Administrative Supplement to Investigate the Effects of Long COVID on SELA study participants

ABSTRACT The NIMHD funded parent project, R01 MD015395, "Social Factors, Epigenomics, and Lupus in African American women (SELA)" seeks to identify the epigenetic mechanisms by which positive and negative social experiences, such as social support and racial discrimination, affect gene function and thereby influence systemic lupus erythematosus (SLE; lupus) in African American (AA) women. SLE is a prototypic autoimmune disease marked by a disproportionate prevalence and severity burden in AA women. AAs experience a disproportionate burden of COVID-19 infection, hospitalization, and adverse outcomes including death. Less is known about long-term outcomes of COVID-19 and long COVID symptoms in SLE, although it is thought that COVID-19 infection may further complicate disparities. Moreover, social determinants of health (SDOH) influence SLE outcomes. Our long-term goal is to understand how the intersection of multiple biological, behavioral, and sociocultural exposures contribute to lupus outcomes in AA women with SLE. Our specific objective is to understand the long-term clinical impact of COVID-19 infection in this health disparity population. In direct response to NOT-OD-24-032, the goal of this Administrative Supplement is to capitalize on the parent grant's research infrastructure to expand it to include additional individual and community exposures and investigate the impact of COVID-19-related morbidity and long COVID symptoms on SLE disease activity in AA women. We will invite 140 participants with SLE and 140 controls from the parent study to have data collected on COVID-19 past infection and vaccination, long COVID symptoms, and census-tract and individual-level SDOH. Samples will be collected and assayed for levels of COVID-19 antigens and antibodies against major SARS-CoV-2 variants. We hypothesize that SLE worsens long COVID symptoms and COVID-19 increases SLE disease activity. We propose to: (Aim 1) investigate the effects of SLE on long COVID symptoms in AA women, and (Aim 2) assess the impact of past COVID-19 infection on SLE disease activity in AA women. Little is known about risk factors and predictors of long COVID in AA women with SLE. Further, the COVID-19 pandemic has complicated treatment of SLE as it is unclear if symptoms are due to SLE, past COVID-19 infection or long COVID. We anticipate that this project will yield critical COVID-19-related and multidimensional SDOH data for multidisciplinary applications focused on analyzing the synergistic effects of multiple exposures on SLE outcomes in AA women. Findings will fill important knowledge gaps related to COVID-19 in AA women with and without SLE and could help identify high-risk groups, inform prevention efforts, and guide clinical care.