Severity of neurological Long-COVID symptoms correlates with increased level of autoantibodies targeting vasoregulatory and autonomic nervous system receptors

Autoimmun Rev. 2023 Nov;22(11):103445. doi: 10.1016/j.autrev.2023.103445. Epub 2023 Sep 7.

Abstract

Background: The Long-COVID syndrome constitutes a plethora of persisting symptoms with neurological disorders being the most disabling ones. The pathogenesis of Long-COVID is currently under heavy scrutiny and existing data on the role of auto-immune reaction to G-protein coupled receptors (GPCR) are conflicting.

Methods: This monocentric, cross-sectional study included patients who suffered a mild to moderate SARS-CoV-2 infection up to 12 months prior to enrollment with (n = 72) or without (n = 58) Long-COVID diagnosis according to the German S1 guideline or with no known history of SARS-CoV-2 infection (n = 70). While autoantibodies specific for the vasoregulation associated Adrenergic Receptor (ADR) B1 and B2 and the CNS and vasoregulation associated muscarinic acetylcholine receptor (CHR) M3 and M4 were measured by ELISA, neurological disorders were quantified by internationally standardized questionnaires.

Results: The prevalence and concentrations of evaluated autoantibodes were significantly higher in Long-COVID compared to the 2 other groups (p = 2.1*10-9) with a significantly higher number of patients with simultaneous detection of more than one autoantibody in the Long-COVID group (p = 0.0419). Importantly, the overall inflammatory state was low in all 3 groups. ARB1 and ARB2 correlated negatively CERAD Trail Marking A and B (R ≤ -0.26, p ≤ 0.043), while CHRM3 correlated positively with Chadler Fatigue Scale (R = 0.37, p = 0.0087).

Conclusions: Concentrations of autoantibodies correlates to the intensity of neurological disorders including psychomotor speed, visual search, attention, and fatigue.

Keywords: Antiadrenergic; Anticholinergic; Antimuscarinergic; Autoantibodies; COVID-19; Chronic fatigue; Coronavirus disease 2019; Long-COVID; Post-COVID; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Autoantibodies
  • Autonomic Nervous System
  • COVID-19*
  • Cross-Sectional Studies
  • Fatigue
  • Humans
  • Nervous System Diseases* / diagnosis
  • Post-Acute COVID-19 Syndrome
  • Receptor, Muscarinic M3
  • SARS-CoV-2

Substances

  • Autoantibodies
  • CHRM3 protein, human
  • Receptor, Muscarinic M3