Preprint Integrative Multi-Omics Framework for Causal Gene Discovery in Long COVID, 2025, Le et al

forestglip

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Integrative Multi-Omics Framework for Causal Gene Discovery in Long COVID

Thuc Duy Le, Sindy Licette Pinero, Xiaomei Li, Lin Liu, Jiuyong Li, Sang Hong Lee, Marnie Winter, Thin Nguyen, Junpeng Zhang

Background
Long COVID, or Post–Acute Sequelae of COVID–19 (PASC), involves persistent, multisystemic symptoms in about 10–20% of COVID-19 patients. Although age, sex, ethnicity, and comorbidities are recognized as risk factors, identifying genetic contributors is essential for developing targeted therapies.

Methods
We developed a multi–omics framework using Transcriptome-Wide Mendelian Randomization (TWMR) and Control Theory (CT). This approach integrates Expression Quantitative Trait Loci (eQTL), Genome-Wide Association Studies (GWAS), RNA sequencing (RNA–seq), and Protein–Protein Interaction (PPI) networks to detect causal genes and regulatory nodes that drive critical expression changes in Long COVID.

Results
We identified 32 causal genes (19 previously reported and 13 novel), which act as regulatory drivers influencing disease risk, progression, and stability. Enrichment analyses highlighted pathways linked to the SARS–CoV–2 response, viral carcinogenesis, cell cycle regulation, and immune function. Analysis of other pathophysiological conditions revealed shared genetic factors across syndromic, metabolic, autoimmune, and connective tissue disorders. Using these genes, we identified three distinct symptom-based subtypes of Long COVID, offering insights for more precise diagnosis and potential therapeutic interventions. Additionally, we provided an open-source Shiny application to enable further data exploration.

Conclusion
Integrating TWMR and CT revealed genetic mechanisms and therapeutic targets for Long COVID, with novel genes informing pathogenesis and precision medicine strategies.

Link | PDF (MedRxiv) [Preprint]
 
This is very dense. But here are the 32 causal genes:

Previously associated with SARS-CoV-2 or long COVID:
androgen receptor (AR)
butyrophilin subfamily 3 member A1 (BTN3A1)
cyclin-dependent kinase inhibitor 1A (CDKN1A)
CREBBP
EIF5A
EP300
estrogen receptor 1 (ESR1)
atos homolog A (ATOSA)
FYN proto-oncogene (FYN)
GRB2
histone deacetylase 1 (HDAC1)
mitogen-activated protein kinase (MAPK1)
NADH:ubiquinone oxidoreductase subunit A6 (NDUFA6)
retinoblastoma transcriptional corepressor 1 (RB1)
SMAD family member 2 (SMAD2)
SMAD3
sarcoma proto-oncogene (SRC)
TP53
YWHAG

Novel genes in the context of SARS-CoV-2 or long COVID:
adenosine deaminase tRNA-specific (ADAT1)
B-cell lymphoma 2 interacting protein 1 (BNIP1)
bole-like 2 (BOLA2)
chromosome 19 open reading frame 18 (C19orf18)
inositol 1,4,5-trisphosphate receptor interacting domain containing 1 (ITPRID1)
CDC26
cytidine deaminase (CDA)
ceramide synthase 4 (CERS4)
casein kinase 2 alpha 1 (CSNK2A1)
GDP-mannose pyrophosphorylase B synthase (GMPPB)
MORN repeat containing 3 (MORN3)
MORN4
von Willebrand factor D and EGF domains gene (VWDE)
 
I searched S4ME, Google Scholar, and PubMed for mentions of these genes in relation to "chronic fatigue syndrome" and found these. I didn't search very deeply, and might have missed some studies, particularly for the short gene names or the ones that could be other words (AR, SRC, CDA).

Immunometabolic changes and potential biomarkers in CFS peripheral immune cells revealed by single-cell RNA sequencing, 2024 (Frontiers in Immunology)
In addition, we used GO BP enrichment analysis on these elevated genes to identify significantly enriched pathways in CD8+ naïve cells. Differentially expressed genes (DEGs) such as CCR7, CD28, LCK, and SMAD3 play important roles in immune cell activation, signaling, viral processes, and cytokine synthesis.

Longitudinal Cytokine and Multi-Modal Health Data of an Extremely Severe ME/CFS Patient with HSD Reveals Insights... 2024 (Journal of Translational Medicine)
This study focused on an exceptionally severe ME/CFS patient with hypermobility spectrum disorder (HSD) during a period of marginal symptom improvements. [...]

Our study unveils novel insights into the potential roles of TP53 (tumor protein p53) and BCL6 (B-cell CLL/lymphoma 6) in ME/CFS pathogenesis (153, 154). Notably, both BCL6 and TP53 function as negative regulators in IgE-mediated mast cell activation (155, 156), exerting a dampening effect on both early and late-phase anaphylaxis. BCL6, a master regulator of humoral immunity, negatively modulates key molecules and cells associated with Th2-type inflammation (156158). The implications of its involvement in preventing or attenuating allergic diseases suggest a potential link to ME/CFS in a subset of patients, especially considering its role in experimental autoimmune encephalomyelitis (EAE) (156). TP53, beyond its role as a tumor suppressor, plays a crucial part in various physiological processes, including cell metabolism, mitochondrial respiration, autophagy, and stress response. Balanced TP53 activation could reduce ME/CFS severity by promoting cellular repair (159), regulating metabolic pathways (160), and mitigating inflammation through the suppression of NF-κB transcriptional activity and mast cells and eosinophil-mediated Th2 dominant response (161). TP53’s role in neurite outgrowth suggests potential benefits for cognitive function and overall neurological health (162, 163). These findings underscore the imperative for further exploration into the involvement of TP53 and BCL6 in ME/CFS pathophysiology.

Bioinformatics and systems biology approach to identify the pathogenetic link of Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, 2022 (Frontiers in Immunology)
We collected the genes associated with Long COVID and ME/CFS in databases by restricted screening conditions and clinical sample datasets with limited filters. The common genes for Long COVID and ME/CFS were finally obtained by taking the intersection. [...] We found nine common genes between Long COVID and ME/CFS and gained a piece of detailed information on their biological functions and signaling pathways through enrichment analysis. Five hub proteins (IL-6, IL-1B, CD8A, TP53, and CXCL8) were collected by the PPI network.

Altered endothelial dysfunction-related miRs in plasma from ME/CFS patients, 2021 (Scientific Reports)
Overall, the set of miRs selected for our study is mainly associated with endothelial function through regulation of highly interconnected proteins, where HDAC1 and Sirt1 are predicted as central players.

Post-Exertional Malaise Is Associated with Hypermetabolism, Hypoacetylation and Purine Metabolism Deregulation in ME/CFS Cases, 2019 (Diagnostics)
A four- and two-fold increase in HDAC2 and HDAC3, respectively, have been confirmed in ME/CFS cases [6] and a very high level of HDAC1 and HDAC2 binding sites occur within the genes upregulated in ME/CFS cases following exercise

Circulating miRNAs Expression in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, 2023 (International Journal of Molecular Sciences)
To investigate the possible pathways affected by the miRNAs resulting from dysregulation in the ME/CFS patients, gene pathways and network analyses were performed by using the MIENTURNET web tool. [...] Most predicted interactions involved genes encoding the [...] SMAD Family Member 3 (SMAD3) [...].

Dysregulation of extracellular vesicle protein cargo in female myalgic encephalomyelitis/chronic fatigue syndrome cases and sedentary controls in response to maximal exercise, 2024 (Journal of Extracellular Vesicles)
Within the ME/CFS group, the EV proteins with increased abundance include six members of the 14-3-3 protein family (YWHAE, YWHAQ, YWHAB, YWHAZ, YWHAG, YWHAH) that were significantly and uniquely associated with pathways related to ‘G2M/checkpoints, cell cycle checkpoints, and transcriptional regulation by TP53’

Dysregulation of Protein Kinase Gene Expression in NK Cells from Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients, 2016 (Gene Regulation and System Biology)
Table 3. List of protein kinase genes significantly downregulated in severe CFS/ME group compared with nonfatigued controls. [includes CSNK2A1]

Gene Profiling of Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, 2009 (Current Rheumatology Reports)
Table 1. CFS/ME-associated genes and transcription factors identified through analysis microarrays, real-time PCR, and transcription-factor binding sites

CREBBP upregulated FC=1.43, p=0.016

Microbial infections in eight genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis, 2009 (Journal of Clinical Pathology)
[CREBBP upregulated in Table 2]

Molecular Mechanisms of Neuroinflammation in ME/CFS and Long COVID to Sustain Disease and Promote Relapses, 2022 (Frontiers in Neurology)
Decreased in abundance were immune related proteins (BTN3A1, [...]
 
Does anything replicate here from the other genetic studies we've seen recently?

I haven't read the paper yet and there are plenty of familiar faces and distant relatives of interest in Forestglip's list: P53, SMAD/TGF-beta, CREBBP/EP300, sex hormone receptors, MAPK, HDAC, NADH, ceramides, vWF. YWHAG relates to muscle and vascular smooth muscle so likely of interest.

But just picking one that jumped out, FYN was the top differentially expressed gene in Blood transcriptomic analyses reveal persistent SARS-CoV-2 RNA and candidate biomarkers in post-COVID-19 condition (2024, The Lancet Microbe)
 
I haven't read the paper yet and there are plenty of familiar faces and distant relatives of interest in Forestglip's list: P53, SMAD/TGF-beta, CREBBP/EP300, sex hormone receptors, MAPK, HDAC, NADH, ceramides, vWF. YWHAG relates to muscle and vascular smooth muscle so likely of interest.

But just picking one that jumped out, FYN was the top differentially expressed gene in Blood transcriptomic analyses reveal persistent SARS-CoV-2 RNA and candidate biomarkers in post-COVID-19 condition (2024, The Lancet Microbe)


'Diseases associated with FYN include Wiskott-Aldrich Syndrome'

From the page about FYN.

A possible link with WASF3?
 
I searched S4ME, Google Scholar, and PubMed for mentions of these genes in relation to "chronic fatigue syndrome" and found these. I didn't search very deeply, and might have missed some studies, particularly for the short gene names or the ones that could be other words (AR, SRC, CDA).
A very quick automated search yields a few more results:

CDKN1A crops up in Pathway-focused genetic evaluation of immune and inflammation related genes with chronic fatigue syndrome (Rajeevan et al, 2015); and CREBBP in Seven genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis: a detailed analysis of gene networks and clinical phenotypes (Kerr et al, 2007). TP53 is of course mentioned in the Wang et al WAVE3/WASF3 paper as the patient in that case report had Li-Fraumeni syndrome.

Looking at other LC papers: SMAD3 comes up in several, including Mapping the Potential Genes and Associated Pathways Involved in Long COVID‐Associated Brain Fog Using Integrative Bioinformatics and Systems Biology Strategy (Chakraborty et al, 2024), Sex differences and immune correlates of Long COVID development, persistence, and resolution (Hamlin et al, 2024); and TP53 in Upregulation of olfactory receptors and neuronal-associated genes highlights complex immune and neuronal dysregulation in Long COVID patients (Shahbaz et al, 2025).
 
The abstract does not actually tell us anything comprehensible about wha was done with what. I am pretty sceptical of this sort of scattershot picking out of molecules without very explicit description of practical issues that may introduce huge confounders.
 
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