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Since the discovery of the neuron-specific protein by Moore and McGregor in 1965, tens of thousands of studies have investigated the basic and applied significance of neuron-specific enolase (NSE). This promising biomarker, according to many researchers, has not found widespread use in clinical practice, particularly in acute cerebrovascular accidents. Moreover, the several studies refuting the usefulness of serum NSE measurement in critically ill patients leads us to consider the reasons for such contradictory conclusions. In this article, we have analyzed the main directions in the study of NSE and expressed our perspective on the reasons for the contradictory results and the difficulties in implementing the results of these studies in clinical practice. In our opinion, the method of the enzyme-linked immunosorbent assay (ELISA) used in the majority of the studies is inappropriate for the evaluation of NSE as a marker of central nervous system damage, because it does not allow for the differentiation of heterodimers of enolases and the assessment of the enzymatic activity of this group of enzymatic proteins. Therefore, the methodological approach for the evaluation of NSE (γγ-enolase) as a biomarker needs to be elaborated and improved. Furthermore, the specificity of the applied research methods and the appropriateness of the continued use of the term “neuron-specific enolase” must be addressed.

Vascular endothelial growth factors (VEGFs) are important regulators of angiogenesis, neuroprotection, and neurogenesis. Studies have indicated the association of VEGF dysregulation with the development of neurodegenerative and cerebrovascular diseases. We studied the changes in serum levels of VEGF-A, VEGFR-1, and VEGFR-2 in patients at various phases of ischemic and hemorrhagic strokes. Quantitative assessment of VEGF-A, VEGFR-1, and VEGFR-2 in serum of patients with hemorrhagic or ischemic stroke was performed by enzyme immunoassay in the hyper-acute (1–24 h from the onset), acute (up to 1–7 days), and early subacute (7 days to 3 months) phases of stroke, and then compared with the control group and each other. Results of our retrospective study demonstrated different levels of VEGF-A and its receptors at various phases of ischemic and hemorrhagic strokes. In ischemic stroke, increased VEGFR-2 level was found in the hyper-acute (p = 0.045) and acute phases (p = 0.024), while elevated VEGF-A and reduced VEGFR-1 levels were revealed in the early subacute phase (p = 0.048 and p = 0.012, respectively). In hemorrhagic stroke, no significant changes in levels of VEGF-A and its receptors were identified in the hyper-acute phase. In the acute and early subacute phases there was an increase in levels of VEGF-A (p < 0.001 and p = 0.006, respectively) and VEGFR-2 (p < 0.001 and p = 0.012, respectively). Serum levels of VEGF-A and its receptors in patients with hemorrhagic and ischemic stroke indicate different pathogenic pathways depending on the phase of the disease.

COVID-19-related thrombosis affects the venous and arterial systems. Data from 156 autopsies of COVID-19 patients were retrospectively analyzed to investigate the pattern of thrombotic complications and factors associated with pulmonary artery thrombosis and thromboembolism. Thrombotic complications were observed in a significant proportion (n = 68, 44%), with pulmonary artery thrombosis the most frequently identified thrombotic event (42, 27%). Multivariate analysis revealed that the length of hospital stay (OR 1.1, p = 0.004), neutrophil infiltration in the alveolar spaces (OR 3.6, p = 0.002), and the absence of hyaline membranes (OR 0.1, p = 0.01) were associated with thrombotic complications. Neutrophil infiltration in the alveolar spaces (OR 8, p < 0.001) and the absence of hyaline membranes (OR 0.1, p = 0.003) were also independent predictors of pulmonary artery thrombosis. The association of pulmonary artery thrombosis with an absence of hyaline membranes suggests it occurs later in the course of COVID-19 infection. As neutrophil infiltration in the alveolar spaces may indicate bacterial infection, our studies suggest the consideration of bacterial infections in these critically ill patients.

Despite the enormous interest in COVID-19, there is no clear understanding of the mechanisms underlying the neurological symptoms in COVID-19. Microglia have been hypothesized to be a potential mediator of the neurological manifestations associated with COVID-19. In most existing studies to date, morphological changes in internal organs, including the brain, are considered in isolation from clinical data and defined as a consequence of COVID-19. We performed histological immunohistochemical (IHC) studies of brain autopsy materials of 18 patients who had died from COVID-19. We evaluated the relationship of microglial changes with the clinical and demographic characteristics of the patients. The results revealed neuronal alterations and circulatory disturbances. We found an inverse correlation between the integral density Iba-1 (microglia/macrophage-specific marker) IHC staining and the duration of the disease (R = −0.81, p = 0.001), which may indicate a reduced activity of microglia and do not exclude their damage in the long-term course of COVID-19. The integral density of Iba-1 IHC staining was not associated with other clinical and demographic factors. We observed a significantly higher number of microglial cells in close contact with neurons in female patients, which confirms gender differences in the course of the disease, indicating the need to study the disease from the standpoint of personalized medicine.

The purpose of the study: to assess the content of BDNF and its TrkB receptor in the populations of hippocampal pyramidal neurons in the post-resuscitation period and to identify the contribution of these factors to the neuron resistance to ischemia.Material and methods. The condition of populations of pyramidal neurons of the CA1 and CA4 hippocampus fields was investigated in white mature male rats that underwent a 10-minute cardiac arrest at different periods of the post-resuscitation period (1st, 4th, 7th, 14th day). Animals after a sham surgery served as a reference group. Immunocytochemical methods were used to determine immunoreactivity to BDNF and TrkB proteins. Based on the visual inspection and analysis of the optical density, the following types of neurons with different color intensity were distinguished: weak (BDNF–, TrkB–), moderate (BDNF+, TrkB+) and strong (BDNF++, TrkB++). The total density of neurons and the number of cells with different immunoreactivity to the studied proteins per 1 mm of length were determined. We used the Olympus BX-41 microscope and Image Scope M, ImageJ 1.48 v, MS Excel software. Statistical data processing was performed using Statistica 7.0 software.Results. There was a decrease in the overall density of the population of pyramidal neurons in both studied fields of the hippocampus of the resuscitated animals as compared to the reference group: in the CA1field, on the 4th day after cardiac arrest (26%); in the CA4 field, on the 7th day (38.5%). It was found that the number of BDNF+ neurons doubled in the CA4 field on the 4th day, and the number of BDNF++ neurons decreased. On the 7th day, the number of BDNF– cells decreased sharply, the number of BDNF+ cells decreased to the reference level, and the number of BDNF++ neurons remained reduced vs. the reference group. There was a decrease in the number of BDNF– and BDNF+ cells in the CA1 field on the 4th day, while the number of BDNF++ neurons remained the same. The observed changes remained on Day 14.The analysis TrkB protein expression in the CA4 field on the 7th day of the post-resuscitation period as revealed by reactivity with anti-TrkB antibody demonstrated a decrease in the number of TrkB– cells as compared to the reference group. By the 14th day, the number of not only TrkB– neurons, but also TrkB+ cells was reduced, while the number of TrkB++ neurons remained at the level of the reference group. There was a decrease in the number of TrkB+ neurons was observed in the CA1 field on the 4th day after resuscitation. On day 7, there was a decreased numbers of both TrkB+ and TrkB–-neurones. The number of TrkB–-neurones remained decreased up to day 14. At that, the number of TrkB++ neurons persisted at the reference level throughout the observation period.Conclusion. The obtained results demonstrate that the resistance of neurons to ischemia-reperfusion is associated with the intracellular expression of BDNF and TrkB proteins. The reduction of the overall density of neurons in the post-resuscitation period was obsereved both in hippocampal fields CA1 and СА4; only cells with minimal and moderate content of the studied proteins died. Neurons with the highest BDNF and TrkB protein content survived.

The increased plasma levels of von Willebrand factor (VWF) in patients with COVID-19 was reported in many studies, and its correlation with disease severity and mortality suggest its important role in the pathogenesis of thrombosis in COVID-19. We performed histological and immunohistochemical studies of the lungs of 29 patients who died from COVID-19. We found a significant increase in the intensity of immunohistochemical reaction for VWF in the pulmonary vascular endothelium when the disease duration was more than 10 days. In the patients who had thrombotic complications, the VWF immunostaining in the pulmonary vascular endothelium was significantly more intense than in nonsurvivors without thrombotic complications. Duration of disease and thrombotic complications were found to be independent predictors of increased VWF immunostaining in the endothelium of pulmonary vessels. We also revealed that bacterial pneumonia was associated with increased VWF staining intensity in pulmonary arterial, arteriolar, and venular endothelium, while lung ventilation was an independent predictor of increased VWF immunostaining in arterial endothelium. The results of the study demonstrated an important role of endothelial VWF in the pathogenesis of thrombus formation in COVID-19.