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SARS-CoV-2、衰老和新冠病毒后神经退行性变。

SARS-CoV-2, aging, and Post-COVID-19 neurodegeneration.

机构信息

Department of Clinical Neurological Sciences and The Robarts Research Institute, Western University, London, Canada.

出版信息

J Neurochem. 2023 Apr;165(2):115-130. doi: 10.1111/jnc.15736. Epub 2022 Dec 11.

Abstract

As the world continues to experience the effects of SARS-CoV-2, there is evidence to suggest that the sequelae of viral infection (the post-COVID-19 condition; PCC) at both an individual and population level will be significant and long-lasting. The history of pandemics or epidemics in the last 100 years caused by members of the RNA virus family, of which coronaviruses are a member, provides ample evidence of the acute neurological effects. However, except for the H1N1 influenza pandemic of 1918/1919 (the Spanish flu) with its associated encephalitis lethargica, there is little information on long-term neurological sequelae. COVID-19 is the first pandemic that has occurred in a setting of an aging population, especially in several high-income countries. Its survivors are at the greatest risk for developing neurodegenerative conditions as they age, rendering the current pandemic a unique paradigm not previously witnessed. The SARS-CoV-2 virus, among the largest of the RNA viruses, is a single-stranded RNA that encodes for 29 proteins that include the spike protein that contains the key domains required for ACE2 binding, and a complex array of nonstructural proteins (NSPs) and accessory proteins that ensure the escape of the virus from the innate immune response, allowing for its efficient replication, translation, and exocytosis as a fully functional virion. Increasingly, these proteins are also recognized as potentially contributing to biochemical and molecular processes underlying neurodegeneration. In addition to directly being taken up by brain endothelium, the virus or key protein constituents can be transported to neurons, astrocytes, and microglia by extracellular vesicles and can accelerate pathological fibril formation. The SARS-CoV-2 nucleocapsid protein is intrinsically disordered and can participate in liquid condensate formation, including as pathological heteropolymers with neurodegenerative disease-associated RNA-binding proteins such as TDP-43, FUS, and hnRNP1A. As the SARS-CoV-2 virus continues to mutate under the immune pressure exerted by highly efficacious vaccines, it is evolving into a virus with greater transmissibility but less severity compared with the original strain. The potential of its lingering impact on the nervous system thus has the potential to represent an ongoing legacy of an even greater global health challenge than acute infection.

摘要

随着世界继续受到 SARS-CoV-2 的影响,有证据表明,病毒感染的后遗症(后 COVID-19 状况;PCC)在个人和人群层面都将是重大且持久的。在过去 100 年中,由 RNA 病毒家族成员引起的大流行或流行病的历史为急性神经影响提供了充分的证据。然而,除了 1918/1919 年的 H1N1 流感大流行(西班牙流感)及其相关的昏睡性脑炎外,关于长期神经后遗症的信息很少。COVID-19 是首次在老龄化人口中发生的大流行,尤其是在一些高收入国家。随着年龄的增长,其幸存者患神经退行性疾病的风险最大,这使得当前的大流行成为一个以前从未见过的独特范例。SARS-CoV-2 病毒是 RNA 病毒中最大的一种,是一条单链 RNA,编码 29 种蛋白质,其中包括刺突蛋白,它包含 ACE2 结合所需的关键结构域,以及一系列复杂的非结构蛋白(NSPs)和辅助蛋白,这些蛋白确保病毒逃避先天免疫反应,从而使其能够有效地复制、翻译和外排为功能齐全的病毒粒子。越来越多的证据表明,这些蛋白质也可能参与神经退行性变的生化和分子过程。除了直接被脑内皮细胞摄取外,病毒或关键蛋白成分还可以通过细胞外囊泡转运到神经元、星形胶质细胞和小胶质细胞,并加速病理性纤维形成。SARS-CoV-2 核衣壳蛋白本质上是无序的,可以参与液体凝聚物的形成,包括与神经退行性疾病相关的 RNA 结合蛋白(如 TDP-43、FUS 和 hnRNP1A)形成病理性杂聚物。随着 SARS-CoV-2 病毒在高效疫苗施加的免疫压力下继续变异,它正在演变成一种与原始毒株相比传染性更强但严重程度较低的病毒。因此,它对神经系统的挥之不去的影响有可能成为比急性感染更大的全球健康挑战的持续遗产。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efba/9877664/3468117eec67/JNC-9999-0-g004.jpg

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