Substance P and Prokineticin-2 are overexpressed in olfactory neurons and play differential roles in persons with persistent post-COVID-19 olfactory dysfunction

Persistent olfactory dysfunction (OD) is one of the most complaining and worrying complications of long COVID19 because of the potential long-term neurological consequences. While causes of OD in the acute phases of the SARS-CoV-2 infection have been figured out, reasons for persistent OD are still unclear.Here we investigated the activity of two inflammatory pathways tightly linked with olfaction pathophysiology, namely Substance P (SP) and Prokineticin-2 (PK2), directly within the olfactory neurons (ONs) of patients to understand mechanisms of persistent post-COVID-19 OD.ONs were collected by non-invasive brushing from ten patients with persistent post-COVID-19 OD and ten healthy controls. Gene expression levels of SP, Neurokinin receptor 1, Interleukin-1 beta (IL-1 beta), PK2, PK2 receptors type 1 and 2, and Prokineticin-2-long peptide were measured in ONs by Real Time-PCR in both the groups, and correlated with residual olfaction. Immunofluorescence staining was also performed to quantify SP and PK2 proteins.OD patients, compared to controls, exhibited increased levels of both SP and PK2 in ONs, the latter proportional to residual olfaction.This work provided unprecedented, preliminary evidence that both SP and PK2 pathways may have a role in persistent post-COVID-19 OD. Namely, if the sustained activation of SP, lasting months after infection's resolution, might foster chronic inflammation and contribute to hyposmia, the PK2 expression could instead support the smell recovery.

Automated summary

Persistent olfactory dysfunction (OD) is a common and concerning complication of long COVID-19, with potential long-term neurological consequences. This study investigated two inflammatory pathways, Substance P (SP) and Prokineticin-2 (PK2), in olfactory neurons (ONs) of patients with persistent post-COVID-19 OD. The findings suggest that both SP and PK2 pathways may play a role in persistent OD, with sustained activation of SP potentially contributing to chronic inflammation and hyposmia, while PK2 expression may support smell recovery.