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Article
Case Report
Exp Neurobiol 2022; 31(4): 270-276
Published online August 31, 2022
https://doi.org/10.5607/en21049
© The Korean Society for Brain and Neural Sciences
Blood-brain Barrier Damage is Pivotal for SARS-CoV-2 Infection to the Central Nervous System
Jahir Rodríguez-Morales1,2†, Sebastián Guartazaca-Guerrero1,2†, Salma A. Rizo-Téllez3,4, Rebeca Viurcos-Sanabria3,4, Eira Valeria Barrón5, Aldo F. Hernández-Valencia6, Porfirio Nava9, Galileo Escobedo3, José Damián Carrillo-Ruiz6,7,8* and Lucía A. Méndez-García3*
1Neurosurgery Specialty, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, 2Neurology and Neurosurgery Unit, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, 3Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, 4PECEM, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, 5Genomic Medicine, General Hospital of Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, 6Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City 06720, 7Direction of Research, General Hospital of Mexico, Mexico City 06720, 8Faculty of Health Sciences, Anahuac University, Mexico City 52786, 9Departments of Physiology, Biophysics and Neurosciences, CINVESTAV-IPN, Mexico City 07360, Mexico
Correspondence to: *To whom correspondence should be addressed.
José Damián Carrillo-Ruiz, TEL: 52-55-2789-2000, ext. 5642,
FAX: 52-55-5623-2669
e-mail: josecarrilloruiz@yahoo.com
Lucía A. Méndez-García, TEL: 52-55-2789-2000, ext. 5644,
FAX: 52-55-5623-2669
e-mail: angelica.mendez.86@hotmail.com
†These authors contributed equally to this article.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Transsynaptic transport is the most accepted proposal to explain the SARS-CoV-2 infection of the CNS. Nevertheless, emerging evidence shows that neurons do not express the SARS-CoV-2 receptor ACE2, which highlights the importance of the blood-brain barrier (BBB) in preventing virus entry to the brain. In this study, we examine the presence of SARS-CoV-2 messenger ribonucleic acid (mRNA) and the cytokine profile in cerebrospinal fluids (CSF) from two patients with a brain tumor and COVID-19. To determine the BBB damage, we evaluate the Q- albumin index, which is an indirect parameter to assess the permeability of this structure. The Q-albumin index of the patient with an intraventricular brain tumor suggests that the BBB is undamaged, preventing the passage of SARS-CoV-2 and pro-inflammatory molecules. The development of brain tumors that disrupt the BBB (measured by the Q-albumin index), in this case, a petroclival meningioma (Case 1), allows the free passage of the SARS-CoV-2 virus and probably lets the free transit of pro-inflammatory molecules to the CNS, which leads to a possible activation of the microglia (astrogliosis) and an exacerbated immune response represented by IL-13, IFN-γ, and IL-2 trying to inhibit both the infection and the carcinogenic process.
Graphical Abstract
Keywords: Blood-brain barrier, SARS-CoV-2, COVID-19, Cerebrospinal fluid, Brain tumor
