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Song E, Zhang C, Israelow B, Lu-Culligan A, Prado AV, Skriabine S, Lu P, Weizman OE, Liu F, Dai Y, Szigeti-Buck K, Yasumoto Y, Wang G, Castaldi C, Heltke J, Ng E, Wheeler J, Alfajaro MM, Levavasseur E, Fontes B, Ravindra NG, Van Dijk D, Mane S, Gunel M, Ring A, Kazmi SAJ, Zhang K, Wilen CB, Horvath TL, Plu I, Haik S, Thomas JL, Louvi A, Farhadian SF, Huttner A, Seilhean D, Renier N, Bilguvar K, Iwasaki A. Neuroinvasion of SARS-CoV-2 in human and mouse brain. J Exp Med 2021; 218:211674. [PMID: 33433624 PMCID: PMC7808299 DOI: 10.1084/jem.20202135] [Citation(s) in RCA: 572] [Impact Index Per Article: 190.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Yet, there is no consensus on the consequences of CNS infections. Here, we used three independent approaches to probe the capacity of SARS-CoV-2 to infect the brain. First, using human brain organoids, we observed clear evidence of infection with accompanying metabolic changes in infected and neighboring neurons. However, no evidence for type I interferon responses was detected. We demonstrate that neuronal infection can be prevented by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Second, using mice overexpressing human ACE2, we demonstrate SARS-CoV-2 neuroinvasion in vivo. Finally, in autopsies from patients who died of COVID-19, we detect SARS-CoV-2 in cortical neurons and note pathological features associated with infection with minimal immune cell infiltrates. These results provide evidence for the neuroinvasive capacity of SARS-CoV-2 and an unexpected consequence of direct infection of neurons by SARS-CoV-2.
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Affiliation(s)
- Eric Song
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | - Ce Zhang
- Department of Genetics, Yale School of Medicine, New Haven, CT.,Department of Neuroscience, Yale School of Medicine, New Haven, CT
| | - Benjamin Israelow
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
| | | | - Alba Vieites Prado
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Sophie Skriabine
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Peiwen Lu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | - Orr-El Weizman
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Biomedical Engineering, Yale University, New Haven, CT
| | - Yile Dai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | - Klara Szigeti-Buck
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Yuki Yasumoto
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Guilin Wang
- Yale Center for Genome Analysis, West Haven, CT
| | | | | | - Evelyn Ng
- Yale Center for Genome Analysis, West Haven, CT
| | | | - Mia Madel Alfajaro
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Etienne Levavasseur
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Benjamin Fontes
- Yale Environmental Health and Safety, Yale University, New Haven, CT
| | - Neal G Ravindra
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Computer Science, Yale University, New Haven, CT
| | - David Van Dijk
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Computer Science, Yale University, New Haven, CT
| | - Shrikant Mane
- Department of Genetics, Yale School of Medicine, New Haven, CT.,Yale Center for Genome Analysis, West Haven, CT
| | - Murat Gunel
- Department of Genetics, Yale School of Medicine, New Haven, CT.,Department of Neuroscience, Yale School of Medicine, New Haven, CT.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Aaron Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
| | | | - Kai Zhang
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA
| | - Craig B Wilen
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Tamas L Horvath
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Isabelle Plu
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France
| | - Stephane Haik
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Yale Environmental Health and Safety, Yale University, New Haven, CT.,Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Paris, France
| | - Jean-Leon Thomas
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Angeliki Louvi
- Department of Neuroscience, Yale School of Medicine, New Haven, CT.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Shelli F Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT.,Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Anita Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Danielle Seilhean
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France
| | - Nicolas Renier
- Sorbonne Université, INSERM U1127, French National Centre for Scientific Research, Joint Research Unit 7225, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Kaya Bilguvar
- Department of Genetics, Yale School of Medicine, New Haven, CT.,Yale Center for Genome Analysis, West Haven, CT
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Molecular, Cellular, and Developmental Biology, Yale School of Medicine, New Haven, CT.,Howard Hughes Medical Institute, Chevy Chase, MD
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Song E, Zhang C, Israelow B, Lu-Culligan A, Prado AV, Skriabine S, Lu P, Weizman OE, Liu F, Dai Y, Szigeti-Buck K, Yasumoto Y, Wang G, Castaldi C, Heltke J, Ng E, Wheeler J, Alfajaro MM, Levavasseur E, Fontes B, Ravindra NG, Van Dijk D, Mane S, Gunel M, Ring A, Kazmi SAJ, Zhang K, Wilen CB, Horvath TL, Plu I, Haik S, Thomas JL, Louvi A, Farhadian SF, Huttner A, Seilhean D, Renier N, Bilguvar K, Iwasaki A. Neuroinvasion of SARS-CoV-2 in human and mouse brain. bioRxiv 2020:2020.06.25.169946. [PMID: 32935108 PMCID: PMC7491522 DOI: 10.1101/2020.06.25.169946] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Yet, there is no consensus whether the virus can infect the brain, or what the consequences of CNS infection are. Here, we used three independent approaches to probe the capacity of SARS-CoV-2 to infect the brain. First, using human brain organoids, we observed clear evidence of infection with accompanying metabolic changes in the infected and neighboring neurons. However, no evidence for the type I interferon responses was detected. We demonstrate that neuronal infection can be prevented either by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Second, using mice overexpressing human ACE2, we demonstrate in vivo that SARS-CoV-2 neuroinvasion, but not respiratory infection, is associated with mortality. Finally, in brain autopsy from patients who died of COVID-19, we detect SARS-CoV-2 in the cortical neurons, and note pathologic features associated with infection with minimal immune cell infiltrates. These results provide evidence for the neuroinvasive capacity of SARS-CoV2, and an unexpected consequence of direct infection of neurons by SARS-CoV-2.
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Affiliation(s)
- Eric Song
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Ce Zhang
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
| | - Benjamin Israelow
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
| | - Alice Lu-Culligan
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Alba Vieites Prado
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
| | - Sophie Skriabine
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
| | - Peiwen Lu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Orr-El Weizman
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, USA
| | - Yile Dai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Klara Szigeti-Buck
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, USA
| | - Yuki Yasumoto
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Guilin Wang
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | | | - Jaime Heltke
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | - Evelyn Ng
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | - John Wheeler
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | - Mia Madel Alfajaro
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Etienne Levavasseur
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
| | - Benjamin Fontes
- Yale Environmental Health and Safety, Yale University, New Haven, CT 06510, USA
| | - Neal G. Ravindra
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Computer Science, Yale University, New Haven, CT 06510, USA
| | - David Van Dijk
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Computer Science, Yale University, New Haven, CT 06510, USA
| | - Shrikant Mane
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | - Murat Gunel
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Aaron Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Syed A. Jaffar Kazmi
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Kai Zhang
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Craig B Wilen
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Tamas L. Horvath
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, USA
- Department of Molecular Biophysics and Biochemistry, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Molecular, Cellular, and Developmental Biology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Isabelle Plu
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France
| | - Stephane Haik
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
- Yale Environmental Health and Safety, Yale University, New Haven, CT 06510, USA
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Paris, France
| | - Jean-Leon Thomas
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Angeliki Louvi
- Department of Neuroscience, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Shelli F. Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Anita Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Danielle Seilhean
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neuropathologie, Paris, France
| | - Nicolas Renier
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris Brain Institute - ICM, Paris, France
| | - Kaya Bilguvar
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
- Yale Center for Genome Analysis, West Haven, CT 06510, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Molecular, Cellular, and Developmental Biology, Yale School of Medicine, New Haven, CT 06510, USA
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
- Lead Contact
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