Vagus nerve inflammation contributes to dysautonomia in COVID-19

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Abstract

Dysautonomia has substantially impacted acute COVID-19 severity as well as symptom burden after recovery from COVID-19 (long COVID), yet the underlying causes remain unknown. Here, we hypothesized that vagus nerves are affected in COVID-19 which might contribute to autonomic dysfunction. We performed a histopathological characterization of postmortem vagus nerves from COVID-19 patients and controls, and detected SARS-CoV-2 RNA together with inflammatory cell infiltration composed primarily of monocytes. Furthermore, we performed RNA sequencing which revealed a strong inflammatory response of neurons, endothelial cells, and Schwann cells which correlated with SARS-CoV-2 RNA load. Lastly, we screened a clinical cohort of 323 patients to detect a clinical phenotype of vagus nerve affection and found a decreased respiratory rate in non-survivors of critical COVID-19. Our data suggest that SARS-CoV-2 induces vagus nerve inflammation followed by autonomic dysfunction which contributes to critical disease courses and might contribute to dysautonomia observed in long COVID.

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APA

Woo, M. S., Shafiq, M., Fitzek, A., Dottermusch, M., Altmeppen, H., Mohammadi, B., … Glatzel, M. (2023). Vagus nerve inflammation contributes to dysautonomia in COVID-19. Acta Neuropathologica, 146(3), 387–394. https://doi.org/10.1007/s00401-023-02612-x

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