While COVID-19 has made a lasting impression on Los Angeles and the world, one of its truly diabolical legacies is that besides causing a florid pneumonia in most people, for some infected cases, it is also associated with the feared neurological complication of stroke. Initially rumored in the limited data that emerged from China, studies from around the world later clearly detailed a nearly seven-fold increased risk of stroke in COVID-19-infected individuals. Often, strokes were occurring in younger individuals without the typical stroke risk factors, like high blood pressure. This perplexing feature of this new disease raises critical questions not only about the virus and its ability to infect the brain but about individual susceptibility for stroke and cerebrovascular disease.
This association of COVID-19 with stroke provided an opportunity for UCLA Neurology faculty. Several years ago, Dr. Jason Hinman and his team, including Dr. Naoki Kaneko in Radiological Sciences, developed a revolutionary approach to study human cerebrovascular (brain blood vessel) disease, utilizing images of the brain’s blood vessels obtained from clinical studies, such as CT angiography and MR angiography. These images of patient brain blood vessels were used to develop exact replicas with 3D-printing, to make patient-specific models of the human brain vasculature lined with endothelial cells that coat the interior surface of the body’s blood vessels. As the pandemic broke, Dr. Hinman’ team was just preparing to use this novel technology to study how specific features of vessel narrowing in the brain, termed “intracranial atherosclerosis”, may increase the risk for stroke using a new 5-year grant from the National Institute of Health. “While most labs were shuttered or downsized due to the pandemic, vital COVID-related research was permitted. Dr. Hinman and his team saw an opportunity to use these 3D models of the brain to safely and rapidly understand how COVID-19 might precipitate stroke. They put on their PPE masks and got to work.
Since beginning these studies in April, Dr. Hinman’s lab has identified that the molecular pathways hijacked by the virus in the lung are fundamentally different from those used by the virus in the brain. Dr. Hinman and his team have preliminary evidence that COVID-19 can directly infect the endothelial cells of the brain, potentially promoting clot formation and stroke. And they have partnered with a campus-wide initiative including experts in virology, cardiology, and bioengineering that is supported by the American Heart Association to study the cardiovascular complications of COVID-19. Using these resources, Dr. Hinman’s team is hoping to make a significant advance in understanding COVID-19 that can help keep stroke-related disability off the long list of COVID-19 complications.