SARS-CoV-2 Infects the Brain Choroid Plexus and Disrupts the Blood-CSF Barrier in Human Brain Organoids

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, leads to respiratory symptoms that can be fatal. However, neurological symptoms have also been observed in some patients. The cause of these complications is currently unknown. Here, we use human-pluripotent-stem-cell-derived brain organoids to examine SARS-CoV-2 neurotropism. We find expression of viral receptor ACE2 in mature choroid plexus cells expressing abundant lipoproteins, but not in neurons or other cell types. We challenge organoids with SARS-CoV-2 spike pseudovirus and live virus to demonstrate viral tropism for choroid plexus epithelial cells but little to no infection of neurons or glia. We find that infected cells are apolipoprotein- and ACE2-expressing cells of the choroid plexus epithelial barrier. Finally, we show that infection with SARS-CoV-2 damages the choroid plexus epithelium, leading to leakage across this important barrier that normally prevents entry of pathogens, immune cells, and cytokines into cerebrospinal fluid and the brain. [Display omitted] •SARS-CoV-2 entry factors are expressed in choroid plexus (ChP) cells•More mature lipid-producing ChP cells could be more susceptible to SARS-CoV-2 infection•SARS-CoV-2 productively infects ChP, but not neurons, in organoids•SARS-CoV-2 infection damages the ChP epithelium, causing leakage of this brain barrier Increasing reports show neurological symptoms in COVID-19 patients, but it is still unclear whether SARS-CoV-2 can directly damage neurons. Lancaster and colleagues investigate viral neurotropism using brain organoids and discover that SARS-CoV-2 does not significantly infect neurons but productively infects choroid plexus, leading to damage of this brain barrier.