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Granholm ACE, Englund E, Gilmore A, Head E, Yong WH, Perez SE, Guzman SJ, Hamlett ED, Mufson EJ. Neuropathological findings in Down syndrome, Alzheimer's disease and control patients with and without SARS-COV-2: preliminary findings. Acta Neuropathol 2024; 147:92. [PMID: 38801558 PMCID: PMC11130011 DOI: 10.1007/s00401-024-02743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
The SARS-CoV-2 virus that led to COVID-19 is associated with significant and long-lasting neurologic symptoms in many patients, with an increased mortality risk for people with Alzheimer's disease (AD) and/or Down syndrome (DS). However, few studies have evaluated the neuropathological and inflammatory sequelae in postmortem brain tissue obtained from AD and people with DS with severe SARS-CoV-2 infections. We examined tau, beta-amyloid (Aβ), inflammatory markers and SARS-CoV-2 nucleoprotein in DS, AD, and healthy non-demented controls with COVID-19 and compared with non-infected brain tissue from each disease group (total n = 24). A nested ANOVA was used to determine regional effects of the COVID-19 infection on arborization of astrocytes (Sholl analysis) and percent-stained area of Iba-1 and TMEM 119. SARS-CoV-2 antibodies labeled neurons and glial cells in the frontal cortex of all subjects with COVID-19, and in the hippocampus of two of the three DS COVID-19 cases. SARS-CoV-2-related alterations were observed in peri-vascular astrocytes and microglial cells in the gray matter of the frontal cortex, hippocampus, and para-hippocampal gyrus. Bright field microscopy revealed scattered intracellular and diffuse extracellular Aβ deposits in the hippocampus of controls with confirmed SARS-CoV-2 infections. Overall, the present preliminary findings suggest that SARS-CoV-2 infections induce abnormal inflammatory responses in Down syndrome.
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Affiliation(s)
- Ann-Charlotte E Granholm
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Research Complex II, Aurora, CO, USA.
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anah Gilmore
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Research Complex II, Aurora, CO, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - William H Yong
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - Sylvia E Perez
- Department of Translational Neuroscience and Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Samuel J Guzman
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eric D Hamlett
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elliott J Mufson
- Department of Translational Neuroscience and Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
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Dell’Aquila M, Cafiero C, Micera A, Stigliano E, Ottaiano MP, Benincasa G, Schiavone B, Guidobaldi L, Santacroce L, Pisconti S, Arena V, Palmirotta R. SARS-CoV-2-Related Olfactory Dysfunction: Autopsy Findings, Histopathology, and Evaluation of Viral RNA and ACE2 Expression in Olfactory Bulbs. Biomedicines 2024; 12:830. [PMID: 38672185 PMCID: PMC11048640 DOI: 10.3390/biomedicines12040830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has been a health emergency with a significant impact on the world due to its high infectiousness. The disease, primarily identified in the lower respiratory tract, develops with numerous clinical symptoms affecting multiple organs and displays a clinical finding of anosmia. Several authors have investigated the pathogenetic mechanisms of the olfactory disturbances caused by SARS-CoV-2 infection, proposing different hypotheses and showing contradictory results. Since uncertainties remain about possible virus neurotropism and direct damage to the olfactory bulb, we investigated the expression of SARS-CoV-2 as well as ACE2 receptor transcripts in autoptic lung and olfactory bulb tissues, with respect to the histopathological features. METHODS Twenty-five COVID-19 olfactory bulbs and lung tissues were randomly collected from 200 initial autopsies performed during the COVID-19 pandemic. Routine diagnosis was based on clinical and radiological findings and were confirmed with post-mortem swabs. Real-time RT-PCR for SARS-CoV-2 and ACE2 receptor RNA was carried out on autoptic FFPE lung and olfactory bulb tissues. Histological staining was performed on tissue specimens and compared with the molecular data. RESULTS While real-time RT-PCR for SARS-CoV-2 was positive in 23 out of 25 lung samples, the viral RNA expression was absent in olfactory bulbs. ACE2-receptor RNA was present in all tissues examined, being highly expressed in lung samples than olfactory bulbs. CONCLUSIONS Our finding suggests that COVID-19 anosmia is not only due to neurotropism and the direct action of SARS-CoV-2 entering the olfactory bulb. The mechanism of SARS-CoV-2 neuropathogenesis in the olfactory bulb requires a better elucidation and further research studies to mitigate the olfactory bulb damage associated with virus action.
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Affiliation(s)
- Marco Dell’Aquila
- Anatomic Pathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (E.S.); (V.A.)
- Pathology Unit, Belcolle Hospital, ASL Viterbo, 01100 Viterbo, Italy
| | - Concetta Cafiero
- Medical Oncology, SG Moscati Hospital, 74010 Statte, Italy;
- Anatomic Pathology Unit, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS–Fondazione Bietti, 00184 Rome, Italy
| | - Egidio Stigliano
- Anatomic Pathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (E.S.); (V.A.)
| | - Maria Pia Ottaiano
- Department of Clinical Pathology and Molecular Biology, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.P.O.); (G.B.); (B.S.)
| | - Giulio Benincasa
- Department of Clinical Pathology and Molecular Biology, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.P.O.); (G.B.); (B.S.)
| | - Beniamino Schiavone
- Department of Clinical Pathology and Molecular Biology, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.P.O.); (G.B.); (B.S.)
| | - Leo Guidobaldi
- Cytodiagnostic Unit, Section of Pathology Sandro Pertini Hospital, ASL Rm2, 00157 Rome, Italy;
| | - Luigi Santacroce
- Section of Microbiology and Virology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | | | - Vincenzo Arena
- Anatomic Pathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (E.S.); (V.A.)
| | - Raffaele Palmirotta
- Section of Sciences and Technologies of Laboratory Medicine, Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
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3
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Clever S, Limpinsel L, Meyer zu Natrup C, Schünemann LM, Beythien G, Rosiak M, Hülskötter K, Gregor KM, Tuchel T, Kalodimou G, Freudenstein A, Kumar S, Baumgärtner W, Sutter G, Tscherne A, Volz A. Single MVA-SARS-2-ST/N Vaccination Rapidly Protects K18-hACE2 Mice against a Lethal SARS-CoV-2 Challenge Infection. Viruses 2024; 16:417. [PMID: 38543782 PMCID: PMC10974247 DOI: 10.3390/v16030417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 05/23/2024] Open
Abstract
The sudden emergence of SARS-CoV-2 demonstrates the need for new vaccines that rapidly protect in the case of an emergency. In this study, we developed a recombinant MVA vaccine co-expressing SARS-CoV-2 prefusion-stabilized spike protein (ST) and SARS-CoV-2 nucleoprotein (N, MVA-SARS-2-ST/N) as an approach to further improve vaccine-induced immunogenicity and efficacy. Single MVA-SARS-2-ST/N vaccination in K18-hACE2 mice induced robust protection against lethal respiratory SARS-CoV-2 challenge infection 28 days later. The protective outcome of MVA-SARS-2-ST/N vaccination correlated with the activation of SARS-CoV-2-neutralizing antibodies (nABs) and substantial amounts of SARS-CoV-2-specific T cells especially in the lung of MVA-SARS-2-ST/N-vaccinated mice. Emergency vaccination with MVA-SARS-2-ST/N just 2 days before lethal SARS-CoV-2 challenge infection resulted in a delayed onset of clinical disease outcome in these mice and increased titers of nAB or SARS-CoV-2-specific T cells in the spleen and lung. These data highlight the potential of a multivalent COVID-19 vaccine co-expressing S- and N-protein, which further contributes to the development of rapidly protective vaccination strategies against emerging pathogens.
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Affiliation(s)
- Sabrina Clever
- Institute of Virology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (S.C.); (C.M.z.N.); (L.-M.S.)
| | - Leonard Limpinsel
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Christian Meyer zu Natrup
- Institute of Virology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (S.C.); (C.M.z.N.); (L.-M.S.)
| | - Lisa-Marie Schünemann
- Institute of Virology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (S.C.); (C.M.z.N.); (L.-M.S.)
| | - Georg Beythien
- Department of Pathology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (G.B.); (M.R.); (K.H.); (K.M.G.); (W.B.)
| | - Malgorzata Rosiak
- Department of Pathology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (G.B.); (M.R.); (K.H.); (K.M.G.); (W.B.)
| | - Kirsten Hülskötter
- Department of Pathology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (G.B.); (M.R.); (K.H.); (K.M.G.); (W.B.)
| | - Katharina Manuela Gregor
- Department of Pathology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (G.B.); (M.R.); (K.H.); (K.M.G.); (W.B.)
| | - Tamara Tuchel
- Institute of Virology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (S.C.); (C.M.z.N.); (L.-M.S.)
| | - Georgia Kalodimou
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Astrid Freudenstein
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Satendra Kumar
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (G.B.); (M.R.); (K.H.); (K.M.G.); (W.B.)
| | - Gerd Sutter
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Alina Tscherne
- Division of Virology, Department of Veterinary Sciences, LMU Munich, 85764 Oberschleißheim, Germany; (L.L.); (G.K.); (A.F.); (S.K.); (G.S.); (A.T.)
| | - Asisa Volz
- Institute of Virology, University of Veterinary Medicine Hannover, Buenteweg 17, 30559 Hanover, Germany; (S.C.); (C.M.z.N.); (L.-M.S.)
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Rittmannsberger H, Barth M, Lamprecht B, Malik P, Yazdi-Zorn K. [Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:1-23. [PMID: 38055146 DOI: 10.1007/s40211-023-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.
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Affiliation(s)
- Hans Rittmannsberger
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich.
| | - Martin Barth
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Bernd Lamprecht
- Med Campus III, Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
| | - Peter Malik
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Kurosch Yazdi-Zorn
- Neuromed Campus, Klinik für Psychiatrie mit Schwerpunkt Suchtmedizin, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
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5
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Bradshaw CM, Georgieva T, Tankersley TN, Taylor-Doyle T, Johnson L, Uhrlaub JL, Besselsen D, Nikolich JŽ. Cutting Edge: Characterization of Low Copy Number Human Angiotensin-Converting Enzyme 2-Transgenic Mice as an Improved Model of SARS-CoV-2 Infection. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 212:523-528. [PMID: 38197714 DOI: 10.4049/jimmunol.2300591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Abstract
A popular mouse model of COVID-19, the K18-hACE2 mouse, expresses the SARS-coronavirus entry receptor, human angiotensin-converting enzyme 2 (hACE2) driven by the keratin-18 promoter. SARS-CoV-2-infected K18-hACE2 mice exhibit neuropathology not representative of human infection. They contain eight transgene (Tg) copies, leading to excess hACE2 expression and rampant viral replication. We generated two new lines of K18-hACE2 mice encoding one and two copies of hACE2 (1-hACE2-Tg and 2-hACE2-Tg, respectively). Relative to the original strain (called 8-hACE2-Tg in this study), 2-hACE2-Tg mice exhibited lower mortality, with less viral replication in the lung and brain. Furthermore, 1-hACE2-Tg mice exhibited no mortality and had no detectable virus in the brain; yet, they exhibited clear viral replication in the lung. All three strains showed SARS-CoV-2-related weight loss commensurate with the mortality rates. 1-hACE2-Tg mice mounted detectable primary and memory T effector cell and Ab responses. We conclude that these strains provide improved models to study hACE2-mediated viral infections.
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Affiliation(s)
- Christine M Bradshaw
- Department of Immunobiology, University of Arizona College of Medicine - Tucson, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | - Teodora Georgieva
- Genetically Engineered Mouse Model (GEMM) Core, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Trevor N Tankersley
- Department of Immunobiology, University of Arizona College of Medicine - Tucson, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | - Tama Taylor-Doyle
- Genetically Engineered Mouse Model (GEMM) Core, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Larry Johnson
- Genetically Engineered Mouse Model (GEMM) Core, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine - Tucson, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | - David Besselsen
- BIO5 Institute, University of Arizona, Tucson, AZ
- Arizona Animal Care, University of Arizona, Tucson, AZ
| | - Janko Ž Nikolich
- Department of Immunobiology, University of Arizona College of Medicine - Tucson, Tucson, AZ
- Arizona Center on Aging, University of Arizona College of Medicine - Tucson, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
- Aegis Consortium for Pandemic-Free Future, University of Arizona Health Sciences, Tucson, AZ
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6
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Gavilán E, Medina-Guzman R, Bahatyrevich-Kharitonik B, Ruano D. Protein Quality Control Systems and ER Stress as Key Players in SARS-CoV-2-Induced Neurodegeneration. Cells 2024; 13:123. [PMID: 38247815 PMCID: PMC10814689 DOI: 10.3390/cells13020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic has brought to the forefront the intricate relationship between SARS-CoV-2 and its impact on neurological complications, including potential links to neurodegenerative processes, characterized by a dysfunction of the protein quality control systems and ER stress. This review article explores the role of protein quality control systems, such as the Unfolded Protein Response (UPR), the Endoplasmic Reticulum-Associated Degradation (ERAD), the Ubiquitin-Proteasome System (UPS), autophagy and the molecular chaperones, in SARS-CoV-2 infection. Our hypothesis suggests that SARS-CoV-2 produces ER stress and exploits the protein quality control systems, leading to a disruption in proteostasis that cannot be solved by the host cell. This disruption culminates in cell death and may represent a link between SARS-CoV-2 and neurodegeneration.
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Affiliation(s)
- Elena Gavilán
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Sevilla (US), 41012 Sevilla, Spain; (R.M.-G.); (B.B.-K.); (D.R.)
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Junta de Andalucía, CSIC, University of Seville (US), 41013 Sevilla, Spain
| | - Rafael Medina-Guzman
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Sevilla (US), 41012 Sevilla, Spain; (R.M.-G.); (B.B.-K.); (D.R.)
| | - Bazhena Bahatyrevich-Kharitonik
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Sevilla (US), 41012 Sevilla, Spain; (R.M.-G.); (B.B.-K.); (D.R.)
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Junta de Andalucía, CSIC, University of Seville (US), 41013 Sevilla, Spain
| | - Diego Ruano
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Sevilla (US), 41012 Sevilla, Spain; (R.M.-G.); (B.B.-K.); (D.R.)
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Junta de Andalucía, CSIC, University of Seville (US), 41013 Sevilla, Spain
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7
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Meinhardt J, Streit S, Dittmayer C, Manitius RV, Radbruch H, Heppner FL. The neurobiology of SARS-CoV-2 infection. Nat Rev Neurosci 2024; 25:30-42. [PMID: 38049610 DOI: 10.1038/s41583-023-00769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
Worldwide, over 694 million people have been infected with SARS-CoV-2, with an estimated 55-60% of those infected developing COVID-19. Since the beginning of the pandemic in December 2019, different variants of concern have appeared and continue to occur. With the emergence of different variants, an increasing rate of vaccination and previous infections, the acute neurological symptomatology of COVID-19 changed. Moreover, 10-45% of individuals with a history of SARS-CoV-2 infection experience symptoms even 3 months after disease onset, a condition that has been defined as 'post-COVID-19' by the World Health Organization and that occurs independently of the virus variant. The pathomechanisms of COVID-19-related neurological complaints have become clearer during the past 3 years. To date, there is no overt - that is, truly convincing - evidence for SARS-CoV-2 particles in the brain. In this Review, we put special emphasis on discussing the methodological difficulties of viral detection in CNS tissue and discuss immune-based (systemic and central) effects contributing to COVID-19-related CNS affection. We sequentially review the reported changes to CNS cells in COVID-19, starting with the blood-brain barrier and blood-cerebrospinal fluid barrier - as systemic factors from the periphery appear to primarily influence barriers and conduits - before we describe changes in brain parenchymal cells, including microglia, astrocytes, neurons and oligodendrocytes as well as cerebral lymphocytes. These findings are critical to understanding CNS affection in acute COVID-19 and post-COVID-19 in order to translate these findings into treatment options, which are still very limited.
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Affiliation(s)
- Jenny Meinhardt
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Simon Streit
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Carsten Dittmayer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Regina V Manitius
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Cluster of Excellence, NeuroCure, Berlin, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
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8
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Magaki S, Zhang T, Han K, Hilda M, Yong WH, Achim C, Fishbein G, Fishbein MC, Garner O, Salamon N, Williams CK, Valdes-Sueiras MA, Hsu JJ, Kelesidis T, Mathisen GE, Lavretsky H, Singer EJ, Vinters HV. HIV and COVID-19: two pandemics with significant (but different) central nervous system complications. FREE NEUROPATHOLOGY 2024; 5:5-5. [PMID: 38469363 PMCID: PMC10925920 DOI: 10.17879/freeneuropathology-2024-5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Abstract
Human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause significant neurologic disease. Central nervous system (CNS) involvement of HIV has been extensively studied, with well-documented invasion of HIV into the brain in the initial stage of infection, while the acute effects of SARS-CoV-2 in the brain are unclear. Neuropathologic features of active HIV infection in the brain are well characterized whereas neuropathologic findings in acute COVID-19 are largely non-specific. On the other hand, neuropathologic substrates of chronic dysfunction in both infections, as HIV-associated neurocognitive disorders (HAND) and post-COVID conditions (PCC)/long COVID are unknown. Thus far, neuropathologic studies on patients with HAND in the era of combined antiretroviral therapy have been inconclusive, and autopsy studies on patients diagnosed with PCC have yet to be published. Further longitudinal, multidisciplinary studies on patients with HAND and PCC and neuropathologic studies in comparison to controls are warranted to help elucidate the mechanisms of CNS dysfunction in both conditions.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Ting Zhang
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Karam Han
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Mirbaha Hilda
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - William H. Yong
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, CA, USA
| | - Cristian Achim
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Gregory Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Omai Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher K. Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Miguel A. Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey J. Hsu
- Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Glenn E. Mathisen
- Department of Infectious Diseases, Olive View-University of California Los Angeles Medical Center, Sylmar, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elyse J. Singer
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Harry V. Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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9
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Michael BD, Dunai C, Needham EJ, Tharmaratnam K, Williams R, Huang Y, Boardman SA, Clark JJ, Sharma P, Subramaniam K, Wood GK, Collie C, Digby R, Ren A, Norton E, Leibowitz M, Ebrahimi S, Fower A, Fox H, Tato E, Ellul MA, Sunderland G, Held M, Hetherington C, Egbe FN, Palmos A, Stirrups K, Grundmann A, Chiollaz AC, Sanchez JC, Stewart JP, Griffiths M, Solomon T, Breen G, Coles AJ, Kingston N, Bradley JR, Chinnery PF, Cavanagh J, Irani SR, Vincent A, Baillie JK, Openshaw PJ, Semple MG, Taams LS, Menon DK. Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses. Nat Commun 2023; 14:8487. [PMID: 38135686 PMCID: PMC10746705 DOI: 10.1038/s41467-023-42320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/06/2023] [Indexed: 12/24/2023] Open
Abstract
To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1-11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely.
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Affiliation(s)
- Benedict D Michael
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK.
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK.
| | - Cordelia Dunai
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
| | - Edward J Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Kukatharmini Tharmaratnam
- Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, L69 3GF, UK
| | - Robyn Williams
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Departments of Neurology and Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Yun Huang
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Sarah A Boardman
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Jordan J Clark
- University of Liverpool, Liverpool, L69 7BE, UK
- Department of Microbiology, Icahn School of Medicine, Mount Sinai, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine, Mount Sinai, NY, 10029, USA
| | - Parul Sharma
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Krishanthi Subramaniam
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Greta K Wood
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Ceryce Collie
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Richard Digby
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Alexander Ren
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Emma Norton
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Maya Leibowitz
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Soraya Ebrahimi
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Andrew Fower
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Hannah Fox
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Esteban Tato
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Mark A Ellul
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK
| | - Geraint Sunderland
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Marie Held
- Centre for Cell Imaging, Liverpool Shared Research Facilities, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Claire Hetherington
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Franklyn N Egbe
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Alish Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Kathy Stirrups
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- Department of Haematology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Alexander Grundmann
- Clinical Neurosciences, Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, SO17 1BF, UK
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Anne-Cecile Chiollaz
- Département de médecine interne des spécialités (DEMED), University of Geneva, Geneva, CH-1211, Switzerland
| | - Jean-Charles Sanchez
- Département de médecine interne des spécialités (DEMED), University of Geneva, Geneva, CH-1211, Switzerland
| | - James P Stewart
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Michael Griffiths
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Tom Solomon
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK
- The Pandemic Institute, Liverpool, L7 3FA, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- University of Cambridge, Cambridge, CB2 0QQ, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Patrick F Chinnery
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
| | - Jonathan Cavanagh
- Centre for Immunology, School of Infection & Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Departments of Neurology and Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Peter J Openshaw
- National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Malcolm G Semple
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
- Respiratory Unit, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, SE1 9RT, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
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10
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Kervancioglu Demirci E, Onen EA, Sevic Yilmaz E, Karagoz Koroglu A, Akakin D. SARS-CoV-2 Causes Brain Damage: Therapeutic Intervention with AZD8797. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2023; 29:2161-2173. [PMID: 37967299 DOI: 10.1093/micmic/ozad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
Elevated CX3CL1 is associated with severe COVID-19 and neurologic symptoms. We aimed to investigate the potential protective effects of selective CX3CR1 antagonist AZD8797 on SARS-CoV-2-induced neuronal damage, and to identify the underlying mechanisms. K18-hACE2 transgenic mice (n = 37) were randomly divided into control groups and SARS-CoV-2 groups, with and without intraperitoneal administration of vehicle or AZD8797 (2.5 mg/mL/day), following exposure to either a single dose of SARS-CoV-2 inhalation or no exposure. Object recognition and hole board tests were performed to assess memory function. Postinfection 8 days, brain tissues were analyzed for histopathological changes, viral, glial, apoptotic, and other immunohistochemical markers, along with measuring malondialdehyde, glutathione, and myeloperoxidase activities. Serum samples were analyzed for proinflammatory cytokines. The SARS-CoV-2 group showed significant weight loss, neuronal damage, oxidative stress, and impaired object recognition memory, while AZD8797 treatment mitigated some of these effects, especially in weight, apoptosis, glutathione, and MCP-1. Histopathological analyses supported the protective effects of AZD8797 against SARS-CoV-2-induced damage. The CX3CL1-CX3CR1 signaling pathway could offer a promising target for reducing SARS-CoV-2's neurological impact, but additional research is needed to confirm these findings in combination with other therapies and assess the clinical significance.
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Affiliation(s)
- Elif Kervancioglu Demirci
- Histology and Embryology Department, Istanbul Faculty of Medicine, Istanbul University, Turgut Ozal Cd. No:118m, Capa-Fatih, Istanbul 34093, Turkey
| | - Engin Alp Onen
- Vaccine and Biotechnology R&D, Kocak Pharmaceuticals, Karaagac O.S.B. 11.Sk No:5, Kapakli, Tekirdag 59520, Turkey
| | - Erva Sevic Yilmaz
- Histology and Embryology Department, Istanbul Faculty of Medicine, Istanbul University, Turgut Ozal Cd. No:118m, Capa-Fatih, Istanbul 34093, Turkey
| | - Ayca Karagoz Koroglu
- Histology and Embryology Department, School of Medicine, Istinye University, Azerbaycan Cd. No:3C, Sariyer, Istanbul 34010, Turkey
- Histology and Embryology Department, School of Medicine, Marmara University, Basibuyuk Mh. Maltepe Basibuyuk Yolu Sk. No:9/2, Basibuyuk-Maltepe, Istanbul 34854, Turkey
| | - Dilek Akakin
- Histology and Embryology Department, School of Medicine, Marmara University, Basibuyuk Mh. Maltepe Basibuyuk Yolu Sk. No:9/2, Basibuyuk-Maltepe, Istanbul 34854, Turkey
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11
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Finsterer J. Sudden Death Is More Likely to Result From SARS-COV-2 Infection Than Multiple Sclerosis. J Korean Med Sci 2023; 38:e393. [PMID: 37967883 PMCID: PMC10643249 DOI: 10.3346/jkms.2023.38.e393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/13/2023] [Indexed: 11/17/2023] Open
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12
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Guichard A, Lu S, Kanca O, Bressan D, Huang Y, Ma M, Sanz Juste S, Andrews JC, Jay KL, Sneider M, Schwartz R, Huang MC, Bei D, Pan H, Ma L, Lin WW, Auradkar A, Bhagwat P, Park S, Wan KH, Ohsako T, Takano-Shimizu T, Celniker SE, Wangler MF, Yamamoto S, Bellen HJ, Bier E. A comprehensive Drosophila resource to identify key functional interactions between SARS-CoV-2 factors and host proteins. Cell Rep 2023; 42:112842. [PMID: 37480566 PMCID: PMC10962759 DOI: 10.1016/j.celrep.2023.112842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 07/24/2023] Open
Abstract
Development of effective therapies against SARS-CoV-2 infections relies on mechanistic knowledge of virus-host interface. Abundant physical interactions between viral and host proteins have been identified, but few have been functionally characterized. Harnessing the power of fly genetics, we develop a comprehensive Drosophila COVID-19 resource (DCR) consisting of publicly available strains for conditional tissue-specific expression of all SARS-CoV-2 encoded proteins, UAS-human cDNA transgenic lines encoding established host-viral interacting factors, and GAL4 insertion lines disrupting fly homologs of SARS-CoV-2 human interacting proteins. We demonstrate the utility of the DCR to functionally assess SARS-CoV-2 genes and candidate human binding partners. We show that NSP8 engages in strong genetic interactions with several human candidates, most prominently with the ATE1 arginyltransferase to induce actin arginylation and cytoskeletal disorganization, and that two ATE1 inhibitors can reverse NSP8 phenotypes. The DCR enables parallel global-scale functional analysis of SARS-CoV-2 components in a prime genetic model system.
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Affiliation(s)
- Annabel Guichard
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Shenzhao Lu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Daniel Bressan
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA; Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Yan Huang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Mengqi Ma
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Sara Sanz Juste
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA; Department of Epigenetics & Molecular Carcinogenesis at MD Anderson, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; Center for Cancer Epigenetics, MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan C Andrews
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kristy L Jay
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Marketta Sneider
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Ruth Schwartz
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Mei-Chu Huang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Danqing Bei
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Hongling Pan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Liwen Ma
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Wen-Wen Lin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Ankush Auradkar
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Pranjali Bhagwat
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Soo Park
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Kenneth H Wan
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Takashi Ohsako
- Advanced Technology Center, Kyoto Institute of Technology, Kyoto 606-8585, Japan
| | - Toshiyuki Takano-Shimizu
- Kyoto Drosophila Stock Center and Faculty of Applied Biology, Kyoto Institute of Technology, Kyoto 616-8354, Japan
| | - Susan E Celniker
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA
| | - Shinya Yamamoto
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA; Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Ethan Bier
- Section of Cell and Developmental Biology, University of California, San Diego (UCSD), La Jolla, CA 92093, USA; Tata Institute for Genetics and Society - UCSD, La Jolla, CA 92093, USA.
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13
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Long J, Li J, Xie B, Jiao Z, Shen G, Liao W, Song X, Le H, Xia J, Wu S. Morphometric similarity network alterations in COVID-19 survivors correlate with behavioral features and transcriptional signatures. Neuroimage Clin 2023; 39:103498. [PMID: 37643521 PMCID: PMC10474075 DOI: 10.1016/j.nicl.2023.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To explore the differences in the cortical morphometric similarity network (MSN) between COVID-19 survivors and healthy controls, and the correlation between these differences and behavioralfeatures and transcriptional signatures. MATERIALS & METHODS 39 COVID-19 survivors and 39 age-, sex- and education years-matched healthy controls (HCs) were included. All participants underwent MRI and behavioral assessments (PCL-17, GAD-7, PHQ-9). MSN analysis was used to compute COVID-19 survivors vs. HCs differences across brain regions. Correlation analysis was used to determine the associations between regional MSN differences and behavioral assessments, and determine the spatial similarities between regional MSN differences and risk genes transcriptional activity. RESULTS COVID-19 survivors exhibited decreased regional MSN in insula, precuneus, transverse temporal, entorhinal, para-hippocampal, rostral middle frontal and supramarginal cortices, and increased regional MSN in pars triangularis, lateral orbitofrontal, superior frontal, superior parietal, postcentral, and inferior temporal cortices. Regional MSN value of lateral orbitofrontal cortex was positively associated with GAD-7 and PHQ-9 scores, and rostral middle frontal was negatively related to PHQ-9 scores. The analysis of spatial similarities showed that seven risk genes (MFGE8, MOB2, NUP62, PMPCA, SDSL, TMEM178B, and ZBTB11) were related to regional MSN values. CONCLUSION The MSN differences were associated with behavioral and transcriptional signatures, early psychological counseling or intervention may be required to COVID-19 survivors. Our study provided a new insight into understanding the altered coordination of structure in COVID-19 and may offer a new endophenotype to further investigate the brain substrate.
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Affiliation(s)
- Jia Long
- Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China
| | - Jiao Li
- School of Life Science and Technology, University of Electronic Science and Technology of China Chengdu, 610054, PR China
| | - Bing Xie
- Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China
| | - Zhuomin Jiao
- Department of Neurology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China
| | - Guoqiang Shen
- Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China
| | - Wei Liao
- School of Life Science and Technology, University of Electronic Science and Technology of China Chengdu, 610054, PR China
| | - Xiaomin Song
- Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China
| | - Hongbo Le
- Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China.
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, PR China.
| | - Song Wu
- South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China.
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14
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Díez-Cirarda M, Yus-Fuertes M, Sanchez-Sanchez R, Gonzalez-Rosa JJ, Gonzalez-Escamilla G, Gil-Martínez L, Delgado-Alonso C, Gil-Moreno MJ, Valles-Salgado M, Cano-Cano F, Ojeda-Hernandez D, Gomez-Ruiz N, Oliver-Mas S, Benito-Martín MS, Jorquera M, de la Fuente S, Polidura C, Selma-Calvo B, Arrazola J, Matias-Guiu J, Gomez-Pinedo U, Matias-Guiu JA. Hippocampal subfield abnormalities and biomarkers of pathologic brain changes: from SARS-CoV-2 acute infection to post-COVID syndrome. EBioMedicine 2023; 94:104711. [PMID: 37453364 PMCID: PMC10366393 DOI: 10.1016/j.ebiom.2023.104711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Cognitive deficits are among the main disabling symptoms in COVID-19 patients and post-COVID syndrome (PCS). Within brain regions, the hippocampus, a key region for cognition, has shown vulnerability to SARS-CoV-2 infection. Therefore, in vivo detailed evaluation of hippocampal changes in PCS patients, validated on post-mortem samples of COVID-19 patients at the acute phase, would shed light into the relationship between COVID-19 and cognition. METHODS Hippocampal subfields volume, microstructure, and perfusion were evaluated in 84 PCS patients and compared to 33 controls. Associations with blood biomarkers, including glial fibrillary acidic protein (GFAP), myelin oligodendrocyte glycoprotein (MOG), eotaxin-1 (CCL11) and neurofilament light chain (NfL) were evaluated. Besides, biomarker immunodetection in seven hippocampal necropsies of patients at the acute phase were contrasted against eight controls. FINDINGS In vivo analyses revealed that hippocampal grey matter atrophy is accompanied by altered microstructural integrity, hypoperfusion, and functional connectivity changes in PCS patients. Hippocampal structural and functional alterations were related to cognitive dysfunction, particularly attention and memory. GFAP, MOG, CCL11 and NfL biomarkers revealed alterations in PCS, and showed associations with hippocampal volume changes, in selective hippocampal subfields. Moreover, post mortem histology showed the presence of increased GFAP and CCL11 and reduced MOG concentrations in the hippocampus in post-mortem samples at the acute phase. INTERPRETATION The current results evidenced that PCS patients with cognitive sequalae present brain alterations related to cognitive dysfunction, accompanied by a cascade of pathological alterations in blood biomarkers, indicating axonal damage, astrocyte alterations, neuronal injury, and myelin changes that are already present from the acute phase. FUNDING Nominative Grant FIBHCSC 2020 COVID-19. Department of Health, Community of Madrid. Instituto de Salud Carlos III through the project INT20/00079, co-funded by European Regional Development Fund "A way to make Europe" (JAMG). Instituto de Salud Carlos III (ISCIII) through Sara Borrell postdoctoral fellowship Grant No. CD22/00043) and co-funded by the European Union (MDC). Instituto de Salud Carlos III through a predoctoral contract (FI20/000145) (co-funded by European Regional Development Fund "A way to make Europe") (MVS). Fundación para el Conocimiento Madri+d through the project G63-HEALTHSTARPLUS-HSP4 (JAMG, SOM).
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Affiliation(s)
- Maria Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Miguel Yus-Fuertes
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Javier J Gonzalez-Rosa
- Institute of Research and Biomedical Innovation of Cadiz (INiBICA), Cadiz 11009, Spain; Department of Psychology, University of Cadiz, Cadiz 11003, Spain
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Lidia Gil-Martínez
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Jose Gil-Moreno
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Valles-Salgado
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Fatima Cano-Cano
- Institute of Research and Biomedical Innovation of Cadiz (INiBICA), Cadiz 11009, Spain
| | - Denise Ojeda-Hernandez
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Natividad Gomez-Ruiz
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Silvia Oliver-Mas
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Soledad Benito-Martín
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Manuela Jorquera
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Sarah de la Fuente
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Polidura
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Selma-Calvo
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Arrazola
- Department of Radiology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Ulises Gomez-Pinedo
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, "San Carlos" Health Research Institute (IdISCC), Universidad Complutense de Madrid, Madrid, Spain.
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15
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Stein JA, Kaes M, Smola S, Schulz-Schaeffer WJ. Neuropathology in COVID-19 autopsies is defined by microglial activation and lesions of the white matter with emphasis in cerebellar and brain stem areas. Front Neurol 2023; 14:1229641. [PMID: 37521293 PMCID: PMC10374362 DOI: 10.3389/fneur.2023.1229641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction This study aimed to investigate microglial and macrophage activation in 17 patients who died in the context of a COVID-19 infection in 2020 and 2021. Methods Through immunohistochemical analysis, the lysosomal marker CD68 was used to detect diffuse parenchymal microglial activity, pronounced perivascular macrophage activation and macrophage clusters. COVID-19 patients were compared to control patients and grouped regarding clinical aspects. Detection of viral proteins was attempted in different regions through multiple commercially available antibodies. Results Microglial and macrophage activation was most pronounced in the white matter with emphasis in brain stem and cerebellar areas. Analysis of lesion patterns yielded no correlation between disease severity and neuropathological changes. Occurrence of macrophage clusters could not be associated with a severe course of disease or preconditions but represent a more advanced stage of microglial and macrophage activation. Severe neuropathological changes in COVID-19 were comparable to severe Influenza. Hypoxic damage was not a confounder to the described neuropathology. The macrophage/microglia reaction was less pronounced in post COVID-19 patients, but detectable i.e. in the brain stem. Commercially available antibodies for detection of SARS-CoV-2 virus material in immunohistochemistry yielded no specific signal over controls. Conclusion The presented microglial and macrophage activation might be an explanation for the long COVID syndrome.
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Affiliation(s)
- Julian A. Stein
- Institute of Neuropathology, Medical Faculty of the Saarland University, Homburg, Germany
| | - Manuel Kaes
- Institute of Neuropathology, Medical Faculty of the Saarland University, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarbrücken, Germany
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16
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Madden N, Mei YZJ, Jakubiak K, Li J, Hargus G, Goldman JE, Al-Dalahmah O. The link between SARS-CoV-2 related microglial reactivity and astrocyte pathology in the inferior olivary nucleus. Front Neurosci 2023; 17:1198219. [PMID: 37483351 PMCID: PMC10359900 DOI: 10.3389/fnins.2023.1198219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
The pathological involvement of the central nervous system in SARS-CoV2 (COVID-19) patients is established. The burden of pathology is most pronounced in the brain stem including the medulla oblongata. Hypoxic/ischemic damage is the most frequent neuropathologic abnormality. Other neuropathologic features include neuronophagia, microglial nodules, and hallmarks of neurodegenerative diseases: astrogliosis and microglial reactivity. It is still unknown if these pathologies are secondary to hypoxia versus a combination of inflammatory response combined with hypoxia. It is also unknown how astrocytes react to neuroinflammation in COVID-19, especially considering evidence supporting the neurotoxicity of certain astrocytic phenotypes. This study aims to define the link between astrocytic and microglial pathology in COVID-19 victims in the inferior olivary nucleus, which is one of the most severely affected brain regions in COVID-19, and establish whether COVID-19 pathology is driven by hypoxic damage. Here, we conducted neuropathologic assessments and multiplex-immunofluorescence studies on the medulla oblongata of 18 COVID-19, 10 pre-pandemic patients who died of acute respiratory distress syndrome (ARDS), and 7-8 control patients with no ARDS or COVID-19. The comparison of ARDS and COVID-19 allows us to identify whether the pathology in COVID-19 can be explained by hypoxia alone, which is common to both conditions. Our results showed increased olivary astrogliosis in ARDS and COVID-19. However, microglial density and microglial reactivity were increased only in COVID-19, in a region-specific manner. Also, olivary hilar astrocytes increased YKL-40 (CHI3L1) in COVID-19, but to a lesser extent than ARDS astrocytes. COVID-19 astrocytes also showed lower levels of Aquaporin-4 (AQP4), and Metallothionein-3 in subsets of COVID-19 brain regions. Cluster analysis on immunohistochemical attributes of astrocytes and microglia identified ARDS and COVID-19 clusters with correlations to clinical history and disease course. Our results indicate that olivary glial pathology and neuroinflammation in the COVID-19 cannot be explained solely by hypoxia and suggest that failure of astrocytes to upregulate the anti-inflammatory YKL-40 may contribute to the neuroinflammation. Notwithstanding the limitations of retrospective studies in establishing causality, our experimental design cannot adequately control for factors external to our design. Perturbative studies are needed to confirm the role of the above-described astrocytic phenotypes in neuroinflammation.
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Chang YM, Chen CH, Wang JN, Cheng CM, Tu YF, Shen CF. Case report: Distinct neurologic manifestation and cytokine profile of a child with COVID-19-associated acute fulminant encephalitis. Front Med (Lausanne) 2023; 10:1209656. [PMID: 37384050 PMCID: PMC10299828 DOI: 10.3389/fmed.2023.1209656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
The neurologic manifestations of coronavirus disease 2019 (COVID-19) may range from mild symptoms such as headache or confusion to profound encephalopathy with variable outcomes and sequelae. Here, we reported a case of fatal COVID-19-associated encephalitis with acute fulminant cerebral edema, presenting first with visual hallucination and then a rapid progression into comatose status in a few hours. Serial brain computed tomography depicted cerebral edematous changes from bilateral ventral temporal lobe to the whole brain leading to brain herniation. Multiple cytokines in serum and cerebrospinal fluid (CSF) were increased, with a more prominent rise in the CSF. Therefore, we postulated a hypothesis regarding the mechanism of this fulminant encephalitis that the SARS-CoV-2 virus attacked ventral temporal lobes initially, triggered a severe cytokine storm, and then led to subsequent disruption of the blood-brain barrier, diffuse brain edema, and brain herniation. The trend of cytokine profiles over time may aid in diagnosing and evaluating the severity and prognosis of COVID-19-associated encephalitis.
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Affiliation(s)
- Yu-Ming Chang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Han Chen
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Saleh T, Fuller T, Cambou MC, Segura ER, Kamau E, Yang S, Garner OB, Nielsen-Saines K. Epidemiology and SARS-CoV-2 Infection Patterns among Youth Followed at a Large Los Angeles Health Network during 2020-2022: Clinical Presentation, Prevalent Strains, and Correlates of Disease Severity. Vaccines (Basel) 2023; 11:1024. [PMID: 37376413 PMCID: PMC10300956 DOI: 10.3390/vaccines11061024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Outcomes of SARS CoV-2 infection in infants, children and young adults are reported less frequently than in older populations. The evolution of SARS-CoV-2 cases in LA County youths followed at a large health network in southern California over two years was evaluated. METHODS A prospective cohort study of patients aged 0-24 years diagnosed with COVID-19 was conducted. Demographics, age distribution, disease severity, circulating variants of concern (VOCs), and immunization rates were compared between first and second pandemic years. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) of factors associated with severe/critical COVID-19. RESULTS In total, 61,208 patients 0-24 years of age were tested for SARS-CoV-2 by polymerase chain reaction (PCR); 5263 positive patients (8.6%) with available data were identified between March 2020 and March 2022. In Year 1, 5.8% (1622/28,088) of youths tested positive, compared to 11% (3641/33,120) in Year 2 (p < 0.001). Most youths had mild/asymptomatic illness over two years. SARS-CoV-2 positivity was >12% across all age groups in the second half of Year 2, when Omicron prevailed. Pulmonary disease was associated with higher risk of severe COVID-19 in both years (OR: 2.4, 95% CI: 1.4-4.3, p = 0.002, Year 1; OR: 11.3, 95% CI: 4.3-29.6, Year 2, p < 0.001). Receipt of at least one COVID-19 vaccine dose was protective against severe COVID-19 (OR: 0.3, 95% CI: 0.11-0.80, p < 0.05). CONCLUSIONS Despite different VOCs and higher rates of test positivity in Year 2 compared to Year 1, most youths with COVID-19 had asymptomatic/mild disease. Underlying pulmonary conditions increased the risk of severe COVID-19, while vaccination was highly protective against severe disease in youths.
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Affiliation(s)
- Tawny Saleh
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Trevon Fuller
- Institute for the Environment and Sustainability at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Mary C. Cambou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Eddy R. Segura
- Facultad de Ciencias de la Salud, Universidad de Huánuco, Huánuco 10260, Peru;
| | - Edwin Kamau
- Department of Clinical Microbiology and Pathology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA; (E.K.)
| | - Shangxin Yang
- Department of Clinical Microbiology and Pathology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA; (E.K.)
| | - Omai B. Garner
- Department of Clinical Microbiology and Pathology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA; (E.K.)
| | - Karin Nielsen-Saines
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA 90095, USA
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19
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Lebrun L, Absil L, Remmelink M, De Mendonça R, D'Haene N, Gaspard N, Rusu S, Racu ML, Collin A, Allard J, Zindy E, Schiavo AA, De Clercq S, De Witte O, Decaestecker C, Lopes MB, Salmon I. SARS-Cov-2 infection and neuropathological findings: a report of 18 cases and review of the literature. Acta Neuropathol Commun 2023; 11:78. [PMID: 37165453 PMCID: PMC10170054 DOI: 10.1186/s40478-023-01566-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/15/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION COVID-19-infected patients harbour neurological symptoms such as stroke and anosmia, leading to the hypothesis that there is direct invasion of the central nervous system (CNS) by SARS-CoV-2. Several studies have reported the neuropathological examination of brain samples from patients who died from COVID-19. However, there is still sparse evidence of virus replication in the human brain, suggesting that neurologic symptoms could be related to mechanisms other than CNS infection by the virus. Our objective was to provide an extensive review of the literature on the neuropathological findings of postmortem brain samples from patients who died from COVID-19 and to report our own experience with 18 postmortem brain samples. MATERIAL AND METHODS We used microscopic examination, immunohistochemistry (using two different antibodies) and PCR-based techniques to describe the neuropathological findings and the presence of SARS-CoV-2 virus in postmortem brain samples. For comparison, similar techniques (IHC and PCR) were applied to the lung tissue samples for each patient from our cohort. The systematic literature review was conducted from the beginning of the pandemic in 2019 until June 1st, 2022. RESULTS In our cohort, the most common neuropathological findings were perivascular haemosiderin-laden macrophages and hypoxic-ischaemic changes in neurons, which were found in all cases (n = 18). Only one brain tissue sample harboured SARS-CoV-2 viral spike and nucleocapsid protein expression, while all brain cases harboured SARS-CoV-2 RNA positivity by PCR. A colocalization immunohistochemistry study revealed that SARS-CoV-2 antigens could be located in brain perivascular macrophages. The literature review highlighted that the most frequent neuropathological findings were ischaemic and haemorrhagic lesions, including hypoxic/ischaemic alterations. However, few studies have confirmed the presence of SARS-CoV-2 antigens in brain tissue samples. CONCLUSION This study highlighted the lack of specific neuropathological alterations in COVID-19-infected patients. There is still no evidence of neurotropism for SARS-CoV-2 in our cohort or in the literature.
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Affiliation(s)
- Laetitia Lebrun
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Lara Absil
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Myriam Remmelink
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Ricardo De Mendonça
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Nicky D'Haene
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Brussels, Belgium
| | - Stefan Rusu
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Marie-Lucie Racu
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Amandine Collin
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
| | - Justine Allard
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
| | - Egor Zindy
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
| | - Andrea Alex Schiavo
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Sarah De Clercq
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital ErasmeErasme University Hospital, Brussels, Belgium
| | - Christine Decaestecker
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
- Laboratory of Image Synthesis and Analysis, Brussels School of Engineering/École Polytechnique de Brussels, ULB, Brussels, Belgium
| | - Maria-Beatriz Lopes
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Isabelle Salmon
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB)Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 808 Route de Lennik, B-1070, Brussels, Belgium.
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium.
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Granholm AC. Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms. J Clin Med 2023; 12:3190. [PMID: 37176630 PMCID: PMC10179128 DOI: 10.3390/jcm12093190] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Numerous investigations have demonstrated significant and long-lasting neurological manifestations of COVID-19. It has been suggested that as many as four out of five patients who sustained COVID-19 will show one or several neurological symptoms that can last months after the infection has run its course. Neurological symptoms are most common in people who are less than 60 years of age, while encephalopathy is more common in those over 60. Biological mechanisms for these neurological symptoms need to be investigated and may include both direct and indirect effects of the virus on the brain and spinal cord. Individuals with Alzheimer's disease (AD) and related dementia, as well as persons with Down syndrome (DS), are especially vulnerable to COVID-19, but the biological reasons for this are not clear. Investigating the neurological consequences of COVID-19 is an urgent emerging medical need, since close to 700 million people worldwide have now had COVID-19 at least once. It is likely that there will be a new burden on healthcare and the economy dealing with the long-term neurological consequences of severe SARS-CoV-2 infections and long COVID, even in younger generations. Interestingly, neurological symptoms after an acute infection are strikingly similar to the symptoms observed after a mild traumatic brain injury (mTBI) or concussion, including dizziness, balance issues, anosmia, and headaches. The possible convergence of biological pathways involved in both will be discussed. The current review is focused on the most commonly described neurological symptoms, as well as the possible molecular mechanisms involved.
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Affiliation(s)
- Ann-Charlotte Granholm
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045-0511, USA
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21
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Gelpi E, Klotz S, Beyerle M, Wischnewski S, Harter V, Kirschner H, Stolz K, Reisinger C, Lindeck-Pozza E, Zoufaly A, Leoni M, Gorkiewicz G, Zacharias M, Haberler C, Hainfellner J, Woehrer A, Hametner S, Roetzer T, Voigtländer T, Ricken G, Endmayr V, Haider C, Ludwig J, Polt A, Wilk G, Schmid S, Erben I, Nguyen A, Lang S, Simonitsch-Klupp I, Kornauth C, Nackenhorst M, Kläger J, Kain R, Chott A, Wasicky R, Krause R, Weiss G, Löffler-Rag J, Berger T, Moser P, Soleiman A, Asslaber M, Sedivy R, Klupp N, Klimpfinger M, Risser D, Budka H, Schirmer L, Pröbstel AK, Höftberger R. Multifactorial White Matter Damage in the Acute Phase and Pre-Existing Conditions May Drive Cognitive Dysfunction after SARS-CoV-2 Infection: Neuropathology-Based Evidence. Viruses 2023; 15:908. [PMID: 37112888 PMCID: PMC10144140 DOI: 10.3390/v15040908] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is an urgent need to better understand the mechanisms underlying acute and long-term neurological symptoms after COVID-19. Neuropathological studies can contribute to a better understanding of some of these mechanisms. METHODS We conducted a detailed postmortem neuropathological analysis of 32 patients who died due to COVID-19 during 2020 and 2021 in Austria. RESULTS All cases showed diffuse white matter damage with a diffuse microglial activation of a variable severity, including one case of hemorrhagic leukoencephalopathy. Some cases revealed mild inflammatory changes, including olfactory neuritis (25%), nodular brainstem encephalitis (31%), and cranial nerve neuritis (6%), which were similar to those observed in non-COVID-19 severely ill patients. One previously immunosuppressed patient developed acute herpes simplex encephalitis. Acute vascular pathologies (acute infarcts 22%, vascular thrombosis 12%, diffuse hypoxic-ischemic brain damage 40%) and pre-existing small vessel diseases (34%) were frequent findings. Moreover, silent neurodegenerative pathologies in elderly persons were common (AD neuropathologic changes 32%, age-related neuronal and glial tau pathologies 22%, Lewy bodies 9%, argyrophilic grain disease 12.5%, TDP43 pathology 6%). CONCLUSIONS Our results support some previous neuropathological findings of apparently multifactorial and most likely indirect brain damage in the context of SARS-CoV-2 infection rather than virus-specific damage, and they are in line with the recent experimental data on SARS-CoV-2-related diffuse white matter damage, microglial activation, and cytokine release.
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Affiliation(s)
- Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Miriam Beyerle
- Departments of Neurology, Biomedicine and Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland; (M.B.); (A.-K.P.)
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
| | - Sven Wischnewski
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Mannheim Center for Translational Neuroscience and Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Verena Harter
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Harald Kirschner
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Katharina Stolz
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Christoph Reisinger
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | | | - Alexander Zoufaly
- Intensive Care Unit, Klinik Favoriten, 1100 Vienna, Austria;
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria
| | - Marlene Leoni
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Gregor Gorkiewicz
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Martin Zacharias
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Till Voigtländer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerda Ricken
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Verena Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Carmen Haider
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Judith Ludwig
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Andrea Polt
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Gloria Wilk
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanne Schmid
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Irene Erben
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Anita Nguyen
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanna Lang
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Ingrid Simonitsch-Klupp
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Christoph Kornauth
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
- Münchner Leukämielabor, 81377 Munich, Germany
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Johannes Kläger
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Andreas Chott
- Institute of Pathology, Klinik Ottakring, 1160 Vienna, Austria; (A.C.); (R.W.)
| | - Richard Wasicky
- Institute of Pathology, Klinik Ottakring, 1160 Vienna, Austria; (A.C.); (R.W.)
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Günter Weiss
- Department of Internal Medicine and Pulmonology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (J.L.-R.)
| | - Judith Löffler-Rag
- Department of Internal Medicine and Pulmonology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (J.L.-R.)
| | - Thomas Berger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrizia Moser
- Department of Neuropathology, Tirol Kliniken GmbH, 6020 Innsbruck, Austria; (P.M.); (A.S.)
| | - Afshin Soleiman
- Department of Neuropathology, Tirol Kliniken GmbH, 6020 Innsbruck, Austria; (P.M.); (A.S.)
| | - Martin Asslaber
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Roland Sedivy
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Nikolaus Klupp
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Martin Klimpfinger
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Daniele Risser
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Herbert Budka
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Lucas Schirmer
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Interdisciplinary Center for Neurosciences, Heidelberg University, 69120 Heidelberg, Germany
| | - Anne-Katrin Pröbstel
- Departments of Neurology, Biomedicine and Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland; (M.B.); (A.-K.P.)
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
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22
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Associations between brain gene expression perturbations implicated by COVID-19 and psychiatric disorders. J Psychiatr Res 2023; 162:79-87. [PMID: 37105022 PMCID: PMC10043811 DOI: 10.1016/j.jpsychires.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
Background Currently, there is increasing evidence from clinic, epidemiology, as well as neuroimaging, demonstrating neuropsychiatric abnormalities in COVID-19, however, whether there were associations between brain changes caused by COVID-19 and genetic susceptibility of psychiatric disorders was still unknown. Methods In this study, we performed a meta-analysis to investigate these associations by combing single-cell RNA sequencing datasets of brain tissues of COVID-19 and genome-wide association study summary statistics of psychiatric disorders. Results The analysis demonstrated that among ten psychiatric disorders, gene expression perturbations implicated by COVID-19 in excitatory neurons of choroid plexus were significantly associated with schizophrenia. Conclusions Our analysis might provide insights for the underlying mechanism of the psychiatric consequence of COVID-19.
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23
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Rabaan AA, Smajlović S, Tombuloglu H, Ćordić S, Hajdarević A, Kudić N, Mutai AA, Turkistani SA, Al-Ahmed SH, Al-Zaki NA, Al Marshood MJ, Alfaraj AH, Alhumaid S, Al-Suhaimi E. SARS-CoV-2 infection and multi-organ system damage: A review. BIOMOLECULES AND BIOMEDICINE 2023; 23:37-52. [PMID: 36124445 PMCID: PMC9901898 DOI: 10.17305/bjbms.2022.7762] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
The SARS-CoV-2 infection causes COVID-19, which has affected approximately six hundred million people globally as of August 2022. Organs and cells harboring angiotensin-converting enzyme 2 (ACE2) surface receptors are the primary targets of the virus. However, once it enters the body through the respiratory system, the virus can spread hematogenously to infect other body organs. Therefore, COVID-19 affects many organs, causing severe and long-term complications, even after the disease has ended, thus worsening the quality of life. Although it is known that the respiratory system is most affected by the SARS-CoV-2 infection, many organs/systems are affected in the short and long term. Since the COVID-19 disease simultaneously affects many organs, redesigning diagnostic and therapy policies to fit the damaged organs is strongly recommended. Even though the pathophysiology of many problems the infection causes is unknown, the frequency of COVID-19 cases rises with age and the existence of preexisting symptoms. This study aims to update our knowledge of SARS-CoV-2 infection and multi-organ dysfunction interaction based on clinical and theoretical evidence. For this purpose, the study comprehensively elucidates the most recent studies on the effects of SARS-CoV-2 infection on multiple organs and systems, including respiratory, cardiovascular, gastrointestinal, renal, nervous, endocrine, reproductive, immune, and parts of the integumentary system. Understanding the range of atypical COVID-19 symptoms could improve disease surveillance, limit transmission, and avoid additional multi-organ-system problems.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan,Correspondence to Ali A. Rabaan: ; Huseyin Tombuloglu:
| | - Samira Smajlović
- Laboratory Diagnostics Institute Dr. Dedić, Bihać, Bosnia and Herzegovina
| | - Huseyin Tombuloglu
- Department of Genetics Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia,Correspondence to Ali A. Rabaan: ; Huseyin Tombuloglu:
| | - Sabahudin Ćordić
- Cantonal Hospital “Dr. Irfan Ljubijankić”, Microbiological Laboratory, Bihać, Bosnia and Herzegovina
| | - Azra Hajdarević
- International Burch University, Faculty of Engineering and Natural Sciences, Department of Genetics and Bioengineering, Ilidža, Bosnia and Herzegovina
| | - Nudžejma Kudić
- University of Sarajevo, Faculty of Agriculture and Food Science, Sarajevo, Bosnia and Herzegovina
| | - Abbas Al Mutai
- Research Center, Almoosa Specialist Hospital, Al Mubarraz, Saudi Arabia,College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia,School of Nursing, Wollongong University, Wollongong, NSW, Australia,Nursing Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Shamsah H Al-Ahmed
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Nisreen A Al-Zaki
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Mona J Al Marshood
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ebtesam Al-Suhaimi
- Biology Department, College of Science and Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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24
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Danesh V, Arroliga AC, Bourgeois JA, Boehm LM, McNeal MJ, Widmer AJ, McNeal TM, Kesler SR. Symptom Clusters Seen in Adult COVID-19 Recovery Clinic Care Seekers. J Gen Intern Med 2023; 38:442-449. [PMID: 36376627 PMCID: PMC9663188 DOI: 10.1007/s11606-022-07908-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND COVID-19 symptom reports describe varying levels of disease severity with differing periods of recovery and symptom trajectories. Thus, there are a multitude of disease and symptom characteristics clinicians must navigate and interpret to guide care. OBJECTIVE To find natural groups of patients with similar constellations of post-acute sequelae of COVID-19 (PASC) symptoms. DESIGN Cohort SETTING: Outpatient COVID-19 recovery clinic with patient referrals from 160 primary care clinics serving 36 counties in Texas. PATIENTS Adult patients seeking COVID-19 recovery clinic care between November 15, 2020, and July 31, 2021, with laboratory-confirmed mild (not hospitalized), moderate (hospitalized), or severe (hospitalized with critical care) COVID-19. MAIN MEASURES Demographics, COVID illness onset, and duration of persistent PASC symptoms via semi-structured medical assessments. KEY RESULTS Four hundred forty-one patients (mean age 51.5 years; 295 [66.9%] women; 99 [22%] Hispanic, and 170 [38.5%] non-White, racial minority) met inclusion criteria. Using a k-medoids algorithm, we found that PASC symptoms cluster into two distinct groups: neuropsychiatric (N = 186) (e.g., subjective cognitive dysfunction) and pulmonary (N = 255) (e.g., dyspnea, cough). The neuropsychiatric cluster had significantly higher incidences of otolaryngologic (X2 = 14.3, p < 0.001), gastrointestinal (X2 = 6.90, p = 0.009), neurologic (X2 = 441, p < 0.001), and psychiatric sequelae (X2 = 40.6, p < 0.001) with more female (X2 = 5.44, p = 0.020) and younger age (t = 2.39, p = 0.017) patients experiencing longer durations of PASC symptoms before seeking care (t = 2.44, p = 0.015). Patients in the pulmonary cluster were more often hospitalized for COVID-19 (X2 = 3.98, p = 0.046) and had significantly higher comorbidity burden (U = 20800, p = 0.019) and pulmonary sequelae (X2 = 13.2, p < 0.001). CONCLUSIONS Health services clinic data from a large integrated health system offers insights into the post-COVID symptoms associated with care seeking for sequelae that are not adequately managed by usual care pathways (self-management and primary care clinic visits). These findings can inform machine learning algorithms, primary care management, and selection of patients for earlier COVID-19 recovery referral. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, 3434 Live Oak St, Dallas, TX, 75204, USA.
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Alejandro C Arroliga
- Baylor Scott & White Health, Dallas, TX, USA
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James A Bourgeois
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J McNeal
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Andrew J Widmer
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Tresa M McNeal
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, USA
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, TX, USA
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Shen X, Wang P, Shen J, Jiang Y, Wu L, Nie X, Liu J, Chen W. Neurological Manifestations of hospitalized patients with mild to moderate infection with SARS-CoV-2 Omicron variant in Shanghai, China. J Infect Public Health 2023; 16:155-162. [PMID: 36535135 PMCID: PMC9726211 DOI: 10.1016/j.jiph.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Accumulating studies demonstrated that patients with coronavirus disease 2019(COVID-19) could develop a variety of neurological manifestations and long-term neurological sequelae, which may be different from the strains. At the peak of the Omicron variant outbreak in Shanghai, China, no relevant epidemiological data about neurological manifestations associated with this strain was reported. OBJECTIVE To investigate neurological manifestations and related clinical features in patients with mild to moderate COVID-19 patients with Omicron variant. METHODS A self-designed clinical information registration form was used to gather the neurological manifestations of mild to moderate COVID-19 patients admitted to a designated hospital in Shanghai from April 18, 2022 to June 1, 2022. Demographics, clinical presentations, laboratory findings, treatments and clinical outcomes were compared between patients with and without neurological manifestations. RESULTS One hundred sixty-nine(48.1 %) of 351 patients diagnosed with mild to moderate COVID-19 exhibited neurological manifestations, the most common of which were fatigue/weakness(25.1 %) and myalgia(20.7 %), whereas acute cerebrovascular disease(0.9 %), impaired consciousness(0.6 %) and seizure(0.6 %) were rare. Younger age(p = 0.001), female gender(p = 0.026) and without anticoagulant medication(p = 0.042) were associated with increasing proportions of neurological manifestations as revealed by multivariate logistic regressions. Patients with neurological manifestations had lower creatine kinase and myoglobin levels, as well as higher proportion of patchy shadowing on chest scan. Vaccination status, clinical classification of COVID-19 and clinical outcomes were similar between the two groups. CONCLUSIONS Nearly half of the involved patients have neurological manifestations which were relatively subjective and closely associated with younger age, female gender and without anticoagulation. Patients with neurologic manifestations may be accompanied by increased lung patchy shadowing.
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Affiliation(s)
- Xiaolei Shen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ping Wang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jun Shen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yuhan Jiang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Li Wu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xin Nie
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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26
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Valyaeva AA, Zharikova AA, Sheval EV. SARS-CoV-2 cellular tropism and direct multiorgan failure in COVID-19 patients: Bioinformatic predictions, experimental observations, and open questions. Cell Biol Int 2023; 47:308-326. [PMID: 36229927 PMCID: PMC9874490 DOI: 10.1002/cbin.11928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/24/2022] [Accepted: 09/25/2022] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has led to an unprecedented public health emergency worldwide. While common cold symptoms are observed in mild cases, COVID-19 is accompanied by multiorgan failure in severe patients. Organ damage in COVID-19 patients is partially associated with the indirect effects of SARS-CoV-2 infection (e.g., systemic inflammation, hypoxic-ischemic damage, coagulopathy), but early processes in COVID-19 patients that trigger a chain of indirect effects are connected with the direct infection of cells by the virus. To understand the virus transmission routes and the reasons for the wide-spectrum of complications and severe outcomes of COVID-19, it is important to identify the cells targeted by SARS-CoV-2. This review summarizes the major steps of investigation and the most recent findings regarding SARS-CoV-2 cellular tropism and the possible connection between the early stages of infection and multiorgan failure in COVID-19. The SARS-CoV-2 pandemic is the first epidemic in which data extracted from single-cell RNA-seq (scRNA-seq) gene expression data sets have been widely used to predict cellular tropism. The analysis presented here indicates that the SARS-CoV-2 cellular tropism predictions are accurate enough for estimating the potential susceptibility of different cells to SARS-CoV-2 infection; however, it appears that not all susceptible cells may be infected in patients with COVID-19.
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Affiliation(s)
- Anna A. Valyaeva
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia
| | - Anastasia A. Zharikova
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia
| | - Eugene V. Sheval
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia,Department of Cell Biology and Histology, School of BiologyLomonosov Moscow State UniversityMoscowRussia
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27
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Lin W, Gao F, Wang X, Qin N, Chen X, Tam KY, Zhang C, Zhang M, Sha O. The oral manifestations and related mechanisms of COVID-19 caused by SARS-CoV-2 infection. Front Cell Neurosci 2023; 16:1006977. [PMID: 36687524 PMCID: PMC9846147 DOI: 10.3389/fncel.2022.1006977] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was reported to be associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and patients present mostly with respiratory symptoms. There have been an increasing number of reports on oral manifestations, and some of these signs are informative in terms of identifying SARS-CoV-2 infection. The goal of present study was to review and synthesize the clinical characteristics and underlying mechanisms of COVID-19 oral manifestations, as well as to evaluate the factors influencing SARS-CoV-2 infectivity, in order to conduct further in-depth investigations and help clinicians diagnose COVID-19 patients exhibiting oral symptoms.
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Affiliation(s)
- Weiming Lin
- Shenzhen University Medical School, Shenzhen, China
| | - Feng Gao
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China
| | - Xia Wang
- Shenzhen University Medical School, Shenzhen, China
| | - Nianhong Qin
- Shenzhen University Medical School, Shenzhen, China
| | - Xianxiong Chen
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China
| | - Kin Yip Tam
- Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
| | - Chengfei Zhang
- Shenzhen University Medical School, Shenzhen, China,School of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mingxia Zhang
- The Third People’s Hospital of Shenzhen, Shenzhen, China,Mingxia Zhang,
| | - Ou Sha
- School of Dentistry, Shenzhen University Medical School, Shenzhen, China,*Correspondence: Ou Sha,
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28
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Fluoxetine plus lithium for treatment of mental health impairment in Long Covid. DISCOVER MENTAL HEALTH 2023; 3:1. [PMID: 36618714 PMCID: PMC9810252 DOI: 10.1007/s44192-022-00027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023]
Abstract
Purposes (1) To summarize the mental conditions that may accompany persistent symptoms following acute infection by SARS-CoV-2, often termed Long Covid; (2) to formulate treatment based upon the brain cells that are dominantly affected. Methods (1) Review the reports relating to the mental symptoms occurring in Long Covid. (2) Review the drugs that address the brain cells affected in Long Covid, and suggest pharmacotherapy for those patients whose response to psychotherapy is suboptimal. Results Long Covid affects ~ 10% of patients infected by SARS-CoV-2, and mental symptoms affect ~ 20% of persons with Long Covid. The brain cell-types that have been demonstrated as dominantly affected in Long Covid are astrocytes, oligodendrocytes, neurons, endothelial cells/pericytes, and microglia. Lithium and fluoxetine each address all of those four cell-types. Low dosage of each is likely to be well-tolerated and to cause neither clinically important adverse events (AE) nor serious adverse events (SAE). Conclusion For those patients whose response to psychotherapy is suboptimal, lithium and fluoxetine should be administered in combination for both depth of benefit and reduction of dosages.
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Scopetti M, Padovano M, Manetti F, Di Fazio N, Radaelli D, D'Errico S, Frati P, Fineschi V. Molecular Autopsy in Asphyxia Deaths: Diagnostic Perspectives of miRNAs in the Evaluation of Hypoxia Response. Int J Med Sci 2023; 20:749-753. [PMID: 37213668 PMCID: PMC10198145 DOI: 10.7150/ijms.79539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/27/2023] [Indexed: 05/23/2023] Open
Abstract
The forensic investigation of asphyxia deaths still poses a challenge due to the need to demonstrate vital exposure to hypoxic insult according to high levels of evidence. The pulmonary effects of hypoxia are complex and the understanding of the mechanisms underlying the acute pneumotoxicity induced by hypoxia is still incomplete. Redox imbalance has been suggested as the protagonist of the main acute changes in pulmonary function in the hypoxic context. The development of knowledge in biochemistry and molecular biology has allowed research in forensic pathology to identify some markers useful in immunohistochemical diagnostics of asphyxia deaths. Several studies have highlighted the diagnostic potential of markers belonging to the HIF-1α and NF-kB pathways. The central role of some highly specific microRNAs has recently been recognized in the complex molecular mechanisms involved in the hypoxia response; thus, several research activities are currently aimed at identifying miRNAs involved in the regulation of oxygen homeostasis (hypoxamiR). The aim of the manuscript is to identify, the miRNAs involved in the early stages of the cellular response to hypoxia, in order to characterize the possible implications in the forensic field of the determination of expression profiles. At present, more than 60 miRNAs involved in the hypoxia response with different expression profiles (upregulation and downregulation) have been identified. Despite the multiple and different effects on reprogramming following the hypoxic insult, the evaluation of the diagnostic implications of hypoxamiRs in the forensic field presupposes a specific treatment of the influences on HIF-1α regulation, cell cycle progression, DNA repair, and apoptosis.
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Affiliation(s)
- Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Davide Radaelli
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- ✉ Corresponding author:
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30
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Autonomic Nerve Involvement in Post-Acute Sequelae of SARS-CoV-2 Syndrome (PASC). J Clin Med 2022; 12:jcm12010073. [PMID: 36614874 PMCID: PMC9821608 DOI: 10.3390/jcm12010073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
The novel SARS-CoV-2 virus and resulting COVID-19 global pandemic emerged in 2019 and continues into 2022. While mortality from COVID-19 is slowly declining, a subset of patients have developed chronic, debilitating symptoms following complete recovery from acute infection with COVID-19. Termed as post-acute sequelae of SARS-CoV-2 syndrome (PASC), the underlying pathophysiology of PASC is still not well understood. Given the similarity between the clinical phenotypes of PASC and postural orthostatic tachycardia syndrome (POTS), it has been postulated that dysautonomia may play a role in the pathophysiology of PASC. However, there have been only a few studies that have examined autonomic function in PASC. In this retrospective study, we performed an analysis of autonomic nerve function testing in PASC patients and compared the results with those of POTS patients and healthy controls. Our results suggest that a significant number of PASC patients have abnormal autonomic function tests, and their clinical features are indistinguishable from POTS.
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31
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Agrawal S, Farfel JM, Arfanakis K, Al-Harthi L, Shull T, Teppen TL, Evia AM, Patel MB, Ely EW, Leurgans SE, Bennett DA, Mehta R, Schneider JA. Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases. Acta Neuropathol Commun 2022; 10:186. [PMID: 36528671 PMCID: PMC9758667 DOI: 10.1186/s40478-022-01493-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study examined neuropathological findings of patients who died following hospitalization in an intensive care unit with SARS-CoV-2. METHODS Data originate from 20 decedents who underwent brain autopsy followed by ex-vivo imaging and dissection. Systematic neuropathologic examinations were performed to assess histopathologic changes including cerebrovascular disease and tissue injury, neurodegenerative diseases, and inflammatory response. Cerebrospinal fluid (CSF) and fixed tissues were evaluated for the presence of viral RNA and protein. RESULTS The mean age-at-death was 66.2 years (range: 26-97 years) and 14 were male. The patient's medical history included cardiovascular risk factors or diseases (n = 11, 55%) and dementia (n = 5, 25%). Brain examination revealed a range of acute and chronic pathologies. Acute vascular pathologic changes were common in 16 (80%) subjects and included infarctions (n = 11, 55%) followed by acute hypoxic/ischemic injury (n = 9, 45%) and hemorrhages (n = 7, 35%). These acute pathologic changes were identified in both younger and older groups and those with and without vascular risk factors or diseases. Moderate-to-severe microglial activation were noted in 16 (80%) brains, while moderate-to-severe T lymphocyte accumulation was present in 5 (25%) brains. Encephalitis-like changes included lymphocytic cuffing (n = 6, 30%) and neuronophagia or microglial nodule (most prominent in the brainstem, n = 6, 30%) were also observed. A single brain showed vasculitis-like changes and one other exhibited foci of necrosis with ball-ring hemorrhages reminiscent of acute hemorrhagic leukoencephalopathy changes. Chronic pathologies were identified in only older decedents: 7 brains exhibited neurodegenerative diseases and 8 brains showed vascular disease pathologies. CSF and brain samples did not show evidence of viral RNA or protein. CONCLUSIONS Acute tissue injuries and microglial activation were the most common abnormalities in COVID-19 brains. Focal evidence of encephalitis-like changes was noted despite the lack of detectable virus. The majority of older subjects showed age-related brain pathologies even in the absence of known neurologic disease. Findings of this study suggest that acute brain injury superimposed on common pre-existing brain disease may put older subjects at higher risk of post-COVID neurologic sequelae.
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Affiliation(s)
- Sonal Agrawal
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Pathology, Rush University Medical Center, Chicago, IL USA
| | - Jose M. Farfel
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Neurological Sciences, Rush University Medical Center, Chicago, IL USA
| | - Konstantinos Arfanakis
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.62813.3e0000 0004 1936 7806Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL USA
| | - Lena Al-Harthi
- grid.240684.c0000 0001 0705 3621Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL USA
| | - Tanner Shull
- grid.240684.c0000 0001 0705 3621Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL USA
| | - Tara L. Teppen
- grid.240684.c0000 0001 0705 3621Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL USA
| | - Arnold M. Evia
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA
| | - Mayur B. Patel
- grid.412807.80000 0004 1936 9916Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN USA ,grid.452900.a0000 0004 0420 4633The Geriatric Research Education Clinical Center (GRECC), Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System (TVHS), Nashville, TN USA
| | - E. Wesley Ely
- grid.412807.80000 0004 1936 9916Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN USA ,grid.452900.a0000 0004 0420 4633The Geriatric Research Education Clinical Center (GRECC), Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System (TVHS), Nashville, TN USA
| | - Sue. E. Leurgans
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Neurological Sciences, Rush University Medical Center, Chicago, IL USA
| | - David A. Bennett
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Neurological Sciences, Rush University Medical Center, Chicago, IL USA
| | - Rupal Mehta
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Pathology, Rush University Medical Center, Chicago, IL USA
| | - Julie A. Schneider
- grid.240684.c0000 0001 0705 3621Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago, IL 60612 USA ,grid.240684.c0000 0001 0705 3621Department of Pathology, Rush University Medical Center, Chicago, IL USA ,grid.240684.c0000 0001 0705 3621Department of Neurological Sciences, Rush University Medical Center, Chicago, IL USA
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Salari M, Zaker Harofteh B, Etemadifar M. Autoimmune meningoencephalitis associated with anti‐glutamic acid decarboxylase antibody following COVID‐19 infection: A case report. Clin Case Rep 2022; 10:e6597. [PMCID: PMC9743303 DOI: 10.1002/ccr3.6597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022] Open
Abstract
Anti‐glutamic acid decarboxylase (Anti‐GAD) are associated with various neurologic condition; but no meningitis has been reported with it, so far. Evidence demonstrates the associated of autoimmune meningoencephalitis with COVID‐19 infection. Here, we report a 44‐year‐old female with progressive loss of consciousness with anti‐GAD65 meningoencephalitis 1 month after COVID‐19 infection.
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Affiliation(s)
- Mehri Salari
- Department of Neurological diseaseShahid Beheshti University of Medical SciencesTehranIran
| | - Bahareh Zaker Harofteh
- Department of Neurological diseaseShahid Beheshti University of Medical SciencesTehranIran
| | - Masoud Etemadifar
- Department of Neurosurgery, Al Zahra University HospitalIsfahan University of Medical SciencesIsfahanIran
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Plantone D, Locci S, Bergantini L, Manco C, Cortese R, Meocci M, Cavallaro D, d'Alessandro M, Bargagli E, De Stefano N. Brain neuronal and glial damage during acute COVID-19 infection in absence of clinical neurological manifestations. J Neurol Neurosurg Psychiatry 2022; 93:1343-1348. [PMID: 36137741 DOI: 10.1136/jnnp-2022-329933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess whether SARS-CoV-2 infection may affect the central nervous system, specifically neurons and glia cells, even without clinical neurological involvement. METHODS In this single centre prospective study, serum levels of neurofilament light chain (sNfL) and glial fibrillar acidic protein (sGFAp) were assessed using SimoaTM assay Neurology 2-Plex B Assay Kit, in 148 hospitalised patients with COVID-19 without clinical neurological manifestations and compared them to 53 patients with interstitial pulmonary fibrosis (IPF) and 108 healthy controls (HCs). RESULTS Age and sex-corrected sNfL levels were higher in patients with COVID-19 (median log10-sNfL 1.41; IQR 1.04-1.83) than patients with IPF (median log10-sNfL 1.18; IQR 0.98-1.38; p<0.001) and HCs (median log10-sNfL 0.89; IQR 0.72-1.14; p<0.001). Likewise, age and sex-corrected sGFAP levels were higher in patients with COVID-19 (median log10-sGFAP 2.26; IQR 2.02-2.53) in comparison with patients with IPF (median log10-sGFAP 2.15; IQR 1.94-2.30; p<0.001) and HCs (median log10-sGFAP 1.87; IQR 0.64-2.09; p<0.001). No significant difference was found between patients with HCs and IPF (p=0.388 for sNfL and p=0.251 for sGFAp). In patients with COVID-19, a prognostic model with mortality as dependent variable (26/148 patients died during hospitalisation) and sNfl, sGFAp and age as independent variables, showed an area under curve of 0.72 (95% CI 0.59 to 0.84; negative predictive value (NPV) (%):80,positive predictive value (PPV)(%): 84; p=0.0008). CONCLUSION The results of our study suggest that neuronal and glial degeneration can occur in patients with COVID-19 regardless of overt clinical neurological manifestations. With age, levels of sNfl and GFAp can predict in-hospital COVID-19-associated mortality and might be useful to assess COVID-19 patient prognostic profile.
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Affiliation(s)
- Domenico Plantone
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sara Locci
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Laura Bergantini
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carlo Manco
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rosa Cortese
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martina Meocci
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Dalila Cavallaro
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Elena Bargagli
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Centre of Precision and Translational Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Octavius GS, Wijaya JH, Tan AO, Muljono MP, Chandra S, Juliansen A. Autopsy findings of pediatric COVID-19: a systematic review. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:32. [PMID: 35855892 PMCID: PMC9281196 DOI: 10.1186/s41935-022-00288-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/26/2022] [Indexed: 12/21/2022] Open
Abstract
Background Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients. Results There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review. Conclusion Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities.
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da Silva Júnior RT, Santos Apolonio J, Cuzzuol BR, da Costa BT, Silva CS, Araújo GRL, Silva Luz M, Marques HS, Santos LKDS, Pinheiro SLR, Lima de Souza Gonçalves V, Calmon MS, Freire de Melo F. COVID-19 neuropsychiatric repercussions: Current evidence on the subject. World J Methodol 2022; 12:365-380. [PMID: 36186752 PMCID: PMC9516547 DOI: 10.5662/wjm.v12.i5.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected the entire world, causing the coronavirus disease 2019 (COVID-19) pandemic since it was first discovered in Wuhan, China in December 2019. Among the clinical presentation of the disease, in addition to fever, fatigue, cough, dyspnea, diarrhea, nausea, vomiting, and abdominal pain, infected patients may also experience neurological and psychiatric repercussions during the course of the disease and as a post-COVID-19 sequelae. Thus, headache, dizziness, olfactory and gustatory dysfunction, cerebrovascular disorders, neuromuscular abnormalities, anxiety, depression, and post-traumatic stress disorder can occur both from the infection itself and from social distancing and quarantine. According to current evidence about this infection, the virus has the ability to infect the central nervous system (CNS) via angiotensin-converting enzyme 2 (ACE2) receptors on host cells. Several studies have shown the presence of ACE2 in nerve cells and nasal mucosa, as well as transmembrane serine protease 2, key points for interaction with the viral Spike glycoprotein and entry into the CNS, being olfactory tract and blood-brain barrier, through hematogenous dissemination, potential pathways. Thus, the presence of SARS-CoV-2 in the CNS supports the development of neuropsychiatric symptoms. The management of these manifestations seems more complex, given that the dense parenchyma and impermeability of brain tissue, despite protecting the brain from the infectious process, may hinder virus elimination. Still, some alternatives used in non-COVID-19 situations may lead to worse prognosis of acute respiratory syndrome, requiring caution. Therefore, the aim of this review is to bring more current points related to this infection in the CNS, as well as the repercussions of the isolation involved by the pandemic and to present perspectives on interventions in this scenario.
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Affiliation(s)
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Beatriz Rocha Cuzzuol
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Bruna Teixeira da Costa
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Camilo Santana Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Hanna Santos Marques
- Universidade Estadual do Sudoeste da Bahia, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083900, Brazil
| | - Luana Kauany de Sá Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Samuel Luca Rocha Pinheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | | | - Mariana Santos Calmon
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
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Hosseinpoor M, Kabiri M, Rajati Haghi M, Ghadam Soltani T, Rezaei A, Faghfouri A, Poustchian Gholkhatmi Z, Bakhshaee M. Intranasal Corticosteroid Treatment on Recovery of Long‐Term Olfactory Dysfunction Due to
COVID
‐19. Laryngoscope 2022; 132:2209-2216. [PMID: 36054369 PMCID: PMC9538270 DOI: 10.1002/lary.30353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Masoumeh Hosseinpoor
- Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Mona Kabiri
- Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Rajati Haghi
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
| | | | - Alireza Rezaei
- Department of Pathology, Mashhad Branch Islamic Azad University of Medical Sciences Mashhad Iran
| | - Atiyeh Faghfouri
- Student Research Committee, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Mehdi Bakhshaee
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
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Jaquet P, Legouy C, Le Fevre L, Grinea A, Sinnah F, Franchineau G, Patrier J, Marzouk M, Wicky PH, Alexis Geoffroy P, Arnoult F, Vledouts S, de Montmollin E, Bouadma L, Timsit JF, Sharshar T, Sonneville R. Neurologic Outcomes of Survivors of COVID-19-Associated Acute Respiratory Distress Syndrome Requiring Intubation. Crit Care Med 2022; 50:e674-e682. [PMID: 35132020 PMCID: PMC9275804 DOI: 10.1097/ccm.0000000000005500] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU. DESIGN A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020). SETTING Two academic hospital ICUs, Paris, France. PATIENTS Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge. INTERVENTIONS Follow-up by face-to-face neurologic consultation. MEASURES AND MAIN RESULTS The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome. CONCLUSIONS COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
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Affiliation(s)
- Pierre Jaquet
- UFR de médecine, Université de Paris, Paris, France
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Camille Legouy
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Lucie Le Fevre
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Fabrice Sinnah
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Guillaume Franchineau
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Juliette Patrier
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Mehdi Marzouk
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Paul-Henri Wicky
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Pierre Alexis Geoffroy
- Department of Psychiatry and Addictive Medicine, AP-HP, Hospital Bichat - Claude Bernard, 75018 Paris, France
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Florence Arnoult
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, AP-HP Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Serafima Vledouts
- Neurophysiologie clinique, service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Etienne de Montmollin
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Lila Bouadma
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Jean-François Timsit
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Tarek Sharshar
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Romain Sonneville
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
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de Melo BAG, Mundim MV, Lemes RMR, Cruz EM, Ribeiro TN, Santiago CF, da Fonsêca JHL, Benincasa JC, Stilhano RS, Mantovani N, Santana LC, Durães‐Carvalho R, Diaz RS, Janini LMR, Maricato JT, Porcionatto MA. 3D Bioprinted Neural-Like Tissue as a Platform to Study Neurotropism of Mouse-Adapted SARS-CoV-2. Adv Biol (Weinh) 2022; 6:e2200002. [PMID: 35521969 PMCID: PMC9347594 DOI: 10.1002/adbi.202200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/05/2022] [Indexed: 01/28/2023]
Abstract
The effects of neuroinvasion by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) become clinically relevant due to the numerous neurological symptoms observed in Corona Virus Disease 2019 (COVID-19) patients during infection and post-COVID syndrome or long COVID. This study reports the biofabrication of a 3D bioprinted neural-like tissue as a proof-of-concept platform for a more representative study of SARS-CoV-2 brain infection. Bioink is optimized regarding its biophysical properties and is mixed with murine neural cells to construct a 3D model of COVID-19 infection. Aiming to increase the specificity to murine cells, SARS-CoV-2 is mouse-adapted (MA-SARS-CoV-2) in vitro, in a protocol first reported here. MA-SARS-CoV-2 reveals mutations located at the Orf1a and Orf3a domains and is evolutionarily closer to the original Wuhan SARS-CoV-2 strain than SARS-CoV-2 used for adaptation. Remarkably, MA-SARS-CoV-2 shows high specificity to murine cells, which present distinct responses when cultured in 2D and 3D systems, regarding cell morphology, neuroinflammation, and virus titration. MA-SARS-CoV-2 represents a valuable tool in studies using animal models, and the 3D neural-like tissue serves as a powerful in vitro platform for modeling brain infection, contributing to the development of antivirals and new treatments for COVID-19.
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Affiliation(s)
- Bruna A. G. de Melo
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Mayara V. Mundim
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Robertha M. R. Lemes
- Department of Biological SciencesUniversidade Federal de São PauloDiadema09920‐540Brazil
| | - Elisa M. Cruz
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Tais N. Ribeiro
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Carolina F. Santiago
- Department of MicrobiologyImmunology and ParasitoloyEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Jéssica H. L. da Fonsêca
- Department of Manufacturing and Materials EngineeringFaculdade de Engenharia MecânicaUniversidade Estadual de CampinasCampinasSP13083‐860Brazil
| | - Julia C. Benincasa
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Roberta S. Stilhano
- Department of Physiological SciencesFaculdade de Ciências MédicasSanta Casa de São PauloSão Paulo01221‐020Brazil
| | - Nathalia Mantovani
- Department of MedicineEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Luiz C. Santana
- Department of MedicineEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Ricardo Durães‐Carvalho
- Department of MicrobiologyImmunology and ParasitoloyEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Ricardo S. Diaz
- Department of MedicineEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Luiz M. R. Janini
- Department of MicrobiologyImmunology and ParasitoloyEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Juliana T. Maricato
- Department of MicrobiologyImmunology and ParasitoloyEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
| | - Marimelia A. Porcionatto
- Department of BiochemistryEscola Paulista de MedicinaUniversidade Federal de São PauloSão Paulo04039‐032Brazil
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COVID-19 and Parkinsonism: A Critical Appraisal. Biomolecules 2022; 12:biom12070970. [PMID: 35883526 PMCID: PMC9313170 DOI: 10.3390/biom12070970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
A few cases of parkinsonism linked to COVID-19 infection have been reported so far, raising the possibility of a post-viral parkinsonian syndrome. The objective of this review is to summarize the clinical, biological, and neuroimaging features of published cases describing COVID-19-related parkinsonism and to discuss the possible pathophysiological mechanisms. A comprehensive literature search was performed using NCBI’s PubMed database and standardized search terms. Thirteen cases of COVID-19-related parkinsonism were included (7 males; mean age: 51 years ± 14.51, range 31–73). Patients were classified based on the possible mechanisms of post-COVID-19 parkinsonism: extensive inflammation or hypoxic brain injury within the context of encephalopathy (n = 5); unmasking of underlying still non-symptomatic Parkinson’s Disease (PD) (n = 5), and structural and functional basal ganglia damage (n = 3). The various clinical scenarios show different outcomes and responses to dopaminergic treatment. Different mechanisms may play a role, including vascular damage, neuroinflammation, SARS-CoV-2 neuroinvasive potential, and the impact of SARS-CoV-2 on α-synuclein. Our results confirm that the appearance of parkinsonism during or immediately after COVID-19 infection represents a very rare event. Future long-term observational studies are needed to evaluate the possible role of SARS-CoV-2 infection as a trigger for the development of PD in the long term.
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Sodagar A, Javed R, Tahir H, Razak SIA, Shakir M, Naeem M, Yusof AHA, Sagadevan S, Hazafa A, Uddin J, Khan A, Al-Harrasi A. Pathological Features and Neuroinflammatory Mechanisms of SARS-CoV-2 in the Brain and Potential Therapeutic Approaches. Biomolecules 2022; 12:biom12070971. [PMID: 35883527 PMCID: PMC9313047 DOI: 10.3390/biom12070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
The number of deaths has been increased due to COVID-19 infections and uncertain neurological complications associated with the central nervous system. Post-infections and neurological manifestations in neuronal tissues caused by COVID-19 are still unknown and there is a need to explore how brainstorming promoted congenital impairment, dementia, and Alzheimer’s disease. SARS-CoV-2 neuro-invasion studies in vivo are still rare, despite the fact that other beta-coronaviruses have shown similar properties. Neural (olfactory or vagal) and hematogenous (crossing the blood–brain barrier) pathways have been hypothesized in light of new evidence showing the existence of SARS-CoV-2 host cell entry receptors into the specific components of human nerve and vascular tissue. Spike proteins are the primary key and structural component of the COVID-19 that promotes the infection into brain cells. Neurological manifestations and serious neurodegeneration occur through the binding of spike proteins to ACE2 receptor. The emerging evidence reported that, due to the high rate in the immediate wake of viral infection, the olfactory bulb, thalamus, and brain stem are intensely infected through a trans-synaptic transfer of the virus. It also instructs the release of chemokines, cytokines, and inflammatory signals immensely to the blood–brain barrier and infects the astrocytes, which causes neuroinflammation and neuron death; and this induction of excessive inflammation and immune response developed in more neurodegeneration complications. The present review revealed the pathophysiological effects, molecular, and cellular mechanisms of possible entry routes into the brain, pathogenicity of autoantibodies and emerging immunotherapies against COVID-19.
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Affiliation(s)
- Aisha Sodagar
- Department of Botany, Faculty of Sciences, University of Agriculture, Faisalabad 38040, Pakistan;
| | - Rasab Javed
- Institute of Microbiology, University of Agriculture, Faisalabad 38040, Pakistan;
| | - Hira Tahir
- Department of Botany, Government College Women University Faisalabad, Faisalabad 38000, Pakistan;
| | - Saiful Izwan Abd Razak
- Bioinspired Device and Tissue Engineering Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia;
- Sports Innovation & Technology Centre, Institute of Human Centred Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Muhammad Shakir
- School of Life Sciences, Northeast Normal University, Changchun 130024, China;
| | - Muhammad Naeem
- College of Life Science, Hebei Normal University, Shijiazhuang 050024, China;
| | - Abdul Halim Abdul Yusof
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia;
| | - Suresh Sagadevan
- Nanotechnology & Catalysis Research Centre, University of Malaya, Kuala Lumpur 50603, Kuala Lumpur, Malaysia;
| | - Abu Hazafa
- Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisalabad 38040, Pakistan
- Correspondence: or (A.H.); (A.K.); (A.A.-H.)
| | - Jalal Uddin
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia;
| | - Ajmal Khan
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al Mauz, Nizwa 616, Oman
- Correspondence: or (A.H.); (A.K.); (A.A.-H.)
| | - Ahmed Al-Harrasi
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al Mauz, Nizwa 616, Oman
- Correspondence: or (A.H.); (A.K.); (A.A.-H.)
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Neuropsychological Predictors of Fatigue in Post-COVID Syndrome. J Clin Med 2022; 11:jcm11133886. [PMID: 35807173 PMCID: PMC9267301 DOI: 10.3390/jcm11133886] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023] Open
Abstract
Fatigue is one of the most disabling symptoms in several neurological disorders and has an important cognitive component. However, the relationship between self-reported cognitive fatigue and objective cognitive assessment results remains elusive. Patients with post-COVID syndrome often report fatigue and cognitive issues several months after the acute infection. We aimed to develop predictive models of fatigue using neuropsychological assessments to evaluate the relationship between cognitive fatigue and objective neuropsychological assessment results. We conducted a cross-sectional study of 113 patients with post-COVID syndrome, assessing them with the Modified Fatigue Impact Scale (MFIS) and a comprehensive neuropsychological battery including standardized and computerized cognitive tests. Several machine learning algorithms were developed to predict MFIS scores (total score and cognitive fatigue score) based on neuropsychological test scores. MFIS showed moderate correlations only with the Stroop Color–Word Interference Test. Classification models obtained modest F1-scores for classification between fatigue and non-fatigued or between 3 or 4 degrees of fatigue severity. Regression models to estimate the MFIS score did not achieve adequate R2 metrics. Our study did not find reliable neuropsychological predictors of cognitive fatigue in the post-COVID syndrome. This has important implications for the interpretation of fatigue and cognitive assessment. Specifically, MFIS cognitive domain could not properly capture actual cognitive fatigue. In addition, our findings suggest different pathophysiological mechanisms of fatigue and cognitive dysfunction in post-COVID syndrome.
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42
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Liu X, Mostafavi H, Ng WH, Freitas JR, King NJC, Zaid A, Taylor A, Mahalingam S. The Delta SARS-CoV-2 Variant of Concern Induces Distinct Pathogenic Patterns of Respiratory Disease in K18-hACE2 Transgenic Mice Compared to the Ancestral Strain from Wuhan. mBio 2022; 13:e0068322. [PMID: 35420469 PMCID: PMC9239116 DOI: 10.1128/mbio.00683-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Compared to the original ancestral strain of SARS-CoV-2, the Delta variant of concern has shown increased transmissibility and resistance toward COVID-19 vaccines and therapies. However, the pathogenesis of the disease associated with Delta is still not clear. In this study, using K18-hACE2 transgenic mice, we assessed the pathogenicity of the Delta variant by characterizing the immune response following infection. We found that Delta induced the same clinical disease manifestations as the ancestral SARS-CoV-2, but with significant dissemination to multiple tissues, such as brain, intestine, and kidney. Histopathological analysis showed that tissue pathology and cell infiltration in the lungs of Delta-infected mice were the same as in mice infected with the ancestral SARS-CoV-2. Delta infection caused perivascular inflammation in the brain and intestinal wall thinning in K18-hACE2 transgenic mice. Increased cell infiltration in the kidney was observed in both ancestral strain- and Delta-infected mice, with no clear visible tissue damage identified in either group. Interestingly, compared with mice infected with the ancestral strain, the numbers of CD45+ cells, T cells, B cells, inflammatory monocytes, and dendritic cells were all significantly lower in the lungs of the Delta-infected mice, although there was no significant difference in the levels of proinflammatory cytokines between the two groups. Our results showed distinct immune response patterns in the lungs of K18-hACE2 mice infected with either the ancestral SARS-CoV-2 or Delta variant of concern, which may help to guide therapeutic interventions for emerging SARS-CoV-2 variants. IMPORTANCE SARS-CoV-2 variants, with the threat of increased transmissibility, infectivity, and immune escape, continue to emerge as the COVID-19 pandemic progresses. Detailing the pathogenesis of disease caused by SARS-CoV-2 variants, such as Delta, is essential to better understand the clinical threat caused by emerging variants and associated disease. This study, using the K18-hACE2 mouse model of severe COVID-19, provides essential observation and analysis on the pathogenicity and immune response of Delta infection. These observations shed light on the changing disease profile associated with emerging SARS-CoV-2 variants and have potential to guide COVID-19 treatment strategies.
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Affiliation(s)
- Xiang Liu
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Helen Mostafavi
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Wern Hann Ng
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Joseph R. Freitas
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Nicholas J. C. King
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- The Discipline of Pathology and Bosch Institute, School of Medical Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Ali Zaid
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Adam Taylor
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
| | - Suresh Mahalingam
- Menzies Health Institute Queensland, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
- School of Medical Sciences, Griffith Universitygrid.1022.1, Gold Coast, Queensland, Australia
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Ruz-Caracuel I, Pian-Arias H, Corral Í, Carretero-Barrio I, Bueno-Sacristán D, Pérez-Mies B, García-Cosío M, Caniego-Casas T, Pizarro D, García-Narros MI, Piris-Villaespesa M, Pestaña D, de Pablo R, Galán JC, Masjuan J, Palacios J. Neuropathological findings in fatal COVID-19 and their associated neurological clinical manifestations. Pathology 2022; 54:738-745. [PMID: 35691726 PMCID: PMC9182090 DOI: 10.1016/j.pathol.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/19/2022]
Abstract
Severe cases of Coronavirus Disease 2019 (COVID-19) can present with multiple neurological symptoms. The available neuropathological studies have described different lesions; the most frequent was the presence of neuroinflammation and vascular-related lesions. The objective of this study was to report the neuropathological studies performed in a medical institution, with abundant long intensive care unit stays, and their associated clinical manifestations. This is a retrospective monocentric case series study based on the neuropathological reports of 13 autopsies with a wide range of illness duration (13–108 days). A neuroinflammatory score was calculated based on the quantification of CD8- and CD68-positive cells in representative areas of the central nervous system. This score was correlated afterwards with illness duration and parameters related to systemic inflammation. Widespread microglial and cytotoxic T-cell activation was found in all patients. There was no correlation between the neuroinflammatory score and the duration of the illness; nor with parameters of systemic inflammation such as the peak of IL-6 or the HScore (a parameter of systemic macrophage activation syndrome). Two patients had global hypoxic ischaemic damage and five patients had subacute infarcts. One patient had many more brain vascular microthrombi compared to the others and multiple subacute pituitary infarcts. SARS-CoV-2 RNA was not detected with qRT-PCR. The proportion of brain lesions in severe COVID-19 patients could be related to illness duration. In our series, with abundant long hospitalisation stays, neuroinflammation was present in all patients and was more prominent between day 34 and day 45 after onset of symptoms. Clinical correlation showed that two patients with the highest neuroinflammatory scores had severe encephalopathies that were not attributable to any other cause. The second most frequent lesions were related to vascular pathology.
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Affiliation(s)
| | - Héctor Pian-Arias
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Íñigo Corral
- Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain
| | - Irene Carretero-Barrio
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain
| | | | - Belén Pérez-Mies
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain; CIBERONC, Madrid, Spain
| | - Mónica García-Cosío
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain; CIBERONC, Madrid, Spain
| | - Tamara Caniego-Casas
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERONC, Madrid, Spain
| | - David Pizarro
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | - David Pestaña
- Universidad de Alcalá de Henares, Madrid, Spain; Anesthesiology and Surgical Critical Care Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Raúl de Pablo
- Universidad de Alcalá de Henares, Madrid, Spain; Department of Intensive Care Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan Carlos Galán
- Clinical Microbiology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERESP, Madrid, Spain
| | - Jaime Masjuan
- Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain.
| | - José Palacios
- Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain; CIBERONC, Madrid, Spain.
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44
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Eskandarian Boroujeni M, Sekrecka A, Antonczyk A, Hassani S, Sekrecki M, Nowicka H, Lopacinska N, Olya A, Kluzek K, Wesoly J, Bluyssen HAR. Dysregulated Interferon Response and Immune Hyperactivation in Severe COVID-19: Targeting STATs as a Novel Therapeutic Strategy. Front Immunol 2022; 13:888897. [PMID: 35663932 PMCID: PMC9156796 DOI: 10.3389/fimmu.2022.888897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/13/2022] [Indexed: 01/08/2023] Open
Abstract
A disease outbreak in December 2019, caused by a novel coronavirus SARS-CoV-2, was named COVID-19. SARS-CoV-2 infects cells from the upper and lower respiratory tract system and is transmitted by inhalation or contact with infected droplets. Common clinical symptoms include fatigue, fever, and cough, but also shortness of breath and lung abnormalities. Still, some 5% of SARS-CoV-2 infections progress to severe pneumonia and acute respiratory distress syndrome (ARDS), with pulmonary edema, acute kidney injury, and/or multiple organ failure as important consequences, which can lead to death. The innate immune system recognizes viral RNAs and triggers the expression of interferons (IFN). IFNs activate anti-viral effectors and components of the adaptive immune system by activating members of the STAT and IRF families that induce the expression of IFN-stimulated genes (ISG)s. Among other coronaviruses, such as Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV, common strategies have been identified to antagonize IFN signaling. This typically coincides with hyperactive inflammatory host responses known as the “cytokine storm” that mediate severe lung damage. Likewise, SARS-CoV-2 infection combines a dysregulated IFN response with excessive production of inflammatory cytokines in the lungs. This excessive inflammatory response in the lungs is associated with the local recruitment of immune cells that create a pathogenic inflammatory loop. Together, it causes severe lung pathology, including ARDS, as well as damage to other vulnerable organs, like the heart, spleen, lymph nodes, and kidney, as well as the brain. This can rapidly progress to multiple organ exhaustion and correlates with a poor prognosis in COVID-19 patients. In this review, we focus on the crucial role of different types of IFN that underlies the progression of SARS-CoV-2 infection and leads to immune cell hyper-activation in the lungs, exuberant systemic inflammation, and multiple organ damage. Consequently, to protect from systemic inflammation, it will be critical to interfere with signaling cascades activated by IFNs and other inflammatory cytokines. Targeting members of the STAT family could therefore be proposed as a novel therapeutic strategy in patients with severe COVID-19.
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Affiliation(s)
- Mahdi Eskandarian Boroujeni
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Agata Sekrecka
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Aleksandra Antonczyk
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Sanaz Hassani
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Michal Sekrecki
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Hanna Nowicka
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Natalia Lopacinska
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Arta Olya
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Katarzyna Kluzek
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Joanna Wesoly
- Laboratory of High Throughput Technologies, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
| | - Hans A R Bluyssen
- Laboratory of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland
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45
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Stram MN, Seifert AC, Cortes E, Akyatan A, Woodoff-Leith E, Borukhov V, Tetlow A, Alyemni D, Greenberg M, Gupta A, Krausert A, Mecca L, Rodriguez S, Stahl-Herz J, Guzman MA, Delman B, Crary JF, Dams-O'Connor K, Folkerth RD. Neuropathology of Pediatric SARS-CoV-2 Infection in the Forensic Setting: Novel Application of Ex Vivo Imaging in Analysis of Brain Microvasculature. Front Neurol 2022; 13:894565. [PMID: 35685741 PMCID: PMC9170881 DOI: 10.3389/fneur.2022.894565] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Two years into the COVID-19 pandemic, there are few published accounts of postmortem SARS-CoV-2 pathology in children. We report 8 such cases (4 infants aged 7–36 weeks, 4 children aged 5–15 years). Four underwent ex vivo magnetic resonance neuroimaging, to assist in identification of subtle lesions related to vascular compromise. All infants were found unresponsive (3 in unsafe sleeping conditions); all but 1 had recent rhinitis and/or influenza-like illness (ILI) in the family; 1 had history of sickle cell disease. Ex vivo neuroimaging in 1 case revealed white matter (WM) signal hyperintensity and diffuse exaggeration of perivascular spaces, corresponding microscopically to WM mineralization. Neurohistology in the remaining 3 infants variably encompassed WM gliosis and mineralization; brainstem gliosis; perivascular vacuolization; perivascular lymphocytes and brainstem microglia. One had ectopic hippocampal neurons (with pathogenic variant in DEPDC5). Among the children, 3 had underlying conditions (e.g., obesity, metabolic disease, autism) and all presented with ILI. Three had laboratory testing suggesting multisystem inflammatory syndrome (MIS-C). Two were hospitalized for critical care including mechanical ventilation and extracorporeal membrane oxygenation (ECMO); one (co-infected with adenovirus) developed right carotid stroke ipsilateral to the ECMO cannula and the other required surgery for an ingested foreign body. Autopsy findings included: acute lung injury in 3 (1 with microthrombi); and one each with diabetic ketoacidosis and cardiac hypertrophy; coronary and cerebral arteritis and aortitis, resembling Kawasaki disease; and neuronal storage and enlarged fatty liver. All 4 children had subtle meningoencephalitis, focally involving the brainstem. On ex vivo neuroimaging, 1 had focal pontine susceptibility with corresponding perivascular inflammation/expanded perivascular spaces on histopathology. Results suggest SARS-CoV-2 in infants may present as sudden unexpected infant death, while in older children, signs and symptoms point to severe disease. Underlying conditions may predispose to fatal outcomes. As in adults, the neuropathologic changes may be subtle, with vascular changes such as perivascular vacuolization and gliosis alongside sparse perivascular lymphocytes. Detection of subtle vascular pathology is enhanced by ex vivo neuroimaging. Additional analysis of the peripheral/autonomic nervous system and investigation of co-infection in children with COVID-19 is necessary to understand risk for cardiovascular collapse/sudden death.
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Affiliation(s)
- Michelle N. Stram
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Alan C. Seifert
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Etty Cortes
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
- Neuropathology Brain Bank & Research Center of Research Excellence (CoRE), Mount Sinai Hospital, New York, NY, United States
| | - Alara Akyatan
- University of New England College of Medicine, Biddeford, ME, United States
| | - Emma Woodoff-Leith
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
- Neuropathology Brain Bank & Research Center of Research Excellence (CoRE), Mount Sinai Hospital, New York, NY, United States
| | - Valeriy Borukhov
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
- Neuropathology Brain Bank & Research Center of Research Excellence (CoRE), Mount Sinai Hospital, New York, NY, United States
| | - Amber Tetlow
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
- Neuropathology Brain Bank & Research Center of Research Excellence (CoRE), Mount Sinai Hospital, New York, NY, United States
| | - Dimath Alyemni
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael Greenberg
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Avneesh Gupta
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Amanda Krausert
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Lauren Mecca
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Sophia Rodriguez
- Office of the Medical Investigator, Albuquerque, NM, United States
| | - Jay Stahl-Herz
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Miguel A. Guzman
- Department of Pathology at Saint Louis University School of Medicine, SSM Cardinal Glennon Hospital, St. Louis, MO, United States
| | - Bradley Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John F. Crary
- Department of Pathology, Molecular and Cell Based Medicine, Mount Sinai Hospital, New York, NY, United States
- Neuropathology Brain Bank & Research Center of Research Excellence (CoRE), Mount Sinai Hospital, New York, NY, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rebecca D. Folkerth
- Office of Chief Medical Examiner, New York, NY, United States
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, United States
- *Correspondence: Rebecca D. Folkerth
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46
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Dunai C, Collie C, Michael BD. Immune-Mediated Mechanisms of COVID-19 Neuropathology. Front Neurol 2022; 13:882905. [PMID: 35665037 PMCID: PMC9160362 DOI: 10.3389/fneur.2022.882905] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
Although SARS-CoV-2 causes a respiratory viral infection, there is a large incidence of neurological complications occurring in COVID-19 patients. These range from headaches and loss of smell to encephalitis and strokes. Little is known about the likely diverse mechanisms causing these pathologies and there is a dire need to understand how to prevent and treat them. This review explores recent research from the perspective of investigating how the immune system could play a role in neurological complications, including cytokines, blood biomarkers, immune cells, and autoantibodies. We also discuss lessons learnt from animal models. Overall, we highlight two key points that have emerged from increasing evidence: (1) SARS-CoV-2 does not invade the brain in the majority of cases and so the associated neurological complications might arise from indirect effects, such as immune activation (2) although the immune system plays a critical role in controlling the virus, its dysregulation can cause pathology.
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Affiliation(s)
- Cordelia Dunai
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, United Kingdom
| | - Ceryce Collie
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Benedict D. Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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47
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Sofizan NMFBN, Rahman AFBA, Soon LP, Ly CK, Abdullah NZB. Autopsy findings in COVID-19 infection-related death: a systematic review. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:22. [PMID: 35573158 PMCID: PMC9086658 DOI: 10.1186/s41935-022-00280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Coronavirus-19 disease (COVID-19) has been declared as pandemic by the World Health Organization (WHO) in March 2020. As of 28 November 2021, there were more than 260 million cases and nearly 5.2 million deaths caused by COVID-19. The most affected system by COVID-19 infection was the respiratory system although several other studies suggested multi-organ involvement with pathophysiology that was not clearly understood. Autopsy findings were beneficial to researchers to determine the mechanism behind these organ failures. The objective of this review was to summarize the autopsy findings related to COVID-19 death. Method Online literature search was conducted via online databases such as Scopus, PubMed and Google Scholar. The keywords inputted during the search were “post-mortem”, “autopsy” and “COVID-19” in title, abstract and keywords. The inclusion criteria were the topic related with the title of this review, published in 2020–2021, have full text available and in English language. Any articles that were not related, duplicated studies, review articles including systematic review and meta-analysis and in other languages were excluded. Results A total of 20 articles were included in this review. The articles reviewed were mostly case reports and case series while others were case-control and cohort study ranging from one to 348 cases. Majority were originated from the United States of America (USA). Conclusion The most frequent system described in autopsy findings in COVID-19 death was the respiratory system, with the most common histological finding of diffuse alveolar damage (DAD). Majority of the findings of other organs were related to chronic diseases.
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48
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Wielgat P, Narejko K, Car H. SARS-CoV-2 Attacks in the Brain: Focus on the Sialome. Cells 2022; 11:1458. [PMID: 35563764 PMCID: PMC9104523 DOI: 10.3390/cells11091458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 12/16/2022] Open
Abstract
The epidemiological observations suggest that respiratory and gastrointestinal symptoms caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) are accompanied by short- and long-term neurological manifestations. There is increasing evidence that the neuroinvasive potential of SARS-CoV-2 is closely related to its capacity to interact with cell membrane sialome. Given the wide expression of sialylated compounds of cell membranes in the brain, the interplay between cell membrane sialoglycans and the virus is crucial for its attachment and cell entry, transport, neuronal damage and brain immunity. Here, we focus on the significance of the brain sialome in the progress of coronavirus disease 2019 (COVID-19) and SARS-CoV-2-induced neuropathology.
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Affiliation(s)
- Przemyslaw Wielgat
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland; (K.N.); (H.C.)
| | - Karolina Narejko
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland; (K.N.); (H.C.)
| | - Halina Car
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland; (K.N.); (H.C.)
- Department of Experimental Pharmacology, Medical University of Bialystok, Szpitalna 37, 15-265 Bialystok, Poland
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49
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Morowitz JM, Pogson KB, Roque DA, Church FC. Role of SARS-CoV-2 in Modifying Neurodegenerative Processes in Parkinson's Disease: A Narrative Review. Brain Sci 2022; 12:536. [PMID: 35624923 PMCID: PMC9139310 DOI: 10.3390/brainsci12050536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact global health regarding both morbidity and mortality. Although SARS-CoV-2 primarily causes acute respiratory distress syndrome (ARDS), the virus interacts with and influences other organs and tissues, including blood vessel endothelium, heart, gastrointestinal tract, and brain. We are learning much about the pathophysiology of SARS-CoV-2 infection; however, we are just beginning to study and understand the long-term and chronic health consequences. Since the pandemic's beginning in late 2019, older adults, those with pre-existing illnesses, or both, have an increased risk of contracting COVID-19 and developing severe COVID-19. Furthermore, older adults are also more likely to develop the neurodegenerative disorder Parkinson's disease (PD), with advanced age as the most significant risk factor. Thus, does SARS-CoV-2 potentially influence, promote, or accelerate the development of PD in older adults? Our initial focus was aimed at understanding SARS-CoV-2 pathophysiology and the connection to neurodegenerative disorders. We then completed a literature review to assess the relationship between PD and COVID-19. We described potential molecular and cellular pathways that indicate dopaminergic neurons are susceptible, both directly and indirectly, to SARS-CoV-2 infection. We concluded that under certain pathological circumstances, in vulnerable persons-with-Parkinson's disease (PwP), SARS-CoV-2 acts as a neurodegenerative enhancer to potentially support the development or progression of PD and its related motor and non-motor symptoms.
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Affiliation(s)
- Jeremy M. Morowitz
- Developmental and Stem Cell Biology Program, Duke University, Durham, NC 27708, USA;
| | - Kaylyn B. Pogson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Daniel A. Roque
- Department of Neurology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA;
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
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50
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van Lith TJ, Sluis WM, Wijers NT, Meijer FJA, Kamphuis-van Ulzen K, de Bresser J, Dankbaar JW, van den Heuvel FMA, Antoni ML, Mulders-Manders CM, de Mast Q, van de Veerdonk FL, Klok FA, Tuladhar AM, Cannegieter SC, Wermer MJH, van der Worp HB, Huisman MV, de Leeuw FE. Prevalence, risk factors, and long-term outcomes of cerebral ischemia in hospitalized COVID-19 patients – study rationale and protocol of the CORONIS study: A multicentre prospective cohort study. Eur Stroke J 2022; 7:180-187. [PMID: 35647315 PMCID: PMC9134783 DOI: 10.1177/23969873221092538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 12/18/2022] Open
Abstract
Background: COVID-19 is often complicated by thrombo-embolic events including ischemic
stroke. The underlying mechanisms of COVID-19-associated ischemic stroke,
the incidence and risk factors of silent cerebral ischemia, and the
long-term functional outcome in these patients are currently unknown. Patients and methods: CORONavirus and Ischemic Stroke (CORONIS) is a multicentre prospective cohort
study investigating the prevalence, risk factors and long-term incidence of
(silent) cerebral ischemia, and the long-term functional outcome among
patients with COVID-19. We aim to include 200 adult patients hospitalized
with COVID-19 without symptomatic ischemic stroke to investigate the
prevalence of silent cerebral ischemia compared with 60 (matched) controls
with MRI. In addition, we will identify potential risk factors and/or causes
of cerebral ischemia in COVID-19 patients with (n = 70) or
without symptomatic stroke (n = 200) by means of blood
sampling, cardiac workup and brain MRI. We will measure functional outcome
and cognitive function after 3 and 12 months with standardized
questionnaires in all patients with COVID-19. Finally, the long-term
incidence of (new) silent cerebral ischemia in patients with COVID-19 will
be assessed with follow up MRI (n = 120). Summary: The CORONIS study is designed to add further insight into the prevalence,
long-term incidence and risk factors of cerebral ischemia, and the long-term
functional outcome in hospitalized adult patients with COVID-19.
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Affiliation(s)
- Theresa J van Lith
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wouter M Sluis
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Naomi T Wijers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederick JA Meijer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - M Louisa Antoni
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Quirijn de Mast
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederikus A Klok
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne C Cannegieter
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno V Huisman
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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