What Can We Still Learn from Brain Autopsies in COVID-19?
What Can We Still Learn from Brain Autopsies in COVID-19?
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DOI：
10.1055/s-0043-1767716
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发表时间：
2023-04-06
影响因子：
2.7
通讯作者：
Mukerji，Shibani S.
中科院分区：
文献类型：
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作者：
Solomon，Isaac H.;Singh，Arjun;Mukerji，Shibani S.
已公布约 900 名因严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染而死亡的患者的神经病理学结果，仅占 2019 年冠状病毒病 (COVID-19) 大流行两年后向世界卫生组织报告的近 640 万人死亡人数的不到 0.01%。在这篇综述中，我们扩展了之前总结 COVID-19 神经病理学的工作，纳入了截至 2022 年 6 月已发表的尸检信息，以及儿童神经病理学研究、COVID-19 变体、继发性脑感染、离体脑成像以及在美国或欧洲以外国家进行的尸检。我们还总结了研究非人类灵长类动物和其他模型的神经发病机制的研究。虽然脑血管病理学和以小胶质细胞为主的炎症模式仍然是与 COVID-19 相关的主要神经病理学发现，但对于急性 COVID-19 或急性后 COVID-19 病症中神经系统症状的机制尚无单一的理解。因此，至关重要的是，我们将脑组织的微观和分子发现纳入我们对临床疾病的了解中，以便我们为研究 COVID-19 的神经发病率获得最佳实践指导和直接研究重点。
Neuropathological findings have been published from ∼900 patients who died with or from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, representing less than 0.01% of the close to 6.4 million deaths reported to the World Health Organization 2 years into the coronavirus disease 2019 (COVID-19) pandemic. In this review, we extend our prior work summarizing COVID-19 neuropathology by including information on published autopsies up to June 2022, and neuropathological studies in children, COVID-19 variants, secondary brain infections,ex vivobrain imaging, and autopsies performed in countries outside of the United States or Europe. We also summarize research studies that investigate mechanisms of neuropathogenesis in nonhuman primates and other models. While a pattern of cerebrovascular pathology and microglial-predominant inflammation remains the primary COVID-19-associated neuropathological finding, there is no singular understanding of the mechanisms that underlie neurological symptoms in acute COVID-19 or the post-acute COVID-19 condition. Thus, it is paramount that we incorporate microscopic and molecular findings from brain tissue into what we know about the clinical disease so that we attain best practice guidance and direct research priorities for the study of the neurological morbidity of COVID-19.