Protective down-regulated states in the human brain: A possible lesson from COVID-19
Name
pnas.2120221119.pdf
Description
Published version
Size
649.95 KB
Format
Adobe PDF
Checksum (MD5)
d008cb347bbd6b9377d7cee19f7cfc62
Author(s)
Schiff, Nicholas D
Brown, Emery Neal
Date Issued
November 16, 2022
Journal
Proceedings of the National Academy of Sciences
Publisher
Proceedings of the National Academy of Sciences
Citation
Schiff, Nicholas D and Brown, Emery N. 2022. "Protective down-regulated states in the human brain: A possible lesson from COVID-19." Proceedings of the National Academy of Sciences, 119 (46).
Version
Final published version
Abstract
The COVID-19 pandemic has created a large population of patients who are slow to recover consciousness following mechanical ventilation and sedation in the intensive care unit. Few clinical scenarios are comparable. Possible exceptions are the rare patients in post-cardiac arrest coma with minimal to no structural brain injuries who recovered cognitive and motor functions after prolonged delays. A common electroencephalogram (EEG) signature seen in these patients is burst suppression [8]. Biophysical modeling has shown that burst suppression is likely a signature of a neurometabolic state that preserves basic cellular function “during states of lowered energy availability.” These states likely act as a brain protective mechanism [9]. Similar EEG patterns are observed in the anoxia resistant painted turtle [24]. We present a conceptual analysis to interpret the brain state of COVID-19 patients suffering prolonged recovery of consciousness. We begin with the Ching model and integrate findings from other clinical scenarios and studies of the anoxia-tolerant physiology of the painted turtle. We postulate that prolonged recovery of consciousness in COVID-19 patients could reflect the effects of modest hypoxic injury to neurons and the unmasking of latent neuroprotective mechanisms in the human brain. This putative protective down-regulated state appears similar to that observed in the painted turtle and suggests new approaches to enhancing coma recovery [12].
MIT Department
Massachusetts Institute of Technology. Department of Brain and Cognitive Sciences
Terms of Use
Creative Commons Attribution 4.0 International license
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DOI of Published Version
https://doi.org/10.1073/pnas.2120221119
