1
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Wellford SA, Moseman EA. Olfactory immunology: the missing piece in airway and CNS defence. Nat Rev Immunol 2024; 24:381-398. [PMID: 38097777 DOI: 10.1038/s41577-023-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
The olfactory mucosa is a component of the nasal airway that mediates the sense of smell. Recent studies point to an important role for the olfactory mucosa as a barrier to both respiratory pathogens and to neuroinvasive pathogens that hijack the olfactory nerve and invade the CNS. In particular, the COVID-19 pandemic has demonstrated that the olfactory mucosa is an integral part of a heterogeneous nasal mucosal barrier critical to upper airway immunity. However, our insufficient knowledge of olfactory mucosal immunity hinders attempts to protect this tissue from infection and other diseases. This Review summarizes the state of olfactory immunology by highlighting the unique immunologically relevant anatomy of the olfactory mucosa, describing what is known of olfactory immune cells, and considering the impact of common infectious diseases and inflammatory disorders at this site. We will offer our perspective on the future of the field and the many unresolved questions pertaining to olfactory immunity.
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Affiliation(s)
- Sebastian A Wellford
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
| | - E Ashley Moseman
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA.
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2
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Valizadeh P, Momtazmanesh S, Plazzi G, Rezaei N. Connecting the dots: An updated review of the role of autoimmunity in narcolepsy and emerging immunotherapeutic approaches. Sleep Med 2024; 113:378-396. [PMID: 38128432 DOI: 10.1016/j.sleep.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Narcolepsy type 1 (NT1) is a chronic disorder characterized by pathological daytime sleepiness and cataplexy due to the disappearance of orexin immunoreactive neurons in the hypothalamus. Genetic and environmental factors point towards a potential role for inflammation and autoimmunity in the pathogenesis of the disease. This study aims to comprehensively review the latest evidence on the autoinflammatory mechanisms and immunomodulatory treatments aimed at suspected autoimmune pathways in NT1. METHODS Recent relevant literature in the field of narcolepsy, its autoimmune hypothesis, and purposed immunomodulatory treatments were reviewed. RESULTS Narcolepsy is strongly linked to specific HLA alleles and T-cell receptor polymorphisms. Furthermore, animal studies and autopsies have found infiltration of T cells in the hypothalamus, supporting T cell-mediated immunity. However, the role of autoantibodies has yet to be definitively established. Increased risk of NT1 after H1N1 infection and vaccination supports the autoimmune hypothesis, and the potential role of coronavirus disease 2019 and vaccination in triggering autoimmune neurodegeneration is a recent finding. Alterations in cytokine levels, gut microbiota, and microglial activation indicate a potential role for inflammation in the disease's development. Reports of using immunotherapies in NT1 patients are limited and inconsistent. Early treatment with IVIg, corticosteroids, plasmapheresis, and monoclonal antibodies has seldomly shown some potential benefits in some studies. CONCLUSION The current body of literature supports that narcolepsy is an autoimmune disorder most likely caused by T-cell involvement. However, the potential for immunomodulatory treatments to reverse the autoinflammatory process remains understudied. Further clinical controlled trials may provide valuable insights into this area.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic, and Neural Sciences, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Zedan A, Winters AD, Yu W, Wang S, Ren Y, Takeshita A, Gong Q. Antiviral Functions of Type I and Type III Interferons in the Olfactory Epithelium. Biomolecules 2023; 13:1762. [PMID: 38136633 PMCID: PMC10741941 DOI: 10.3390/biom13121762] [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: 11/01/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The olfactory neuroepithelium (OE) is one of the few neuronal tissues where environmental pathogens can gain direct access. Despite this vulnerable arrangement, little is known about the protective mechanisms in the OE to prevent viral infection and its antiviral responses. We systematically investigated acute responses in the olfactory mucosa upon exposure to vesicular stomatitis virus (VSV) via RNA-seq. VSVs were nasally inoculated into C57BL/6 mice. Olfactory mucosae were dissected for gene expression analysis at different time points after viral inoculation. Interferon functions were determined by comparing the viral load in interferon receptor knockout (Ifnar1-/- and Ifnlr1-/-) with wildtype OE. Antiviral responses were observed as early as 24 h after viral exposure in the olfactory mucosa. The rapidly upregulated transcripts observed included specific type I as well as type III interferons (Ifn) and interferon-stimulated genes. Genetic analyses demonstrated that both type I and type III IFN signaling are required for the suppression of viral replication in the olfactory mucosa. Exogenous IFN application effectively blocks viral replication in the OE. These findings reveal that the OE possesses an innate ability to suppress viral infection. Type I and type III IFNs have prominent roles in OE antiviral functions.
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Affiliation(s)
- Ahmad Zedan
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA 95616, USA; (A.Z.); (A.D.W.); (A.T.)
| | - Ashley D. Winters
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA 95616, USA; (A.Z.); (A.D.W.); (A.T.)
| | - Wei Yu
- Department of Physiology, Xi’an Medical University, Xi’an 710021, China;
| | - Shuangyan Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, China;
| | - Ying Ren
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;
| | - Ashley Takeshita
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA 95616, USA; (A.Z.); (A.D.W.); (A.T.)
| | - Qizhi Gong
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA 95616, USA; (A.Z.); (A.D.W.); (A.T.)
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4
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Tsukahara T, Brann DH, Datta SR. Mechanisms of SARS-CoV-2-associated anosmia. Physiol Rev 2023; 103:2759-2766. [PMID: 37342077 PMCID: PMC10625840 DOI: 10.1152/physrev.00012.2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023] Open
Abstract
Anosmia, the loss of the sense of smell, is one of the main neurological manifestations of COVID-19. Although the SARS-CoV-2 virus targets the nasal olfactory epithelium, current evidence suggests that neuronal infection is extremely rare in both the olfactory periphery and the brain, prompting the need for mechanistic models that can explain the widespread anosmia in COVID-19 patients. Starting from work identifying the non-neuronal cell types that are infected by SARS-CoV-2 in the olfactory system, we review the effects of infection of these supportive cells in the olfactory epithelium and in the brain and posit the downstream mechanisms through which sense of smell is impaired in COVID-19 patients. We propose that indirect mechanisms contribute to altered olfactory system function in COVID-19-associated anosmia, as opposed to neuronal infection or neuroinvasion into the brain. Such indirect mechanisms include tissue damage, inflammatory responses through immune cell infiltration or systemic circulation of cytokines, and downregulation of odorant receptor genes in olfactory sensory neurons in response to local and systemic signals. We also highlight key unresolved questions raised by recent findings.
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Affiliation(s)
- Tatsuya Tsukahara
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States
| | - David H Brann
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States
| | - Sandeep Robert Datta
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States
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5
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Howe de la Torre S, Parlatini V, Cortese S. Long-term central nervous system (CNS) consequences of COVID-19 in children. Expert Rev Neurother 2023; 23:703-720. [PMID: 37545414 DOI: 10.1080/14737175.2023.2239500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research. AREAS COVERED The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms. EXPERT OPINION Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.
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Affiliation(s)
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, UK
- Horizon Centre, CAMHS West, William Macleod Way, Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
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6
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Karimian A, Behjati M, Karimian M. Molecular mechanisms involved in anosmia induced by SARS-CoV-2, with a focus on the transmembrane serine protease TMPRSS2. Arch Virol 2022; 167:1931-1946. [PMID: 35939103 PMCID: PMC9358639 DOI: 10.1007/s00705-022-05545-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Since 2020, SARS-CoV-2 has caused a pandemic virus that has posed many challenges worldwide. Infection with this virus can result in a number of symptoms, one of which is anosmia. Olfactory dysfunction can be a temporary or long-term viral complication caused by a disorder of the olfactory neuroepithelium. Processes such as inflammation, apoptosis, and neuronal damage are involved in the development of SARS-CoV-2-induced anosmia. One of the receptors that play a key role in the entry of SARS-CoV-2 into the host cell is the transmembrane serine protease TMPRSS2, which facilitates this process by cleaving the viral S protein. The gene encoding TMPRSS2 is located on chromosome 21. It contains 15 exons and has many genetic variations, some of which increase the risk of disease. Delta strains have been shown to be more dependent on TMPRSS2 for cell entry than Omicron strains. Blockade of this receptor by serine protease inhibitors such as camostat and nafamostat can be helpful for treating SARS-CoV-2 symptoms, including anosmia. Proper understanding of the different functional aspects of this serine protease can help to overcome the therapeutic challenges of SARS-CoV-2 symptoms, including anosmia. In this review, we describe the cellular and molecular events involved in anosmia induced by SARS-CoV-2 with a focus on the function of the TMPRSS2 receptor.
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Affiliation(s)
- Ali Karimian
- Department of Otorhinolaryngology, School of Medicine, Kashan University of Medical Science, Kashan, Iran
| | - Mohaddeseh Behjati
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Karimian
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, 47416-95447, Iran.
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Silva J, Patricio F, Patricio-Martínez A, Santos-López G, Cedillo L, Tizabi Y, Limón ID. Neuropathological Aspects of SARS-CoV-2 Infection: Significance for Both Alzheimer's and Parkinson's Disease. Front Neurosci 2022; 16:867825. [PMID: 35592266 PMCID: PMC9111171 DOI: 10.3389/fnins.2022.867825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/14/2022] [Indexed: 01/08/2023] Open
Abstract
Evidence suggests that SARS-CoV-2 entry into the central nervous system can result in neurological and/or neurodegenerative diseases. In this review, routes of SARS-Cov-2 entry into the brain via neuroinvasive pathways such as transcribrial, ocular surface or hematogenous system are discussed. It is argued that SARS-Cov-2-induced cytokine storm, neuroinflammation and oxidative stress increase the risk of developing neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. Further studies on the effects of SARS-CoV-2 and its variants on protein aggregation, glia or microglia activation, and blood-brain barrier are warranted.
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Affiliation(s)
- Jaime Silva
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Felipe Patricio
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Aleidy Patricio-Martínez
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- Facultad de Ciencias Biológicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Gerardo Santos-López
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Mexico
| | - Lilia Cedillo
- Centro de Detección Biomolecular, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, United States
| | - Ilhuicamina Daniel Limón
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
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8
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Razi O, Tartibian B, Laher I, Govindasamy K, Zamani N, Rocha-Rodrigues S, Suzuki K, Zouhal H. Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19. Front Physiol 2022; 13:783251. [PMID: 35492581 PMCID: PMC9048028 DOI: 10.3389/fphys.2022.783251] [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: 09/25/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Sports Injuries, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, India
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Silvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Quinta de Prados, Edifício Ciências de Desporto, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, i3S, Porto, Portugal
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- *Correspondence: Katsuhiko Suzuki, ; Hassane Zouhal,
| | - Hassane Zouhal
- Laboratoire Mouvement, Sport, Santé, University of Rennes, Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
- *Correspondence: Katsuhiko Suzuki, ; Hassane Zouhal,
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9
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Abstract
Although the number of SARS-CoV-2 new cases may be declining due to the implementation of the vaccine in the USA, there is a rising cohort of people with long-term effects from the virus. These long-term effects include loss of taste, heart palpitations, and chronic pain syndromes. In this commentary, we assess the current literature to appraise the knowledge of long-term COVID-19 effects related to long-term pain syndromes including testicular pain, headache, chronic pain, and chest pain.
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10
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COVID-19 and Postural Control—A Stabilographic Study Using Rambling-Trembling Decomposition Method. Medicina (B Aires) 2022; 58:medicina58020305. [PMID: 35208628 PMCID: PMC8877894 DOI: 10.3390/medicina58020305] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 01/16/2023] Open
Abstract
Background and Objectives: Some respiratory viruses demonstrate neurotropic capacities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently taken over the globe, causing coronavirus disease 2019 (COVID-19). The aim of the study was to evaluate the impact of COVID-19 on postural control in subjects who have recently recovered from the infection. Materials and Methods: Thirty-three convalescents who underwent COVID-19 within the preceding 2–4 weeks, and 35 healthy controls were enrolled. The ground reaction forces were registered with the use of a force platform during quiet standing. The analysis of the resultant center of foot pressure (COP) decomposed into rambling (RAMB) and trembling (TREMB) and sample entropy was conducted. Results: Range of TREMB was significantly increased in subjects who experienced anosmia/hyposmia during COVID-19 when the measurement was performed with closed eyes (p = 0.03). In addition, subjects who reported dyspnea during COVID-19 demonstrated significant increase of length and velocity of COP (p < 0.001), RAMB (p < 0.001), and TREMB (p < 0.001), indicating substantial changes in postural control. Conclusions: Subjects who had experienced olfactory dysfunction or respiratory distress during COVID-19 demonstrate symptoms of balance deficits after COVID-19 recovery, and the analysis using rambling-trembling decomposition method might point at less efficient peripheral control. Monitoring for neurological sequelae of COVID-19 should be considered.
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11
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Jha NK, Ojha S, Jha SK, Dureja H, Singh SK, Shukla SD, Chellappan DK, Gupta G, Bhardwaj S, Kumar N, Jeyaraman M, Jain R, Muthu S, Kar R, Kumar D, Goswami VK, Ruokolainen J, Kesari KK, Singh SK, Dua K. Evidence of Coronavirus (CoV) Pathogenesis and Emerging Pathogen SARS-CoV-2 in the Nervous System: A Review on Neurological Impairments and Manifestations. J Mol Neurosci 2021; 71:2192-2209. [PMID: 33464535 PMCID: PMC7814864 DOI: 10.1007/s12031-020-01767-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is an issue of global significance that has taken the lives of many across the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for its pathogenesis. The pulmonary manifestations of COVID-19 have been well described in the literature. Initially, it was thought to be limited to the respiratory system; however, we now recognize that COVID-19 also affects several other organs, including the nervous system. Two similar human coronaviruses (CoV) that cause severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) are also known to cause disease in the nervous system. The neurological manifestations of SARS-CoV-2 infection are growing rapidly, as evidenced by several reports. There are several mechanisms responsible for such manifestations in the nervous system. For instance, post-infectious immune-mediated processes, direct virus infection of the central nervous system (CNS), and virus-induced hyperinflammatory and hypercoagulable states are commonly involved. Guillain-Barré syndrome (GBS) and its variants, dysfunction of taste and smell, and muscle injury are numerous examples of COVID-19 PNS (peripheral nervous system) disease. Likewise, hemorrhagic and ischemic stroke, encephalitis, meningitis, encephalopathy acute disseminated encephalomyelitis, endothelialitis, and venous sinus thrombosis are some instances of COVID-19 CNS disease. Due to multifactorial and complicated pathogenic mechanisms, COVID-19 poses a large-scale threat to the whole nervous system. A complete understanding of SARS-CoV-2 neurological impairments is still lacking, but our knowledge base is rapidly expanding. Therefore, we anticipate that this comprehensive review will provide valuable insights and facilitate the work of neuroscientists in unfolding different neurological dimensions of COVID-19 and other CoV associated abnormalities.
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Affiliation(s)
- Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Greater Noida, 201310, UP, India.
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, UAE
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Greater Noida, 201310, UP, India
| | - Harish Dureja
- Faculty of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI), University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Mahal Road, Jaipur, India
| | - Shanu Bhardwaj
- Department of Biotechnology, HIMT, CCS University, Greater Noida, UP, India
| | - Neeraj Kumar
- Department of Chemistry, University of Delhi, Delhi, 110007, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, UP, 201310, Greater Noida, India
| | - Rashmi Jain
- School of Medical Sciences and Research, Sharda University, UP, 201310, Greater Noida, India
| | - Sathish Muthu
- Research Associate, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Rohan Kar
- Indian Institute of Management Ahmedabad (IIMA), Gujarat, 380015, India
| | - Dhruv Kumar
- Amity Institute of Molecular Medicine and Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh, Noida, 201313, India
| | - Vineet Kumar Goswami
- Department of Biological Sciences, School of Basic and Applied Sciences, G.D. Goenka University, G.D. Goenka Education City Sohna Gurugram Road, Haryana- 122103, India
| | - Janne Ruokolainen
- Department of Applied Physics, School of Science, Aalto University, 00076, Espoo, Finland
| | - Kavindra Kumar Kesari
- Department of Applied Physics, School of Science, Aalto University, 00076, Espoo, Finland
| | - Sandeep Kumar Singh
- Centre of Biomedical Research, SGPGI Campus, Lucknow, 226014, UP, India
- Indian Scientific Education and Technology Foundation, Lucknow, 226002, UP, India
| | - Kamal Dua
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI), University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
- School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Post box no. 9, Solan, Himachal Pradesh, 173229, India
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Kim YS. COVID-19 and encephalitis. ENCEPHALITIS 2021; 1:98-102. [PMID: 37470052 PMCID: PMC10295891 DOI: 10.47936/encephalitis.2021.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 07/21/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. Due to the increasing number of confirmed cases and accumulating clinical data, in addition to the predominant respiratory symptoms, a significant proportion of patients with COVID-19 experience neurological complications. Presumedly, several mechanisms, such as direct viral effects on the brain parenchyma and endothelium, and activation of the inflammatory and thrombotic pathways, cause these neurological disorders. Herein, the literature focusing on encephalitis among the central nervous system disorders associated with COVID-19 was reviewed.
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Affiliation(s)
- Young-Soo Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
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13
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Williams ME, Fielding BC. Insult to Injury-Potential Contribution of Coronavirus Disease-19 to Neuroinflammation and the Development of HIV-Associated Neurocognitive Disorders. AIDS Res Hum Retroviruses 2021; 37:601-609. [PMID: 32993321 DOI: 10.1089/aid.2020.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 is responsible for a new coronavirus disease known as coronavirus disease-19 (COVID-19). SARS-CoV-2 reports neurotropic properties and may have neurological implications, and this creates another health burden for people living with HIV. As yet, the impact of COVID-19 on (neuro)inflammation and the development of HIV-associated neurocognitive disorders (HAND) is not fully known. Here, we reviewed preliminary evidence that provides clues that COVID-19 may exacerbate inflammatory mechanisms related to the development of HAND.
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Affiliation(s)
| | - Burtram Clinton Fielding
- Molecular Biology and Virology Research Laboratory, Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa
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14
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Alipoor SD, Mortaz E, Varahram M, Garssen J, Adcock IM. The Immunopathogenesis of Neuroinvasive Lesions of SARS-CoV-2 Infection in COVID-19 Patients. Front Neurol 2021; 12:697079. [PMID: 34393976 PMCID: PMC8363128 DOI: 10.3389/fneur.2021.697079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
The new coronavirus disease COVID-19 was identified in December 2019. It subsequently spread across the world with over 125 M reported cases and 2.75 M deaths in 190 countries. COVID-19 causes severe respiratory distress; however, recent studies have reported neurological consequences of infection by the COVID-19 virus SARS-CoV-2 even in subjects with mild infection and no initial neurological effects. It is likely that the virus uses the olfactory nerve to reach the CNS and that this transport mechanism enables virus access to areas of the brain stem that regulates respiratory rhythm and may even trigger cell death by alteration of these neuronal nuclei. In addition, the long-term neuronal effects of COVID-19 suggest a role for SARS-CoV-2 in the development or progression of neurodegerative disease as a result of inflammation and/or hypercoagulation. In this review recent findings on the mechanism(s) by which SARS-CoV-2 accesses the CNS and induces neurological dysregulation are summarized.
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Affiliation(s)
- Shamila D. Alipoor
- Molecular Medicine Department, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Varahram
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Ian M. Adcock
- National Heart and Lung Institute, Imperial College London and the National Institute for Health Research Imperial Biomedical Research Centre, London, United Kingdom
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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15
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Bandala C, Cortes-Altamirano JL, Reyes-Long S, Lara-Padilla E, Ilizaliturri-Flores I, Alfaro-Rodríguez A. Putative mechanism of neurological damage in COVID-19 infection. Acta Neurobiol Exp (Wars) 2021; 81:69-79. [PMID: 33949163 DOI: 10.21307/ane-2021-008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/28/2021] [Indexed: 11/11/2022]
Abstract
The recent pandemic of the coronavirus infectious disease 2019 (COVID-19) has affected around 192 countries, and projections have shown that around 40% to 70% of world population could be infected in the next months. COVID-19 is caused by the virus SARS- CoV-2, it enters the cells through the ACE2 receptor (angiotensin converting enzyme 2). It is well known that SARS-CoV-2 could develop mild, moderate, and severe respiratory symptoms that could lead to death. The virus receptor is expressed in different organs such as the lungs, kidney, intestine, and brain, among others. In the lung could cause pneumonia and severe acute respiratory syndrome (SARS). The brain can be directly affected by cellular damage due to viral invasion, which can lead to an inflammatory response, by the decrease in the enzymatic activity of ACE2 that regulates neuroprotective, neuro-immunomodulatory and neutralizing functions of oxidative stress. Another severe damage is hypoxemia in patients that do not receive adequate respiratory support. The neurological symptoms that the patient presents, will depend on factors that condition the expression of ACE2 in the brain such as age and sex, as well as the mechanism of neuronal invasion, the immune response and the general state of the patient. Clinical and histopathological studies have described neurological alterations in human patients with COVID-19. These conditions could have a possible contribution to the morbidity and mortality caused by this disease and may even represent the onset of neurodegenerative activity in recovered patients. The recent pandemic of the coronavirus infectious disease 2019 (COVID-19) has affected around 192 countries, and projections have shown that around 40% to 70% of world population could be infected in the next months. COVID-19 is caused by the virus SARS- CoV-2, it enters the cells through the ACE2 receptor (angiotensin converting enzyme 2). It is well known that SARS-CoV-2 could develop mild, moderate, and severe respiratory symptoms that could lead to death. The virus receptor is expressed in different organs such as the lungs, kidney, intestine, and brain, among others. In the lung could cause pneumonia and severe acute respiratory syndrome (SARS). The brain can be directly affected by cellular damage due to viral invasion, which can lead to an inflammatory response, by the decrease in the enzymatic activity of ACE2 that regulates neuroprotective, neuro-immunomodulatory and neutralizing functions of oxidative stress. Another severe damage is hypoxemia in patients that do not receive adequate respiratory support. The neurological symptoms that the patient presents, will depend on factors that condition the expression of ACE2 in the brain such as age and sex, as well as the mechanism of neuronal invasion, the immune response and the general state of the patient. Clinical and histopathological studies have described neurological alterations in human patients with COVID-19. These conditions could have a possible contribution to the morbidity and mortality caused by this disease and may even represent the onset of neurodegenerative activity in recovered patients.
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Affiliation(s)
- Cindy Bandala
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Escuela Superior de Medicina , Instituto Politécnico Nacional , México
| | - José Luis Cortes-Altamirano
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Universidad Estatal del Valle de Ecatepec , México
| | - Samuel Reyes-Long
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Escuela Superior de Medicina , Instituto Politécnico Nacional , México
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16
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Schirinzi T, Landi D, Liguori C. COVID-19: dealing with a potential risk factor for chronic neurological disorders. J Neurol 2021; 268:1171-1178. [PMID: 32852580 PMCID: PMC7450256 DOI: 10.1007/s00415-020-10131-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
Abstract
SARS-CoV2 infection is responsible for a complex clinical syndrome, named Coronavirus Disease 2019 (COVID-19), whose main consequences are severe pneumonia and acute respiratory distress syndrome. Occurrence of acute and subacute neurological manifestations (encephalitis, stroke, headache, seizures, Guillain-Barrè syndrome) is increasingly reported in patients with COVID-19. Moreover, SARS-CoV2 immunopathology and tissue colonization in the gut and the central nervous system, and the systemic inflammatory response during COVID-19 may potentially trigger chronic autoimmune and neurodegenerative disorders. Specifically, Parkinson's disease, multiple sclerosis and narcolepsy present several pathogenic mechanisms that can be hypothetically initiated by SARS-CoV2 infection in susceptible individuals. In this short narrative review, we summarize the clinical evidence supporting the rationale for investigating SARS-CoV2 infection as risk factor for these neurological disorders, and suggest the opportunity to perform in the future SARS-CoV2 serology when diagnosing these disorders.
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Affiliation(s)
- Tommaso Schirinzi
- Neurology Unit, University Hospital of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, University Hospital of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Claudio Liguori
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
- Neurology Unit, University Hospital of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
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17
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Veronese S, Sbarbati A. Chemosensory Systems in COVID-19: Evolution of Scientific Research. ACS Chem Neurosci 2021; 12:813-824. [PMID: 33559466 PMCID: PMC7885804 DOI: 10.1021/acschemneuro.0c00788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
COVID-19 disease induced by coronavirus SARS-CoV-2 presents among its symptoms alterations of the chemosensory functions. In the first studies on the Chinese population, this symptomatology was not particularly relevant, and hyposmia and hypogeusia were excluded from the symptoms to be evaluated to diagnose the disease. With the pandemic spread of the illness, there has been an augment in reports on chemosensory dysfunctions among patients. The first data analysis showed the presence of these disorders mainly in paucisymptomatic and asymptomatic patients. The interest in chemosensory systems therefore increased considerably, because the olfactory and gustatory symptoms could be the key to stop the infection spread. Furthermore, the degree of alert and attention grew, considering that these types of dysfunctions are prognostic symptoms of serious neurodegenerative diseases. About 9 months have passed since the first anecdotal reports on the involvement of the olfactory and gustatory systems in the COVID-19 pathology. For this reason, a careful review of the literature was conducted to understand if it is clearer which people present chemosensory symptoms and if these are related to the severity of the disease. Furthermore, we have identified which aspects still remain to be clarified.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience,
Biomedicine and Movement Sciences, University
of Verona, 37134 Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience,
Biomedicine and Movement Sciences, University
of Verona, 37134 Verona, Italy
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18
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Abstract
PURPOSE OF REVIEW The COVID-19 infection results in various viral-related physical and mental health problems, joined with the long-term psychological impact of the pandemic in general. However, the accompanying neurocognitive changes remain poorly understood. RECENT FINDINGS We synthetize the current knowledge of viral (SARS-CoV-2) induced inflammation, mechanisms to viral entry into the central nervous system and altered neurotransmitter systems to provide an informed neurobiological explanation for the rise of neurocognitive disorders (defined as per the DSM-5 criteria). SUMMARY The mild and major neurocognitive disorder symptoms due to the COVID-19 pandemic provide a unique opportunity to address the early changes underlying neurocognitive impairment at both clinical and molecular level. We discuss the utilization of the available evidence for their management and future novel therapeutic opportunities.
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19
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Serrano GE, Walker JE, Arce R, Glass MJ, Vargas D, Sue LI, Intorcia AJ, Nelson CM, Oliver J, Papa J, Russell A, Suszczewicz KE, Borja CI, Belden C, Goldfarb D, Shprecher D, Atri A, Adler CH, Shill HA, Driver-Dunckley E, Mehta SH, Readhead B, Huentelman MJ, Peters JL, Alevritis E, Bimi C, Mizgerd JP, Reiman EM, Montine TJ, Desforges M, Zehnder JL, Sahoo MK, Zhang H, Solis D, Pinsky BA, Deture M, Dickson DW, Beach TG. Mapping of SARS-CoV-2 Brain Invasion and Histopathology in COVID-19 Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.15.21251511. [PMID: 33619496 PMCID: PMC7899461 DOI: 10.1101/2021.02.15.21251511] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The coronavirus SARS-CoV-2 (SCV2) causes acute respiratory distress, termed COVID-19 disease, with substantial morbidity and mortality. As SCV2 is related to previously-studied coronaviruses that have been shown to have the capability for brain invasion, it seems likely that SCV2 may be able to do so as well. To date, although there have been many clinical and autopsy-based reports that describe a broad range of SCV2-associated neurological conditions, it is unclear what fraction of these have been due to direct CNS invasion versus indirect effects caused by systemic reactions to critical illness. Still critically lacking is a comprehensive tissue-based survey of the CNS presence and specific neuropathology of SCV2 in humans. We conducted an extensive neuroanatomical survey of RT-PCR-detected SCV2 in 16 brain regions from 20 subjects who died of COVID-19 disease. Targeted areas were those with cranial nerve nuclei, including the olfactory bulb, medullary dorsal motor nucleus of the vagus nerve and the pontine trigeminal nerve nuclei, as well as areas possibly exposed to hematogenous entry, including the choroid plexus, leptomeninges, median eminence of the hypothalamus and area postrema of the medulla. Subjects ranged in age from 38 to 97 (mean 77) with 9 females and 11 males. Most subjects had typical age-related neuropathological findings. Two subjects had severe neuropathology, one with a large acute cerebral infarction and one with hemorrhagic encephalitis, that was unequivocally related to their COVID-19 disease while most of the 18 other subjects had non-specific histopathology including focal β-amyloid precursor protein white matter immunoreactivity and sparse perivascular mononuclear cell cuffing. Four subjects (20%) had SCV2 RNA in one or more brain regions including the olfactory bulb, amygdala, entorhinal area, temporal and frontal neocortex, dorsal medulla and leptomeninges. The subject with encephalitis was SCV2-positive in a histopathologically-affected area, the entorhinal cortex, while the subject with the large acute cerebral infarct was SCV2-negative in all brain regions. Like other human coronaviruses, SCV2 can inflict acute neuropathology in susceptible patients. Much remains to be understood, including what viral and host factors influence SCV2 brain invasion and whether it is cleared from the brain subsequent to the acute illness.
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Affiliation(s)
| | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Daisy Vargas
- Banner Sun Health Research Institute, Sun City, AZ
| | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | - Javon Oliver
- Banner Sun Health Research Institute, Sun City, AZ
| | - Jaclyn Papa
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | | | | | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Charles H. Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | | | | | - Shyamal H. Mehta
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Benjamin Readhead
- Arizona State University-Banner Neurodegenerative Disease Research Center, Tempe, AZ
| | | | | | | | | | | | | | - Thomas J. Montine
- Stanford University School of Medicine, Department of Pathology, Stanford, CA
| | - Marc Desforges
- Centre Hospitalier Universitaire Sainte-Justine, Laboratory of Virology, Montreal, Canada
| | - James L. Zehnder
- Stanford University School of Medicine, Department of Pathology, Stanford, CA
| | - Malaya K. Sahoo
- Stanford University School of Medicine, Department of Pathology, Stanford, CA
| | - Haiyu Zhang
- Stanford University School of Medicine, Department of Pathology, Stanford, CA
| | - Daniel Solis
- Stanford University School of Medicine, Department of Pathology, Stanford, CA
| | - Benjamin A. Pinsky
- Stanford University Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, CA
| | - Michael Deture
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville FL
| | - Dennis W. Dickson
- Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville FL
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20
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Alipoor SD, Mortaz E, Jamaati H, Tabarsi P, Bayram H, Varahram M, Adcock IM. COVID-19: Molecular and Cellular Response. Front Cell Infect Microbiol 2021; 11:563085. [PMID: 33643932 PMCID: PMC7904902 DOI: 10.3389/fcimb.2021.563085] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
In late December 2019, a vtiral pneumonia with an unknown agent was reported in Wuhan, China. A novel coronavirus was identified as the causative agent. Because of the human-to-human transmission and rapid spread; coronavirus disease 2019 (COVID-19) has rapidly increased to an epidemic scale and poses a severe threat to human health; it has been declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). This review aims to summarize the recent research progress of COVID-19 molecular features and immunopathogenesis to provide a reference for further research in prevention and treatment of SARS coronavirus2 (SARS-CoV-2) infection based on the knowledge from researches on SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS-CoV).
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Affiliation(s)
- Shamila D. Alipoor
- Molecular Medicine Department, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Esmaeil Mortaz
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koc University School of Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Mohammad Varahram
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian M. Adcock
- National Heart and Lung Institute, Imperial College London and the NIHR Imperial Biomedical Research Centre, London, United Kingdom
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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21
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Fakhri S, Piri S, Majnooni MB, Farzaei MH, Echeverría J. Targeting Neurological Manifestations of Coronaviruses by Candidate Phytochemicals: A Mechanistic Approach. Front Pharmacol 2021; 11:621099. [PMID: 33708124 PMCID: PMC7941749 DOI: 10.3389/fphar.2020.621099] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/08/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a wide range of manifestations. In this regard, growing evidence is focusing on COVID-19 neurological associations; however, there is a lack of established pathophysiological mechanisms and related treatments. Accordingly, a comprehensive review was conducted, using electronic databases, including PubMed, Scopus, Web of Science, and Cochrane, along with the author's expertize in COVID-19 associated neuronal signaling pathways. Besides, potential phytochemicals have been provided against neurological signs of COVID-19. Considering a high homology among SARS-CoV, Middle East Respiratory Syndrome and SARS-CoV-2, revealing their precise pathophysiological mechanisms seems to pave the road for the treatment of COVID-19 neural manifestations. There is a complex pathophysiological mechanism behind central manifestations of COVID-19, including pain, hypo/anosmia, delirium, impaired consciousness, pyramidal signs, and ischemic stroke. Among those dysregulated neuronal mechanisms, neuroinflammation, angiotensin-converting enzyme 2 (ACE2)/spike proteins, RNA-dependent RNA polymerase and protease are of special attention. So, employing multi-target therapeutic agents with considerable safety and efficacy seems to show a bright future in fighting COVID-19 neurological manifestations. Nowadays, natural secondary metabolites are highlighted as potential multi-target phytochemicals in combating several complications of COVID-19. In this review, central pathophysiological mechanisms and therapeutic targets of SARS-CoV-2 has been provided. Besides, in terms of pharmacological mechanisms, phytochemicals have been introduced as potential multi-target agents in combating COVID-19 central nervous system complications.
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Affiliation(s)
- Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sana Piri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javier Echeverría
- Departamento de Ciencias del Ambiente, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
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22
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Bodro M, Compta Y, Sánchez-Valle R. Presentations and mechanisms of CNS disorders related to COVID-19. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e923. [PMID: 33310765 PMCID: PMC7808129 DOI: 10.1212/nxi.0000000000000923] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the coronavirus disease 2019 (COVID-19) pandemic. In addition to severe respiratory symptoms, there are a growing number of reports showing a wide range of CNS complications in patients with COVID-19. Here, we review the literature on these complications, ranging from nonspecific symptoms to necrotizing encephalopathies, encephalitis, myelitis, encephalomyelitis, endotheliitis, and stroke. We postulate that there are several different mechanisms involved in COVID-19-associated CNS dysfunction, particularly activation of inflammatory and thrombotic pathways and, in a few patients, a direct viral effect on the endothelium and the parenchyma. Last, critically ill patients frequently present with protracted cognitive dysfunction in the setting of septic encephalopathy likely due to multifactorial mechanisms. Further studies are needed to clarify the relative contribution of each of these mechanisms, but available data suggest that CNS complications in COVID-19 are rare and probably not directly caused by the virus.
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Affiliation(s)
- Marta Bodro
- From the Infectious Diseases Department (M.B.), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., R.S.-V.), Barcelona; Department of Medicine (M.B., Y.C., R.S.-V.), Universitat de Barcelona; Neurology Department (Y.C., R.S.-V.), Hospital Clínic de Barcelona; and Institut de Neurociències (Y.C., R.S.-V.), Maria de Maeztu Excellence Center, Universitat de Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- From the Infectious Diseases Department (M.B.), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., R.S.-V.), Barcelona; Department of Medicine (M.B., Y.C., R.S.-V.), Universitat de Barcelona; Neurology Department (Y.C., R.S.-V.), Hospital Clínic de Barcelona; and Institut de Neurociències (Y.C., R.S.-V.), Maria de Maeztu Excellence Center, Universitat de Barcelona, Catalonia, Spain.
| | - Raquel Sánchez-Valle
- From the Infectious Diseases Department (M.B.), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., R.S.-V.), Barcelona; Department of Medicine (M.B., Y.C., R.S.-V.), Universitat de Barcelona; Neurology Department (Y.C., R.S.-V.), Hospital Clínic de Barcelona; and Institut de Neurociències (Y.C., R.S.-V.), Maria de Maeztu Excellence Center, Universitat de Barcelona, Catalonia, Spain
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23
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Ekusheva E, Voitenkov V, Rizakhanova O. The effectiveness of cytoflavin in complex therapy of patients with the coronavirus infection COVID-19. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:33-39. [DOI: 10.17116/jnevro202112112133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Banerjee D, Viswanath B. Neuropsychiatric manifestations of COVID-19 and possible pathogenic mechanisms: Insights from other coronaviruses. Asian J Psychiatr 2020; 54:102350. [PMID: 33271682 PMCID: PMC7422836 DOI: 10.1016/j.ajp.2020.102350] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has emerged as a global public health threat. Though the fear, anxiety, and stress related to COVID-19 have been studied in depth, the direct effects of SARS-CoV-2 on the central nervous system (CNS) remain elusive. Research related to the earlier coronavirus (CoV) outbreaks (like Severe Acute Respiratory Syndrome, SARS and Middle East Respiratory Syndrome, MERS) shows the neurotropic nature of CoV and the plethora of neuropsychiatric effects that it can cause. Though the current health priorities in managing COVID-19 remain restricted to containment and targeting pulmonary symptoms, the potential acute and long-term neuropsychiatric sequelae of the infection can increase morbidity and worsen the quality of life. Emerging evidence shows neural spread of the novel coronavirus. Delirium, encephalopathy, olfactory disturbances, acute behavioral changes, headache and cerebrovascular accidents are its common neuropsychiatric complications. These are directly related to increase in peripheral immunological markers, severity of infection and case fatality rate. This narrative review synthesizes available evidence related to the neuropsychiatric manifestations of COVID-19. Also, as SARS-CoV-2 shares structural and functional similarities with its earlier congeners, this article proposes possible long-term neuropsychological sequelae and pathogenic mechanisms for the same, based on research in the other coronavirus outbreaks.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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25
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Keyhanian K, Umeton RP, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol 2020; 350:577436. [PMID: 33212316 PMCID: PMC7647896 DOI: 10.1016/j.jneuroim.2020.577436] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide.
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Affiliation(s)
- Kiandokht Keyhanian
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Raffaella Pizzolato Umeton
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Babak Mohit
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vahid Davoudi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fatemeh Hajighasemi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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26
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Pang KW, Chee J, Subramaniam S, Ng CL. Frequency and Clinical Utility of Olfactory Dysfunction in COVID-19: a Systematic Review and Meta-analysis. Curr Allergy Asthma Rep 2020; 20:76. [PMID: 33048282 PMCID: PMC7552599 DOI: 10.1007/s11882-020-00972-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
Background Olfactory dysfunction (OD) has been gaining recognition as a symptom of COVID-19, but its clinical utility has not been well defined. Objectives To quantify the clinical utility of identifying OD in the diagnosis of COVID-19 and determine an estimate of the frequency of OD amongst these patients. Methods PubMed was searched up to 1 August 2020. Meta-analysis A included studies if they compared the frequency of OD in COVID-19 positive patients (proven by reverse transcription polymerase chain reaction) to COVID-19 negative controls. Meta-analysis B included studies if they described the frequency of OD in COVID-19 positive patients and if OD symptoms were explicitly asked in questionnaires or interviews or if smell tests were performed. Results The pooled frequency of OD in COVID-19 positive patients (17,401 patients, 60 studies) was 0.56 (0.47–0.64) but differs between detection via smell testing (0.76 [0.51–0.91]) and survey/questionnaire report (0.53 [0.45–0.62]), although not reaching statistical significance (p = 0.089). Patients with reported OD were more likely to test positive for COVID-19 (diagnostic odds ratio 11.5 [8.01–16.5], sensitivity 0.48 (0.40 to 0.56), specificity 0.93 (0.90 to 0.96), positive likelihood ratio 6.10 (4.47–8.32) and negative likelihood ratio 0.58 (0.52–0.64)). There was significant heterogeneity amongst studies with possible publication bias. Conclusion Frequency of OD in COVID-19 differs greatly across studies. Nevertheless, patients with reported OD were significantly more likely to test positive for COVID-19. Patient-reported OD is a highly specific symptom of COVID-19 which should be included as part of the pre-test screening of suspect patients.
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Affiliation(s)
- Khang Wen Pang
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore.
| | - Jeremy Chee
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Somasundaram Subramaniam
- Department of Otolaryngology-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Chew Lip Ng
- Department of Otolaryngology-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
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Le Bon SD, Horoi M. Is anosmia the price to pay in an immune-induced scorched-earth policy against COVID-19? Med Hypotheses 2020; 143:109881. [PMID: 32474381 PMCID: PMC7248625 DOI: 10.1016/j.mehy.2020.109881] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
Since the outbreak of Coronavirus Disease 2019 (COVID-19), loss of smell has increasingly been reported as a frequent clinical sign. Understanding the underlying mechanism and the prognostic value of this symptom will help better manage patients. SARS-CoV-2, as SARS-CoV-1, may likely spread to the central nervous system (CNS) via the olfactory nerve, a known gateway for respiratory neurotropic viruses. We hypothesise that sudden loss of smell due to COVID-19 is the consequence of a protective host defence mechanism involving apoptosis of olfactory receptor neurons. Sacrificing smelling over neuroprotection is a logical strategy, even more so as olfaction is the only sense with the ability to regenerate in adults. Induced apoptosis of olfactory neurons has been shown in mice, successfully preventing neuroinvasion. On the other hand, adult olfactory neurogenesis has been shown to be regulated in part by the immune system, allowing to restore olfactory function. Understanding anosmia as part of a defence mechanism would support the concept of sudden anosmia as being a positive prognostic factor in the short term. Also, it may orient research to investigate the risk of future neurodegenerative disease linked to persisting coronavirus in neurons.
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Affiliation(s)
- S D Le Bon
- Department of Otorhinolaryngology, St. Peter's Hospital, Brussels, Belgium.
| | - M Horoi
- Department of Otorhinolaryngology, St. Peter's Hospital, Brussels, Belgium
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28
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Ghosh R, Dubey S, Finsterer J, Chatterjee S, Ray BK. SARS-CoV-2-Associated Acute Hemorrhagic, Necrotizing Encephalitis (AHNE) Presenting with Cognitive Impairment in a 44-Year-Old Woman without Comorbidities: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925641. [PMID: 32799213 PMCID: PMC7447297 DOI: 10.12659/ajcr.925641] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Female, 44-year-old Final Diagnosis: COVID-19 Symptoms: Confusion Medication:— Clinical Procedure: — Specialty: Neurology
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College, Burdwan, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
| | - Josef Finsterer
- Department of Neurology, Klinik Landstrasse, Messerli Institute, Vienna, Austria
| | - Subham Chatterjee
- Department of Psychiatry, Bangur Institute of Neurosciences, Kolkata, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
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29
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Liguori C, Pierantozzi M, Spanetta M, Sarmati L, Cesta N, Iannetta M, Ora J, Mina GG, Puxeddu E, Balbi O, Pezzuto G, Magrini A, Rogliani P, Andreoni M, Mercuri NB. Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection. Brain Behav Immun 2020; 88:11-16. [PMID: 32416289 PMCID: PMC7235586 DOI: 10.1016/j.bbi.2020.05.037] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) represents a novel pneumonia leading to severe acute respiratory syndrome (SARS). Recent studies documented that SARS-Coronavirus2 (SARS-CoV2), responsible for COVID-19, can affect the nervous system. The aim of the present observational study was to prospectively assess subjective neurological symptoms (sNS) in patients with SARS-CoV2 infection. METHODS We included patients hospitalized at the University Hospital of Rome "Tor Vergata", medical center dedicated to the treatment of patients with COVID-19 diagnosis, who underwent an anamnestic interview about sNS consisting of 13 items, each related to a specific symptom, requiring a dichotomized answer. RESULTS We included 103 patients with SARS-CoV2 infection. Ninety-four patients (91.3%) reported at least one sNS. Sleep impairment was the most frequent symptom, followed by dysgeusia, headache, hyposmia, and depression. Women more frequently complained hyposmia, dysgeusia, dizziness, numbeness/paresthesias, daytime sleepiness, and muscle ache. Moreover, muscle ache and daytime sleepiness were more frequent in the first 2 days after admission. Conversely, sleep impairment was more frequent in patients with more than 7 days of hospitalization. In these patients we also documented higher white blood cells and lower C-reactive protein levels. These laboratory findings correlated with the occurrence of hyposmia, dysgeusia, headache, daytime sleepiness, and depression. CONCLUSIONS Patients with SARS-CoV2 infection frequently present with sNS. These symptoms are present from the early phases of the disease. The possibly intrinsic neurotropic properties of SARS-CoV2 may justify the very high frequency of sNS. Further studies targeted at investigating the consequences of SARS-CoV2 infection on the CNS should be planned.
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Affiliation(s)
- Claudio Liguori
- Neurology Unit, University Hospital "Tor Vergata", Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Mariangela Pierantozzi
- Neurology Unit, University Hospital "Tor Vergata", Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Matteo Spanetta
- Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Loredana Sarmati
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Novella Cesta
- Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Grazia Genga Mina
- Occupational Medicine Department, University of Rome "Tor Vergata",Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Ottavia Balbi
- Occupational Medicine Department, University of Rome "Tor Vergata",Rome, Italy
| | - Gabriella Pezzuto
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Andrea Magrini
- Occupational Medicine Department, University of Rome "Tor Vergata",Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, University Hospital "Tor Vergata", Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
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30
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Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci 2020; 41:2657-2669. [PMID: 32725449 PMCID: PMC7385206 DOI: 10.1007/s10072-020-04575-3] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
Respiratory viruses are opportunistic pathogens that infect the upper respiratory tract in humans and cause severe illnesses, especially in vulnerable populations. Some viruses have neuroinvasive properties and activate the immune response in the brain. These immune events may be neuroprotective or they may cause long-term damage similar to what is seen in some neurodegenerative diseases. The new “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is one of the Respiratory viruses causing highly acute lethal pneumonia coronavirus disease 2019 (COVID-19) with clinical similarities to those reported in “Severe Acute Respiratory Syndrome Coronavirus”(SARS-CoV) and the “Middle East Respiratory Syndrome Coronavirus”(MERS-CoV) including neurological manifestation. To examine the possible neurological damage induced by SARS-CoV-2, it is necessary to understand the immune reactions to viral infection in the brain, and their short- and long-term consequences. Considering the similarities between SARS-CoV and SARS-CoV-2, which will be discussed, cooperative homological and phylogenetical studies lead us to question if SARS-CoV-2 can have similar neuroinvasive capacities and neuroinflammatiory events that may lead to the same short- and long-term neuropathologies that SARS-CoV had shown in human and animal models. To explain the neurological manifestation caused by SARS-CoV-2, we will present a literature review of 765 COVID-19 patients, in which 18% had neurological symptoms and complications, including encephalopathy, encephalitis and cerebrovascular pathologies, acute myelitis, and Guillain-Barré syndrome. Clinical studies describe anosmia or partial loss of the sense of smell as the most frequent symptom in COVID19 patients, suggesting that olfactory dysfunction and the initial ultrarapid immune responses could be a prognostic factor.
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Affiliation(s)
- Yassine Yachou
- Neurology Department, Astrakhan State Medical University, Astrakhan, Russia.
| | - Abdeslem El Idrissi
- Center for Developmental Neuroscience, City University of New York, College of Staten Island, New York, USA
| | - Vladimir Belapasov
- Neurology Department, Astrakhan State Medical University, Astrakhan, Russia
| | - Said Ait Benali
- Neurosurgery Department, Mohammed VI University Hospital Center, Cadi Ayyad University, Marrakech, Morocco
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31
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Abstract
Based on the available publications, the article systematizes the forms of damage to the central nervous system in СOVID-19patients. Along with a description of clinical manifestations, pathogenesis, methods of laboratory, instrumental and radiological diagnosis with the discussion of the nosological forms. An interdisciplinary approach and international cooperation are required to study the problems pathogenesis, course, outcomes, and the development of new methods of diagnosis and treatment.
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32
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Abstract
At the present state of COVID-19 we may propose some preliminary thoughts on its direct and distant sequels. In our review we propose that novel virus SARS-CoV-2, as well as other members of Coronaviridae family, may possess neurotropic and neuroinvasive features; it may enter the nervous system via the intranasal way and directly infect human brain, causing lesions in the brainstem nuclei of the cardiorespiratory center. We propose, that such a lesion may worsen the respiratory distress and lead to the respiratory failure in some patients. Taking this into the consideration, immunomodulating and antiviral drugs that utilize the intranasal way of delivery may help in prophylactic and treatment of the COVID-19. All these proposals are preliminary; we call for the wide range of experimental and clinical investigations to prove or disprove them.
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33
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Ahmadirad N, Ghasemi Z. COVID-19 and Central Nervous System: Entry Routes And. Basic Clin Neurosci 2020; 11:217-224. [PMID: 32855781 PMCID: PMC7368099 DOI: 10.32598/bcn.11.covid19.2360.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022] Open
Abstract
Awareness of the current outbreak of Coronavirus Disease - 2019 (COVID-19) affecting the nervous system and identifying its possible ways to enter the Central Nervous System (CNS) are critical for the prevention and treatment of the disease. Hence, the CNS implications of the COVID-19 since the spread of the virus were reviewed in this study.
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Affiliation(s)
- Nooshin Ahmadirad
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghasemi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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34
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Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020; 87:18-22. [PMID: 32240762 PMCID: PMC7146689 DOI: 10.1016/j.bbi.2020.03.031] [Citation(s) in RCA: 1184] [Impact Index Per Article: 296.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 02/06/2023] Open
Abstract
Viral infections have detrimental impacts on neurological functions, and even to cause severe neurological damage. Very recently, coronaviruses (CoV), especially severe acute respiratory syndrome CoV 2 (SARS-CoV-2), exhibit neurotropic properties and may also cause neurological diseases. It is reported that CoV can be found in the brain or cerebrospinal fluid. The pathobiology of these neuroinvasive viruses is still incompletely known, and it is therefore important to explore the impact of CoV infections on the nervous system. Here, we review the research into neurological complications in CoV infections and the possible mechanisms of damage to the nervous system.
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Affiliation(s)
- Yeshun Wu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiaolin Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China
| | - Zijun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Jiahao Duan
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Cunming Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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35
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Abstract
The potential for central nervous system (CNS) involvement in coronavirus disease 2019 (COVID-19) is a matter of grave concern and there is a relevant body of evidence in the basic sciences to support this possibility. A neuroradiologist should be aware of the potential mechanisms involved in the neuropathogenesis of this virus, as we begin to see cases with abnormal brain scans emerging from all parts of the world.
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Affiliation(s)
- Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
| | - Michael D Perry
- Great Western Hospital, Severn Foundation School, Marlborough, UK
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Andrea Rossi
- Head, Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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36
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Archie SR, Cucullo L. Cerebrovascular and Neurological Dysfunction under the Threat of COVID-19: Is There a Comorbid Role for Smoking and Vaping? Int J Mol Sci 2020; 21:E3916. [PMID: 32486196 PMCID: PMC7312781 DOI: 10.3390/ijms21113916] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
The recently discovered novel coronavirus, SARS-CoV-2 (COVID-19 virus), has brought the whole world to standstill with critical challenges, affecting both health and economic sectors worldwide. Although initially, this pandemic was associated with causing severe pulmonary and respiratory disorders, recent case studies reported the association of cerebrovascular-neurological dysfunction in COVID-19 patients, which is also life-threatening. Several SARS-CoV-2 positive case studies have been reported where there are mild or no symptoms of this virus. However, a selection of patients are suffering from large artery ischemic strokes. Although the pathophysiology of the SARS-CoV-2 virus affecting the cerebrovascular system has not been elucidated yet, researchers have identified several pathogenic mechanisms, including a role for the ACE2 receptor. Therefore, it is extremely crucial to identify the risk factors related to the progression and adverse outcome of cerebrovascular-neurological dysfunction in COVID-19 patients. Since many articles have reported the effect of smoking (tobacco and cannabis) and vaping in cerebrovascular and neurological systems, and considering that smokers are more prone to viral and bacterial infection compared to non-smokers, it is high time to explore the probable correlation of smoking in COVID-19 patients. Herein, we have reviewed the possible role of smoking and vaping on cerebrovascular and neurological dysfunction in COVID-19 patients, along with potential pathogenic mechanisms associated with it.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
- Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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37
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Gómez-Iglesias P, Porta-Etessam J, Montalvo T, Valls-Carbó A, Gajate V, Matías-Guiu JA, Parejo-Carbonell B, González-García N, Ezpeleta D, Láinez JM, Matías-Guiu J. An Online Observational Study of Patients With Olfactory and Gustory Alterations Secondary to SARS-CoV-2 Infection. Front Public Health 2020; 8:243. [PMID: 32574308 PMCID: PMC7273853 DOI: 10.3389/fpubh.2020.00243] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Since the beginning of the Covid-19 epidemic produced by SARS2-Cov virus, olfactory alterations have been observed at a greater frequency than in other coronavirus epidemics. While olfactory alterations may be observed in patients with rhinovirus, influenza virus, or parainfluenza virus infection, they are typically explained by nasal obstruction with mucus or direct epithelial damage; in the case of SARS-CoV-2, olfactory alterations may present without nasal congestion with mucus. We performed a study of patients presenting olfactory/gustatory alterations in the context of SARS-CoV-2 infection in order to contribute to the understanding of this phenomenon. Material and Methods: We performed a descriptive, cross-sectional, observational study of the clinical characteristics of olfactory/gustatory alterations using a self-administered, anonymous online questionnaire. Results: A total of 909 patients with SARS-CoV-2 infection and olfactory/gustatory alterations responded to the questionnaire in the 4-day data collection period; 824 cases (90.65%) reported simultaneous olfactory and gustatory involvement. Patients' responses to the questionnaire revealed ageusia (581, 64.1% of respondents), hypogeusia (256, 28.2%), dysgeusia (22, 2.4%), anosmia (752 82.8%), hyposmia (142, 15.6%), and dysosmia (8, 0.9%). Fifty-four percent (489) did not report concomitant nasal congestion or mucus. Conclusion: Olfactory alterations are frequent in patients with SARS-CoV-2 infection and is only associated with nasal congestion in half of the cases.
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Affiliation(s)
- Patricia Gómez-Iglesias
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Porta-Etessam
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Montalvo
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Adrián Valls-Carbó
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Gajate
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Jordi A Matías-Guiu
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria González-García
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | - José Miguel Láinez
- Department of Neurology, Hospital Clínico de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Institute of Neurosciences, IdISSC, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Lahiri D, Ardila A. COVID-19 Pandemic: A Neurological Perspective. Cureus 2020; 12:e7889. [PMID: 32489743 PMCID: PMC7255551 DOI: 10.7759/cureus.7889] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to principally affect the respiratory system, neurological involvements have already been reported in some published work. We have reviewed original articles, case reports, and existing open-source data-sets to delineate the spectrum of neurological disorders potentially observed in SARS-CoV-2 positive cases. Neurological involvement in coronavirus disease 2019 (COVID-19) corresponds to three situations: (a) neurological manifestations of viral infection, (b) post-infective neurological complications, and (c) infection in patients with neurological co-morbidity. Neurological manifestations can further be subdivided into the central nervous system (headache, dizziness, alteration of the sensorium, ataxia encephalitis, stroke, and seizures) and peripheral nervous system (skeletal muscle injury and peripheral nerve involvement including hyposmia and hypogeusia) symptomatology. Post-infective neurological complications include demyelinating conditions. Reduced mobility and dementia as co-morbidities may predispose a patient to have a viral infection. It is concluded that the pandemic of COVID-19 presents for a neurologist some unique challenges. We observe that SARS-CoV-2 may have various neurological manifestations and in many cases, neurological features may precede typical respiratory symptoms.
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Affiliation(s)
- Durjoy Lahiri
- Neurology, Institute of Post Graduate Medical Education & Research, Kolkata, IND
| | - Alfredo Ardila
- Neuropsychology, I.M. Sechenov First Moscow State Medical University, Moscow, RUS
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39
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Oppo V, Melis M, Melis M, Tomassini Barbarossa I, Cossu G. "Smelling and Tasting" Parkinson's Disease: Using Senses to Improve the Knowledge of the Disease. Front Aging Neurosci 2020; 12:43. [PMID: 32161534 PMCID: PMC7052524 DOI: 10.3389/fnagi.2020.00043] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022] Open
Abstract
Among non-motor manifestations of Parkinson's Disease (PD), peripheral, sensory symptoms are particularly relevant. Smell dysfunction starts very early and frequently precedes the PD motor symptoms by years (being often a cue to the diagnosis). Moreover, olfactory system could be, together with gut, one of those peripheral sites where PD pathology first develops. Unlike smell loss, the relationship between PD and taste impairment is far less established. It can start early in the course of the disease but more frequently appears in advanced stages, in parallel with the advent of MCI, likely reflecting cortical involvement. Among PD patients has been demonstrated an increase in the frequency of the non-tasters for PROP (prototypical gustatory stimulus, 6- n-propylthiouracil), a genetically determined bitter taste which is mediated by TAS2RS38 receptor, and a significant increase of the recessive non-testing variant of this receptor. TAS2R38 receptors are expressed also in other tissues, such as in the epithelia of the gut and nasal cavities, where they can influence epithelial immunity ad its interaction with microbiota. Those pieces of evidence suggest that not only systematic assessment of taste and smell can be of a remarkable help for clinicians in the early diagnosis, but also that understanding the mechanisms of sensory involvement in PD could increase the knowledge of the pathophysiology of the disease.
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Affiliation(s)
- Valentina Oppo
- Department of Neuroscience, Brotzu Hospital, Cagliari, Italy
| | - Marta Melis
- Department of Neurology, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, Italy
| | - Melania Melis
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giovanni Cossu
- Department of Neuroscience, Brotzu Hospital, Cagliari, Italy
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Yamamoto V, Bolanos JF, Fiallos J, Strand SE, Morris K, Shahrokhinia S, Cushing TR, Hopp L, Tiwari A, Hariri R, Sokolov R, Wheeler C, Kaushik A, Elsayegh A, Eliashiv D, Hedrick R, Jafari B, Johnson JP, Khorsandi M, Gonzalez N, Balakhani G, Lahiri S, Ghavidel K, Amaya M, Kloor H, Hussain N, Huang E, Cormier J, Wesson Ashford J, Wang JC, Yaghobian S, Khorrami P, Shamloo B, Moon C, Shadi P, Kateb B. COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications. J Alzheimers Dis 2020; 77:459-504. [PMID: 32925078 PMCID: PMC7592693 DOI: 10.3233/jad-200831] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.
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Affiliation(s)
- Vicky Yamamoto
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
- USC Keck School of Medicine, The USC Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
- USC-Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Joe F. Bolanos
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
| | - John Fiallos
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
| | - Susanne E. Strand
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
| | - Kevin Morris
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
| | - Sanam Shahrokhinia
- Cedars-Sinai Medical Center, Department of Nutrition, Los Angeles, CA, USA
| | - Tim R. Cushing
- UCLA-Cedar-Sinai California Rehabilitation Institute, Los Angeles, CA, USA
| | - Lawrence Hopp
- Cedars Sinai Medical Center Department of Ophthalmology and UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Ambooj Tiwari
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- New York University, Department of Neurology, New York, NY, USA
| | - Robert Hariri
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Celularity Corporation, Warren, NJ, USA
- Weill Cornell School of Medicine, Department of Neurosurgery, New York, NY, USA
| | - Rick Sokolov
- Cedars-Sinai Medical Center, Department of Infectious Disease Los Angeles, CA, USA
| | - Christopher Wheeler
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
- T-NeuroPharma, Albuquerque, NM, USA
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Natural Sciences, Division of Sciences, Arts, and Mathematics, Florida Polytechnic University, Lakeland, FL, USA
| | - Ashraf Elsayegh
- Cedars Sinai Medical Center, Department of Pulmonology, Los Angeles, CA, USA
| | - Dawn Eliashiv
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- UCLA David Geffen, School of Medicine, Department of Neurology, Los Angeles, CA, USA
| | - Rebecca Hedrick
- Cedars Sinai Medical Center, Department of Psychiatry, Los Angeles, CA, USA
| | - Behrouz Jafari
- University of California, Irvine, School of Medicine, Department of Medicine, Irvine, CA, USA
| | - J. Patrick Johnson
- Cedars Sinai Medical Center, Spine Institute, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Department of Neurosurgery, Los Angeles, CA, USA
| | - Mehran Khorsandi
- Cedars-Sinai Medical Center, Department of Cardiology, Los Angeles, CA, USA
| | - Nestor Gonzalez
- Cedars-Sinai Medical Center, Department of Neurosurgery, Los Angeles, CA, USA
| | - Guita Balakhani
- Cedars-Sinai Medical Center, Department of Nephrology, Los Angeles, CA, USA
| | - Shouri Lahiri
- Cedars-Sinai Medical Center, Department of Neurology, Los Angeles, CA, USA
| | - Kazem Ghavidel
- University of Tehran School of Medicine, Department of Cardiology, Tehran, Iran
| | - Marco Amaya
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
| | - Harry Kloor
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
| | - Namath Hussain
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Loma Linda University, Department of Neurosurgery, Loma Linda, CA, USA
| | - Edmund Huang
- Cedars-Sinai Medical Center, Department of Nephrology, Los Angeles, CA, USA
| | - Jason Cormier
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Lafayette Surgical Specialty Hospital, Lafayette, Louisiana, USA
| | - J. Wesson Ashford
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Stanford University School of Medicine (Affiliated), Department of Psychiatry and Behavioral Science and Department of Veteran’s Affair, Palo Alto, CA, USA
| | - Jeffrey C. Wang
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- USC-Keck School of Medicine, Department of Orthopedic Surgery, Los Angeles, CA, USA
| | - Shadi Yaghobian
- Cedars-Sinai Medical Center, Department of Internal Medicine, Los Angeles, CA, USA
| | - Payman Khorrami
- Cedars Sinai Medical Center, Department of Gastroenterology, Los Angeles, CA, USA
| | - Bahman Shamloo
- Cedars Sinai Medical Center, Pain Management, Los Angeles, CA, USA
| | - Charles Moon
- Cedars Sinai Orthopaedic Center, Department of Orthopedics, Los Angeles, CA, USA
| | - Payam Shadi
- Cedars-Sinai Medical Center, Department of Internal Medicine, Los Angeles, CA, USA
| | - Babak Kateb
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
- Brain Mapping Foundation (BMF), Los Angeles, CA, USA
- Loma Linda University, Department of Neurosurgery, Loma Linda, CA, USA
- National Center for NanoBioElectronic (NCNBE), Los Angeles, CA, USA
- Brain Technology and Innovation Park, Los Angeles, CA, USA
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Levine A, Sacktor N, Becker JT. Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research. J Neurovirol 2020; 26:809-823. [PMID: 32880873 PMCID: PMC7471564 DOI: 10.1007/s13365-020-00897-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 01/14/2023]
Abstract
The virology of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the human immune response to the virus are under vigorous investigation. There are now several reports describing neurological symptoms in individuals who develop coronavirus disease 2019 (COVID-19), the syndrome associated with SARS-CoV-2 infection. The prevalence, incidence, and clinical course of these symptoms will become clearer in the coming months and years through epidemiological studies. However, the long-term neurological and cognitive consequence of SARS-CoV-2 infection will remain conjectural for some time and will likely require the creation of cohort studies that include uninfected individuals. Considering the early evidence for neurological involvement in COVID-19 it may prove helpful to compare SARS-CoV-2 with another endemic and neurovirulent virus, human immunodeficiency virus-1 (HIV-1), when designing such cohort studies and when making predictions about neuropsychological outcomes. In this paper, similarities and differences between SARS-CoV-2 and HIV-1 are reviewed, including routes of neuroinvasion, putative mechanisms of neurovirulence, and factors involved in possible long-term neuropsychological sequelae. Application of the knowledge gained from over three decades of neuroHIV research is discussed, with a focus on alerting researchers and clinicians to the challenges in determining the cause of neurocognitive deficits among long-term survivors.
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Affiliation(s)
- Andrew Levine
- grid.19006.3e0000 0000 9632 6718Department of Neurology David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Ned Sacktor
- grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - James T. Becker
- grid.21925.3d0000 0004 1936 9000Departments of Psychiatry, Neurology, and Psychology, University of Pittsburgh, Pittsburgh, PA 15260 USA
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Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System? Viruses 2019; 12:v12010014. [PMID: 31861926 PMCID: PMC7020001 DOI: 10.3390/v12010014] [Citation(s) in RCA: 650] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
Respiratory viruses infect the human upper respiratory tract, mostly causing mild diseases. However, in vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, these opportunistic pathogens can also affect the lower respiratory tract, causing a more severe disease (e.g., pneumonia). Respiratory viruses can also exacerbate asthma and lead to various types of respiratory distress syndromes. Furthermore, as they can adapt fast and cross the species barrier, some of these pathogens, like influenza A and SARS-CoV, have occasionally caused epidemics or pandemics, and were associated with more serious clinical diseases and even mortality. For a few decades now, data reported in the scientific literature has also demonstrated that several respiratory viruses have neuroinvasive capacities, since they can spread from the respiratory tract to the central nervous system (CNS). Viruses infecting human CNS cells could then cause different types of encephalopathy, including encephalitis, and long-term neurological diseases. Like other well-recognized neuroinvasive human viruses, respiratory viruses may damage the CNS as a result of misdirected host immune responses that could be associated with autoimmunity in susceptible individuals (virus-induced neuro-immunopathology) and/or viral replication, which directly causes damage to CNS cells (virus-induced neuropathology). The etiological agent of several neurological disorders remains unidentified. Opportunistic human respiratory pathogens could be associated with the triggering or the exacerbation of these disorders whose etiology remains poorly understood. Herein, we present a global portrait of some of the most prevalent or emerging human respiratory viruses that have been associated with possible pathogenic processes in CNS infection, with a special emphasis on human coronaviruses.
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Mori I. The olfactory bulb: A link between environmental agents and narcolepsy, from the standpoint of autoimmune etiology. Med Hypotheses 2019; 131:109294. [PMID: 31443760 DOI: 10.1016/j.mehy.2019.109294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
Abstract
Narcolepsy type 1 is a lifelong sleep disorder characterized by the loss of hypocretin-producing neurons in the brain. Environmental agents, including influenza, neurotoxic metals, and combustion smoke, have been implicated in the pathogenesis, especially in carriers of the human leukocyte antigen class II DQB1*06:02 allele. Sensitive experimental approaches have recently revealed hypocretin-autoreactive CD4+ and CD8+ T cells in the blood of narcoleptic patients. However, such potentially harmful cells are also detectable, to a lesser degree, in control DQB1*06:02 carriers, suggesting that the integrity of the blood-brain barrier (BBB) provides a neuroprotective effect. Here, we present the hypothesis that external toxic agents induce neuroinflammation in the olfactory bulb and concomitant overproduction of proinflammatory cytokines (e.g., tumor necrosis factor-α and interferon-γ); this, in turn, compromises the BBB, allowing autoimmune cells to access and kill hypocretinergic neurons. Such sequential pathological alterations could occur insidiously, passing unnoticed and consequently being underestimated. The elevated number of autoreactive T cells in narcoleptics relative to controls might reflect externally induced immunomodulation rather than a direct disease trigger.
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Affiliation(s)
- Isamu Mori
- Faculty of Health and Nutrition, Shubun University, Ichinomiya, Aichi 491-0938, Japan.
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Norins LC. The Beehive Theory: Role of microorganisms in late sequelae of traumatic brain injury and chronic traumatic encephalopathy. Med Hypotheses 2019; 128:1-5. [PMID: 31203899 DOI: 10.1016/j.mehy.2019.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury and chronic traumatic encephalopathy are both major health problems, well-publicized for the severe delayed effects attributed to them, including cognitive decline, psychiatric disorders, seizures, impaired motor function, and personality changes. For convenience, the two afflictions are considered together under the rubric traumatic brain injury. Despite the need for neuroprotective agents, no substances have shown efficacy in clinical studies. Thus, a deeper understanding of the neuropathological mechanism of such injury is still needed. Proposed here is a theory that microorganisms from within the brain and elsewhere in the body contribute to the long-term neurological deterioration characteristic of traumatic brain injury. The label, "The Beehive Theory", is drawn from the well-known fact that disturbing a tranquil beehive with a blow can cause a swarm of angry bees to exit their dwelling place and attack nearby humans. Similarly, an impact to the head can initiate dislocations and disruptions in the microbiota present in the brain and body. First, since the normal human brain is not sterile, but is host to a variety of microorganisms, blows to the skull may dislodge them from their accustomed local environments, in which they have been living in quiet equilibrium with neighboring brain cells. Deleterious substances may be released by the displaced microbes, including metabolic products and antigens. Second, upon impact commensal microbes already resident on surfaces of the nose, mouth, and eyes, and potentially harmful organisms from the environment, may gain access to the brain through the distal ends of the olfactory and optic nerves or even a disrupted blood-brain barrier. Third, microbes dwelling in more distant parts of the body may be propelled through the walls of local blood vessels into the bloodstream, and then leak out into damaged areas of the brain that have increased blood-brain barrier permeability. Fourth, the impact may cause dysbiosis in the gastrointestinal microbiome, thereby disrupting signaling via the gut-brain axis. Possible preventatives or therapeutics that would address the adverse contributions of microbes to the late sequelae of traumatic brain injury include anti-inflammatories, antibacterials, antivirals, and probiotics.
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Affiliation(s)
- Leslie C Norins
- Alzheimer's Germ Quest, Inc., 4301 Gulfshore Blvd, Suite 1404, Naples, FL 34103, USA.
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45
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Mori I. The olfactory bulb: A link between environmental agents and narcolepsy. Med Hypotheses 2019; 126:66-68. [PMID: 31010502 DOI: 10.1016/j.mehy.2019.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/18/2019] [Accepted: 03/21/2019] [Indexed: 12/18/2022]
Abstract
Narcolepsy with cataplexy is a lifelong sleep disorder associated with orexin/hypocretin deficiency in the central nervous system. In addition to a genetic predisposition, a variety of environmental factors, such as influenza viruses, have been implicated in the pathogenesis of the disease. In this article, a hypothesis is proposed that environmental agents access the olfactory bulb and trigger neuroinflammation, which in turn induces neurodegeneration of orexinergic neurons in the lateral hypothalamus and other neuronal subpopulations regulating the sleep-wake cycle, which triggers the development of narcolepsy.
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Affiliation(s)
- Isamu Mori
- Faculty of Health and Nutrition, Shubun University, Ichinomiya, Aichi 491-0938, Japan.
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Intranasal Borna Disease Virus (BoDV-1) Infection: Insights into Initial Steps and Potential Contagiosity. Int J Mol Sci 2019; 20:ijms20061318. [PMID: 30875911 PMCID: PMC6470550 DOI: 10.3390/ijms20061318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/10/2019] [Accepted: 03/10/2019] [Indexed: 12/11/2022] Open
Abstract
Mammalian Bornavirus (BoDV-1) typically causes a fatal neurologic disorder in horses and sheep, and was recently shown to cause fatal encephalitis in humans with and without transplant reception. It has been suggested that BoDV-1 enters the central nervous system (CNS) via the olfactory pathway. However, (I) susceptible cell types that replicate the virus for successful spread, and (II) the role of olfactory ensheathing cells (OECs), remained unclear. To address this, we studied the intranasal infection of adult rats with BoDV-1 in vivo and in vitro, using olfactory mucosal (OM) cell cultures and the cultures of purified OECs. Strikingly, in vitro and in vivo, viral antigen and mRNA were present from four days post infection (dpi) onwards in the olfactory receptor neurons (ORNs), but also in all other cell types of the OM, and constantly in the OECs. In contrast, in vivo, BoDV-1 genomic RNA was only detectable in adult and juvenile ORNs, nerve fibers, and in OECs from 7 dpi on. In vitro, the rate of infection of OECs was significantly higher than that of the OM cells, pointing to a crucial role of OECs for infection via the olfactory pathway. Thus, this study provides important insights into the transmission of neurotropic viral infections with a zoonotic potential.
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Affiliation(s)
- J H van der Kolk
- a Editor-in-Chief, Swiss Institute for Equine Medicine (ISME), Vetsuisse Faculty, University of Bern , Bern , Switzerland
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Axonal Transport Enables Neuron-to-Neuron Propagation of Human Coronavirus OC43. J Virol 2018; 92:JVI.00404-18. [PMID: 29925652 DOI: 10.1128/jvi.00404-18] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
Human coronaviruses (HCoVs) are recognized respiratory pathogens for which accumulating evidence indicates that in vulnerable patients the infection can cause more severe pathologies. HCoVs are not always confined to the upper respiratory tract and can invade the central nervous system (CNS) under still unclear circumstances. HCoV-induced neuropathologies in humans are difficult to diagnose early enough to allow therapeutic interventions. Making use of our already described animal model of HCoV neuropathogenesis, we describe the route of neuropropagation from the nasal cavity to the olfactory bulb and piriform cortex and then the brain stem. We identified neuron-to-neuron propagation as one underlying mode of virus spreading in cell culture. Our data demonstrate that both passive diffusion of released viral particles and axonal transport are valid propagation strategies used by the virus. We describe for the first time the presence along axons of viral platforms whose static dynamism is reminiscent of viral assembly sites. We further reveal that HCoV OC43 modes of propagation can be modulated by selected HCoV OC43 proteins and axonal transport. Our work, therefore, identifies processes that may govern the severity and nature of HCoV OC43 neuropathogenesis and will make possible the development of therapeutic strategies to prevent occurrences.IMPORTANCE Coronaviruses may invade the CNS, disseminate, and participate in the induction of neurological diseases. Their neuropathogenicity is being increasingly recognized in humans, and the presence and persistence of human coronaviruses (HCoV) in human brains have been proposed to cause long-term sequelae. Using our mouse model relying on natural susceptibility to HCoV OC43 and neuronal cell cultures, we have defined the most relevant path taken by HCoV OC43 to access and spread to and within the CNS toward the brain stem and spinal cord and studied in cell culture the underlying modes of intercellular propagation to better understand its neuropathogenesis. Our data suggest that axonal transport governs HCoV OC43 egress in the CNS, leading to the exacerbation of neuropathogenesis. Exploiting knowledge on neuroinvasion and dissemination will enhance our ability to control viral infection within the CNS, as it will shed light on underlying mechanisms of neuropathogenesis and uncover potential druggable molecular virus-host interfaces.
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Carter CJ. Genetic, Transcriptome, Proteomic, and Epidemiological Evidence for Blood-Brain Barrier Disruption and Polymicrobial Brain Invasion as Determinant Factors in Alzheimer's Disease. J Alzheimers Dis Rep 2017; 1:125-157. [PMID: 30480234 PMCID: PMC6159731 DOI: 10.3233/adr-170017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Diverse pathogens are detected in Alzheimer's disease (AD) brains. A bioinformatics survey showed that AD genome-wide association study (GWAS) genes (localized in bone marrow, immune locations and microglia) relate to multiple host/pathogen interactomes (Candida albicans, Cryptococcus neoformans, Bornavirus, Borrelia burgdorferri, cytomegalovirus, Ebola virus, HSV-1, HERV-W, HIV-1, Epstein-Barr, hepatitis C, influenza, Chlamydia pneumoniae, Porphyrymonas gingivalis, Helicobacter pylori, Toxoplasma gondii, Trypanosoma cruzi). These interactomes also relate to the AD hippocampal transcriptome and to plaque or tangle proteins. Upregulated AD hippocampal genes match those upregulated by multiple bacteria, viruses, fungi, or protozoa in immunocompetent cells. AD genes are enriched in GWAS datasets reflecting pathogen diversity, suggesting selection for pathogen resistance, as supported by the old age of AD patients, implying resistance to earlier infections. APOE4 is concentrated in regions of high parasitic burden and protects against childhood tropical infections and hepatitis C. Immune/inflammatory gain of function applies to APOE4, CR1, and TREM2 variants. AD genes are also expressed in the blood-brain barrier (BBB), which is disrupted by AD risk factors (age, alcohol, aluminum, concussion, cerebral hypoperfusion, diabetes, homocysteine, hypercholesterolemia, hypertension, obesity, pesticides, pollution, physical inactivity, sleep disruption, smoking) and by pathogens, directly or via olfactory routes to basal-forebrain BBB control centers. The BBB benefits from statins, NSAIDs, estrogen, melatonin, memantine, and the Mediterranean diet. Polymicrobial involvement is supported by upregulation of bacterial, viral, and fungal sensors/defenders in the AD brain, blood, or cerebrospinal fluid. AD serum amyloid-β autoantibodies may attenuate its antimicrobial effects favoring microbial survival and cerebral invasion leading to activation of neurodestructive immune/inflammatory processes, which may also be augmented by age-related immunosenescence. AD may thus respond to antibiotic, antifungal, or antiviral therapy.
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50
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Non-CNS pathogenic origin of Parkinson's disease. J Neurol 2017; 264:2027-2030. [PMID: 28808780 DOI: 10.1007/s00415-017-8588-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
The gut with its variety of microbiota may serve as an etiological origin of diseases. Gut microbes may also play a role in the pathogenesis of diseases beyond their simple nutritional maintenance and support. For example, gut protein aggregation, possibly aided by microbes as well as nasal influences, might be linked to disease that may move to the brain through the vagus nerve. To this end, Braak has offered a "dual-hit" hypothesis that proposes a novel etiology for Parkinson's disease (PD). The hypothesis places the initial origin of the disease in the nose and the gastrointestinal tract (GI) after infection by an unknown pathogen that could aggregate in the gut and then eventually spread to the brain via the autonomic plexuses. Gut health functioning, therefore, may affect brain status and behavior. A protein known as alpha-synuclein accumulates in brains of people with Parkinson's disease that is also present in the GI before the onset of motor symptoms. Therefore, the stomach, previously thought to be a stable mechanism throughout life, might explain some etiological origins of disease. Finally, the vagus nerve of the autonomic system that extends from the brain to the abdomen and exercises both sympathetic and parasympathetic roles might be associated with PD diagnosis along with Lewy body influences.
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