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Autopsies show COVID-19 virus in brain and other parts of body

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

Source: university of minnesota

An analysis of tissue samples from the autopsies of 44 people who died from COVID-19 shows that the SAR-CoV-2 virus spread throughout the entire body – including the brain – and lingered for nearly 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 performed extensive sampling of the nervous system, including the brain, in 11 of the patients.

RNA and viruses viable in multiple organs

All patients died from COVID-19 and none were vaccinated. Blood plasma from 38 patients tested positive for SARS-CoV-2, three tested negative, and plasma was unavailable for the other 3.

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

The analysis showed that SARS-CoV-2, as expected, primarily infected and damaged the airways and lung tissue. But the researchers also found viral RNA in 84 distinct sites in the body and body fluids, and in one case isolated viral RNA 230 days after the onset of a patient’s symptoms.

Researchers detected 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 a substantial viral load.”

Researchers also isolated viable SARS-CoV-2 virus from a variety of tissues inside and outside the respiratory tract, including the brain, heart, lymph nodes, gastrointestinal tract, adrenal gland, and eye. They isolated the virus from 25 of the 55 samples tested (45%).

The authors wrote, “We demonstrate virus replication in multiple non-respiratory sites during the first two weeks after symptom onset.”

This shows fabric swatches
In situ RNA detection (RNAscope) of SARS-CoV-2 in extrapulmonary tissues. Credit: The researchers

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

Possible ramifications for long COVID

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

Finding viral presence throughout the body — and sharing these findings with colleagues a year ago — has helped scientists explore a relationship between widely infected body tissues and “long-lasting COVID,” or symptoms that persist for weeks and months after infection.

Part of a Paxlovid RECOVER trial due to begin in 2023 includes an extension of the autopsy work highlighted in Nature study, according to co-author Stephen Hewitt, MD, Ph.D., who serves on a steering committee for the RECOVER project. The autopsies in the RECOVER study include people who were vaccinated and infected with worrisome variants – data that was not available in yesterday’s study.

“We hope to replicate the data on viral persistence and study the relationship with long-term COVID,” said Hewitt. “In less than a year, we have about 85 cases and we are working to expand those efforts.”

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About this research news on COVID-19 and neurology

Author: Jim Wappes
Source: university of minnesota
Contact: Jim Wappes – University of Minnesota
Image: The image is credited to the researchers

Original search: 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 human body and brain at autopsy

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

However, the burden of infection outside the respiratory tract and the timing of viral shedding are not well characterized, particularly in the brain.

Here we performed full autopsies on 44 patients who died from COVID-19, with extensive central nervous system sampling in 11 of these patients, to map and quantify the distribution, 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, predominantly among patients who have died from severe COVID-19, and that virus replication is present in various respiratory and non-respiratory tissues, including the brain, early in the infection. Additionally, we detected persistent SARS-CoV-2 RNA in multiple anatomical sites, including throughout the brain, up to 230 days after symptom onset in one case.

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

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