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

Neurology. 2020 Sep 22;95(12):e1754-e1759. doi: 10.1212/WNL.0000000000010111. Epub 2020 Jun 16.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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

Substances

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