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This is a monthly e-newsletter from the Lifebrain Horizon2020 project.
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Lifebrain Newsletter March 2021
 

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Is covid-19 a brain disease?

Recent findings show that up to more than two-thirds of patients with covid-19 had neurological complications, and many develop a mental health problem within 90 days of contracting the virus. This has led the European Brain Council to consider covid-19 a brain disease.

Background

Quite early after the recognition of the severe acute respiratory syndrome (SARS), the coronavirus SARS-CoV-2 was found responsible for a pandemic with many signs of the brain being affected (Mao L et al. 2020). In addition to the classical signs of respiratory disease, covid-19 may also affect the nervous system in several ways (see Figure 1): 
a) central nervous system; dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure
b) peripheral nervous system; taste impairment, smell impairment, vision impairment, and nerve pain
c) skeletal muscular interaction with the nervous system; paralyses, weakness

Source: Colourbox

There are convincing data showing that the central nervous system is strongly and markedly affected during covid-19 infections. For example, several reports suggest that fatigue and other general psychiatric conditions like depressions and anxiety are quite common; approximately 20 to 70 % of infected patients have symptoms/signs of the brain being affected during covid-19 infections (The European Brain Council 2021). The most commonly reported long-term health consequences include fatigue, headaches, difficulty breathing, anxiety and depression, chest pains, joint pains and dizziness (Norwegian Institute of Public Health 2020).
Moreover, there are indications that viral infections in general, and covid-19 in particular, may be important for development of neurodegenerative diseases like dementia, Parkinson’s disease, amyotrophic lateral sclerosis, and multiple sclerosis (Karim S et al. 2014).

Figure 1. Symptoms or diseases in the central nervous system of patients with covid-19 (with permission from Baptista AF et al. 2020).

What is the link between the covid-19 infection and the brain?

We know that the SARS-CoV-2 virus infects host cells by using a specific type of receptor named the angiotensin converting enzyme (ACE2) receptor, observed in several organs including the lung, heart, kidney, and intestine. A receptor is a protein that can bind another protein with very high specificity. Thus, a receptor allows very specific signals or transport to take place. 
ACE2 receptors are also found on endothelial cells (covering the inside of small vessels supplying the brain) and on vascular smooth muscle cells (regulating the tension in the small vessels) in the brain (Ferrario CM et al. 2005; Hamming I et al. 2004).
The ACE2 receptors are also present on the surface of some cell types such as the olfactory epithelium (cells covering the “smell” nerve) in the nose. The path from the olfactory nerve to the inside of the brain is very short, and this is a likely pathway for infecting the brain with SARS-CoV-2 virus (Jakhmola S et al. 2020). 
It has been shown that patients dying from covid-19 infections have damaged small vessels in several parts of the brain, most likely due to infections via cells covering the inside of small vesicles in the brain (Lee M-H et al. 2021).

A Lifebrain statement: Covid-19 is a brain disease

The findings above may explain why many patients have so many symptoms of covid-19 infections affecting the central nervous system, and that we in Lifebrain also believe it is correct to classify the pandemic as a brain disease.

References

Mao L et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020, 77, 683-90

European Brain Council (2021) “EBC statement: The impact of covid-19 on brain health. January 2021”: retrieved February 15, 2021

Karim S et al. The role of viruses in neurodegenerative and neurobehavioral diseases. CNS Neurol Disord Drug Targets. 2014, 13, 1213–23. 

Ferrario CM et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005, 111, 2605–10

Hamming I et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004, 203, 631–7.

Jakhmola S et al. SARS-CoV-2, an underestimated pathogen of the nervous system. SN Compr Clin Med 2020,2, 2137–46

Lee M-H et al. Microvascular injury in the brains of patients with Covid-19. N Engl J Med 2021, 384, 481-3

Norwegian Institute of Public Health (2020) Facts about the SARS-CoV-2 virus and COVID-19 disease, retrieved February 16th, 2021.

Baptista AF et al. Applications of non-invasive neuromodulation for the management of disorders related to COVID-19. Front Neurol. 2020, Nov 25;11:573718.

Source of newsletter

This newsletter was edited by Christian A. Drevon, Lifebrain researcher, Professor emeritus of Medicine (nutrition) at the University of Oslo, and consultant in the analytical contract laboratory Vitas Ltd. in Oslo Science Park. Has studied effects of nutrients and physical activity on health, with special focus on molecular nutrition and biomarkers. 

CONTACT US

Your comments are always valuable to us, so do not hesitate to contact us.

Center for Lifespan Changes in Brain and Cognition at the University of Oslo
Kristine B. Walhovd project coordinator
Barbara B. Friedman administrative coordinator
e-mail: info@lifebrain.uio.no
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This project has received funding from the European Union ’s Horizon 2020 research and innovation programme under grant agreement No 732592.
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