In the recent months, a number of transcriptomic studies have generated high-resolution data on the genes and pathways that are dysregulated in the patients infected with SARS-CoV-2 and enriched our understanding of the disease biology of this novel viral infection. The cumulative evidence collected from these data are considered in this article. Three motifs emerge with potential for future research and clinical translation. First, instead of a broad cytokine storm, one needs to interrogate the disease in terms of timing of specific cytokine up-regulation. Second, there is a subpopulation of immature or developing neutrophils in the patients with severe COVID-19 illness. This needs to be probed further for mechanistic insight and possible drug targets. Third, complement and coagulation cascades are significantly dysregulated in COVID-19, leading to the common clinical observation of a hypercoagulable state being associated with poor outcome. Interactions of these pathways with other immune-inflammatory pathways are important areas of future research. Finally, with rapid advances in relevant technologies in medicine (clinical transcriptomics, systems biology and artificial intelligence), we envisage deployment of these platforms in the clinical laboratory which shall benefit timely management of critical infectious illnesses such as COVID-19 and sepsis.

中文翻译：

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宿主对SARS-CoV-2的反应：转录组研究的见解

在最近的几个月中，许多转录组学研究获得了有关SARS-CoV-2感染患者中基因和途径失调的高分辨率数据，丰富了我们对这种新型病毒感染的疾病生物学的理解。本文考虑了从这些数据收集的累积证据。出现了三个主题，它们有可能用于未来的研究和临床翻译。首先，代替特定的细胞因子风暴，需要根据特定的细胞因子上调的时间来询问疾病。其次，患有严重COVID-19疾病的患者中存在未成熟或正在发育的嗜中性粒细胞亚群。这需要进一步探究，以获取机械学见解和可能的药物靶标。第三，补体和凝血级联在COVID-19中明显失调，导致临床上普遍观察到高凝状态与不良预后相关。这些途径与其他免疫炎症途径的相互作用是未来研究的重要领域。最后，随着医学相关技术（临床转录组学，系统生物学和人工智能）的飞速发展，我们设想在临床实验室中部署这些平台，这将有利于及时管理关键传染病，例如COVID-19和败血症。