- Song, Eric;
- Bartley, Christopher M;
- Chow, Ryan D;
- Ngo, Thomas T;
- Jiang, Ruoyi;
- Zamecnik, Colin R;
- Dandekar, Ravi;
- Loudermilk, Rita P;
- Dai, Yile;
- Liu, Feimei;
- Sunshine, Sara;
- Liu, Jamin;
- Wu, Wesley;
- Hawes, Isobel A;
- Alvarenga, Bonny D;
- Huynh, Trung;
- McAlpine, Lindsay;
- Rahman, Nur-Taz;
- Geng, Bertie;
- Chiarella, Jennifer;
- Goldman-Israelow, Benjamin;
- Vogels, Chantal BF;
- Grubaugh, Nathan D;
- Casanovas-Massana, Arnau;
- Phinney, Brett S;
- Salemi, Michelle;
- Alexander, Jessa R;
- Gallego, Juan A;
- Lencz, Todd;
- Walsh, Hannah;
- Wapniarski, Anne E;
- Mohanty, Subhasis;
- Lucas, Carolina;
- Klein, Jon;
- Mao, Tianyang;
- Oh, Jieun;
- Ring, Aaron;
- Spudich, Serena;
- Ko, Albert I;
- Kleinstein, Steven H;
- Pak, John;
- DeRisi, Joseph L;
- Iwasaki, Akiko;
- Pleasure, Samuel J;
- Wilson, Michael R;
- Farhadian, Shelli F
Individuals with coronavirus disease 2019 (COVID-19) frequently develop neurological symptoms, but the biological underpinnings of these phenomena are unknown. Through single-cell RNA sequencing (scRNA-seq) and cytokine analyses of cerebrospinal fluid (CSF) and blood from individuals with COVID-19 with neurological symptoms, we find compartmentalized, CNS-specific T cell activation and B cell responses. All affected individuals had CSF anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies whose target epitopes diverged from serum antibodies. In an animal model, we find that intrathecal SARS-CoV-2 antibodies are present only during brain infection and not elicited by pulmonary infection. We produced CSF-derived monoclonal antibodies from an individual with COVID-19 and found that these monoclonal antibodies (mAbs) target antiviral and antineural antigens, including one mAb that reacted to spike protein and neural tissue. CSF immunoglobulin G (IgG) from 5 of 7 patients showed antineural reactivity. This immune survey reveals evidence of a compartmentalized immune response in the CNS of individuals with COVID-19 and suggests a role of autoimmunity in neurologic sequelae of COVID-19.