVID-19 and treatable by the anti-inflammatory effects of hyperbaric oxygen (HBO2). HBO2 delivered by inhalation of 100% oxygen in a hyperbaric chamber in daily treatments over several weeks, has several anti-inflammatory effects. It is used for chronic inflammatory conditions such as osteomyelitis, radiation cystitis and acute flares of ulcerative colitis. The purpose of this proposal is to investigate biomarkers, epigenetic signatures and response to HBO2 in a clinical trial that may explain mechanisms of the post COVID condition and enable future precision medicine.Aims: To investigate biomarkers, redox-balance and epigenetic profile of patients with PCCTo determine the efficacy of HBOT on endothelial dysfunction, objective physical performance, autonomic dysfunction, restorative sleep.To investigate if the effect of HBOT in PCC in a clinical trial correlates with age, gender and epigenetic signatures. Preliminary results from our clinical trial on 31 acute covid-19 indicates effect from HBO but treatment may need individual tailoring. To date we have treated 20 PCC patients, aiming for a total of 80 participants.