# Evaluating the Epidemiology and Determinants of Neurologic Post-acute Sequelae of SARS-CoV-2

> **NIH NIH K23** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $192,260

## Abstract

PROJECT SUMMARY/ABSTRACT: Rationale: The COVID-19 pandemic has affected over 42 million
individuals in the United States and long-term complications are frequently reported, referred to as post-acute
sequelae of SARS-CoV-2 (PASC). Even among survivors with mild acute illness, neurologic symptoms such
as chronic fatigue, dysautonomia, and cognitive impairment are frequently reported. To date, the etiology and
pathophysiology of neurologic PASC remain unclear; however, underlying autoantibodies and immune
activation are suspected. In our prospective COVID-19 ID Persistence Cohort (C-PIC), more than half of
COVID-19 survivors are reporting neurologic PASC at one year. We have identified an association between
neurologic PASC with both SARS-CoV-2 specific antibodies and ANA. Specifically, nucleocapsid (NP)
antibody levels are elevated compared to spike trimer (ST) antibody levels in participants with neurologic
PASC. Furthermore, our preliminary data has identified a potential signal linking neurologic PASC and
decreased gastrointestinal microbiota diversity. In this mentored career project, we hypothesize that
autoimmunity, immune activation, and microbiome dysbiosis are associated with neurologic PASC. Candidate:
As an Infectious Diseases physician with a master’s in public health and applied epidemiology and outbreak
training through the Center for Disease Control and Prevention’s Epidemic Intelligence Service, I am uniquely
positioned to study the epidemiology and determinants for neurologic PASC. My experience studying post-
Ebola syndrome in Liberia provided me with the foresight to contribute viral persistence and sequelae aims to
the C-PIC study, which includes longitudinal PASC survey data and biorepository specimens. Through the
guidance of my outstanding multidisciplinary team of mentors, I plan to fulfill my training objectives of (1)
developing expertise in advanced biostatistical analysis of survey data and (2) bridging translational research
and descriptive cohort data. Environment: My team of mentors at Columbia University Irving Medical Center
(CUIMC) are experts in epidemiology, biostatistics, immunology, and microbiome analysis. CUIMC also has a
long track record of enabling young physician-scientists to develop independent and successful careers in
academic medicine. Approach: We hypothesize that chronic fatigue, dysautonomia, and cognitive impairment
sub-phenotypes of neurologic PASC have different underlying pathophysiology, including autoimmunity,
immune activation, and microbiome dysbiosis. In Aim 1, we will characterize neurologic PASC epidemiology,
trajectory, and sub-phenotypes using longitudinal neurologic PASC surveys. In Aim 2, we will identify
associations between neurologic PASC with SARS-CoV-2 specific antibodies and autoantibodies. In Aim 3, we
will identify associations between neurologic PASC and immune activation and explore the role of gut
microbiota. This proposal provides an innovative approach to studying dete...

## Key facts

- **NIH application ID:** 10894841
- **Project number:** 5K23AI171263-03
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Lawrence James Purpura
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $192,260
- **Award type:** 5
- **Project period:** 2022-08-16 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10894841

## Citation

> US National Institutes of Health, RePORTER application 10894841, Evaluating the Epidemiology and Determinants of Neurologic Post-acute Sequelae of SARS-CoV-2 (5K23AI171263-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10894841. Licensed CC0.

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