Implications for Neuromodulation Therapy to Control Inflammation and Related Organ Dysfunction in COVID-19

• Authors: Marat Fudim, Duke University; Yawar J. Qadri, Duke University; Kamrouz Ghadimi, Duke University; David B. MacLeod, Duke University; Jeroen Molinger, Duke University; Jonathan P. Piccini, Duke University; John Whittle, Duke University; Paul E. Wischmeyer, Duke University; Manesh R. Patel, Duke University; Luis Ulloa, Duke University
• Journal Title: Journal of Cardiovascular Translational Research
• Volume: Volume 13, Number 6
• Publisher: Springer Nature | 2020-12-01, Pages 894-899
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s12265-020-10031-6
• Subjects: Biology, Neuroscience; Health Sciences, Immunology; Biology, Virology
• Keywords: ACE2; COVID-19; SARS-CoV2; Vagus; Vagus nerve stimulation; Animals; COVID-19; Cholinergic Fibers; Cytokine Release Syndrome; Host-Pathogen Interactions; Humans; Inflammation; SARS-CoV-2; Treatment Outcome; Vagus Nerve Stimulation

Abstract

COVID-19 is a syndrome that includes more than just isolated respiratory disease, as severe acute respiratory syndrome–coronavirus 2 (SARS-CoV2) also interacts with the cardiovascular, nervous, renal, and immune system at multiple levels, increasing morbidity in patients with underlying cardiometabolic conditions and inducing myocardial injury or dysfunction. Emerging evidence suggests that patients with the highest rate of morbidity and mortality following SARS-CoV2 infection have also developed a hyperinflammatory syndrome (also termed cytokine release syndrome). We lay out the potential contribution of a dysfunction in autonomic tone to the cytokine release syndrome and related multiorgan damage in COVID-19. We hypothesize that a cholinergic anti-inflammatory pathway could be targeted as a therapeutic avenue. [Figure not available: see fulltext.]