Health
Long-term neurological COVID patients exhibit immune dysregulation
Widespread immune dysregulation was found in the cerebrospinal fluid (CSF) of a small cohort of people with long-lasting neurological symptoms of COVID. deep phenotypic analysis Indicated.
People who had persistent neurological symptoms after SARS-CoV-2 infection had lower levels of CD4+ and CD8+ T cells compared to healthy controls, said Avindra of NIH’s National Institute of Neurological Disorders and Stroke (NINDS) in Bethesda. Nath, M.D. reported. Maryland, and co-authors.
In addition, B cells and other types of immune cells were increased in people with persistent neurological symptoms. Neurology: neuroimmunology and neuroinflammationAutonomic tests also showed dysfunction.
The findings warrant further investigation to confirm these changes and assess the role of immunomodulators in clinical trials, Nath and co-authors said.
The results may also guide researchers in further characterizing long-lasting neurological COVID, also known as acute neurological sequelae of COVID-19 or neuro-PASC.
Nath et al. conducted an observational study of 12 people with persistent neurological symptoms after SARS-CoV-2 infection at the NIH Clinical Center. They compared the CSF and autonomic function results to data collected before his COVID pandemic from healthy volunteers in other of his NIH studies.
The assessment was performed a median of 9 months after acute SARS-CoV-2 infection and COVID was diagnosed between March and December 2020. Nearly all participants (11 of 12) had mild infections. One was moderately ill.
All participants were Caucasian, had a mean age of 45 years, and 83% of participants were female. Only one participant received the SARS-CoV-2 vaccine before evaluation.
More than half (58%) of the participants had a history of depression or anxiety prior to COVID-19. A third (4 participants) had a history of long-term resolution of disability after an infection.
Most participants (83%) Karnofsky performance status A score of 80 or less indicates disabling disease. Neurologic examination showed signs consistent with mild peripheral neuropathy in three participants (25%).
Cognitive testing showed evidence of mild cognitive impairment.half of the participants Montreal Cognitive Assessment Your score is less than 26. Short-term memory was the most commonly affected domain.
Varying degrees of microsmear were seen University of Pennsylvania Odor Discrimination Test None of the 8 participants (66%) had anosmia. Her MRI scan of the brain was largely normal, with no structural abnormalities in the brainstem and olfactory pathways that may have long been correlated with her COVID.
CSF analysis showed no evidence of cell proliferation in any participant. Unique intrathecal oligoclonal bands were seen in 3 of his cases (25%).
Compared to healthy controls, long-term participants with COVID had a lower frequency of effector memory phenotypes in both CD4+ T cells (P.<0.0001) and CD8 + T cells (P.= 0.002). There was also an increased frequency of antibody-secreting B cells (P.=0.009) Some increase in immune checkpoint molecules.
“The persistence of these immune abnormalities months after mild infection suggests the possibility of persistent infection or an abnormal immune response to infection,” Nath and co-authors observed.
Autonomic testing showed abnormalities, including decreased baroreflex-cardiovagal gain (P.=0.009) and the increase in peripheral resistance during the tilt table test (P.<0.0001) longer COVID participants compared to controls. Her CSF levels of catechol did not differ between the long-term COVID and control groups.
Study limitations included the study’s small sample size and lack of a perfectly matched control group, Nath and coauthors acknowledged.
Disclosure
This work was supported by the NINDS Intramural Research Program.
Nath had no disclosures. Co-authors reported that there were no relevant disclosures in the manuscript.
Primary information
Neurology: neuroimmunology and neuroinflammation
Source reference: Mina Y, et al “Profound phenotype of acute neurological sequelae of SARS-CoV2 infection” Neurol Neuroimmunol Neuroinflamm 2023; DOI: 10.1212/nxi.0000000000200097.
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