Glial activation among individuals with neurological post-acute sequelae of coronavirus disease 2019: A positron emission tomography study of brain fog using [18F]-FEPPA

IF 3.7 Q2 IMMUNOLOGY

Brain, behavior, & immunity - health Pub Date : 2025-01-16 DOI:10.1016/j.bbih.2025.100945

Sean A.P. Clouston , Paul Vaska , Tesleem Babalola , John Gardus III , Chuan Huang , Nicola Soriolo , Ashley Fontana , Christine DeLorenzo , Ramin Parsey , Benjamin J. Luft

{"title":"Glial activation among individuals with neurological post-acute sequelae of coronavirus disease 2019: A positron emission tomography study of brain fog using [18F]-FEPPA","authors":"Sean A.P. Clouston , Paul Vaska , Tesleem Babalola , John Gardus III , Chuan Huang , Nicola Soriolo , Ashley Fontana , Christine DeLorenzo , Ramin Parsey , Benjamin J. Luft","doi":"10.1016/j.bbih.2025.100945","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study examined the regional distribution of glial activation in essential workers with neurological post-acute sequelae of coronavirus disease 2019 (COVID-19) infections (N-PASC).</div></div><div><h3>Methods</h3><div>We injected ≤185 MBq of [<sup>18</sup>F]-FEPPA as an intravenous bolus and positron-emission tomography over 2 h. To measure distribution volume (V<sub>T</sub>) we recruited 24 essential workers (14 N-PASC, 10 Never-COVID-19 Controls, of whom 22 successfully placed arterial lines). Individuals with low binding affinity were excluded from this study, and V<sub>T</sub> was adjusted for translocator protein genotype. Analyses that passed the false discovery rate are reported.</div></div><div><h3>Results</h3><div>Participants at midlife survived mild to moderate COVID-19 without hospitalization but reported onset of post-acute sequelae of COVID-19 (PASC) for, on average, 22 months before undergoing neuroimaging. Hippocampal V<sub>T</sub> was higher (V<sub>T</sub> = 1.70, 95% C.I. = [1.30–2.21], p = 0.001) in participants with persistent brain fog after COVID-19, reflecting an increase of 10.58 mL/cm<sup>3</sup> in V<sub>T</sub> (area under the receiver-operating curve, AUC = 0.95 [0.85–1.00]). At a cutoff of 10.6, sensitivity/specificity/accuracy were 0.88/0.93/0.91.</div></div><div><h3>Conclusion</h3><div>The results from this study imply that neuroimmune response is a distinct and identifiable characteristic of brain fog after COVID-19. Results suggest that [<sup>18</sup>F]-FEPPA could be used to support N-PASC diagnosis.</div></div>","PeriodicalId":72454,"journal":{"name":"Brain, behavior, & immunity - health","volume":"44 ","pages":"Article 100945"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786203/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain, behavior, & immunity - health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666354625000031","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

This study examined the regional distribution of glial activation in essential workers with neurological post-acute sequelae of coronavirus disease 2019 (COVID-19) infections (N-PASC).

Methods

We injected ≤185 MBq of [¹⁸F]-FEPPA as an intravenous bolus and positron-emission tomography over 2 h. To measure distribution volume (V_T) we recruited 24 essential workers (14 N-PASC, 10 Never-COVID-19 Controls, of whom 22 successfully placed arterial lines). Individuals with low binding affinity were excluded from this study, and V_T was adjusted for translocator protein genotype. Analyses that passed the false discovery rate are reported.

Results

Participants at midlife survived mild to moderate COVID-19 without hospitalization but reported onset of post-acute sequelae of COVID-19 (PASC) for, on average, 22 months before undergoing neuroimaging. Hippocampal V_T was higher (V_T = 1.70, 95% C.I. = [1.30–2.21], p = 0.001) in participants with persistent brain fog after COVID-19, reflecting an increase of 10.58 mL/cm³ in V_T (area under the receiver-operating curve, AUC = 0.95 [0.85–1.00]). At a cutoff of 10.6, sensitivity/specificity/accuracy were 0.88/0.93/0.91.

Conclusion

The results from this study imply that neuroimmune response is a distinct and identifiable characteristic of brain fog after COVID-19. Results suggest that [¹⁸F]-FEPPA could be used to support N-PASC diagnosis.

Abstract Image