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MCAS

Fekete R, Simats A, Bíró E, et al. Microglia dysfunction, neurovascular inflammation and focal neuropathologies are linked to IL-1- and IL-6-related systemic inflammation in COVID-19. Nat Neurosci. 2025;28(3):558-576. doi:10.1038/s41593-025-01871-z.

Impaired microglia function and vascular inflammation in COVID

• Observational study evaluating Long COVID patients treated with H1/H2 antihistamines.

• Reports improvement in fatigue, cognitive symptoms, tachycardia, and other systemic complaints.

• Supports the hypothesis that mast cell activation contributes to Long COVID symptom persistence.

• Suggests immune dysregulation—rather than viral persistence—may drive ongoing symptoms in a subset of patients.

Slama Schwok A, et al. Long Neuro-COVID-19: Current Mechanistic Views and Therapeutic Options. Biomolecules. 2024;14(9):1081. doi:10.3390/biom14091081.

• Comprehensive review of proposed mechanisms underlying neurological Long COVID.

• Describes neuroimmune activation, endothelial dysfunction, blood–brain barrier disruption, and microglial priming.

• Emphasizes that neurological symptoms can persist without detectable viral RNA in the CNS.

• Supports reframing Long COVID brain symptoms as a disorder of immune and vascular regulation.

Salvucci F, Codella R, Coppola A, et al. Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation. Front Cardiovasc Med. 2023;10:1202696. doi:10.3389/fcvm.2023.1202696.

Mast cell activation in Long COVID (related work)

• Observational study evaluating Long COVID patients treated with H1/H2 antihistamines.

• Reports improvement in fatigue, cognitive symptoms, tachycardia, and other systemic complaints.

• Supports the hypothesis that mast cell activation contributes to Long COVID symptom persistence.

• Suggests immune dysregulation—rather than viral persistence—may drive ongoing symptoms in a subset of patients.