Neurochemical evidence of astrocytic and neuronal injury commonly found in COVID-19.

Abstract

OBJECTIVE:

To test the hypothesis that coronavirus disease 2019 (COVID-19) has an impact on the CNS by measuring plasma biomarkers of CNS injury.

METHODS:

We recruited 47 patients with mild (n = 20), moderate (n = 9), or severe (n = 18) COVID-19 and measured 2 plasma biomarkers of CNS injury by single molecule array, neurofilament light chain protein (NfL; a marker of intra-axonal neuronal injury) and glial fibrillary acidic protein (GFAp; a marker of astrocytic activation/injury), in samples collected at presentation and again in a subset after a mean of 11.4 days. Cross-sectional results were compared with results from 33 age-matched controls derived from an independent cohort.

RESULTS:

The patients with severe COVID-19 had higher plasma concentrations of GFAp (p = 0.001) and NfL (p < 0.001) than controls, while GFAp was also increased in patients with moderate disease (p = 0.03). In patients with severe disease, an early peak in plasma GFAp decreased on follow-up (p < 0.01), while NfL showed a sustained increase from first to last follow-up (p < 0.01), perhaps reflecting a sequence of early astrocytic response and more delayed axonal injury.

CONCLUSION:

We show neurochemical evidence of neuronal injury and glial activation in patients with moderate and severe COVID-19. Further studies are needed to clarify the frequency and nature of COVID-19-related CNS damage and its relation to both clinically defined CNS events such as hypoxic and ischemic events and mechanisms more closely linked to systemic severe acute respiratory syndrome coronavirus 2 infection and consequent immune activation, as well as to evaluate the clinical utility of monitoring plasma NfL and GFAp in the management of this group of patients.

• Authors: Nelly Kanberg, Nicholas J Ashton, Lars-Magnus Andersson, Aylin Yilmaz, Magnus Lindh, Staffan Nilsson, Richard W Price, Kaj Blennow, Henrik Zetterberg, Magnus Gisslén
• Journal: Neurology (Neurology) Vol. 95 Issue 12 Pg. e1754-e1759 (09 22 2020) ISSN: 1526-632X [Electronic] United States
• PMID: 32546655 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 American Academy of Neurology.

Chemical References

• Biomarkers
• GFAP protein, human
• Glial Fibrillary Acidic Protein
• Neurofilament Proteins
• neurofilament protein L

Topics

• Adult
• Age Factors
• Aged
• Astrocytes (metabolism)
• Betacoronavirus
• Biomarkers (blood)
• COVID-19
• Case-Control Studies
• Coronavirus Infections (blood)
• Female
• Follow-Up Studies
• Glial Fibrillary Acidic Protein (blood)
• Humans
• Male
• Middle Aged
• Neurofilament Proteins (blood)
• Neurons (metabolism)
• Pandemics
• Pneumonia, Viral (blood)
• SARS-CoV-2
• Severity of Illness Index
• Single Molecule Imaging