Muscle abnormalities worsen after post-exertional malaise in long COVID

Brent Appelman, Braeden T. Charlton, Richie P. Goulding, Tom J. Kerkhoff, Ellen A. Breedveld, Wendy Noort, Carla Offringa, Frank W. Bloemers, Michel Weeghel, Bauke V. Schomakers, Pedro Coelho, Jelle J. Posthuma, Eleonora Aronica, W. Joost Wiersinga, Michèle Vugt () and Rob C. I. Wüst ()
Additional contact information
Brent Appelman: Center for Experimental and Molecular Medicine
Braeden T. Charlton: Vrije Universiteit Amsterdam
Richie P. Goulding: Vrije Universiteit Amsterdam
Tom J. Kerkhoff: Vrije Universiteit Amsterdam
Ellen A. Breedveld: Vrije Universiteit Amsterdam
Wendy Noort: Vrije Universiteit Amsterdam
Carla Offringa: Vrije Universiteit Amsterdam
Frank W. Bloemers: Amsterdam Movement Sciences
Michel Weeghel: Amsterdam UMC location University of Amsterdam
Bauke V. Schomakers: Amsterdam UMC location University of Amsterdam
Pedro Coelho: Hospital de Santa Maria, CHULN
Jelle J. Posthuma: Amsterdam UMC location University of Amsterdam
Eleonora Aronica: Amsterdam UMC location University of Amsterdam
W. Joost Wiersinga: Center for Experimental and Molecular Medicine
Michèle Vugt: Infectious diseases
Rob C. I. Wüst: Vrije Universiteit Amsterdam

Nature Communications, 2024, vol. 15, issue 1, 1-15

Abstract: Abstract A subgroup of patients infected with SARS-CoV-2 remain symptomatic over three months after infection. A distinctive symptom of patients with long COVID is post-exertional malaise, which is associated with a worsening of fatigue- and pain-related symptoms after acute mental or physical exercise, but its underlying pathophysiology is unclear. With this longitudinal case-control study (NCT05225688), we provide new insights into the pathophysiology of post-exertional malaise in patients with long COVID. We show that skeletal muscle structure is associated with a lower exercise capacity in patients, and local and systemic metabolic disturbances, severe exercise-induced myopathy and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with long COVID worsen after induction of post-exertional malaise. This study highlights novel pathways that help to understand the pathophysiology of post-exertional malaise in patients suffering from long COVID and other post-infectious diseases.

Date: 2024
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DOI: 10.1038/s41467-023-44432-3

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