The potential role of the carotid body in COVID-19

Porzionato, Andrea; Emmi, Aron; Stocco, Elena; Barbon, Silvia; Boscolo‐Berto, Rafael; Macchi, Verónica; De, Raffaele

doi:10.1152/ajplung.00309.2020

Cited by 40 publications

(44 citation statements)

References 81 publications

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“…Given the low partial pressure of oxygen in arterial blood (PaO 2 ) of patients infected with SARS-CoV-2 virus ( Sartini et al, 2020 ; Chen et al, 2020 ), the carotid bodies and the resulting reflex responses are likely to play a central role in the symptoms and outcomes ( Porzionato et al, 2020a , Porzionato et al, 2020b ; Holmes, 2020 ). Hence, our focus will be related to the involvement of this sensory system across COVID patients expressing distinct disease characteristics and including differing age, gender, co-morbidities and genetic backgrounds ( Tobin et al, 2020 ).…”

Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

“…Further, its sensitivity may be changed by a SARS-CoV-2 infection and this could be either sensitisation or de-sensitisation as we discuss below. In this regard, Gattinoni et al (2020) and Porzionato et al, 2020a , Porzionato et al, 2020b report each COVID-19 patient has an exclusive finger print and an unpredictable combination of multiple factors that determine the course of the infection and symptoms experienced. Thus, such factors will affect an individual's response profile to hypoxia this may determine the degree of involvement of carotid body activation in COVID-19 patients affecting their response to the disease and their outcome.…”

Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

“…Thus, such factors will affect an individual's response profile to hypoxia this may determine the degree of involvement of carotid body activation in COVID-19 patients affecting their response to the disease and their outcome. We recognise that the carotid bodies are not solely sensors of blood gases but are multi-modal arterial sensors responding to inflammation, low blood pressure, sympathetic activity and a variety of metabolically related hormones, so their involvement may well go beyond responding to hypoxia in COVID-19 patients ( De Burgh Daly, 1997 ; Iturriaga et al, 2015 ; Zera et al, 2019 ; Porzionato et al, 2020a , Porzionato et al, 2020b ; Gattinoni et al, 2020 ; Tobin et al, 2020 ; Holmes et al, 2019 ; Holmes, 2020 ).…”

Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

“…1 ). Based on predominance of evidence, we will focus on the changes in sensitivity of the carotid body and to a lesser extent on alterations in down stream synaptic processing as this scenario is known to cause respiratory, cardiovascular and autonomic dysregulation during hypoxia ( Porzionato et al, 2020a , Porzionato et al, 2020b ; Gattinoni et al, 2020 ; Chen et al, 2020 ; Archer et al, 2020 ). In this regard, we compare the effects of high altitude on the carotid body and their relevance to potential mechanisms and symptoms expressed in COVID-19 patients.…”

Section: Plasticity In the Chemoreflexmentioning

confidence: 99%

“…The severity and prevalence of SARS-CoV-2 infection appears highest in older males and those with co-morbidities such as hypertension, heart failure, obesity and diabetes ( Guzik et al, 2020 ). In all these clinical conditions, increased carotid body excitability has been found ( Porzionato et al, 2020a , Porzionato et al, 2020b ). [Note: we use the term excitability to describe both reflex sensitivity (e.g.…”

Section: Covid Cardiorespiratory Disease and Excessive Carotid Body Excitabilitymentioning

confidence: 99%

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Relevance of carotid bodies in COVID-19: A hypothetical viewpoint

Machado

Paton

2021

Autonomic Neuroscience

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We have considered some of the available evidence to account for the impact of SARS-CoV on the regulatory control of the autonomic nervous and respiratory systems. Apart from stimulating general interest in the subject, our hope was to provide putative explanations for some of the patients' symptoms based on described physiological and pathophysiological mechanisms seen in other diseases. Herein, we have focused on the carotid bodies. In this hypothetical viewpoint, we have discussed the plasticity of the carotid body chemoreflex and made a comparison between acute and chronic exposures to high altitude with COVID-19. From these discussions, we have postulated that the sensitivity of the hypoxic ventilatory response may well determine the outcome of disease severity and those that live at high altitude may be more resistant. We have provided insight into silent hypoxia and attempted to explain an absence of ventilatory drive and anxiety yet maintenance of consciousness. In an attempt to discover more about the mysteries of COVID-19, we conclude with questions and some hypothetical studies that may answer them.

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Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

Section: Carotid Body May Be Central To Survival In Covid-19 Patients: a Hypothesismentioning

confidence: 99%

Section: Plasticity In the Chemoreflexmentioning

confidence: 99%

Section: Covid Cardiorespiratory Disease and Excessive Carotid Body Excitabilitymentioning

confidence: 99%

See 3 more Smart Citations

Relevance of carotid bodies in COVID-19: A hypothetical viewpoint

Machado

Paton

2021

Autonomic Neuroscience

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Carotid Body Dysfunction and Mechanisms of Disease

Lazarov,

Atanasova

2023

Advances in Anatomy, Embryology and Cell Biology

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Post-COVID breathlessness: a mathematical model of respiratory processing in the brain

von Werder,

Regnath,

Schäfer

et al. 2024

Eur Arch Psychiatry Clin Neurosci

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Breathlessness is among the most common post-COVID symptoms. In a considerable number of patients, severe breathlessness cannot be explained by peripheral organ impairment. Recent concepts have described how such persistent breathlessness could arise from dysfunctional processing of respiratory information in the brain. In this paper, we present a first quantitative and testable mathematical model of how processing of respiratory-related signals could lead to breathlessness perception. The model is based on recent theories that the brain holds an adaptive and dynamic internal representation of a respiratory state that is based on previous experiences and comprises gas exchange between environment, lung and tissue cells. Perceived breathlessness reflects the brain’s estimate of this respiratory state signaling a potentially hazardous disequilibrium in gas exchange. The internal respiratory state evolves from the respiratory state of the last breath, is updated by a sensory measurement of CO2 concentration, and is dependent on the current activity context. To evaluate our model and thus test the assumed mechanism, we used data from an ongoing rebreathing experiment investigating breathlessness in patients with post-COVID without peripheral organ dysfunction (N = 5) and healthy control participants without complaints after COVID-19 (N = 5). Although the observed breathlessness patterns varied extensively between individual participants in the rebreathing experiment, our model shows good performance in replicating these individual, heterogeneous time courses. The model assumes the same underlying processes in the central nervous system in all individuals, i.e., also between patients and healthy control participants, and we hypothesize that differences in breathlessness are explained by different weighting and thus influence of these processes on the final percept. Our model could thus be applied in future studies to provide insight into where in the processing cascade of respiratory signals a deficit is located that leads to (post-COVID) breathlessness. A potential clinical application could be, e.g., the monitoring of effects of pulmonary rehabilitation on respiratory processing in the brain to improve the therapeutic strategies.

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The potential role of the carotid body in COVID-19

Cited by 40 publications

References 81 publications

Relevance of carotid bodies in COVID-19: A hypothetical viewpoint

Relevance of carotid bodies in COVID-19: A hypothetical viewpoint

Carotid Body Dysfunction and Mechanisms of Disease

Post-COVID breathlessness: a mathematical model of respiratory processing in the brain

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