Protective down-regulated states in the human brain: A possible lesson from COVID-19
<jats:p>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...
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| Format: | Article |
| Language: | English |
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Proceedings of the National Academy of Sciences
2023
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| Online Access: | https://hdl.handle.net/1721.1/148701 |
| _version_ | 1826194842363887616 |
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| author | Schiff, Nicholas D Brown, Emery N |
| author2 | Massachusetts Institute of Technology. Department of Brain and Cognitive Sciences |
| author_facet | Massachusetts Institute of Technology. Department of Brain and Cognitive Sciences Schiff, Nicholas D Brown, Emery N |
| author_sort | Schiff, Nicholas D |
| collection | MIT |
| description | <jats:p>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].</jats:p> |
| first_indexed | 2024-09-23T10:02:41Z |
| format | Article |
| id | mit-1721.1/148701 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T10:02:41Z |
| publishDate | 2023 |
| publisher | Proceedings of the National Academy of Sciences |
| record_format | dspace |
| spelling | mit-1721.1/1487012023-03-25T03:40:46Z Protective down-regulated states in the human brain: A possible lesson from COVID-19 Schiff, Nicholas D Brown, Emery N Massachusetts Institute of Technology. Department of Brain and Cognitive Sciences <jats:p>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].</jats:p> 2023-03-24T16:31:09Z 2023-03-24T16:31:09Z 2022-11-16 2023-03-24T14:54:58Z Article http://purl.org/eprint/type/JournalArticle https://hdl.handle.net/1721.1/148701 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). en 10.1073/pnas.2120221119 Proceedings of the National Academy of Sciences Creative Commons Attribution 4.0 International license https://creativecommons.org/licenses/by/4.0/ application/pdf Proceedings of the National Academy of Sciences PNAS |
| spellingShingle | Schiff, Nicholas D Brown, Emery N Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title | Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title_full | Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title_fullStr | Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title_full_unstemmed | Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title_short | Protective down-regulated states in the human brain: A possible lesson from COVID-19 |
| title_sort | protective down regulated states in the human brain a possible lesson from covid 19 |
| url | https://hdl.handle.net/1721.1/148701 |
| work_keys_str_mv | AT schiffnicholasd protectivedownregulatedstatesinthehumanbrainapossiblelessonfromcovid19 AT brownemeryn protectivedownregulatedstatesinthehumanbrainapossiblelessonfromcovid19 |