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

• Published in: Neurology Vol. 95; no. 12; pp. e1754 - e1759
• Main Authors: Kanberg, Nelly, Ashton, Nicholas J., Andersson, Lars-Magnus, Yilmaz, Aylin, Lindh, Magnus, Nilsson, Staffan, Price, Richard W., Blennow, Kaj, Zetterberg, Henrik, Gisslén, Magnus
• Format: Journal Article
• Language: English
• Published: United States American Academy of Neurology 22-09-2020
• Subjects: Adult; Age Factors; Aged; Astrocytes; Astrocytes - metabolism; Betacoronavirus; Biomarkers; Biomarkers - blood; blood; Case-Control Studies; Coronavirus Infections; Coronavirus Infections - blood; COVID-19; Female; Follow-Up Studies; Glial Fibrillary Acidic Protein; Glial Fibrillary Acidic Protein - blood; Humans; Infectious Medicine; Infektionsmedicin; Male; metabolism; Middle Aged; Neurofilament Proteins; Neurofilament Proteins - blood; Neurons; Neurons - metabolism; Pandemics; Pneumonia; Pneumonia, Viral - blood; SARS-CoV-2; Severity of Illness Index; Single Molecule Imaging; Viral
• ISSN: 0028-3878; 1526-632X; 1526-632X
• DOI: 10.1212/WNL.0000000000010111

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