The second patient appeared to have a modest response to immunotherapy with improved cognition and working memory, but continued to have “impaired mood and cognitive symptoms” six months later. Wilson, MD, of the UCSF Department of Neurology and of the UCSF Weill Institute, noting that the diagnosis of schizophrenia is based on a constellation of symptoms, rather than a specific biomarker. However, “we don’t know that the antibodies are actually interfering with the protein’s function,” said co-corresponding author, Michael R. This patient was also found to have autoantibodies targeting the protein TCF4, which is genetically implicated in some cases of schizophrenia. Five days later, the first patient had “more organized thoughts, decreased paranoia and improved insight.” “The patients had significant neuropsychiatric manifestations despite mild respiratory symptoms, suggesting potential short and long-term effects of COVID.”Īfter weekslong hospitalizations and ongoing psychiatric medications, the two UCSF patients, whose cerebrospinal fluid tested positive for SARS-CoV-2 antibodies and anti-neural antibodies, were treated with intravenous immunoglobulin, an immunomodulatory therapy that curbs inflammation in autoimmune disorders. Unlike most psychiatric presentations, the three patients in the UCSF study had symptoms with sudden onset and rapid progression, representing a marked change from their baselines, said co-first author Claire Johns, MD, of the UCSF Department of Pediatrics. There’s certainly more work to be done in this area.” “These autoantibodies may be most clinically meaningful as markers of immune dysregulation, but we haven’t found evidence that they are actually causing the patients’ symptoms. “It is currently totally unknown whether patients predisposed to neuropsychiatric illnesses are more likely to develop worsened symptoms after COVID, or whether COVID infection can act as an independent trigger.”Įfforts to identify an autoantibody shared by patients with similar neuropsychiatric symptoms have so far failed, said co-first author Christopher Bartley, MD, PhD, of the UCSF Department of Psychiatry and Behavioral Science and of the UCSF Weill Institute. “It is way too soon to know whether COVID is a common trigger for neuropsychiatric illnesses, but it does seem to be a potent trigger for the development of autoantibodies,” said co-corresponding author Samuel Pleasure, MD, PhD, of the UCSF Department of Neurology and of the UCSF Weill Institute. The research follows a UC San Francisco study with Yale, published on May 18, 2021, in Cell Reports Medicine, that also found a high level of autoantibodies in the cerebrospinal fluid of adult patients with acute COVID, who had neurological symptoms, including intractable headaches, seizures and loss of smell.
Autoantibody Parallel in Adults with Neurological Symptoms This suggests an immune system running amok, mistakenly targeting the brain instead of infectious microbes. The same patients, who had mild/asymptomatic COVID, also had anti-neural antibodies in their cerebrospinal fluid, which were identified by immunostaining brain tissue. The researchers examined the patients’ cerebrospinal fluid, obtained via lumbar puncture, and found that two of the patients, both of whom had histories of unspecified depression and/or anxiety, had antibodies indicating that SARS-CoV-2 may have invaded the central nervous system. They included the three patients in the study who underwent neurological evaluations. Over a duration of five months in 2020, a total of 18 children and teens were hospitalized with confirmed COVID at UCSF Benioff Children’s Hospital San Francisco, according to the study publishing in JAMA Neurology on Oct. The study, led by researchers at the UCSF Weill Institute for Neurosciences and the UCSF Department of Pediatrics, is the first to look at anti-neural antibodies – “turncoat” antibodies that may attack brain tissue – in pediatric patients who had been infected with SARS-CoV-2. Now, a new study into their immune responses identifies a potential mechanism by which these symptoms emerged. Suicidal thoughts, “paranoia-like fears,” delusions and “foggy brain” have been identified in three adolescents who had mild or asymptomatic COVID-19. The green in the image shows immunostained cerebrospinal fluid from one patient containing neural autoantibodies.