How dexamethasone saves lives in severe COVID-19

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Dexamethasone has become a crucial drug in treating severe COVID-19, but patients’ responses to it vary widely.

Researchers at the German Center for Neurodegenerative Diseases (DZNE) and Charité—Universitätsmedizin Berlin have discovered how this drug affects the immune system and which patients benefit the most.

Their findings could lead to better predictions of treatment success for various diseases.

The study, published in the journal Cell, used a method called single-cell analysis to understand why some patients respond well to dexamethasone while others do not.

This method examines individual cells in detail, providing a clearer picture of the drug’s effects.

At the start of the pandemic, it became clear that the immune systems of some severely ill COVID-19 patients were overreacting to the virus.

Dexamethasone, a cortisone derivative, was given to these patients to help calm their immune response.

Many patients improved quickly with dexamethasone, but others did not. The study found that the drug’s effectiveness is linked to the response of a specific type of immune cell called monocytes.

Monocytes are white blood cells that play a central role in the immune system.

Dr. Anna Aschenbrenner from DZNE and Prof. Dr. Florian Kurth from Charité led the study. They found that in patients who improved with dexamethasone, their monocytes responded positively to the treatment.

This response occurred before the patients’ health visibly improved, suggesting that early monocyte reaction can predict the success of the therapy.

In 2020, researchers noticed an abnormal “signature” in monocytes of severe COVID-19 patients.

This signature is a molecular fingerprint indicating the cells’ characteristics. Dexamethasone treatment reversed these changes in patients who responded well to the therapy.

The ability to predict whether dexamethasone will work could save lives. If monocytes respond to the drug early, doctors can expect the treatment to be effective. If not, they can quickly try additional treatments.

This predictive method needs more research before it can be used in everyday medical practice.

The findings have implications beyond COVID-19. Prof. Dr. Leif Erik Sander, one of the study’s lead researchers, believes this approach can apply to other diseases. By combining clinical trials with detailed molecular analysis, scientists can better understand how drugs work and speed up the development of new treatments.

This method, known as “companion diagnostics,” involves monitoring a therapy with molecular tests. Dr. Aschenbrenner sees this as particularly useful for infectious diseases, but it could also apply to non-infectious diseases like cancer and Alzheimer’s, which also affect immune cells in the blood.

Understanding the role of monocytes in dexamethasone treatment provides hope for more effective and personalized therapies. This research highlights the importance of detailed molecular analysis in predicting treatment success and could lead to better outcomes for patients with various diseases.

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