Secondly, various cytotoxic molecules (e.g., PRF1, GZMA and GNLY, etc.)that were highly expressed in T and NK cells might also be associated with the immunopathology in COVID-19 acute necrotizing encephalopathy patients, because these effector molecules can damage multiple organs, including the CNS, by eliciting an inflammatory response and degrading the extracellular matrix. This evidence concerns the gene GZMA and COVID-19.