Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis, 2021, Shin Jie Yong

Andy · Feb 5, 2021

Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis

Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others.

While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved.

This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases.

The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID.

Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.
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Edited to shorter paragraphs for easier reading.
Paywall, https://pubs.acs.org/doi/full/10.1021/acschemneuro.0c00793

Sly Saint · Feb 5, 2021

Andy said: ↑

https://pubs.acs.org/doi/full/10.1021/acschemneuro.0c00793
Click to expand...

Snow Leopard · Feb 5, 2021

Andy said: ↑

Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis

Edited to shorter paragraphs for easier reading.
Paywall, https://pubs.acs.org/doi/full/10.1021/acschemneuro.0c00793
Click to expand...

This might explain some of the distinct (albeit rare) neurological subsets, but probably doesn't explain most cases of long-covid.

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Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis, 2021, Shin Jie Yong

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Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis, 2021, Shin Jie Yong

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