The potential role of microvascular pathology in the neurological manifestations of coronavirus infection
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(2020) 17:55 MacLean et al. Fluids Barriers CNS https://doi.org/10.1186/s12987-020-00216-1
Open Access
REVIEW
The potential role of microvascular pathology in the neurological manifestations of coronavirus infection M. A. MacLean1* , L. Kamintsky2, E. D. Leck1 and A. Friedman2
Abstract Human coronaviruses are highly pathogenic viruses that pose a serious threat to human health. Examples include the severe acute respiratory syndrome outbreak of 2003 (SARS-CoV-1), the Middle East Respiratory Syndrome (MERS-CoV) outbreak of 2012, and the current SARS-CoV-2 (COVID-19) pandemic. Herein, we review the neurological manifestations of coronaviruses and discuss the potential pathogenic role of blood–brain barrier dysfunction. We present the hypothesis that pre-existing vascular damage (due to aging, cardiovascular disease, diabetes, hypertension or other conditions) facilitates infiltration of the virus into the central nervous system (CNS), increasing neuro-inflammation and the likelihood of neurological symptoms. We also discuss the role of a neuroinflammatory cytokine profile in both blood–brain barrier dysfunction and macrovascular disease (e.g. ischemic stroke and thromboembolism). Future studies are needed to better understand the involvement of the microvasculature in coronavirus neuropathology, and to test the diagnostic potential of minimally-invasive screening tools (e.g. serum biomarkers, fluorescein retinal angiography and dynamic-contrast MRI). Keywords: Blood–brain barrier, Neurological, Coronavirus, SARS-CoV-2, Neurology, Stroke Introduction Coronaviruses are enveloped viruses found in animals and humans. Coronaviruses possess a single-stranded RNA genome that encodes structural proteins that allow binding to host cells, and replicase proteins that allow viral replication [1]. The first coronavirus causing severe acute respiratory syndrome (SARS-CoV-1) was identified as a clinical entity in 2002 [2]. This was followed by the emergence of the Middle East Respiratory Distress Syndrome (MERS-CoV) in 2012 [3], and SARS-CoV-2 in 2019 [4, 5]. Severe cases of coronavirus infection are associated with acute microvascular disease of the respiratory *Correspondence: [email protected] 1 Division of Neurosurgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre (Halifax Infirmary), 1796 Summer Street, Halifax, NS B3H 3A7, Canada Full list of author information is available at the end of the article
system [6]. Clinically, this manifests as failure to breath due to widespread lung inflammation, termed acute respiratory distress syndrome (ARDS) [7–9]. Risk factors for ARDS are old age and comorbidities such as cerebrovascular disease, diabetes, and hypertension [10, 11]. These conditions are associated with immune and vascular dysfunction, and predispose patients to severe infection [10–16]. In addition to the established role of coronavirus infection in respiratory system dysfunction, accumulating evidence associates coronaviruses with neuropathology [6, 8, 9, 17–24]. Herein, we review the neurolog
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