Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms
Open Access
- 26 May 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Zeitschrift für Neurologie
- Vol. 267 (8), 2179-2184
- https://doi.org/10.1007/s00415-020-09929-7
Abstract
Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus (SARS-CoV-2), has become a global pandemic threat. The potential involvement of COVID-19 in central nervous system (CNS) has attracted considerable attention due to neurological manifestations presented throughout the disease process. In addition, SARS-CoV-2 is structurally similar to SARS-CoV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. Thus, cells expressing ACE2, such as neurons and glial cells may act as targets and are thus vulnerable to SARS-CoV-2 infection. Here, we have reviewed the neurological characteristics of COVID-19 and summarized possible mechanisms of SARS-CoV-2 invasion of the CNS. COVID-19 patients have presented with a number of different neurological symptoms such as headache, dizziness, hyposmia, and hypogeusia during the course of illness. It has also been reported recently that some cases of COVID-19 have presented with concurrent acute cerebrovascular disease (acute ischemic stroke, cerebral venous sinus thrombosis, cerebral hemorrhage, subarachnoid hemorrhage), meningitis/encephalitis, acute necrotizing hemorrhagic encephalopathy, and acute Guillain–Barré syndrome. Furthermore, SARS-CoV-2 RNA detected in a cerebrospinal fluid specimen of a patient with COVID-19 have provided direct evidence to support the theory of neurotropic involvement of SARS-CoV-2. However, the underlying neurotropic mechanisms of SARS-CoV-2 are yet to be established. SARS-CoV-2 may affect CNS through two direct mechanisms (hematogenous dissemination or neuronal retrograde dissemination) or via indirect routes. The underlying mechanisms require further elucidation in the future.Keywords
Funding Information
- National Natural Science Foundation of China (81974279)
This publication has 65 references indexed in Scilit:
- Viral diseases of the central nervous systemCurrent Opinion in Virology, 2015
- The olfactory nerve: a shortcut for influenza and other viral diseases into the central nervous systemThe Journal of Pathology, 2014
- Human coronaviruses: Viral and cellular factors involved in neuroinvasiveness and neuropathogenesisVirus Research, 2014
- Severe Acute Respiratory Syndrome Coronavirus Infection Causes Neuronal Death in the Absence of Encephalitis in Mice Transgenic for Human ACE2Journal of Virology, 2008
- Pathogenetic mechanisms of severe acute respiratory syndromeVirus Research, 2008
- Lethal Infection of K18- hACE2 Mice Infected with Severe Acute Respiratory Syndrome CoronavirusJournal of Virology, 2007
- Detection of Severe Acute Respiratory Syndrome Coronavirus in the Brain: Potential Role of the Chemokine Mig in PathogenesisClinical Infectious Diseases, 2005
- Multiple organ infection and the pathogenesis of SARSThe Journal of Experimental Medicine, 2005
- Possible Central Nervous System Infection by SARS CoronavirusEmerging Infectious Diseases, 2004
- Cardiac arrest and joggingAnnals of Emergency Medicine, 1982