ArticleNature neuroscience2021
Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19.
Registry-linked trialOpen access · hybridAbstract read
In one paragraph
Article in Nature neuroscience, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04853836 (Olfactory Disfunction After COVID-19), which is not on this map. Cited by 889 papers, 9 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
889citing papers in PubMed, 9 pooled it
87.5field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Olfactory Disfunction After COVID-19: Conventional Therapy Versus Intervention Treatment With Co-ultraPEALut
Who cites it
889 citing papers in PubMed, 9 syntheses or guidelines pooled it, 1,476 citations in OpenAlex.
- Brain microstructural alterations in COVID-19: a systematic review of diffusion weighted imaging studies.Brain imaging and behavior · 2026Pooled it
- Neurocardiac Autonomic Dysfunction in Patients With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis.European journal of neurology · 2026Pooled it
- Audiovestibular Dysfunction Related to Long COVID-19 Syndrome: A Systematic Review of Characteristics, Pathophysiology, Diagnosis, and Management.International journal of molecular sciences · 2026Pooled it
- Neurological Manifestations of SARS-CoV-2.Viruses · 2025Pooled it
- Neuropsychiatric disorders in the course to SARS-CoV-2 virus infection, including biological pathomechanisms, psychosocial factors and long COVID-19 associated with "brain fog".Journal of neurovirology · 2025Pooled it
- Mucosal immune response in biology, disease prevention and treatment.Signal transduction and targeted therapy · 2025Pooled it
- Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review.European journal of neurology · 2024Pooled it
- Neuroimaging findings in children with COVID-19 infection: a systematic review and meta-analysis.Scientific reports · 2024Pooled it
- Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports.Frontiers in pain research (Lausanne, Switzerland) · 2024Pooled it
- Safety and antiviral activity of inhaled siRNA SNS812 for treatment of mild-to-moderate COVID-19: a phase 2 randomized trial.Journal of biomedical science · 2026Trial
- Profiles of Individuals With Long COVID Reporting Persistent Cognitive Complaints.Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists · 2025Trial
- Efficacy of physiological seawater nasal irrigation for the treatment of children with SARS-CoV-2 Omicron BA.2 variant infection: a randomized controlled trial.World journal of pediatrics : WJP · 2024Trial
- Multiple Sclerosis and Viruses: « Liaisons Dangereuses ».Reviews in medical virology · 2026Review
- Human brain matters: Navigating the neuropathology of COVID-19.Brain pathology (Zurich, Switzerland) · 2026Review
- Association of Prodromal Parkinson's Disease-Like Features in Long COVID With Dream-Enactment Behaviours.Journal of sleep research · 2026Article
- Olfactory Tuft Cells Are Critical to Basal Inflammation, Innate Immune Response to Viral Infection, and Modulation of Quiescent Stem Cell Activation, Proliferation and Differentiation.Cell proliferation · 2026Article
- Cadherin 1 negatively regulates SARS-CoV-2 infection in the olfactory epithelium.EMBO reports · 2026Article
- Acute viral infection accelerates neurodegeneration in a mouse model of ALS.Nature communications · 2026Article
- SARS-CoV-2 disrupts the integrity of a human blood-brain barrier model in the absence of infection.Journal of neurovirology · 2026Article
- The potential role of indomethacin in COVID-19 management: A systematic review of therapeutic and mechanistic evidence.New microbes and new infections · 2026Review
829 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
43 authors at 8 institutions in 1 country.
Jenny Meinhardt *Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Josefine Radke *Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.ORCID http://orcid.org/0000-0001-9860-2007
Carsten Dittmayer *Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Jonas FranzInstitute of Neuropathology, University Medical Center, Göttingen, Germany.ORCID http://orcid.org/0000-0001-7523-6622
Carolina ThomasInstitute of Neuropathology, University Medical Center, Göttingen, Germany.ORCID http://orcid.org/0000-0002-7386-1181
Ronja MothesDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Michael LaueCentre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany.
Julia SchneiderInstitute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany.ORCID http://orcid.org/0000-0002-0494-1022
Sebastian BrüninkInstitute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany.
Selina GreuelInstitute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Malte LehmannDivision of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Olga HassanDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Tom AschmanDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Elisa SchumannDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Robert Lorenz ChuaCenter for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0001-5945-9957
Christian ConradCenter for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Roland EilsCenter for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0002-0034-4036
Werner StenzelDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Marc WindgassenInstitute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Larissa RößlerInstitute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Hans-Hilmar GoebelDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Hans R GelderblomCentre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany.
Hubert MartinDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Andreas NitscheCentre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany.
Walter J Schulz-SchaefferInstitute of Neuropathology, University of the Saarland, Homburg, Germany.
Samy HakroushInstitute of Pathology, University Medical Center Göttingen, Göttingen, Germany.
Martin S WinklerDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany.
Björn TampeDepartment of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.ORCID http://orcid.org/0000-0002-4357-9863
Franziska ScheibeDepartment of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.ORCID http://orcid.org/0000-0002-8773-6090
Péter KörtvélyessyDepartment of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Dirk ReinholdInstitute of Molecular and Clinical Immunology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Britta SiegmundDivision of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.ORCID http://orcid.org/0000-0002-0055-958X
Anja A KühlCharité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, and iPATH.Berlin, Berlin, Germany.
Sefer ElezkurtajInstitute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
David HorstInstitute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Lars OesterhelwegInstitute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Michael TsokosInstitute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Barbara Ingold-HeppnerInstitute of Pathology, DRK Kliniken Berlin, Berlin, Germany.
Christine StadelmannInstitute of Neuropathology, University Medical Center, Göttingen, Germany.ORCID http://orcid.org/0000-0003-1766-5458
Christian DrostenInstitute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany.
Victor Max CormanInstitute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany.ORCID http://orcid.org/0000-0002-3605-0136
Helena RadbruchDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Frank L HeppnerDepartment of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany. frank.heppner@charite.de.ORCID http://orcid.org/0000-0001-9816-8917
Humboldt-Universität zu Berlin · DEUniversitätsmedizin Göttingen · DERobert Koch Institute · DEGerman Center for Neurodegenerative Diseases · DEDRK Kliniken Berlin · DEHeidelberg University · DEOtto-von-Guericke-Universität Magdeburg · DESaarland University · DE
Funding
No grant is acknowledged in the PubMed record.
Abstract
The newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a pandemic respiratory disease. Moreover, thromboembolic events throughout the body, including in the CNS, have been described. Given the neurological symptoms observed in a large majority of individuals with COVID-19, SARS-CoV-2 penetrance of the CNS is likely. By various means, we demonstrate the presence of SARS-CoV-2 RNA and protein in anatomically distinct regions of the nasopharynx and brain. Furthermore, we describe the morphological changes associated with infection such as thromboembolic ischemic infarction of the CNS and present evidence of SARS-CoV-2 neurotropism. SARS-CoV-2 can enter the nervous system by crossing the neural-mucosal interface in olfactory mucosa, exploiting the close vicinity of olfactory mucosal, endothelial and nervous tissue, including delicate olfactory and sensory nerve endings. Subsequently, SARS-CoV-2 appears to follow neuroanatomical structures, penetrating defined neuroanatomical areas including the primary respiratory and cardiovascular control center in the medulla oblongata.
Indexed as
BrainCentral Nervous SystemCOVID-19HumansOlfactory MucosaRNA, ViralSARS-CoV-2SmellVirus InternalizationRNA, Viral
Identifiers
What OpenQuestion holds
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Registered trials
NCT04853836ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.