Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± SD), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.

In a preregistered, cross-sectional study we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC=0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4<OR<10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.

Granule cells (GCs) are the most abundant inhibitory neuronal type in the olfactory bulb and play a critical role in olfactory processing. GCs regulate the activity of principal neurons, the mitral cells, through dendrodendritic synapses, shaping the olfactory bulb output to other brain regions. GC excitability is regulated precisely by intrinsic and extrinsic inputs, and this regulation is fundamental for odor discrimination. Here, we used channelrhodopsin to stimulate GABAergic axons from the basal forebrain selectively and show that this stimulation generates reliable inhibitory responses in GCs. Furthermore, selective in vivo inhibition of GABAergic neurons in the basal forebrain by targeted expression of designer receptors exclusively activated by designer drugs produced a reversible impairment in the discrimination of structurally similar odors, indicating an important role of these inhibitory afferents in olfactory processing.habituation | uncaging S ensory information from the external world is integrated through a series of feed-forward stages toward higher cognitive cortical areas. At these different stages, sensory perception can be regulated by an individual's internal state to enhance meaningful information relative to less valuable information associated with different behavioral tasks (1, 2). Unlike other sensory systems, peripheral sensory input onto principal neurons in the olfactory bulb (OB) is relayed directly to olfactory cortices and subcortical nuclei, bypassing the thalamus (3). The OB is the first stage in which extensive fine-tuning and processing of olfactory information occurs (4). This processing involves integration of bottom-up and top-down information by the most abundant OB cell type, the granule cells (GCs). GCs establish most of their connections with output neurons, the mitral and tufted cells (MCs herein), through the ubiquitous dendrodendritic synapses (DDS) and with a few other subtypes of interneurons (5-8). Importantly, the interaction between MCs and GCs is thought to give rise to network oscillations in the OB that are associated with MC firing synchronization, adding an important time component to olfactory processing (9-13).In analogy with the regulation of thalamic neurons by cortical inputs, GCs receive important feedback regulation from cortical and subcortical projection areas of MCs and afferents from neuromodulatory systems (3, 14-16). Activation of these feedback projections and neuromodulatory systems increases GC excitability (14, 17, 18), thus increasing GABA-mediated inhibition at DDS and regulating olfactory processing. For example, regulation of GC-mediated inhibition by noradrenaline in the main olfactory bulbs (MOBs) and accessory olfactory bulbs (AOBs) has been shown to affect a range of olfactory behaviors including odor discrimination and more complex behaviors such as memory formation during mating (19). In addition, other studies have indicated an extensive innervation by GABAergic fibers originating in the horizontal limb of the diagonal band of B...

Background: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. Methods: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. Results: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. Conclusions: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

The vomeronasal system (VNS) participates in the detection and processing of pheromonal information related to social and sexual behaviors. Within the VNS, two different populations of sensory neurons, with a distinct pattern of distribution, line the epithelium of the vomeronasal organ (VNO) and give rise to segregated sensory projections to the accessory olfactory bulb (AOB). Apical sensory neurons in the VNO project to the anterior AOB (aAOB), while basal neurons project to the posterior AOB (pAOB). In the AOB, the largest population of neurons are inhibitory, the granule and periglomerular cells (GCs and PGs) and remarkably, these neurons are continuously born and functionally integrated in the adult brain, underscoring their role on olfactory function. Here we show that behaviors mediated by the VNS differentially regulate adult neurogenesis across the anterior-posterior axis of the AOB. We used immunohistochemical labeling of newly born cells under different behavioral conditions in mice. Using a resident-intruder aggression paradigm, we found that subordinate mice exhibited increased neurogenesis in the aAOB. In addition, in sexually naive adult females exposed to soiled bedding odorized by adult males, the number of newly born cells was significantly increased in the pAOB; however, neurogenesis was not affected in females exposed to female odors. In addition, we found that at two months of age adult neurogenesis was sexually dimorphic, with male mice exhibiting higher levels of newly born cells than females. Interestingly, adult neurogenesis was greatly reduced with age and this decrease correlated with a decrease in progenitor cells proliferation but not with an increase in cell death in the AOB. These results indicate that the physiological regulation of adult neurogenesis in the AOB by behaviors is both sex and age dependent and suggests an important role of newly born neurons in sex dependent behaviors mediated by the VNS.