Neurological Manifestations of COVID-19 Feature T Cell Exhaustion and Dedifferentiated Monocytes in Cerebrospinal Fluid

Heming, Michael; Li, Xiaolin; Räuber, Saskia; Mausberg, Anne K.; Börsch, Anna-Lena; Hartlehnert, Maike; Singhal, Arpita; Lu, I-Na; Fleischer, Michael; Szepanowski, Fabian; Witzke, Oliver; Brenner, Thorsten; Dittmer, Ulf; Yosef, Nir; Kleinschnitz, Christoph; Wiendl, Heinz; Stettner, Mark; Meyer zu Hörste, Gerd

Patients suffering from Coronavirus disease 2019 (COVID-19) can develop neurological sequelae, such as headache and neuroinflammatory or cerebrovascular disease. These conditions—termed here as Neuro-COVID—are more frequent in patients with severe COVID-19. To understand the etiology of these neurological sequelae, we utilized single-cell sequencing and examined the immune cell profiles from the cerebrospinal fluid (CSF) of Neuro-COVID patients compared with patients with non-inflammatory and autoimmune neurological diseases or with viral encephalitis. The CSF of Neuro-COVID patients exhibited an expansion of dedifferentiated monocytes and of exhausted CD4(+) T cells. Neuro-COVID CSF leukocytes featured an enriched interferon signature; however, this was less pronounced than in viral encephalitis. Repertoire analysis revealed broad clonal T cell expansion and curtailed interferon response in severe compared with mild Neuro-COVID patients. Collectively, our findings document the CSF immune compartment in Neuro-COVID patients and suggest compromised antiviral responses in this setting.