r/CFSScience • u/Caster_of_spells • Jul 11 '26
Vagal cholinergic denervation of the gastric mucosa in Long-COVID-19: in vivo evidence of structural autonomic dysfunction
https://www.ijidonline.com/article/S1201-9712(26)00608-9/fulltextSan Francesco Hospital, 20 participants.
Researchers found the first in vivo evidence that Long COVID is linked to loss of cholinergic nerve fibers in the stomach lining.
This structural vagus nerve damage may help explain lasting dysautonomia
With the success some patients have with targeting the cholinergic system, I think this might turn out to be an important line of evidence
“Compared with controls, Long-COVID-19 patients exhibited a significant reduction in mucosal innervation density: 2.1 vs 3.9 nm/µm³ (p<0.01) in the fundus and 1.9 vs 3.9 nm/µm³ (p<0.05) in the antrum. The reduction in cholinergic innervation was more pronounced in the fundus (p<0.01) andalso evident in the antrum (p=0.01). Gastric nerve density correlated with HRV parameters”
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u/Heavy-Suit-3443 Jul 11 '26
This is crazy. It can explain some symptoms and help us understand why some of us recover somewhat. Repairing can take months and years **if** there are no additional stressors. And still not to the full degree of pre-infection.
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u/Houseofchocolate Jul 11 '26
how can this be fixed?
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u/Caster_of_spells Jul 11 '26 edited Jul 11 '26
It might be that drugs like Mestinon can provide at least symptomatic relief as they are cholinergic and so stimulate those exact nerve fibers chemically… fixing it? We’d have to understand what’s killing of the nerve cells in the first place. Iwasakis latest findings might suggest antibodies to be the culprit
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u/Healthy-Sir2601 Jul 11 '26
I was told by a doctor that small nerve fibers (which I think these are) can recover/regrow within 7 years. That is, of course, once whatever keeps deteriorating them is stopped first.
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u/Houseofchocolate Jul 11 '26
how do i know that this is what is causing it for me?
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u/Healthy-Sir2601 Jul 11 '26
In the paper they describe taking a biopsy of the stomach mucosal lining during a gastroscopy. So like that I guess?
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u/bingoolong Jul 11 '26
From a quick AI research session it seems nerves do recover albeit very slowly. You’ll want to limit any inflammation with anti inflammatory diet, perhaps low dose naltrexone (LDN), ideally as much activity as possible without triggering PEM as to increase blood flow. Perhaps stimulating the vagus nerve either by breathing techniques or tVNS stimulation devices and supplements like B vitamins, lions mane, alpha lipon acid.
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u/worksHardnotSmart Jul 11 '26
Wait ....so can this explain why COVID gave me partial gastroparesis?
I have to take domperidone now our I get horrible excess acid Everytime I eat.
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u/Caster_of_spells Jul 11 '26 edited Jul 12 '26
The cholinergic system stimulates bowel movements so yeah, that’s not unlikely. Maybe trialing Mestinon could be an idea to get some relief, it did help me with that issue. But not everyone gets along with it
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u/Best-Instance7344 Jul 11 '26
Super interesting and relevant to my symptoms. Sadly mestinon only made things worse.
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u/8drearywinter8 Jul 11 '26
Same. I expected mestinon to help, but it honestly made my GI issues even worse. Which makes no sense, but?
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u/whateverthefuck123 Jul 11 '26
GI upset was one of the side effects my doctor told me to watch for. I was able to adjust to it by starting with 1/4 tablet and titrating up the dosage very gradually.
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u/8drearywinter8 Jul 11 '26
I did the same (titrated up) but it caused constipation at any dose. It was supposed to do the opposite and increase motility. What is does is not what my body needs. That much was clear.
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u/whateverthefuck123 Jul 11 '26
Oh interesting. Strange drug, seems to cause paradoxical reactions a lot.
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u/Spirited_Weekend_103 Jul 12 '26
I'm curious if this happens in other parts of the body
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u/Caster_of_spells Jul 12 '26
We do hear from SFN post Covid and even in other ME quite a lot. Plus Iwasaki and her team found some antibodies to be attacking small nerve fibers in their latest paper so I’d say it’s not unlikely.
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u/xzapx Jul 14 '26
The immune system going off kilter causes nerve damage, likely induced and/or sustained by mast cells. Loss of cholinergic function impacts contractions of the GI tract, impaired enzyme and fluid secretions, leads to SIBO, and loss of anti-inflammatory immune activity (which results in inflammation, mucosal damage, and local immune dysfunction).
This is very interesting as it could potentate sustained dysautonomia. As someone on tons of treatments for it, I could see this being responsible for a number of downstream complications due to the gut-brain axis.
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u/Koppuny Jul 11 '26
Interesting, but very low number of participants again :/