Unraveling the Possible Routes of SARS-COV-2 Invasion into the Central Nervous System

Maria Lima; Vasileios Siokas; Athina-Maria Aloizou; Ioannis Liampas; Alexios-Fotios A Mentis; Zisis Tsouris; Anastasios Papadimitriou; Panayiotis D Mitsias; Aristidis Tsatsakis; Dimitrios P Bogdanos; Stavros J Baloyannis; Efthimios Dardiotis

doi:10.1007/s11940-020-00647-z

Unraveling the Possible Routes of SARS-COV-2 Invasion into the Central Nervous System

Curr Treat Options Neurol. 2020;22(11):37. doi: 10.1007/s11940-020-00647-z. Epub 2020 Sep 25.

Authors

Affiliations

¹ Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
² Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece.
³ Department of Neurology, School of Medicine, University of Crete, 71003 Heraklion, Greece.
⁴ Department of Neurology, Henry Ford Hospital, Detroit, MI 48202 USA.
⁵ School of Medicine, Wayne State University, Detroit, MI 48202 USA.
⁶ Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion, Greece.
⁷ Department of Rheumatology and clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
⁸ Research Institute for Alzheimer's Disease, Aristotelian University of Thessaloniki, Thessaloniki, Greece.

Abstract

Purpose of review: To describe the possible neuroinvasion pathways of Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2), the virus responsible for the Coronavirus disease-19 (Covid-19) pandemic.

Recent findings: We present data regarding the family of Coronaviruses (CoVs) and the central nervous system (CNS), and describe parallels between SARS-CoV-2 and other members of the family, which have been investigated in more depth and combine these findings with the recent advancements regarding SARS-CoV-2.

Summary: SARS-CoV-2 like other CoVs is neuroinvasive, neurotropic and neurovirulent. Two main pathways of CNS penetration seem to be the strongest candidates, the hematogenous and the neuronal. Τhe olfactory route in particular appears to play a significant role in neuroinvasion of coronaviruses and SARS-CoV-2, as well. However, existing data suggest that other routes, involving the nasal epithelium in general, lymphatic tissue and the CSF may also play roles in SARS-CoV-2 invasion into the CNS.

Keywords: CNS penetration; COVID-19; Coronaviruses (CoVs); Neuroinvasion; Neurological manifestations; Neurotropism; Neurovirulence; Pandemic; SARS-2; SARS-CoV-2.

Publication types

Review