Published: 07 March 2022
The NIHR-supported GenOMICC study, the world’s largest study of the genetics of critical COVID-19, has revealed details about some of the biological mechanisms behind the severe form of the disease
Involving more than 57,000 people, the trial has discovered 16 new genetic variants associated with severe COVID-19, including some related to blood clotting, immune response and intensity of inflammation.
These findings will act as a roadmap for future efforts, opening new fields of research focused on potential new therapies and diagnostics with pinpoint accuracy, experts say.
Researchers from the GenOMICC consortium – a global collaboration to study genetics in critical illness – led by University of Edinburgh in partnership with Genomics England, made these discoveries by sequencing the genomes of 7,491 patients from 224 intensive care units in the UK.
Their DNA was compared with 48,400 other people who had not had COVID-19, participants in Genomics England’s 100,000 Genomes Project and that of a further 1,630 people who had experienced mild cases of the disease.
Determining the whole genome sequence (an organism’s complete set of genetic instructions) for all participants in the study allowed the team to create a precise map and identify genetic variation linked to severity of COVID-19.
The team found key differences in 16 genes from intensive care unit patients when compared with the DNA of the other groups.
They also confirmed the involvement of seven other genetic variations already associated with severe COVID-19.
The findings included how a single gene variant that disrupts a key messenger molecule in immune system signalling – called interferon alpha-10 – was enough to increase a patient’s risk of severe disease.
This highlights the gene’s key role in the immune system and suggests that treating patients with interferon – proteins released by immune cells to defend against viruses – may help manage disease in the early stages.
Professor Kenneth Baillie, the project’s chief investigator and a Consultant in Critical Care Medicine at University of Edinburgh, said: “Our latest findings point to specific molecular targets in critical COVID-19. These results explain why some people develop life-threatening COVID-19, while others get no symptoms at all. But more importantly, this gives us a deep understanding of the process of disease and is a big step forward in finding more effective treatments.
“It is now true to say that we understand the mechanisms of COVID-19 better than the other syndromes we treat in intensive care in normal times – sepsis, flu, and other forms of critical illness. COVID-19 is showing us the way to tackle those problems in the future.”
The study also found that variations in genes that control the levels of a central component of blood clotting – known as Factor 8 – were associated with critical illness in COVID-19. This may explain some of the clotting abnormalities that are seen in severe cases of COVID-19. Factor 8 is the gene underlying the most common type of haemophilia.
Dr Rich Scott, Chief Medical Officer at Genomics England, said: “Strategically, we’re at a point where genomic science is becoming an integral part of the national infrastructure in routine healthcare. This study illustrates the value of whole genome sequencing to detect rare and common variants that influence critical illness requiring intensive care. It represents a major leap forward in our understanding of how our genetic makeup influences severe illness with COVID-19.”
“All those involved in the study went to great efforts to engage with all communities within the UK – including groups that have historically been under-represented in medical studies. The inclusive element of our work has generated meaningful results for everyone in the country.”
Professor Nick Lemoine, Medical Director of the NIHR Clinical Research Network, said: "The GenOMICC study has been a key part of the UK's urgent public health research response to the COVID-19 pandemic. The scale and speed of recruitment to this important study has been enabled by the NIHR's Clinical Research Network - which mobilised its workforce across every NHS trust in the country.
“Once again, the research community in the UK has delivered results that have the potential to change clinical practice and save lives across the world."
Lord Kamall, Minister for Innovation at the Department of Health and Social Care, said: "Clinical research has been vital in our fight against COVID-19 and the UK’s innovation is enabling us to transform our health service and ensure the NHS is able to deliver world-class care.
“This research is an important step forward in better understanding how COVID-19 impacts certain people, allowing us to take the necessary action to protect the most vulnerable and save lives.”
The findings have been published in Nature.