Opinion Pieces

Kate Chander Chiang, Ravi Raghavan, Ajay Gupta
Free Neuropathol 2: 18 (2021)
The COVID-19 vaccines comprised of adenoviral vectors encoding the Spike (S) glycoprotein of SARS-CoV-2 are highly effective but associated with rare thrombotic complications. The adenovirus vector infects epithelial cells expressing the coxsackievirus and adenovirus receptor (CAR). The S glycoprotein expressed locally stimulates neutralizing antibody and cellular immune responses. These vaccines have been associated with thromboembolic events including cerebral venous sinus thrombosis (CVST). S glycoprotein stimulates the expression of cyclooxygenase-2 (COX-2) and leads to massive generation of thromboxane A2 in COVID-19. Megakaryocytes express CAR and we postulate that S glycoprotein stimulated generation of thromboxane A2 leads to megakaryocyte activation, biogenesis of activated platelets and thereby increased thrombogenicity. Cerebral vein sinuses express podoplanin, a natural ligand for CLEC2 receptors on platelets. Platelets traversing through the cerebral vein sinuses could be further activated by thromboxane A2-dependent podoplanin-CLEC2 signaling, leading to CVST. A prothrombotic hormonal milieu, and increased generation of thromboxane A2 and platelet activation in healthy females compared to males is consistent with increased risk for CVST observed in women. We propose that antiplatelet agents targeting thromboxane A2 receptor signaling such as low-dose aspirin merit consideration for chemoprophylaxis when administering the adenovirus based COVID-19 vaccines to young adults at risk of thrombosis provided there are no contraindications.
 
Clayton A. Wiley
Free Neuropathol 2: 15 (2021)
For the past 400 years, the most common cause of dementia was tertiary syphilis [1]. Its prevalence declined dramatically with the advent of potent antibiotics in the 20th century, but these same antibiotics also helped increase our average lifespan, leading to dramatic increases in the prevalence of age-related dementias. Abundant progress has been made connecting early onset dementias with mutations in neural genes. Late onset dementias have been linked to a more enigmatic set of genes, some of which have been connected to neuroinflammation, begging the question: Are age-related dementias linked to infection? Numerous studies have reported an association between dementia and infections in general and viral infections in particular. While these associations have been subject to extensive reviews, the purpose of this synthesis is to examine the hypothesized link of viral infections and dementia from the opposite perspective: What do we know about acute and chronic encephalitides that could forge a link with dementias? There appears to be little support for the concept that viral infections are a major contributor to today’s common dementias. However, the emergence of new central nervous system (CNS) viral infections, coupled with senescent immune and nervous systems in our aged population, create new opportunities for infections to contribute to dementia.
 
Arie Perry
Free Neuropathol 2: 8 (2021)
 
Adrien de Guilhem de Lataillade, Thibaud Lebouvier, Wendy Noble, Laurene Leclair-Visonneau, Pascal Derkinderen
Free Neuropathol 1: 26 (2020)
An accumulating body of literature has emerged in the past 25 years to show that Parkinson’s disease (PD) is not only a disorder of the brain but also of the gastrointestinal tract and more generally of the gut-brain axis. Gastrointestinal symptoms occur in almost every PD patient at some point and in nearly every case examined pathologically autopsy studies find alpha-synuclein deposits, the pathological hallmarks of PD, in the enteric nervous system. This concept of ‘enteric synucleinopathy’ led to the hypothesis that the enteric nervous system might play a pivotal role in the initiation and spreading of PD. Although this hypothesis opens up interesting perspectives on the pathogenesis of neurodegenerative disorders, some important questions are still pending. The present opinion paper describes and compares the physiological and pathophysiological properties of alpha-synuclein in the brain and the enteric nervous system. We conclude that the existing data supports the existence of pathological alpha-synuclein species in the gut in PD. We also discuss if gut-brain interactions are important in other neurodegenerative disorders.
 
Adám Dénes, Stuart M Allan, Tibor Hortobágyi, Craig J Smith
Free Neuropathol 1: 16 (2020)
 
Lokman Cevik, Michele Joana Alves, Jose Javier Otero
Free Neuropathol 1: 11 (2020)
SARS-CoV2 infection causes COVID-19, and represents the most emergent health care crisis of our generation. Ample evidence in the scientific literature suggests that SARS-CoV, MERS-CoV, and endemic human coronaviruses infect brain cells. We delineate a rationale for encouraging evaluation of the brain, and in particular the brainstem, in COVID-19 so that potential neuropathological mechanisms can be delineated.
 
Arie Perry
Free Neuropathol 1: 2 (2020)
The “neuroepithelial tumor”: Exchanging our trash can for an industrial size dumpster?