01 November 2020: Review Articles
Long-Term Respiratory and Neurological Sequelae of COVID-19
Fuzhou Wang 1ABCDEF , Richard M. Kream 2ABCDEF , George B. Stefano 23ABCDEF*DOI: 10.12659/MSM.928996
Med Sci Monit 2020; 26:e928996
Background
Lung Injury Due to SARS-CoV-2
Lung Alveolar Injury and Diffuse Alveolar Damage (DAD) in Acute Respiratory Distress Syndrome (ARDS)
Thrombosis of the Alveolar Microcirculation Due to Coagulopathy
Airway Injury Due to Pro-Inflammatory Cytokines
Long-Term Sequelae of COVID-19 Pneumonia
Neuronal Injury Due to SARS-CoV-2
Indirect Evidence of Damage to the CNS by SARS-CoV-2
Neuro-Invasive Mechanisms of SARS-CoV-2
Olfactory Nerve Channels and Trans-Synaptic Viral Transfer
Vascular Endothelial Cells of the Blood–Brain Barrier (BBB) and Immune Cells
Underlying Molecular Mechanisms of SARS-CoV-2-Related Neuronal Injury
Pro-Inflammatory Cytokines and the ‘Cytokine Storm’
Mitochondrial Pathways
Autophagy
Neurodegenerative Diseases and SARS-CoV-2
Alzheimer Disease (AD)
Parkinson Disease (PD)
Multiple Sclerosis (MS)
Conclusions
References
Figure 1 Respiratory injury associated with SARS-CoV-2 infection. SARS-CoV-2 induces inflammatory changes in all 3 main locations of the respiratory system from the trachea (A), to the bronchi (B), and the alveolar sacs (C). The respiratory system will experience acute inflammation following the pro-inflammatory ‘cytokine storm,’ followed by long-term fibrotic changes. Pulmonary fibrosis is associated with the upregulation of transforming growth factor-beta (TGF-β) and chronic inflammation.