[트리니티메디컬뉴스=강다은 기자] “After vaccination against the novel coronavirus infection (Corona 19), the world seems to be gradually relieved of fear of infection. However, it is not over, it is a new beginning. Now, we need to prepare for the’second pandemic’ in which we must fight the aftereffects of Corona 19 in earnest.”
NIH neuroscientist Dr. Myung-Hwa Lee (52), who is participating in a study of “post-infectious encephalomyelitis and chronic fatigue syndrome” led by the National Institutes of Health (NIH), emphasized that vaccination is important, but research to overcome the aftereffects of COVID-19 should be hurried. did.
Dr. Lee received global attention by publishing the results of brain autopsies of patients who died from Corona 19 in the latest issue of the prestigious international journal’NEJM (New England Journal of Medicine). Dr. Lee was the first author of this paper.
In the paper, the research team presented the results that neurological symptoms such as headache, fatigue, and vomiting caused by Corona 19 infection were not caused by viral infection of the brain tissue itself, but to blood vessel damage caused by a wide range of inflammatory reactions in the body. This is considered the first result of confirming how the Corona 19 virus affects the brain based on an autopsy.
Reporter Kim Gil-won of Yonhap News had a conversation with Dr. Lee to hear detailed research results and overall opinions on Corona 19. The following is a summary of the conversations between the two in a question and answer format.
▲ ⓒ Dr. Myung-Hwa Lee’s research paper published in the international journal’New England Journal of Medicine’Q. In the United States, the vaccine for Corona 19 is in full swing. Did you get it?
A. I finished the 2nd dose of modder or vaccine a few days ago.
Q. Are there any sequelae?
A. After the 2nd vaccination, I was lying down for two days because of a cold feeling. Although there are individual differences after the COVID-19 vaccination, some people seem to be more difficult. Compared to the general influenza vaccine, the body ache was worse. In particular, the arm on the side of the vaccine was a little difficult to move, and there was a headache. My older sister (nurse) received the Pfizer vaccine, but the symptoms were similar.
Q. According to the paper, is the Corona 19 virus not directly penetrating the human brain?
A. Right now. This means that neurological symptoms such as headache and chronic fatigue are more likely to appear as damage to related blood vessels due to a wide range of inflammatory reactions in the body, not as an infection of the brain tissue itself.
Q. Is there a reason you specifically focused on brain research?
A. Since the outbreak of the pandemic, almost all researchers have forgotten about the brain, focusing on organs that are primarily targets of viruses, such as the lungs. However, our research team saw that neuroinflammatory diseases are more prevalent and can cause more problems than they expected. In fact, many patients have chronic fatigue and brain fog even after recovery, making it difficult to think clearly, and several neurological symptoms such as decreased memory complain of experiences lasting weeks to months. In serious cases, they may complain that they greatly interfere with daily life.
Q. A common coronavirus that causes influenza does not penetrate brain tissue. Is it different?
A. Coronavirus usually causes animal diseases, but seven coronaviruses (HCoV), including SARS and MERS, are known to infect humans. All of these human coronaviruses cause neurological complications. The particles and genomic sequences of the SARS virus have already been detected in the brain tissues of patients with SARS.
Q. If so, can the corona 19 virus have a significantly different infection route from SARS and MERS?
A. Since the corona 19 virus belongs to the beta corona virus along with SARS and MERS, there were many opinions that it also penetrated the brain and appeared to have various neurological symptoms. This is the background for the (research team) to question exactly how the Corona 19 virus affects the human brain. However, none of the autopsied brain tissue was virus-free.
Q. Could you explain the research method and results in detail?
A. Brain tissues of 19 patients (5 to 73 years old) in the United States who died from Corona 19 infection were autopsied. Using a high-power MRI scanner that is 10 times more sensitive than normal magnetic resonance imaging and can be photographed at a microscope level, the olfactory bulb of the brain that controls the sense of smell and the brainstem that controls breathing and heart rate are observed with focus. did. As a result, in both areas, bright spots showing signs of inflammation and dark spots due to bleeding were seen, rather than the surrounding area. As a result of performing immunostaining on the same tissue, it was confirmed that the microvascular wall in the area where bright spots were visible became abnormally thin, and that fibrinogen, one of the plasma proteins, leaked into the brain parenchyma following the destruction of blood vessels. It seems that plasma proteins and immune cells in the blood (TQ.cell) leak into the brain parenchyma due to such damage to the cerebrovascular vessels, activating inflammatory cells in the brain and triggering immune and inflammatory reactions in the brain. The dark spots appear to have a different pattern of clots and there is no evidence of an immune response.
Q. How was the virus detection test done?
A. Several research methods (RTQ.PCR, RNA seQ.uencing, RNA in situ hybridization, immunostaining) were used to test, but no virus was detected. The possibility of the virus entering the brain through several pathways, such as the bloodstream or neurotransmitters, has been raised, but this is not clear. However, pathology in the brain is understood as an inflammatory response due to microvascular damage rather than a direct effect of a virus.
Q. However, there have been several papers suggesting viral infection of brain tissue.
A. Although viral RNA was detected by the RTQ.PCR method in 10 of the 15 papers published so far, the RNA copy number was very low. In addition, viral proteins were not detected in many cases, and there is controversy about the three papers that were positive. Therefore, looking at the neuropathological findings observed in the posterior tissues of the brain, it is a common opinion that various neurological symptoms appear to be’immune Q. mediated’ process rather than a direct result of viral infection to the brain tissue.
Q. It is said that it does not penetrate directly into the brain tissue but causes similar symptoms. Has the mechanism been identified?
A. A follow-up study is currently underway to clarify the mechanism. Currently, it is approaching due to damage to the brain microvessels due to activation of the complement system, which is the innate immune system. We will try to make follow-up research published in the near future.
Q. In Korea, there is a lack of autopsy research on infected deaths. How did you secure brain tissue?
A. We received 17 and 3 brain tissues from the New York Autopsy Office and Iowa State University, respectively. Autopsy research is essential to understanding the new disease. By closely examining the body organs including the brain of a deceased Corona 19 patient, the degree of infection of the virus and the degree of involvement of the body organs can be determined. Through this, the characteristics of the disease can be identified, and further, mechanism studies can be conducted in a more controlled form by conducting cell-level research or animal research.
Q. Who are the collaborators?
With Dr. A. NIH Avindra Nas as the general manager, neuroscientists, multiple pathologists for autopsy and pathological findings, medical physicists for magnetic resonance imaging tests, and bioinformatics experts for RNA sequencing were teamed up.
Q. NIH’s ongoing research on chronic fatigue syndrome after infection is drawing attention.
A. The study began in 2015 with a letter from NIH President Francis Collins from a former Washington Post reporter patient. However, even at the NIH, research funding has not been received and there is little research funding, so the need for research has increased as the number of patients rapidly increased in the Corona 19 situation.
Q. If group immunity is achieved through vaccination, will this infection sequelae be reduced?
A. Of course, with vaccination in full swing, the infection rate, inpatient rate, and death rate in the United States are significantly decreasing every day. I, too, escaped the fear of infection after the second vaccination. However, it is not a situation to be relieved. Rather, it seems that there is a second pandemic left to fight the aftereffects in earnest.