COVID-19, Mast Cells, Cytokine Storm, Psychological Stress, and Neuroinflammation

Neuroscientist. 2020 Oct-Dec;26(5-6):402-414. doi: 10.1177/1073858420941476. Epub 2020 Jul 18.


Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new pandemic infectious disease that originated in China. COVID-19 is a global public health emergency of international concern. COVID-19 causes mild to severe illness with high morbidity and mortality, especially in preexisting risk groups. Therapeutic options are now limited to COVID-19. The hallmark of COVID-19 pathogenesis is the cytokine storm with elevated levels of interleukin-6 (IL-6), IL-1β, tumor necrosis factor-alpha (TNF-α), chemokine (C-C-motif) ligand 2 (CCL2), and granulocyte-macrophage colony-stimulating factor (GM-CSF). COVID-19 can cause severe pneumonia, and neurological disorders, including stroke, the damage to the neurovascular unit, blood-brain barrier disruption, high intracranial proinflammatory cytokines, and endothelial cell damage in the brain. Mast cells are innate immune cells and also implicated in adaptive immune response, systemic inflammatory diseases, neuroinflammatory diseases, traumatic brain injury and stroke, and stress disorders. SARS-CoV-2 can activate monocytes/macrophages, dendritic cells, T cells, mast cells, neutrophils, and induce cytokine storm in the lung. COVID-19 can activate mast cells, neurons, glial cells, and endothelial cells. SARS-CoV-2 infection can cause psychological stress and neuroinflammation. In conclusion, COVID-19 can induce mast cell activation, psychological stress, cytokine storm, and neuroinflammation.

Keywords: COVID-19; angiotensin-converting enzyme 2; cytokine storm; mast cells; neuroinflammation; severe acute respiratory syndrome coronavirus 2; traumatic brain injury.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Betacoronavirus / immunology*
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / physiopathology*
  • Cytokines / immunology*
  • Humans
  • Mast Cells / immunology*
  • Mast Cells / virology
  • Nervous System Diseases / complications
  • Nervous System Diseases / immunology*
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / physiopathology*
  • SARS-CoV-2
  • Stress, Psychological / physiopathology*


  • Cytokines