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Autopsies show the COVID-19 virus in the brain and elsewhere in the body

Autopsies show the COVID-19 virus in the brain and elsewhere in the body

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Summary: Autopsy tissue samples of 44 people who died of COVID-19 showed that SAR-CoV-2, the virus responsible for the coronavirus, had spread throughout the body and brain, with traces of the virus remaining for 8 months.

source: University of Minnesota

An analysis of tissue samples from the autopsy of 44 people who died with COVID-19 showed that the SAR-CoV-2 virus had spread throughout the body – including the brain – and that it remained for almost eight months.

The study was published in Nature.

Scientists at the National Institutes of Health (NIH) tested samples from autopsies performed from April 2020 to March 2021. They conducted extensive sampling of the nervous system, including the brain, in 11 of the patients.

RNA and viable virus in various organs

All patients died of COVID-19, and none were vaccinated. The blood plasma of 38 patients was positive for SARS-CoV-2, three were negative, and for the remaining three plasma was not available.

Thirty percent of the patients were women, and the average age was 62.5 years. Twenty-seven patients (61.4%) had three or more comorbidities. The mean interval from onset of symptoms to death was 18.5 days.

The analysis showed that SARS-CoV-2, as expected, primarily infects and damages the respiratory tract and lung tissue. But the researchers also found viral RNA in 84 different body sites and body fluids, and in one case they isolated viral RNA 230 days after the patient’s symptoms began.

The researchers found SARS-CoV-2 RNA and protein in the hypothalamus and cerebellum of one patient and in the spinal cord and basal ganglia of two other patients. But they found little damage to brain tissue, “despite the significant viral burden.”

The researchers also isolated viable SARS-CoV-2 virus from various tissues inside and outside the respiratory tract, including the brain, heart, lymph nodes, gastrointestinal tract, adrenal glands, and eyes. They isolated virus from 25 of 55 samples tested (45%).

The authors write: “We demonstrated viral replication in multiple non-respiratory sites during the first two weeks after symptom onset.”

RNA in situ (RNAscope) detection of SARS-CoV-2 in extrapulmonary tissues. Credit: The researchers

They add: “Our focus on short postmortem intervals, a comprehensive standardized tissue collection approach, brain dissection before fixation, preservation of tissue for RNA later, and rapid freezing of fresh tissue allowed us to detect and quantify levels of SARS- High-sensitivity CoV-2 RNA from [polymerase chain reaction] and [in situ hybridization]as well as isolation of virus in cell culture from multiple non-respiratory tissues, including the brain, which are notable differences compared to other studies.

Possible consequences for prolonged COVID

Senior study author Daniel Chertow, MD, MPH, said in an NIH news release that before the work, “the thinking in the field was that SARS-CoV-2 was primarily a respiratory virus.”

Detecting viral presence throughout the body — and sharing those findings with colleagues a year ago — helped scientists investigate the link between widely infected body tissues and “long COVID,” or symptoms that persist for weeks and months after infection.

Part of the Paxlovid RECOVER study, which is expected to start in 2023, includes expanding the autopsy work highlighted in Nature study, according to co-author Stephen Hewitt, MD, Ph.D., who serves on the RECOVER project steering committee. The autopsies in the RECOVER study included people who had been vaccinated and infected with worrisome variants—data not available in yesterday’s study.

“We hope to replicate the data on the persistence of the virus and explore the relationship with long-term COVID,” Hewitt said. “After less than a year, we have about 85 cases and we’re working to expand that effort.”

See also

Autopsies show the COVID-19 virus in the brain and elsewhere in the body

About this news about COVID-19 and neurological research

Author: Jim Waps
source: University of Minnesota
Contact: Jim Waps – University of Minnesota
Image: Image is credited to the researchers

Original Research: Closed access.
SARS-CoV-2 infection and persistence in the human body and brain at autopsy” by Sydney R. Stein et al. Nature


Summary

SARS-CoV-2 infection and persistence in the human body and brain at autopsy

Coronavirus disease 2019 (COVID-19) is known to cause multiorgan dysfunction during acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with some patients experiencing prolonged symptoms called post-acute complications of SARS- CoV-2.

However, the severity of infection outside the respiratory tract and the time to viral clearance are not well characterized, particularly in the brain.

Here, we performed complete autopsies of 44 patients who died of COVID-19, with extensive central nervous system sampling in 11 of these patients, to map and quantify the spread, replication, and cell-type specificity of SARS-CoV-2 in the human body , including the brain, from acute infection to more than seven months after the onset of symptoms.

We show that SARS-CoV-2 is widely distributed, primarily among patients who died with severe COVID-19, and that viral replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Furthermore, we detected persistent SARS-CoV-2 RNA in multiple anatomical sites, including the whole brain, up to 230 days after symptom onset in one case.

Despite the widespread distribution of SARS-CoV-2 RNA in the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data show that in some patients, SARS-CoV-2 can cause systemic infection and persist in the body for months.


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