Your browser doesn't support javascript.
Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.
Alexopoulos, Harry; Magira, Eleni; Bitzogli, Kleopatra; Kafasi, Nikolitsa; Vlachoyiannopoulos, Panayiotis; Tzioufas, Athanasios; Kotanidou, Anastasia; Dalakas, Marinos C.
  • Alexopoulos H; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Magira E; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Bitzogli K; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Kafasi N; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Vlachoyiannopoulos P; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Tzioufas A; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Kotanidou A; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
  • Dalakas MC; From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility
Neurol Neuroimmunol Neuroinflamm ; 7(6)2020 11.
Article in English | MEDLINE | ID: covidwho-1105773
Semantic information from SemMedBD (by NLM)
1. Comatose PROCESS_OF Patients
Subject
Comatose
Predicate
PROCESS_OF
Object
Patients
2. Anti-Antibodies PART_OF 2019 novel coronavirus
Subject
Anti-Antibodies
Predicate
PART_OF
Object
2019 novel coronavirus
3. Anti-Antibodies ASSOCIATED_WITH Comatose
Subject
Anti-Antibodies
Predicate
ASSOCIATED_WITH
Object
Comatose
4. Anti-Antibodies ASSOCIATED_WITH Lethargy
Subject
Anti-Antibodies
Predicate
ASSOCIATED_WITH
Object
Lethargy
5. Malaise PROCESS_OF Patients
Subject
Malaise
Predicate
PROCESS_OF
Object
Patients
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Encephalopathies PROCESS_OF Patients
Subject
Encephalopathies
Predicate
PROCESS_OF
Object
Patients
8. Serum LOCATION_OF Antibodies
Subject
Serum
Predicate
LOCATION_OF
Object
Antibodies
9. Antibodie PART_OF C5203676
Subject
Antibodie
Predicate
PART_OF
Object
C5203676
10. Circumferential Supracrestal Fiberotomy TREATS Patients
Subject
Circumferential Supracrestal Fiberotomy
Predicate
TREATS
Object
Patients
11. Polymerase Chain Reaction METHOD_OF Circumferential Supracrestal Fiberotomy
Subject
Polymerase Chain Reaction
Predicate
METHOD_OF
Object
Circumferential Supracrestal Fiberotomy
12. Focal neurologic signs PROCESS_OF Patients
Subject
Focal neurologic signs
Predicate
PROCESS_OF
Object
Patients
13. Comatose PROCESS_OF Patients
Subject
Comatose
Predicate
PROCESS_OF
Object
Patients
14. Anti-Antibodies PART_OF 2019 novel coronavirus
Subject
Anti-Antibodies
Predicate
PART_OF
Object
2019 novel coronavirus
15. Anti-Antibodies ASSOCIATED_WITH Comatose
Subject
Anti-Antibodies
Predicate
ASSOCIATED_WITH
Object
Comatose
16. Anti-Antibodies ASSOCIATED_WITH Lethargy
Subject
Anti-Antibodies
Predicate
ASSOCIATED_WITH
Object
Lethargy
17. Malaise PROCESS_OF Patients
Subject
Malaise
Predicate
PROCESS_OF
Object
Patients
18. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
19. Encephalopathies PROCESS_OF Patients
Subject
Encephalopathies
Predicate
PROCESS_OF
Object
Patients
20. Serum LOCATION_OF Antibodies
Subject
Serum
Predicate
LOCATION_OF
Object
Antibodies
21. Antibodies, Anti-Idiotypic PART_OF 2019 novel coronavirus
Subject
Antibodies, Anti-Idiotypic
Predicate
PART_OF
Object
2019 novel coronavirus
22. Circumferential Supracrestal Fiberotomy TREATS Patients
Subject
Circumferential Supracrestal Fiberotomy
Predicate
TREATS
Object
Patients
23. Polymerase Chain Reaction METHOD_OF Circumferential Supracrestal Fiberotomy
Subject
Polymerase Chain Reaction
Predicate
METHOD_OF
Object
Circumferential Supracrestal Fiberotomy
24. Focal neurologic signs PROCESS_OF Patients
Subject
Focal neurologic signs
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

OBJECTIVE:

To investigate the pathophysiologic mechanism of encephalopathy and prolonged comatose or stuporous state in severally ill patients with coronavirus disease 2019 (COVID-19).

METHODS:

Eight COVID-19 patients with signs of encephalopathy were tested for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the serum and CSF using a Food and Drug Administration-approved and independently validated ELISA. Blood-brain barrier (BBB) integrity and immunoglobulin G (IgG) intrathecal synthesis were further tested using albumin and IgG indices. The CSF was also tested for autoimmune encephalitis antibodies and 14-3-3, a marker of ongoing neurodegeneration.

RESULTS:

All patients had anti-SARS-CoV-2 antibodies in their CSF, and 4 of 8 patients had high titers, comparable to high serum values. One patient had anti-SARS-CoV-2 IgG intrathecal synthesis, and 3 others had disruption of the blood-brain barrier. The CSF in 4 patients was positive for 14-3-3-protein suggesting ongoing neurodegeneration. In all patients, the CSF was negative for autoimmune encephalitis antibodies and SARS-CoV-2 by PCR. None of the patients, apart from persistent encephalopathic signs, had any focal neurologic signs or history or specific neurologic disease.

CONCLUSIONS:

High-titer anti-SARS-CoV-2 antibodies were detected in the CSF of comatose or encephalopathic patients demonstrating intrathecal IgG synthesis or BBB disruption. A disrupted BBB may facilitate the entry of cytokines and inflammatory mediators into the CNS enhancing neuroinflammation and neurodegeneration. The observations highlight the need for prospective CSF studies to determine the pathogenic role of anti-SARS-CoV-2 antibodies and identify early therapeutic interventions.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Autoantibodies / Blood-Brain Barrier / Coronavirus Infections / Coma / Stupor / Betacoronavirus / Nervous System Diseases Subject: Pneumonia, Viral / Autoantibodies / Blood-Brain Barrier / Coronavirus Infections / Coma / Stupor / Betacoronavirus / Nervous System Diseases Type of study: Diagnostic study / Prognostic study Language: English Year: 2020

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Autoantibodies / Blood-Brain Barrier / Coronavirus Infections / Coma / Stupor / Betacoronavirus / Nervous System Diseases Subject: Pneumonia, Viral / Autoantibodies / Blood-Brain Barrier / Coronavirus Infections / Coma / Stupor / Betacoronavirus / Nervous System Diseases Type of study: Diagnostic study / Prognostic study Language: English Year: 2020
...