Trends Post-COVID-19 Attack: The Cardiocerebral System Safety Remains of Utmost Concern

The spread of the SARS-CoV-2 virus exposed humanity to serious illness named COVID-19, first manifested by respiratory distress but eventually leading to death in subjects with compromised health. Millions of people succumbed to the pandemic, particularly those with cardiovascular disease (CVD). The infection is not only targeting the respiratory system, but it also reaches several tissues particularly the myocardium, and subsequently drives the heart into failure. More data are also showing short and importantly long-term effects of the SARS-CoV-2 infection on the nervous system. Irrespective of the modalities of the SARS-CoV-2 virus transmission/entry to the human body, the myocardium expresses the Angiotensin Converting Enzyme 2 (ACE2) receptor which makes it a favorable port of entry to the myocardial cells. Nonetheless, the continuous pumping of the blood exposes cardiac tissues to a higher viral load, thus increasing the risk of infection. Viral inclusions in the myocardium lead to cardiac injury in different veins: 1) a direct infection of the myocardium by viremia (coronary arteries), 2) local inflammation of the infected myocardial zone, 3) a cytokine storm by activated pro-immune cells, 4) hypoxia-induced inflammation/injury due to reduced pulmonary function and/or thrombosis in the coronary arterial tree. Since both neurons and cardiomyocytes completely withdraw from cell cycle after birth, the regenerative capacity of the injured tissues is jeopardized. Thus, several studies addressed cardiac safety in COVID-19 subjects. However, the high infectivity of the virus along with the newly identified mutations in the spike proteins of SARS-CoV-2 virus (gain of higher infectivity) kept the heart under obsolete therapeutic strategies, imposing a significant gap in overcoming this life-threatening condition. Nonetheless, the different treatment therapies adopted to fight COVID-19, irrespective of their success rate, did not reveal myocardium friendly. Similarly, the central nervous system (CNS) also expresses the ACE2 receptor which favors its interaction with the spike protein of the SARS-CoV-2. The CNS seems to be affected in several ways post-SARS-CoV-2 infection in an unexpected manner, such as loss of smell, memory perturbations, and loss of certain neuro-somatic functions. Of interest, the intimate interaction between the CNS and the cardiovascular system is vital for the human body; uncoupling of the two modules is highly associated with morbidities and mortalities. On the other hand, the world adopted the long-awaited vaccine for the SARS-CoV-2 virus however, the outcomes from these trials especially those related to the cardiocerebral system are yet to be discovered particularly with the surge of novel variants of SARS-CoV-2 that escape the acquired immunity.

We aim, in this collection, to strengthen our knowledge on the coronavirus manifestations in the heart and brain, together with its effect on the cardiovascular and nervous systems function/dysfunction. Manuscripts from different types are accepted: empirical research, reviews, rapid or short communications.

Articles with in depth focus on the molecular cues facilitating myocardial and neuronal infectivity and describing the detrimental outcomes of COVID-19 on cardiac and neuronal function are welcomed. Of particularity, the design of therapeutic strategies tailored to halt the myocardium and the nervous system from SARS-CoV-2-induced deterioration will be considered. The pathophysiological remodeling of the cerebrovascular and cardiocerebral systems in COVID-19 subjects and their influence on cardiac and neuronal function are of interest for this special edition. In addition, manuscripts dealing with the identification of cardiac and neuronal injury biomarkers for early detection of myocardial/neuronal dysfunction and prevention of their failure in COVID-19 patients are important inclusions to this series. Early observation of the SARS-CoV-2 vaccine outcomes on the cardiovascular and nervous systems will also be considered for this collection. The consequences on the ethical attitudes as well as the society response and behavior raised by cardiac and/or brain damage, together with possible therapeutic views will be given attention for publication in this series.

Topic Editor Sriharsha Kantamneni holds patent applications. He is the founding director, owns shares, and is the chief scientific officer of Haiku Therapeutics. The other Topic Editors declare no competing interests with regard to the Research Topic subject.