key: cord-0701526-d5n35n59
authors: Arenas-Prat, Joan
title: Neuroimmune interactions and COVID-19 in lung transplant recipients
date: 2021-03-24
journal: Nat Rev Neurol
DOI: 10.1038/s41582-021-00484-x
sha: d230fd07f8ab55350e8d5b1a5cb08237f5346977
doc_id: 701526
cord_uid: d5n35n59

nan

parasympathetic and sensory neuroimmune modulation should be taken into account, and further research is needed to comprehend the precise physiopathology and the role of both types of fibre in neurogenic lung inflammation. Vagal, sympathetic and sensory neurectomy following lung denervation could exacerbate COVID-19-associated inflammation through neuroimmune modulation but in theory could also exert anti-inflammatory effects secondary to disruption of inflammatory neuropeptide release 6 .

In summary, if denervation exerts antiinflammatory effects in the joints, could it have similar effects in the lungs?

There is a reply to this letter by De Virgiliis, F. & Di Giovanni, S. Nat. Rev. Neurol. https:// doi.org/10.1038/s41582-021-00485-w (2021).

Lung innervation in the eye of a cytokine storm: neuroimmune interactions and COVID-19

Lung denervation and its effect on bronchial responsiveness following lung transplant surgery

COVID-19 in lung transplant recipients: a multicenter study

Joint denervation in the digits: technique and patient satisfaction

Protective effect of sensory denervation in inflammatory arthritis (evidence of regulatory neuroimmune pathways in the arthritic joint)

The role of substance P in inflammatory disease

The author declares no competing interests. effect of the vagus nerve by complete denervation of the lungs 2 -including sensory, sympathetic and parasympathetic fibres -as a result of the transplant surgery. Consistent with the authors' model, a recent multicentre study showed that, although lung transplant recipients have a clinical presentation of SARS-CoV-2 infection similar to that of the general population, they have a worse prognosis and higher mortality compared with non-transplanted patients 3 . However, lung transplantation also results in elimination of sensory C-fibres, which would block the release of inflammatory neuropeptides such as substance P and CGRP. This potential anti-inflammatory effect of lung denervation might contradict the authors' model, unless there is crosstalk between vagal parasympathetic and sensory neuroimmune modulation.Neurogenic inflammation is a key process in many inflammatory conditions and its modulation or blockade offers several treatment options. In this respect, surgical joint denervation is a well-recognized technique that improves osteoarthritic pain and synovial inflammation in the hand, where joints are densely innervated 4, 5 . Nevertheless, in the more complex scenario of a denervated lung, the hypothetical equilibrium between vagal

Joan Arenas-Prat C o r r e s p o n d e n C e Nature reviews | Neurology