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Narasaraju T, Neeli I, Criswell SL, Krishnappa A, Meng W, Silva V, Bila G, Vovk V, Serhiy Z, Bowlin GL, Meyer N, Luning Prak ET, Radic M, Bilyy R. Neutrophil Activity and Extracellular Matrix Degradation: Drivers of Lung Tissue Destruction in Fatal COVID-19 Cases and Implications for Long COVID. Biomolecules 2024; 14:236. [PMID: 38397474 PMCID: PMC10886497 DOI: 10.3390/biom14020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Pulmonary fibrosis, severe alveolitis, and the inability to restore alveolar epithelial architecture are primary causes of respiratory failure in fatal COVID-19 cases. However, the factors contributing to abnormal fibrosis in critically ill COVID-19 patients remain unclear. This study analyzed the histopathology of lung specimens from eight COVID-19 and six non-COVID-19 postmortems. We assessed the distribution and changes in extracellular matrix (ECM) proteins, including elastin and collagen, in lung alveoli through morphometric analyses. Our findings reveal the significant degradation of elastin fibers along the thin alveolar walls of the lung parenchyma, a process that precedes the onset of interstitial collagen deposition and widespread intra-alveolar fibrosis. Lungs with collapsed alveoli and organized fibrotic regions showed extensive fragmentation of elastin fibers, accompanied by alveolar epithelial cell death. Immunoblotting of lung autopsy tissue extracts confirmed elastin degradation. Importantly, we found that the loss of elastin was strongly correlated with the induction of neutrophil elastase (NE), a potent protease that degrades ECM. This study affirms the critical role of neutrophils and neutrophil enzymes in the pathogenesis of COVID-19. Consistently, we observed increased staining for peptidyl arginine deiminase, a marker for neutrophil extracellular trap release, and myeloperoxidase, an enzyme-generating reactive oxygen radical, indicating active neutrophil involvement in lung pathology. These findings place neutrophils and elastin degradation at the center of impaired alveolar function and argue that elastolysis and alveolitis trigger abnormal ECM repair and fibrosis in fatal COVID-19 cases. Importantly, this study has implications for severe COVID-19 complications, including long COVID and other chronic inflammatory and fibrotic disorders.
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Affiliation(s)
- Teluguakula Narasaraju
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA; or (T.N.); (I.N.); (V.S.)
- Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Center for Research and Innovation, Adichunchanagiri University, Mandya 571448, India
| | - Indira Neeli
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA; or (T.N.); (I.N.); (V.S.)
| | - Sheila L. Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Amita Krishnappa
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Mandya 571448, India;
| | - Wenzhao Meng
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (W.M.); (E.T.L.P.)
| | - Vasuki Silva
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA; or (T.N.); (I.N.); (V.S.)
| | - Galyna Bila
- Department of Histology, Cytology, Histology & Embryology, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine; (G.B.); (R.B.)
| | - Volodymyr Vovk
- Department of Pathological Anatomy and Forensic Medicine, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
- Lviv Regional Pathological Anatomy Office, CU ENT (Pulmonology Lviv Regional Diagnostic Center), 79000 Lviv, Ukraine;
| | - Zolotukhin Serhiy
- Lviv Regional Pathological Anatomy Office, CU ENT (Pulmonology Lviv Regional Diagnostic Center), 79000 Lviv, Ukraine;
| | - Gary L. Bowlin
- Department of Biomedical Engineering, University of Memphis, Memphis, TN 38152, USA;
| | - Nuala Meyer
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Pulmonary, Allergy, and Critical Care Medicine and Center for Translational Lung Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eline T. Luning Prak
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (W.M.); (E.T.L.P.)
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Marko Radic
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA; or (T.N.); (I.N.); (V.S.)
| | - Rostyslav Bilyy
- Department of Histology, Cytology, Histology & Embryology, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine; (G.B.); (R.B.)
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Milross L, Hunter B, McDonald D, Merces G, Thomson A, Hilkens CMU, Wills J, Rees P, Jiwa K, Cooper N, Majo J, Ashwin H, Duncan CJA, Kaye PM, Bayraktar OA, Filby A, Fisher AJ. Distinct lung cell signatures define the temporal evolution of diffuse alveolar damage in fatal COVID-19. EBioMedicine 2024; 99:104945. [PMID: 38142637 PMCID: PMC10788437 DOI: 10.1016/j.ebiom.2023.104945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Lung damage in severe COVID-19 is highly heterogeneous however studies with dedicated spatial distinction of discrete temporal phases of diffuse alveolar damage (DAD) and alternate lung injury patterns are lacking. Existing studies have also not accounted for progressive airspace obliteration in cellularity estimates. We used an imaging mass cytometry (IMC) analysis with an airspace correction step to more accurately identify the cellular immune response that underpins the heterogeneity of severe COVID-19 lung disease. METHODS Lung tissue was obtained at post-mortem from severe COVID-19 deaths. Pathologist-selected regions of interest (ROIs) were chosen by light microscopy representing the patho-evolutionary spectrum of DAD and alternate disease phenotypes were selected for comparison. Architecturally normal SARS-CoV-2-positive lung tissue and tissue from SARS-CoV-2-negative donors served as controls. ROIs were stained for 40 cellular protein markers and ablated using IMC before segmented cells were classified. Cell populations corrected by ROI airspace and their spatial relationships were compared across lung injury patterns. FINDINGS Forty patients (32M:8F, age: 22-98), 345 ROIs and >900k single cells were analysed. DAD progression was marked by airspace obliteration and significant increases in mononuclear phagocytes (MnPs), T and B lymphocytes and significant decreases in alveolar epithelial and endothelial cells. Neutrophil populations proved stable overall although several interferon-responding subsets demonstrated expansion. Spatial analysis revealed immune cell interactions occur prior to microscopically appreciable tissue injury. INTERPRETATION The immunopathogenesis of severe DAD in COVID-19 lung disease is characterised by sustained increases in MnPs and lymphocytes with key interactions occurring even prior to lung injury is established. FUNDING UK Research and Innovation/Medical Research Council through the UK Coronavirus Immunology Consortium, Barbour Foundation, General Sir John Monash Foundation, Newcastle University, JGW Patterson Foundation, Wellcome Trust.
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Affiliation(s)
- Luke Milross
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Bethany Hunter
- Newcastle University Biosciences Institute, Newcastle upon Tyne, UK; Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David McDonald
- Newcastle University Biosciences Institute, Newcastle upon Tyne, UK; Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - George Merces
- Newcastle University Biosciences Institute, Newcastle upon Tyne, UK; Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amanda Thomson
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK; Newcastle University Biosciences Institute, Newcastle upon Tyne, UK; Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catharien M U Hilkens
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Wills
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Paul Rees
- Department of Biomedical Engineering, Swansea University, Wales, UK; Imaging Platform, Broad Institute of MIT and Harvard, 415 Main Street, Boston, Cambridge, MA, USA
| | - Kasim Jiwa
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nigel Cooper
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joaquim Majo
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Ashwin
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
| | - Christopher J A Duncan
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK; Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul M Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
| | | | - Andrew Filby
- Newcastle University Biosciences Institute, Newcastle upon Tyne, UK; Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Andrew J Fisher
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK; Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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3
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Karam M, Auclair C. Sphingosine-1-Phosphate as Lung and Cardiac Vasculature Protecting Agent in SARS-CoV-2 Infection. Int J Mol Sci 2023; 24:13088. [PMID: 37685894 PMCID: PMC10488186 DOI: 10.3390/ijms241713088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause severe respiratory illness with high mortality. SARS-CoV-2 infection results in a massive inflammatory cell infiltration into the infected lungs accompanied by excessive pro-inflammatory cytokine production. The lung histology of dead patients shows that some areas are severely emphysematous, with enormously dilated blood vessels and micro-thromboses. The inappropriate inflammatory response damaging the pulmonary interstitial arteriolar walls suggests that the respiratory distress may come in a large part from lung vasculature injuries. It has been recently observed that low plasmatic sphingosine-1-phosphate (S1P) is a marker of a worse prognosis of clinical outcome in severe coronavirus disease (COVID) patients. S1P is an angiogenic molecule displaying anti-inflammatory and anti-apoptotic properties, that promote intercellular interactions between endothelial cells and pericytes resulting in the stabilization of arteries and capillaries. In this context, it can be hypothesized that the benefit of a normal S1P level is due to its protective effect on lung vasculature functionality. This paper provides evidence supporting this concept, opening the way for the design of a pharmacological approach involving the use of an S1P lyase inhibitor to increase the S1P level that in turn will rescue the lung vasculature functionality.
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Affiliation(s)
| | - Christian Auclair
- AC BioTech, Villejuif Biopark, Cancer Campus, 1 mail du Professeur Georges Mathé, 94800 Villejuif, France;
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4
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da Silva Santos Y, Gamon THM, de Azevedo MSP, Telezynski BL, de Souza EE, de Oliveira DBL, Dombrowski JG, Rosa-Fernandes L, Palmisano G, de Moura Carvalho LJ, Luvizotto MCR, Wrenger C, Covas DT, Curi R, Marinho CRF, Durigon EL, Epiphanio S. Virulence Profiles of Wild-Type, P.1 and Delta SARS-CoV-2 Variants in K18-hACE2 Transgenic Mice. Viruses 2023; 15:v15040999. [PMID: 37112979 PMCID: PMC10146242 DOI: 10.3390/v15040999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
Since December 2019, the world has been experiencing the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and we now face the emergence of several variants. We aimed to assess the differences between the wild-type (Wt) (Wuhan) strain and the P.1 (Gamma) and Delta variants using infected K18-hACE2 mice. The clinical manifestations, behavior, virus load, pulmonary capacity, and histopathological alterations were analyzed. The P.1-infected mice showed weight loss and more severe clinical manifestations of COVID-19 than the Wt and Delta-infected mice. The respiratory capacity was reduced in the P.1-infected mice compared to the other groups. Pulmonary histological findings demonstrated that a more aggressive disease was generated by the P.1 and Delta variants compared to the Wt strain of the virus. The quantification of the SARS-CoV-2 viral copies varied greatly among the infected mice although it was higher in P.1-infected mice on the day of death. Our data revealed that K18-hACE2 mice infected with the P.1 variant develop a more severe infectious disease than those infected with the other variants, despite the significant heterogeneity among the mice.
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Affiliation(s)
- Yasmin da Silva Santos
- Laboratory of Cellular and Molecular Immunopathology of Malaria, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Laboratory of Malaria Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
| | - Thais Helena Martins Gamon
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Marcela Santiago Pacheco de Azevedo
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Laboratory of Experimental Immunoparasitology, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Bruna Larotonda Telezynski
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Edmarcia Elisa de Souza
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Danielle Bruna Leal de Oliveira
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Jamille Gregório Dombrowski
- Laboratory of Experimental Immunoparasitology, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Livia Rosa-Fernandes
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- GlycoProteomics Laboratory, Department of Parasitology, ICB, University of São Paulo, São Paulo 05508-000, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics Laboratory, Department of Parasitology, ICB, University of São Paulo, São Paulo 05508-000, Brazil
- School of Natural Sciences, Macquarie University, Sydney 2109, Australia
| | | | | | - Carsten Wrenger
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Dimas Tadeu Covas
- Butantan Institute, São Paulo 05508-040, Brazil
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Rui Curi
- Interdisciplinary Program of Health Sciences, Cruzeiro do Sul University, São Paulo 08060-070, Brazil
- Immunobiological Production Section, Bioindustrial Center, Butantan Institute, São Paulo 05503-900, Brazil
| | - Claudio Romero Farias Marinho
- Laboratory of Experimental Immunoparasitology, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Edison Luiz Durigon
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Scientific Plataform Pasteur/USP, University of São Paulo, São Paulo 05508-020, Brazil
| | - Sabrina Epiphanio
- Laboratory of Cellular and Molecular Immunopathology of Malaria, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
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5
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Rodriguez F, Nin N, Fajardo A, Aunchayna M, Guerendiaín R, Hurtado J. [Early lung autopsy in deceased patients with acute respiratory distress syndrome due to infection by SARS-CoV-2]. Med Intensiva 2023; 47:173-175. [PMID: 35935246 PMCID: PMC9339975 DOI: 10.1016/j.medin.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022]
Affiliation(s)
- F. Rodriguez
- Unidad de Medicina Intensiva, Hospital Español «Juan J. Crottogini» ASSE, Montevideo, Uruguay,Autor para correspondencia
| | - N. Nin
- Unidad de Medicina Intensiva, Hospital Español «Juan J. Crottogini» ASSE, Montevideo, Uruguay
| | - A. Fajardo
- Laboratorio de Virología Molecular, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - M. Aunchayna
- Laboratorio de Anatomía Patológica, Hospital Maciel ASSE, Montevideo, Uruguay
| | - R. Guerendiaín
- Unidad de Medicina Intensiva, Hospital Español «Juan J. Crottogini» ASSE, Montevideo, Uruguay
| | - J. Hurtado
- Unidad de Medicina Intensiva, Hospital Español «Juan J. Crottogini» ASSE, Montevideo, Uruguay
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6
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Rodriguez F, Nin N, Fajardo A, Auchayna M, Guerendiaín R, Hurtado J. Early lung autopsy in deceased patients with acute respiratory distress syndrome due to infection by SARS-CoV-2. Med Intensiva 2023; 47:173-175. [PMID: 36272904 PMCID: PMC9579894 DOI: 10.1016/j.medine.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F Rodriguez
- Unidad de Medicina Intensiva, Hospital Español "Juan J Crottogini" ASSE, Montevideo, Uruguay.
| | - N Nin
- Unidad de Medicina Intensiva, Hospital Español "Juan J Crottogini" ASSE, Montevideo, Uruguay
| | - A Fajardo
- Laboratorio de Virología Molecular, Facultad de Ciencias. Universidad de la República, Montevideo, Uruguay
| | - M Auchayna
- Laboratorio de Anatomía Patológica, Hospital Maciel ASSE, Montevideo, Uruguay
| | - R Guerendiaín
- Unidad de Medicina Intensiva, Hospital Español "Juan J Crottogini" ASSE, Montevideo, Uruguay
| | - J Hurtado
- Unidad de Medicina Intensiva, Hospital Español "Juan J Crottogini" ASSE, Montevideo, Uruguay
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7
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Ramos-Rincon JM, Herrera-García C, Silva-Ortega S, Portilla-Tamarit J, Alenda C, Jaime-Sanchez FA, Arenas-Jiménez J, Fornés-Riera FE, Scholz A, Escribano I, Pedrero-Castillo V, Muñoz-Miguelsanz C, Orts-Llinares P, Martí-Pastor A, Amo-Lozano A, García-Sevila R, Ribes-Mengual I, Moreno-Perez O, Concepcion-Aramendía L, Merino E, Sánchez-Martínez R, Aranda I. Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course. Front Med (Lausanne) 2022; 9:874307. [PMID: 35872778 PMCID: PMC9301383 DOI: 10.3389/fmed.2022.874307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022] Open
Abstract
Background Autopsies can shed light on the pathogenesis of new and emerging diseases. Aim To describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19. Material Cross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19. Histopathological analyses were performed, and clinical data and patient course evaluated. Results Chest core necropsies were performed in 71 decedents with a median age of 81 years (range 52–97); 47 (65.3%) were men. The median interval from symptoms onset to death was 17.5 days (range 1–84). Samples of lung (n = 62, 87.3%), heart (n = 48, 67.6%) and liver (n = 39, 54.9%) were obtained. Fifty-one lung samples (82.3%) were abnormal: 19 (30.6%) showed proliferative diffuse alveolar damage (DAD), 12 (19.4%) presented exudative DAD, and 10 (16.1%) exhibited proliferative plus exudative DAD. Of the 46 lung samples tested for SARS-CoV-19 by RT-PCR, 39 (84.8%) were positive. DAD was associated with premortem values of lactate dehydrogenase of 400 U/L or higher [adjusted odds ratio (AOR) 21.73; 95% confidence interval (CI) 3.22–146] and treatment with tocilizumab (AOR 6.91; 95% CI 1.14–41.7). Proliferative DAD was associated with an onset-to-death interval of over 15 days (AOR 7.85, 95% CI 1.29–47.80). Twenty-three of the 48 (47.9%) heart samples were abnormal: all showed fiber hypertrophy, while 9 (18.8%) presented fibrosis. Of the liver samples, 29/39 (74.4%) were abnormal, due to steatosis (n = 12, 30.8%), cholestasis (n = 6, 15.4%) and lobular central necrosis (n = 5, 12.8%). Conclusion Proliferative DAD was the main finding on lung core needle necropsy in people who died from COVID-19; this finding was related to a longer disease course. Changes in the liver and heart were common.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Cristian Herrera-García
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Sandra Silva-Ortega
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Julia Portilla-Tamarit
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Cristina Alenda
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Pathology and Surgery Department, Miguel Hernández University of Elche, Elche, Spain
| | - Francisco-Angel Jaime-Sanchez
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain.,Intensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Juan Arenas-Jiménez
- Pathology and Surgery Department, Miguel Hernández University of Elche, Elche, Spain.,Radiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Francisca-Eugenia Fornés-Riera
- Anesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Alexander Scholz
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Isabel Escribano
- Microbiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Víctor Pedrero-Castillo
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Carlos Muñoz-Miguelsanz
- Anesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Pedro Orts-Llinares
- Intensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Ana Martí-Pastor
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Antonio Amo-Lozano
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Raquel García-Sevila
- Pneumology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Isabel Ribes-Mengual
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Oscar Moreno-Perez
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain.,Endocrinology and Nutrition Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Luis Concepcion-Aramendía
- Radiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Rosario Sánchez-Martínez
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Ignacio Aranda
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
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8
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Petrini C, Peritore D, Riva L, Floridia G, Gainotti S, Grossi P, Castiglione A, Beretta M, Rea F, Nosotti M, Lombardini L, Cardillo M. POST COVID-19 LUNG TRANSPLANTATION ITALIAN PIVOTAL PROTOCOL: SOME ETHICAL CONSIDERATIONS. Transplant Proc 2022; 54:1524-1527. [PMID: 35863996 PMCID: PMC9156951 DOI: 10.1016/j.transproceed.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
SARS‑CoV‑2 mostly affects the respiratory system with clinical patterns ranging from the common cold to fatal pneumonia. During the first wave of the COVID-19 pandemic, owing to the high number of patients who were infected with SARS‑CoV‑2 and subsequently recovered, it has been shown that some patients with post–COVID-19 terminal respiratory failure need lung transplantation for survival. There is increasing evidence coming from worldwide observations that this procedure can be performed successfully in post–COVID-19 patients. However, owing to the scarcity of organs, there is a need to define the safety and efficacy of lung transplant for post–COVID-19 patients as compared to patients waiting for a lung transplant for other pre-existing conditions, in order to ensure that sound ethical criteria are applied in organ allocation. The Milan's Policlinic Lung Transplant Surgery Unit, with the revision of the National Second Opinion for Infectious Diseases and the contribution of the Italian Lung Transplant Centres and the Italian National Transplant Centre, set up a pivotal observational protocol for the lung transplant of patients infected and successively turned negative for SARS‑CoV‑2, albeit with lung consequences such as acute respiratory distress syndrome or some chronic interstitial lung disease. The protocol was revised and approved by the Italian National Institute of Health Ethics Committee. Description of the protocol and some ethical considerations are reported in this article.
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Bocchino M, Lieto R, Romano F, Sica G, Bocchini G, Muto E, Capitelli L, Sequino D, Valente T, Fiorentino G, Rea G. Chest CT-based Assessment of 1-year Outcomes after Moderate COVID-19 Pneumonia. Radiology 2022; 305:479-485. [PMID: 35536134 PMCID: PMC9619196 DOI: 10.1148/radiol.220019] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background COVID-19 pneumonia may lead to pulmonary fibrosis in the long term. Chest CT is useful to evaluate changes in the lung parenchyma over time. Purpose To illustrate the temporal change of lung abnormalities on chest CT scans associated with COVID-19 pneumonia over 1 year. Materials and Methods In this prospective study, patients previously hospitalized due to COVID-19 pneumonia who visited the radiology department of a tertiary care center for imaging follow-up were consecutively enrolled between March 2020 and July 2021. Exclusion criteria were acute respiratory distress syndrome, requirement of intubation and/or mechanical ventilation, pulmonary embolism, and any interstitial lung disease. High-resolution volumetric noncontrast chest CT scans were acquired at 3, 6, and 12 months from the first diagnosis and were compared with baseline CT scans. The imaging features analyzed were ground-glass opacity (GGO), consolidation, pleuroparenchymal band, linear atelectasis, bronchiectasis and/or bronchiolectasis, reticulation, traction bronchiectasis and/or bronchiolectasis, and honeycombing. The prevalence distribution of lung abnormalities was recorded at all time points. Results Eighty-four participants (56 men; mean age, 61 years ± 11 [SD]) were studied. GGOs and consolidations represented the main baseline lung abnormalities, accounting for a median severity score of 9 (IQR, 7–12.7; maximum possible score, 20), which indicates moderate lung involvement. The baseline prevalence of GGOs decreased from 100% to 2% of participants at 1 year, and that of consolidations decreased from 71% to 0% at 6 months. Fibrotic-like abnormalities (pleuroparenchymal bands, linear atelectasis, bronchiectasis and/or bronchiolectasis) were detected at 3 months (50% of participants), 6 months (42% of participants), and 1 year (5% of participants). Among these, pleuroparenchymal bands were the most represented finding. Fibrotic changes (reticulation and traction bronchiectasis and/or bronchiolectasis) were detected at 3–6 months (2%) and remained stable at 1 year, with no evidence of honeycombing. At 1 year, lung abnormalities due to COVID-19 pneumonia were completely resolved in 78 of 84 (93%) participants. Conclusion Residual lung abnormalities in individuals hospitalized with moderate COVID-19 pneumonia were infrequent, with no evidence of fibrosis at 1-year chest CT. © RSNA, 2022
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Affiliation(s)
- Marialuisa Bocchino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Emanuele Muto
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Ludovica Capitelli
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Davide Sequino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Giuseppe Fiorentino
- Pathophysiology and Respiratory Rehabilitation Department of Critical Area, Monaldi Hospital, AO dei Colli, Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
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Li H, Wu Q, Qin Z, Hou X, Zhang L, Guo J, Li Y, Yang F, Zhang Y, Wu Q, Li L, Chen H. Serum levels of laminin and von Willebrand factor in COVID-19 survivors 6 months after discharge. Int J Infect Dis 2022; 115:134-141. [PMID: 34843955 PMCID: PMC8626146 DOI: 10.1016/j.ijid.2021.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical characteristics, pulmonary diffusion function, chest computed tomography (CT), and serum lung cell damage indicators of coronavirus disease 2019 (COVID-19) survivors 6 months after discharge. METHODS Data of COVID-19 survivors discharged from hospital between January 21, 2020 and January 11, 2021 and healthy controls were collected. Serum levels of surfactant protein D (SP-D)1, the receptor for advanced glycation end products (RAGE)2, laminin, and von Willebrand factor (vWF) were measured in the healthy controls and COVID-19 survivors 6 months after discharge. The relationships between serum lung cell damage indicator levels and various parameters were explored. RESULTS Fifty-two COVID-19 survivors (31 with non-severe disease and 21 with severe disease) and 30 controls were included. Serum levels of laminin in COVID-19 survivors 6 months after discharge were significantly higher than those in the controls. The increase was more significant in elderly and female patients. Serum levels of RAGE and vWF were not statistically different from those of the controls. However, 6 months after discharge, COVID-19 survivors with abnormal chest CT and those in the severe group had higher vWF levels. CONCLUSIONS COVID-19 patients had abnormal lung injury indicators 6 months after discharge. The recovery time after infection is currently unknown, and long-term observation is required.
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Affiliation(s)
- Hongwei Li
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Qian Wu
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China; Haihe Clinical School, Tianjin Medical University, Tianjin, China
| | - Zhonghua Qin
- Department of Laboratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Xinwei Hou
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Limin Zhang
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Jin Guo
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Yajie Li
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Fangfei Yang
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Yan Zhang
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Qi Wu
- Haihe Clinical School, Tianjin Medical University, Tianjin, China; Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, China.
| | - Li Li
- Department of Respiratory Medicine, Haihe Hospital, Tianjin University, Tianjin, China.
| | - Huaiyong Chen
- Department of Basic Medicine, Haihe Hospital, Tianjin University, Tianjin, China; Department of Basic Medicine, Haihe Clinical College of Tianjin Medical University, Tianjin, China; Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin Institute of Respiratory Diseases, Tianjin, China; Tianjin Key Laboratory of Lung Regenerative Medicine, Tianjin, China.
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11
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Kamp JC, Neubert L, Ackermann M, Stark H, Werlein C, Fuge J, Haverich A, Tzankov A, Steinestel K, Friemann J, Boor P, Junker K, Hoeper MM, Welte T, Laenger F, Kuehnel MP, Jonigk DD. Time-Dependent Molecular Motifs of Pulmonary Fibrogenesis in COVID-19. Int J Mol Sci 2022; 23:ijms23031583. [PMID: 35163504 PMCID: PMC8835897 DOI: 10.3390/ijms23031583] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: In COVID-19 survivors there is an increased prevalence of pulmonary fibrosis of which the underlying molecular mechanisms are poorly understood; (2) Methods: In this multicentric study, n = 12 patients who succumbed to COVID-19 due to progressive respiratory failure were assigned to an early and late group (death within ≤7 and >7 days of hospitalization, respectively) and compared to n = 11 healthy controls; mRNA and protein expression as well as biological pathway analysis were performed to gain insights into the evolution of pulmonary fibrogenesis in COVID-19; (3) Results: Median duration of hospitalization until death was 3 (IQR25-75, 3–3.75) and 14 (12.5–14) days in the early and late group, respectively. Fifty-eight out of 770 analyzed genes showed a significantly altered expression signature in COVID-19 compared to controls in a time-dependent manner. The entire study group showed an increased expression of BST2 and IL1R1, independent of hospitalization time. In the early group there was increased activity of inflammation-related genes and pathways, while fibrosis-related genes (particularly PDGFRB) and pathways dominated in the late group; (4) Conclusions: After the first week of hospitalization, there is a shift from pro-inflammatory to fibrogenic activity in severe COVID-19. IL1R1 and PDGFRB may serve as potential therapeutic targets in future studies.
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Affiliation(s)
- Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.F.); (M.M.H.); (T.W.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Correspondence:
| | - Lavinia Neubert
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Maximilian Ackermann
- Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, 42283 Wuppertal, Germany;
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
| | - Helge Stark
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Christopher Werlein
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.F.); (M.M.H.); (T.W.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
| | - Axel Haverich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Konrad Steinestel
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, 89081 Ulm, Germany;
| | - Johannes Friemann
- Institute of Pathology, Märkische Kliniken GmbH, Klinikum Lüdenscheid, 58515 Lüdenscheid, Germany;
| | - Peter Boor
- Institute of Pathology and Department of Nephrology, RWTH University of Aachen, 52062 Aachen, Germany;
| | - Klaus Junker
- Institute of Pathology, Bremen Central Hospital, 28177 Bremen, Germany;
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.F.); (M.M.H.); (T.W.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.F.); (M.M.H.); (T.W.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
| | - Florian Laenger
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Mark P. Kuehnel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Danny D. Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (C.W.); (A.H.); (F.L.); (M.P.K.); (D.D.J.)
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
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12
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Abstract
Recent world events have refocused attention on the pathology associated with clinical acute respiratory distress syndrome (ARDS). The vast majority of cases of clinical ARDS will have diffuse alveolar damage (DAD) histologically, but other histologies may occur less frequently. The aim of this paper is to provide a review of the pathology of DAD and acute fibrinous and organizing pneumonia and provide insights into the pathologic features associated with the E-cigarette/vaping-associated lung-injury outbreak and the ongoing SARS-CoV-2 pandemic.
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Affiliation(s)
- Mary Beth Beasley
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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13
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Riera J, Alcántara S, Bonilla C, Fortuna P, Blandino Ortiz A, Vaz A, Albacete C, Millán P, Ricart P, Victoria Boado M, Ruiz de Gopegui P, Santa Teresa P, Sandoval E, Pérez-Chomón H, González-Pérez A, Duerto J, Gimeno R, Colomina J, Gómez V, Renedo G, Naranjo J, Alfonso García M, Rodríguez-Ruiz E, Eduardo Silva P, Pérez D, Veganzones J, Voces R, Martínez S, Blanco-Schweizer P, García M, Villanueva-Fernández H, Paz Fuset M, María Luna S, Martínez-Martínez M, Argudo E, Chiscano L, Roncon-Albuquerque R. Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support. Eur Respir J 2021; 59:13993003.02463-2021. [PMID: 34824058 PMCID: PMC8620104 DOI: 10.1183/13993003.02463-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/11/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Jordi Riera
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain .,SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain.,CIBERES, CIBERESUCICOVID, Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Alcántara
- Department of Intensive Care, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Camilo Bonilla
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Phillip Fortuna
- Medical Emergency Unit, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Aaron Blandino Ortiz
- Department of Intensive Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Vaz
- Department of Intensive Care, São João Universitary Hospital Center, Porto, Portugal
| | - Carlos Albacete
- Department of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pablo Millán
- Department of Intensive Care, Hospital Universitario La Paz, Madrid, Spain
| | - Pilar Ricart
- Department of Intensive Care, Hospital Universitari Germans-Trias i Pujol, Badalona, Spain
| | | | | | - Patricia Santa Teresa
- Department of Intensive Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Sandoval
- Department of Cardiac Surgery, Hospital Universitari Clínic, Barcelona, Spain
| | - Helena Pérez-Chomón
- Department of Intensive Care, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Jorge Duerto
- Department of Intensive Care, Hospital Clínico San Carlos, Madrid, Spain
| | - Ricardo Gimeno
- Department of Intensive Care, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Joaquín Colomina
- Department of Intensive Care, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Vanesa Gómez
- Department of Intensive Care, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Gloria Renedo
- Department of Intensive Care, Hospital Clínico Universitario, Valladolid, Spain
| | - José Naranjo
- Department of Intensive Care, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Emilio Rodríguez-Ruiz
- Department of Intensive Care, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Pedro Eduardo Silva
- Medical Emergency Unit, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Daniel Pérez
- Department of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Javier Veganzones
- Department of Anesthesiology, Hospital Universitario La Paz, Madrid, Spain
| | - Roberto Voces
- Department of Cardiac Surgery, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sergi Martínez
- Department of Intensive Care, Hospital Universitari Germans-Trias i Pujol, Badalona, Spain
| | | | - Marta García
- Department of Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - María Paz Fuset
- Department of Intensive Care, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Stephani María Luna
- Department of Intensive Care, Hospital Universitari Bellvitge, Barcelona, Spain
| | - María Martínez-Martínez
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Eduard Argudo
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Luis Chiscano
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
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