Potential involvement of monoamine oxidase activity in delirium onset and SARS-COV2 infection

Delirium is an acute change in attention and cognition occurring in ~65% of severe SARS-CoV-2 cases. It is also common following surgery and an indicator of brain vulnerability and risk for the development of dementia. In this work we analyzed the underlying role of metabolism in delirium-susceptibility in the postoperative setting using metabolomic profiling of cerebrospinal fluid and blood taken from the same patients prior to planned orthopaedic surgery. Significant concentration differences in several amino acids, acylcarnitines and polyamines were found in delirium-prone patients leading us to a hypothesis about the significance of monoamine oxidase B (MAOB) in predisposition to delirium. Subsequent computational structural comparison between MAOB and angiotensin converting enzyme 2 as well as protein-protein docking analysis showed possibly strong binding of SARS-CoV-2 spike protein to MAOB resulting in a hypothesis that SARS-CoV-2 influences MAOB activity possibly lead to many observed neurological and platelet-based complications of SARS-CoV-2 infection. This proposition is possibly of significance for diagnosis, treatment and prevention of vulnerabilities causing delirium, dementias and severe COVID-19 response.