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Dimbath E, Maddipati V, Stahl J, Sewell K, Domire Z, George S, Vahdati A. Implications of microscale lung damage for COVID-19 pulmonary ventilation dynamics: A narrative review. Life Sci 2021; 274:119341. [PMID: 33716059 PMCID: PMC7946865 DOI: 10.1016/j.lfs.2021.119341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic surges on as vast research is produced to study the novel SARS-CoV-2 virus and the disease state it induces. Still, little is known about the impact of COVID-19-induced microscale damage in the lung on global lung dynamics. This review summarizes the key histological features of SARS-CoV-2 infected alveoli and links the findings to structural tissue changes and surfactant dysfunction affecting tissue mechanical behavior similar to changes seen in other lung injury. Along with typical findings of diffuse alveolar damage affecting the interstitium of the alveolar walls and blood-gas barrier in the alveolar airspace, COVID-19 can cause extensive microangiopathy in alveolar capillaries that further contribute to mechanical changes in the tissues and may differentiate it from previously studied infectious lung injury. Understanding microlevel damage impact on tissue mechanics allows for better understanding of macroscale respiratory dynamics. Knowledge gained from studies into the relationship between microscale and macroscale lung mechanics can allow for optimized treatments to improve patient outcomes in case of COVID-19 and future respiratory-spread pandemics.
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Affiliation(s)
- Elizabeth Dimbath
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, USA
| | | | - Jennifer Stahl
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Kerry Sewell
- Laupus Library, East Carolina University, Greenville, NC, USA
| | - Zachary Domire
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Stephanie George
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, USA
| | - Ali Vahdati
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, USA.
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52
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Morens DM, Taubenberger JK, Fauci AS. A Centenary Tale of Two Pandemics: The 1918 Influenza Pandemic and COVID-19, Part I. Am J Public Health 2021; 111:1086-1094. [PMID: 33950739 PMCID: PMC8101587 DOI: 10.2105/ajph.2021.306310] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Separated by a century, the influenza pandemic of 1918 and the COVID-19 pandemic of 2019-2021 are among the most disastrous infectious disease emergences of modern times. Although caused by unrelated viruses, the two pandemics are nevertheless similar in their clinical, pathological, and epidemiological features, and in the civic, public health, and medical responses to combat them. Comparing and contrasting the two pandemics, we consider what lessons we have learned over the span of a century and how we are applying those lessons to the challenges of COVID-19.
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Affiliation(s)
- David M Morens
- David M. Morens and Anthony S. Fauci are with Office of the Director, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD. Jeffery K. Taubenberger is with Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, NIAID
| | - Jeffery K Taubenberger
- David M. Morens and Anthony S. Fauci are with Office of the Director, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD. Jeffery K. Taubenberger is with Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, NIAID
| | - Anthony S Fauci
- David M. Morens and Anthony S. Fauci are with Office of the Director, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD. Jeffery K. Taubenberger is with Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, NIAID
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Sridhar S, Nicholls J. Pathophysiology of infection with SARS-CoV-2-What is known and what remains a mystery. Respirology 2021; 26:652-665. [PMID: 34041821 PMCID: PMC8242464 DOI: 10.1111/resp.14091] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.
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Affiliation(s)
- Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - John Nicholls
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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de Bruin S, Bos LD, van Roon MA, Tuip-de Boer AM, Schuurman AR, Koel-Simmelinck MJA, Bogaard HJ, Tuinman PR, van Agtmael MA, Hamann J, Teunissen CE, Wiersinga WJ, Koos Zwinderman AH, Brouwer MC, van de Beek D, Vlaar APJ. Clinical features and prognostic factors in Covid-19: A prospective cohort study. EBioMedicine 2021; 67:103378. [PMID: 34000622 PMCID: PMC8118723 DOI: 10.1016/j.ebiom.2021.103378] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mortality rates are high among hospitalized patients with COVID-19, especially in those intubated on the ICU. Insight in pathways associated with unfavourable outcome may lead to new treatment strategies. METHODS We performed a prospective cohort study of patients with COVID-19 admitted to general ward or ICU who underwent serial blood sampling. To provide insight in the pathways involved in disease progression, associations were estimated between outcome risk and serial measurements of 64 biomarkers in potential important pathways of COVID-19 infection (inflammation, tissue damage, complement system, coagulation and fibrinolysis) using joint models combining Cox regression and linear mixed-effects models. For patients admitted to the general ward, the primary outcome was admission to the ICU or mortality (unfavourable outcome). For patients admitted to the ICU, the primary outcome was 12-week mortality. FINDINGS A total of 219 patients were included: 136 (62%) on the ward and 119 patients (54%) on the ICU; 36 patients (26%) were included in both cohorts because they were transferred from general ward to ICU. On the general ward, 54 of 136 patients (40%) had an unfavourable outcome and 31 (23%) patients died. On the ICU, 54 out of 119 patients (45%) died. Unfavourable outcome on the general ward was associated with changes in concentrations of IL-6, IL-8, IL-10, soluble Receptor for Advanced Glycation End Products (sRAGE), vascular cell adhesion molecule 1 (VCAM-1) and Pentraxin-3. Death on the ICU was associated with changes in IL-6, IL-8, IL-10, sRAGE, VCAM-1, Pentraxin-3, urokinase-type plasminogen activator receptor, IL-1-receptor antagonist, CD14, procalcitonin, tumor necrosis factor alfa, tissue factor, complement component 5a, Growth arrest-specific 6, angiopoietin 2, and lactoferrin. Pathway analysis showed that unfavourable outcome on the ward was mainly driven by chemotaxis and interleukin production, whereas death on ICU was associated with a variety of pathways including chemotaxis, cell-cell adhesion, innate host response mechanisms, including the complement system, viral life cycle regulation, angiogenesis, wound healing and response to corticosteroids. INTERPRETATION Clinical deterioration in patients with severe COVID-19 involves multiple pathways, including chemotaxis and interleukin production, but also endothelial dysfunction, the complement system, and immunothrombosis. Prognostic markers showed considerable overlap between general ward and ICU patients, but we identified distinct differences between groups that should be considered in the development and timing of interventional therapies in COVID-19. FUNDING Amsterdam UMC, Amsterdam UMC Corona Fund, and Dr. C.J. Vaillant Fonds.
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Affiliation(s)
- Sanne de Bruin
- From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lieuwe D Bos
- From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marian A van Roon
- Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anita M Tuip-de Boer
- From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alex R Schuurman
- Department of Infectious Diseases, University of Amsterdam, Amsterdam UMC, Amsterdam Infection and Immunity, Amsterdam, The Netherlands
| | - Marleen J A Koel-Simmelinck
- Neurochemistry Laboratory, Department of Clinical Chemistry, Free University, Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter Roel Tuinman
- Department of Intensive Care, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jörg Hamann
- Biobank Core Facility, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Free University, Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Department of Infectious Diseases, University of Amsterdam, Amsterdam UMC, Amsterdam Infection and Immunity, Amsterdam, The Netherlands
| | - A H Koos Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Alexander P J Vlaar
- From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Tanni SE, Fabro AT, de Albuquerque A, Ferreira EVM, Verrastro CGY, Sawamura MVY, Ribeiro SM, Baldi BG. Pulmonary fibrosis secondary to COVID-19: a narrative review. Expert Rev Respir Med 2021; 15:791-803. [PMID: 33902377 DOI: 10.1080/17476348.2021.1916472] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is still increasing worldwide, and as a result, the number of patients with pulmonary fibrosis secondary to COVID-19 will expand over time. Risk factors, histopathological characterization, pathophysiology, prevalence, and management of post-COVID-19 pulmonary fibrosis are poorly understood, and few studies have addressed these issues.Areas covered:This article reviews the current evidence regarding post-COVID-19 pulmonary fibrosis, with an emphasis on the potential risk factors, histopathology, pathophysiology, functional and tomographic features, and potential therapeutic modalities. A search on the issue was performed in the MEDLINE, Embase, and SciELO databases and the Cochrane library between 1 December 2019, and 25 January 2021. Studies were reviewed and relevant topics were incorporated into this narrative review. Expert opinion: Pulmonary sequelae may occur secondary to COVID-19, which needs to be included as a potential etiology in the current differential diagnosis of pulmonary fibrosis. Therefore, serial clinical, tomographic, and functional screening for pulmonary fibrosis is recommended after COVID-19, mainly in patients with pulmonary involvement in the acute phase of the disease. Further studies are necessary to determine the risk factors, markers, pathophysiology, and appropriate management of post-COVID-19 pulmonary fibrosis.
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Affiliation(s)
- Suzana Erico Tanni
- Division of Internal Medicine of Botucatu Medical School, São Paulo State University-UNESP, Botucatu, Brazil
| | - Alexandre Todorovic Fabro
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - André de Albuquerque
- Divisão De Pneumologia, Instituto Do Coração (Incor), Hospital Das Clínicas HCFMUSP, Faculdade De Medicina, Universidade De São Paulo, São Paulo, SP, Brazil
| | | | | | - Márcio Valente Yamada Sawamura
- Instituto De Radiologia, Hospital Das Clínicas HCFMUSP, Faculdade De Medicina, Universidade De São Paulo, São Paulo, SP, Brazil
| | - Sergio Marrone Ribeiro
- Department of Radiology, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, Brazil
| | - Bruno Guedes Baldi
- Divisão De Pneumologia, Instituto Do Coração (Incor), Hospital Das Clínicas HCFMUSP, Faculdade De Medicina, Universidade De São Paulo, São Paulo, SP, Brazil
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Abstract
PURPOSE OF REVIEW COVID-19 lung injury is a common manifestation of severe illness. Lung tissue examination has been largely derived from autopsy - a combination of case reports, small and moderately sized series with international scope. Common and uncommon histopathology provides insight into the progression of severe, fatal disease. RECENT FINDINGS COVID-19 lung histology is most commonly diffuse alveolar damage as part of acute respiratory distress syndrome. Lung injury can be temporally heterogeneous, with patterns of healing alongside new injury. Viral studies, including immunohistochemistry, RNA in-situ hybridization, and tissue-based Polymerase chain reaction (PCR) assist in discerning complications of therapy (e.g. ventilator-associated pneumonia) from primary viral-induced injury. Response to viral infection produces systemic effects, and one major manifestation is thrombosis of micro-circulation and larger vessels. Less common patterns include neutrophil-rich inflammation, raising speculation that neutrophil extra-cellular traps may play a role in both viral control and exaggerated immune response. SUMMARY The heterogeneity of fatal cases- persistence of viral infection in lung, clearance of virus but severe lung injury, thrombosis, and exaggerated immune response - suggest that antiviral, antithrombotic, anti-inflammatory, and supportive therapy play a role in treatment, but that the patient-specific cause and timing of the lung injury is important in choosing intervention.
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Sessa F, Salerno M, Pomara C. Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:309. [PMID: 33806100 PMCID: PMC8064502 DOI: 10.3390/medicina57040309] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome-Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, Institute of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
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Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, Mehta AC, Mukhopadhyay S. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol 2021; 155:506-514. [PMID: 33316056 PMCID: PMC7799292 DOI: 10.1093/ajcp/aqaa264] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. METHODS We conducted a retrospective case series. RESULTS The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. CONCLUSIONS This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.
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Affiliation(s)
| | | | - Ruchi Yadav
- Imaging Institute, and Cleveland Clinic, Cleveland, OH
| | - Summer L Nugent
- Department of Pathology Critical Care, WellSpan York Hospital, York, PA
| | - Dmitriy Zubkus
- Department of Pulmonary and Critical Care, WellSpan York Hospital, York, PA
| | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Brogna B, Bignardi E, Brogna C, Volpe M, Lombardi G, Rosa A, Gagliardi G, Capasso PFM, Gravino E, Maio F, Pane F, Picariello V, Buono M, Colucci L, Musto LA. A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia. Diagnostics (Basel) 2021; 11:437. [PMID: 33806423 PMCID: PMC8000129 DOI: 10.3390/diagnostics11030437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays an important role in the detection of coronavirus (COVID-19) pneumonia in both managing the disease and evaluating the complications. Imaging with chest computed tomography (CT) can also have a potential predictive and prognostic role in COVID-19 patient outcomes. The aim of this pictorial review is to describe the role of imaging with chest X-ray (CXR), lung ultrasound (LUS), and CT in the diagnosis and management of COVID-19 pneumonia, the current indications, the scores proposed for each modality, the advantages/limitations of each modality and their role in detecting complications, and the histopathological correlations.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Elio Bignardi
- Radiology Unit, Cotugno Hospital, Naples, Via Quagliariello 54, 80131 Naples, Italy;
| | - Claudia Brogna
- Neuropsychiatric Unit ASL Avellino, Via Degli Imbimbo 10/12, 83100 Avellino, Italy;
| | - Mena Volpe
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Giulio Lombardi
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Alessandro Rosa
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Giuliano Gagliardi
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Pietro Fabio Maurizio Capasso
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Enzo Gravino
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Francesca Maio
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Francesco Pane
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Valentina Picariello
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Marcella Buono
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Lorenzo Colucci
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
| | - Lanfranco Aquilino Musto
- Department of Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (M.V.); (G.L.); (A.R.); (G.G.); (P.F.M.C.); (E.G.); (F.M.); (F.P.); (V.P.); (M.B.); (L.C.); (L.A.M.)
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Li Y, Wu J, Wang S, Li X, Zhou J, Huang B, Luo D, Cao Q, Chen Y, Chen S, Ma L, Peng L, Pan H, Travis WD, Nie X. Progression to fibrosing diffuse alveolar damage in a series of 30 minimally invasive autopsies with COVID-19 pneumonia in Wuhan, China. Histopathology 2021; 78:542-555. [PMID: 32926596 PMCID: PMC8848295 DOI: 10.1111/his.14249] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
AIMS Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), infection has been deemed as a global pandemic by the World Health Organisation. While diffuse alveolar damage (DAD) is recognised to be the primary manifestation of COVID-19 pneumonia, there has been little emphasis on the progression to the fibrosing phase of DAD. This topic is of great interest, due to growing concerns regarding the potential long-term complications in prolonged survivors. METHODS AND RESULTS Here we report a detailed histopathological study of 30 autopsy cases with COVID-19 virus infection, based on minimally invasive autopsies performed between February and March, 2020. The mean age was 69 years, with 20 (67%) males and 10 (33%) females and frequent (70.0%) underlying comorbidities. The duration of illness ranged from 16 to 82 (median = 42) days. Histologically, the most common manifestation was diffuse alveolar damage (DAD) in 28 (93.3%) cases which showed predominantly acute (32%), organising (25%) and/or fibrosing (43%) patterns. Patients with fibrosing DAD were one decade younger (P = 0.034) and they had a longer duration of illness (P = 0.033), hospitalisation (P = 0.037) and mechanical ventilation (P = 0.014) compared to those with acute DAD. Patients with organising DAD had a longer duration of illness (P = 0.032) and hospitalisation (P = 0.023) compared to those with acute DAD. CONCLUSIONS COVID-19 pneumonia patients who develop DAD can progress to the fibrosing pattern. While we observed fibrosing DAD in fatal cases, whether or not surviving patients are at risk for developing pulmonary fibrosis and the frequency of this complication will require further clinical and radiological follow-up studies.
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Affiliation(s)
- Yan Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Wu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sihua Wang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjie Zhou
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danju Luo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Cao
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajun Chen
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Chen
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Ma
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Peng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaxiong Pan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
BACKGROUND Analyses for the presence of SARS-CoV‑2 in the tissues of COVID-19 patients is important in order to improve our understanding of the disease pathophysiology for interpretation of diagnostic histopathological findings in autopsies, biopsies, or surgical specimens and to assess the potential for occupational infectious hazard. MATERIAL AND METHODS In this review we identified 136 published studies in PubMed's curated literature database LitCovid on SARS-CoV‑2 detection methods in tissues and evaluated them regarding sources of error, specificity, and sensitivity of the methods, taking into account our own experience. RESULTS Currently, no sufficiently specific histomorphological alterations or diagnostic features for COVID-19 are known. Therefore, three approaches for SARS-CoV‑2 detection are used: RNA, proteins/antigens, or morphological detection by electron microscopy. In the preanalytical phase, the dominant source of error is tissue quality, especially the different intervals between sample collection and processing or fixation (and its duration) and specifically the interval between death and sample collection in autopsies. However, this information is found in less than half of the studies (e.g., in only 42% of autopsy studies). Our own experience and first studies prove the significantly higher sensitivity and specificity of RNA-based detection methods compared to antigen or protein detection by immunohistochemistry or immunofluorescence. Detection by electron microscopy is time consuming and difficult to interpret. CONCLUSIONS Different methods are available for the detection of SARS-CoV‑2 in tissue. Currently, RNA detection by RT-PCR is the method of choice. However, extensive validation studies and method harmonization are not available and are absolutely necessary.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
- Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Clancy CJ, Schwartz IS, Kula B, Nguyen MH. Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies. Open Forum Infect Dis 2021; 8:ofab065. [PMID: 33732753 PMCID: PMC7928570 DOI: 10.1093/ofid/ofab065] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Limited clinical data suggest a ~16% prevalence of bacterial superinfections among critically ill patients with coronavirus disease 2019 (COVID-19). METHODS We reviewed postmortem studies of patients with COVID-19 published in English through September 26, 2020, for histopathologic findings consistent with bacterial lung infections. RESULTS Worldwide, 621 patients from 75 studies were included. The quality of data was uneven, likely because identifying superinfections was not a major objective in 96% (72/75) of studies. Histopathology consistent with a potential lung superinfection was reported in 32% (200/621) of patients (22-96 years old; 66% men). Types of infections were pneumonia (95%), abscesses or empyema (3.5%), and septic emboli (1.5%). Seventy-three percent of pneumonias were focal rather than diffuse. The predominant histopathologic findings were intra-alveolar neutrophilic infiltrations that were distinct from those typical of COVID-19-associated diffuse alveolar damage. In studies with available data, 79% of patients received antimicrobial treatment; the most common agents were beta-lactam/beta-lactamase inhibitors (48%), macrolides (16%), cephalosoprins (12%), and carbapenems (6%). Superinfections were proven by direct visualization or recovery of bacteria in 25.5% (51/200) of potential cases and 8% of all patients in postmortem studies. In rank order, pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Lung superinfections were the cause of death in 16% of potential cases and 3% of all patients with COVID-19. CONCLUSIONS Potential bacterial lung superinfections were evident at postmortem examination in 32% of persons who died with COVID-19 (proven, 8%; possible, 24%), but they were uncommonly the cause of death.
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Affiliation(s)
- Cornelius J Clancy
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Kula
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Hong Nguyen
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Jackson NR, Zeigler K, Torrez M, Makino Y, Adolphi NL, Lathrop S, Decker L, Dvorscak L, Proe L, Paul ID, Zumwalt R, Jarrell H. New Mexico's COVID-19 Experience. Am J Forensic Med Pathol 2021; 42:1-8. [PMID: 33416234 PMCID: PMC7870043 DOI: 10.1097/paf.0000000000000664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.
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Affiliation(s)
- Nicole R. Jackson
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Karen Zeigler
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Mary Torrez
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Yohsuke Makino
- Department of Forensic Medicine, University of Tokyo, Tokyo
- Department of Forensic Radiology and Imaging, Chiba University, Chiba, Japan
| | - Natalie L. Adolphi
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Sarah Lathrop
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Lauren Decker
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Lauren Dvorscak
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Lori Proe
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Ian D. Paul
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Ross Zumwalt
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
| | - Heather Jarrell
- From the Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
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64
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McMullen PD, Cho JH, Miller JL, Husain AN, Pytel P, Krausz T. A Descriptive and Quantitative Immunohistochemical Study Demonstrating a Spectrum of Platelet Recruitment Patterns Across Pulmonary Infections Including COVID-19. Am J Clin Pathol 2021; 155:354-363. [PMID: 33174599 PMCID: PMC7717231 DOI: 10.1093/ajcp/aqaa230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Pulmonary platelet deposition and microangiopathy are increasingly recognized components of coronavirus disease 2019 (COVID-19) infection. Thrombosis is a known component of sepsis and disseminated intravascular coagulation. We sought to compare the level of platelet deposition in the pulmonary vasculature in cases of confirmed COVID-19 infection to other lung injuries and infections. METHODS Immunohistochemistry was performed on 27 autopsy cases and 2 surgical pathology cases targeting CD61. Multiple cases of normal lung, diffuse alveolar damage, COVID-19, influenza, and bacterial and fungal infections, as well as one case of pulmonary emboli, were included. The levels of CD61 staining were compared quantitatively in the autopsy cases, and patterns of staining were described. RESULTS Nearly all specimens exhibited an increase in CD61 staining relative to control lung tissue. The area of CD61 staining in COVID-19 infection was higher than influenza but still comparable to many other infectious diseases. Cases of aspiration pneumonia, Staphylococcus aureus infection, and blastomycosis exhibited the highest levels of CD61 staining. CONCLUSIONS Platelet deposition is a phenomenon common to many pulmonary insults. A spectrum of staining patterns was observed, suggestive of pathogen-specific mechanisms of platelet deposition. Further study into the mechanisms driving platelet deposition in pulmonary injuries and infections is warranted.
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Affiliation(s)
- Phillip D McMullen
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Joseph H Cho
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Jonathan L Miller
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Aliya N Husain
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Peter Pytel
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Thomas Krausz
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
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65
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Bashir DA, Da Q, Pradhan S, Sekhar N, Valladolid C, Lam F, Guffey D, Goldman J, Desai MS, Cruz MA, Allen C, Nguyen TC, Vijayan KV. Secretion of von Willebrand Factor and Suppression of ADAMTS-13 Activity by Markedly High Concentration of Ferritin. Clin Appl Thromb Hemost 2021; 27:1076029621992128. [PMID: 33539188 PMCID: PMC7868463 DOI: 10.1177/1076029621992128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hyperferritinemia is associated with poor outcomes in critically ill patients with sepsis, hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndromes (MAS) and coronavirus disease 19 (COVID-19). Autopsies of hyperferritinemic patients that succumbed to either sepsis, HLH, MAS or COVID-19 have revealed disseminated microvascular thromboses with von Willebrand factor (VWF)-, platelets-, and/or fibrin-rich microthrombi. It is unknown whether high plasma ferritin concentration actively promotes microvascular thrombosis, or merely serves as a prognostic biomarker in these patients. Here, we show that secretion of VWF from human umbilical vein endothelial cells (HUVEC) is significantly enhanced by 100,000 ng/ml of recombinant ferritin heavy chain protein (FHC). Ferritin fraction that was isolated by size exclusion chromatography from the plasma of critically ill HLH patients promoted VWF secretion from HUVEC, compared to similar fraction from non-critically ill control plasma. Furthermore, recombinant FHC moderately suppressed the activity of VWF cleaving metalloprotease ADAMTS-13. These observations suggest that a state of marked hyperferritinemia could promote thrombosis and organ injury by inducing endothelial VWF secretion and reducing the ADAMTS-13 activity.
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Affiliation(s)
- Dalia A Bashir
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - Qi Da
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Subhashree Pradhan
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nitin Sekhar
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christian Valladolid
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fong Lam
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Jordana Goldman
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Miguel A Cruz
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Carl Allen
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Trung C Nguyen
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
| | - K Vinod Vijayan
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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66
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Brumeanu TD, Vir P, Karim AF, Kar S, Benetiene D, Lok M, Greenhouse J, Putmon-Taylor T, Kitajewski C, Chung KK, Pratt KP, Casares SA. A Human-Immune-System (HIS) humanized mouse model (DRAGA: HLA-A2. HLA-DR4. Rag1 KO.IL-2Rγc KO. NOD) for COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021. [PMID: 32839773 PMCID: PMC7444284 DOI: 10.1101/2020.08.19.251249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report the first Human Immune System (HIS)-humanized mouse model (“DRAGA”: HLA-A2.HLA-DR4.Rag1KO.IL-2RγcKO.NOD) for COVID-19 research. This mouse is reconstituted with human cord blood-derived, HLA-matched hematopoietic stem cells. It engrafts human epi/endothelial cells expressing the human ACE2 receptor for SARS-CoV-2 and TMPRSS2 serine protease co-localized on lung epithelia. HIS-DRAGA mice sustained SARS-CoV-2 infection, showing deteriorated clinical condition, replicating virus in the lungs, and human-like lung immunopathology including T-cell infiltrates, microthrombi and pulmonary sequelae. Among T-cell infiltrates, lung-resident (CD103+) CD8+ T cells were sequestered in epithelial (CD326+) lung niches and secreted granzyme B and perforin, indicating cytotoxic potential. Infected mice also developed antibodies against the SARS-CoV-2 viral proteins. Hence, HIS-DRAGA mice showed unique advantages as a surrogate in vivo human model for studying SARS-CoV-2 immunopathology and for testing the safety and efficacy of candidate vaccines and therapeutics.
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Affiliation(s)
- Teodor-D Brumeanu
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A
| | - Pooja Vir
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A
| | - Ahmad Faisal Karim
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A
| | | | | | - Megan Lok
- Bioqual Inc., Rockville, MD 20852, U.S.A
| | | | | | | | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A
| | - Kathleen P Pratt
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A
| | - Sofia A Casares
- Uniformed Services University of the Health Sciences, Department of Medicine, Division of Immunology, Bethesda, MD 20814, U.S.A.,Naval Medical Research Center/Walter Reed Army Institute of Research, Infectious Diseases Directorate, Silver Spring, MD 20910, U.S.A
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67
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Kwaan HC, Lindholm PF. The Central Role of Fibrinolytic Response in COVID-19-A Hematologist's Perspective. Int J Mol Sci 2021; 22:1283. [PMID: 33525440 PMCID: PMC7919196 DOI: 10.3390/ijms22031283] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease (COVID-19) has many characteristics common to those in two other coronavirus acute respiratory diseases, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). They are all highly contagious and have severe pulmonary complications. Clinically, patients with COVID-19 run a rapidly progressive course of an acute respiratory tract infection with fever, sore throat, cough, headache and fatigue, complicated by severe pneumonia often leading to acute respiratory distress syndrome (ARDS). The infection also involves other organs throughout the body. In all three viral illnesses, the fibrinolytic system plays an active role in each phase of the pathogenesis. During transmission, the renin-aldosterone-angiotensin-system (RAAS) is involved with the spike protein of SARS-CoV-2, attaching to its natural receptor angiotensin-converting enzyme 2 (ACE 2) in host cells. Both tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) are closely linked to the RAAS. In lesions in the lung, kidney and other organs, the two plasminogen activators urokinase-type plasminogen activator (uPA) and tissue plasminogen activator (tPA), along with their inhibitor, plasminogen activator 1 (PAI-1), are involved. The altered fibrinolytic balance enables the development of a hypercoagulable state. In this article, evidence for the central role of fibrinolysis is reviewed, and the possible drug targets at multiple sites in the fibrinolytic pathways are discussed.
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Affiliation(s)
- Hau C. Kwaan
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Paul F. Lindholm
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
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68
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Szabolcs M, Sauter JL, Frosina D, Geronimo JA, Hernandez E, Selbs E, Rapkiewicz AV, Rekhtman N, Baine MK, Jäger E, Travis WD, Jungbluth AA. Identification of Immunohistochemical Reagents for In Situ Protein Expression Analysis of Coronavirus-associated Changes in Human Tissues. Appl Immunohistochem Mol Morphol 2021; 29:5-12. [PMID: 33086222 PMCID: PMC7713639 DOI: 10.1097/pai.0000000000000878] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023]
Abstract
We studied the suitability of commercially available monoclonal antibodies (mAbs) for the immunohistochemical (IHC) detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in standard archival specimens. Antibodies were screened on HEK293 cells transfected with viral nucleoprotein, S1 subunit and S2 subunit of spike protein and on untransfected cells, as well as a panel of normal tissue. Lung tissue with presence of SARS-CoV2 confirmed by in situ hybridization (ISH) was also used. A total of 7 mAbs were tested: (1) mAb 001 (Sino Biological, 40143-R001), (2) mAb 007 (Sino Biological, 40150-R007), (3) mAb 019 (Sino Biological, 40143-R019), (4) mAb 1A9 (GeneTex, GTX632604), (5) mAb ABM19C9 (Abeomics, 10-10007), (6) FIPV3-70 (Santa Cruz, SC-65653), and (7) mAb 6F10 (BioVision, A2060). Only 2 mAbs, clone 001 to the nucleoprotein and clone 1A9 to the S2 subunit spike protein displayed specific immunoreactivity. Both clones showed strong staining in the acute phase of COVID-19 pneumonia, mostly in areas of acute diffuse alveolar damage, but were not completely congruent. Viral protein was also found in kidney tubules, endothelia of multiple organs and a nasal swab of a patient with persistent SARS-CoV2 infection. The other tested reagents were either poorly reactive or demonstrated nonspecific staining in tissues and lesions not infected by SARS-CoV2. Our study demonstrates that rigid specificity testing is mandatory for the evaluation of mAbs to SARS-CoV2 and that clones 001 to nucleoprotein and 1A9 to S2 subunit spike protein are useful for the in situ detection of SARS-CoV2.
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Affiliation(s)
| | - Jennifer L. Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Denise Frosina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Jerica A. Geronimo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Enmily Hernandez
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Elena Selbs
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY
| | - Amy V. Rapkiewicz
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Marina K. Baine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Elke Jäger
- Department of Oncology, Medical Center Nordwest, Frankfurt, Germany
| | - William D. Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Achim A. Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
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69
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Akilesh S, Nast CC, Yamashita M, Henriksen K, Charu V, Troxell ML, Kambham N, Bracamonte E, Houghton D, Ahmed NI, Chong CC, Thajudeen B, Rehman S, Khoury F, Zuckerman JE, Gitomer J, Raguram PC, Mujeeb S, Schwarze U, Shannon MB, De Castro I, Alpers CE, Najafian B, Nicosia RF, Andeen NK, Smith KD. Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria. Am J Kidney Dis 2021; 77:82-93.e1. [PMID: 33045255 PMCID: PMC7546949 DOI: 10.1053/j.ajkd.2020.10.001] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE & OBJECTIVE Kidney biopsy data inform us about pathologic processes associated with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a multicenter evaluation of kidney biopsy findings in living patients to identify various kidney disease pathology findings in patients with coronavirus disease 2019 (COVID-19) and their association with SARS-CoV-2 infection. STUDY DESIGN Case series. SETTING & PARTICIPANTS We identified 14 native and 3 transplant kidney biopsies performed for cause in patients with documented recent or concurrent SARS-CoV-2 infection treated at 7 large hospital systems in the United States. OBSERVATIONS Men and women were equally represented in this case series, with a higher proportion of Black (n=8) and Hispanic (n=5) patients. All 17 patients had SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction, but only 3 presented with severe COVID-19 symptoms. Acute kidney injury (n=15) and proteinuria (n=11) were the most common indications for biopsy and these symptoms developed concurrently or within 1 week of COVID-19 symptoms in all patients. Acute tubular injury (n=14), collapsing glomerulopathy (n=7), and endothelial injury/thrombotic microangiopathy (n=6) were the most common histologic findings. 2 of the 3 transplant recipients developed active antibody-mediated rejection weeks after COVID-19. 8 patients required dialysis, but others improved with conservative management. LIMITATIONS Small study size and short clinical follow-up. CONCLUSIONS Cases of even symptomatically mild COVID-19 were accompanied by acute kidney injury and/or heavy proteinuria that prompted a diagnostic kidney biopsy. Although acute tubular injury was seen among most of them, uncommon pathology such as collapsing glomerulopathy and acute endothelial injury were detected, and most of these patients progressed to irreversible kidney injury and dialysis.
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Affiliation(s)
- Shreeram Akilesh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA.
| | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Vivek Charu
- Department of Pathology, Stanford University, Stanford, CA
| | | | | | | | - Donald Houghton
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | | | - Chyi Chyi Chong
- Division of Nephrology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Bijin Thajudeen
- Division of Nephrology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Shehzad Rehman
- Division of Nephrology Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Firas Khoury
- Oregon Kidney & Hypertension Clinic, Portland, OR
| | - Jonathan E Zuckerman
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | | | | - Ulrike Schwarze
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - M Brendan Shannon
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Iris De Castro
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Charles E Alpers
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Behzad Najafian
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Roberto F Nicosia
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Nicole K Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR.
| | - Kelly D Smith
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA.
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Parada D, Peña KB, Gumà J, Guilarte C, Riu F. Liquid-based cytological and immunohistochemical study of nasopharyngeal swab from persons under investigation for SARS-CoV-2 infection. Histopathology 2020; 78:586-592. [PMID: 32970870 PMCID: PMC7537171 DOI: 10.1111/his.14257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022]
Abstract
Introduction We describe cytologic and immunohistologic findings in virus transport medium on cases under investigation of SARS‐CoV‐2 infection. Methods Cytologic findings in cases under investigation of SARS‐CoV‐2 infection from one hundred consecutive nasopharyngeal swab were reviewed. Immunohistochemistry and SARSCoV‐2 RT‐PCR determination were performed to detect virus. Results No viral inclusions were noted in squamous cells obtained from virus transport medium. Immunohistochemical study with monoclonal antibody against SARS‐CoV‐2 viral nucleoprotein showed positivity in squamous cells. No positivity was present in others cellular components. Conclusions SARS‐CoV‐2 predominantly localizes squamous cells in cytology samples of patients with RT‐PCR positive determination of SARSCoV‐2. The results of the current study support the notion that the nasopharyngeal region is the anatomical station that SARS‐CoV‐2 infects first, and the infection can lead to the migration of the virus into the lower airways.
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Affiliation(s)
- David Parada
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Karla B Peña
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Josep Gumà
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Carmen Guilarte
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Francesc Riu
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Facultat de Medicine, Universitat Rovira i Virgili, Reus, Spain
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71
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COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol 2020; 33:2156-2168. [PMID: 32879413 PMCID: PMC7463226 DOI: 10.1038/s41379-020-00661-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/04/2023]
Abstract
SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.
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72
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Toldo S, Bussani R, Nuzzi V, Bonaventura A, Mauro AG, Cannatà A, Pillappa R, Sinagra G, Nana-Sinkam P, Sime P, Abbate A. Inflammasome formation in the lungs of patients with fatal COVID-19. Inflamm Res 2020; 70:7-10. [PMID: 33079210 PMCID: PMC7572246 DOI: 10.1007/s00011-020-01413-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Objective The orf8b protein of the coronavirus SARS-CoV, analogous to SARS-CoV-2, triggers the NLRP3 inflammasome in macrophages in vitro. Deregulated inflammasome-mediated release of interleukin-1 family cytokines is important in hyper-inflammatory syndromes, like happens in SARS-CoV-2-mediated cytokine release syndrome. We propose that an intense inflammasome formation characterizes the lungs of patients with fatal COVID-19 disease due to pneumonia and acute respiratory distress syndrome (ARDS). Methods Samples from four patients with confirmed COVID-19 pneumonia who had been hospitalized at the Hospital of the University of Trieste (Italy) and died of ARDS and four lung samples from a historical repository from subjects who had died of cardiopulmonary arrest and had not been placed on mechanical ventilation and without evidence of pulmonary infection at postmortem examination were collected. Pathology samples had been fixed in formalin 10% at time of collection and subsequently embedded in paraffin. We conducted staining for ASC (Apoptosis-associated Speck-like protein containing a Caspase recruitment domain), NLRP3 (NACHT, LRR, and PYD domains-containing protein 3), and cleaved caspase-1. Results Intense expression of the inflammasome was detected, mainly in leukocytes, within the lungs of all patients with fatal COVID-19 in the areas of lung injury. The number of ASC inflammasome specks per high power fields was significantly higher in the lungs of patients with fatal COVID-19 as compared with the lungs of control subjects (52 ± 22 vs 6 ± 3, P = 0.0064). Conclusions These findings identify the presence of NLRP3 inflammasome aggregates in the lungs of fatal COVID-19 pneumonia thus providing the potential molecular link between viral infection and cytokine release syndrome. Electronic supplementary material The online version of this article (10.1007/s00011-020-01413-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Toldo
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA.
| | - Rossana Bussani
- Istituto di Anatomia Patologica, Università di Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Istitituto di Cardiologia, Università di Trieste, Trieste, Italy
| | - Aldo Bonaventura
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
| | - Adolfo G Mauro
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
| | - Antonio Cannatà
- Istitituto di Cardiologia, Università di Trieste, Trieste, Italy
| | | | | | - Patrick Nana-Sinkam
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Sime
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
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73
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Sanguedolce F, Zanelli M, Ascani S, Zizzo M, Tortorella S, Soriano A, Cavazza A, Sollitto F, Loizzi D. SARS-CoV-2-related lung pathology: macroscopic and histologic features and their clinical implications. Panminerva Med 2020; 64:80-95. [PMID: 33073555 DOI: 10.23736/s0031-0808.20.04157-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ongoing global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been posing challenges to proper patients' management. Lungs are the first, and often the most affected organ by SARS-CoV-2; viral infection involves and damages both epithelial and vascular compartments, sometimes leading to severe and even fatal acute respiratory distress syndrome. Histopathological findings, mainly from postmortem examination of COVID-19 deceased patients, have been increasingly published in the last few months, helping to elucidate the sequence of events resulting in organ injury, and the complex multifactorial pathogenesis of this novel disease. A multidisciplinary approach to autopsy, including light microscopy examination along with the detection of viral proteins and/or RNA in tissue samples through ancillary techniques, provided crucial information on the mechanisms underlying the often-heterogeneous clinical picture of COVID-19.
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Affiliation(s)
- Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy -
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Tortorella
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Alessandra Soriano
- Gastroenterology, Division and Inflammatory Bowel Disease Center Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Domenico Loizzi
- Institute of Thoracic Surgery, University of Foggia, Foggia, Italy
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Zheng WJ, Yan Q, Ni YS, Zhan SF, Yang LL, Zhuang HF, Liu XH, Jiang Y. Examining the effector mechanisms of Xuebijing injection on COVID-19 based on network pharmacology. BioData Min 2020; 13:17. [PMID: 33082858 PMCID: PMC7563914 DOI: 10.1186/s13040-020-00227-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background Chinese medicine Xuebijing (XBJ) has proven to be effective in the treatment of mild coronavirus disease 2019 (COVID-19) cases. But the bioactive compounds and potential mechanisms of XBJ for COVID-19 prevention and treatment are unclear. This study aimed to examine the potential effector mechanisms of XBJ on COVID-19 based on network pharmacology. Methods We searched Chinese and international papers to obtain the active ingredients of XBJ. Then, we compiled COVID-19 disease targets from the GeneCards gene database and via literature searches. Next, we used the SwissTargetPrediction database to predict XBJ’s effector targets and map them to the abovementioned COVID-19 disease targets in order to obtain potential therapeutic targets of XBJ. Cytoscape software version 3.7.0 was used to construct a “XBJ active-compound-potential-effector target” network and protein-protein interaction (PPI) network, and then to carry out network topology analysis of potential targets. We used the ClueGO and CluePedia plugins in Cytoscape to conduct gene ontology (GO) biological process (BP) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis of XBJ’s effector targets. We used AutoDock vina and PyMOL software for molecular docking. Results We obtained 144 potential COVID-19 effector targets of XBJ. Fourteen of these targets-glyceraldehyde 3-phosphate dehydrogenase (GAPDH), albumin (ALB), tumor necrosis factor (TNF), epidermal growth factor receptor (EGFR), mitogen-activated protein kinase 1 (MAPK1), Caspase-3 (CASP3), signal transducer and activator of transcription 3 (STAT3), MAPK8, prostaglandin-endoperoxide synthase 2 (PTGS2), JUN, interleukin-2 (IL-2), estrogen receptor 1 (ESR1), and MAPK14 had degree values > 40 and therefore could be considered key targets. They participated in extracellular signal–regulated kinase 1 and 2 (ERK1, ERK2) cascade, the T-cell receptor signaling pathway, activation of MAPK activity, cellular response to lipopolysaccharide, and other inflammation- and immune-related BPs. XBJ exerted its therapeutic effects through the renin-angiotensin system (RAS), nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), MAPK, phosphatidylinositol-4, 5-bisphosphate 3-kinase (PI3K)-protein kinase B (Akt)-vascular endothelial growth factor (VEGF), toll-like receptor (TLR), TNF, and inflammatory-mediator regulation of transient receptor potential (TRP) signaling pathways to ultimately construct a “drug-ingredient-target-pathway” effector network. The molecular docking results showed that the core 18 effective ingredients had a docking score of less than − 4.0 with those top 10 targets. Conclusion The active ingredients of XBJ regulated different genes, acted on different pathways, and synergistically produced anti-inflammatory and immune-regulatory effects, which fully demonstrated the synergistic effects of different components on multiple targets and pathways. Our study demonstrated that key ingredients and their targets have potential binding activity, the existing studies on the pharmacological mechanisms of XBJ in the treatment of sepsis and severe pneumonia, could explain the effector mechanism of XBJ in COVID-19 treatment, and those provided a preliminary examination of the potential effector mechanism in this disease.
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Affiliation(s)
- Wen-Jiang Zheng
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qian Yan
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Shi Ni
- The Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shao-Feng Zhan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liu-Liu Yang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Fa Zhuang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Hong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Jiang
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
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75
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Takano AM. Pulmonary pathology of infection by SARS-CoV-2, what we have learnt through post-mortem studies and pathophysiological considerations. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820960495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Since the declaration of Coronavirus Disease 2019 (COVID-19) caused the by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic, millions of people throughout the world have contracted the disease and more than 500,000 have died. While this terrible disease has brought devastation to many countries, it has also generated the fastest growing amount of research output that science has seen during the last decades. Objectives: The objectives of this work were to review the pulmonary pathology from post-mortem studies and case reports of patients who succumbed to COVID-19, perform clinicopathologic correlation and hypothesize about pathogenetic mechanisms, and translate this understanding into better prevention, management and outcomes in the battle against COVID-19. Method: I performed a literature search through PubMed. Results: The main histopathologic findings in COVID-19 pneumonia are diffuse alveolar damage, organizing pneumonia, acute fibrinous and organizing pneumonia, interstitial pneumonia, endotheliitis, thromboembolism that correlates with respiratory failure and manifestations of thrombotic microangiopathy and hypercoagulable state. Immunohistochemical and transmission electron microscopic studies demonstrate viral proteins and viral structures within epithelial and endothelial cells. Reverse transcriptase polymerase chain reaction demonstrates the presence of viral RNA in nasopharynx and lung tissue post-mortem. Conclusions: SARS-CoV-2 is a respiratory virus that infects cells by binding to angiotensin-converting enzyme II (ACE2) receptors, produces cell death and ACE2 downregulation, which, in conjunction with dysregulated immune response, orchestrates a proinflammatory and prothrombic state that results in respiratory and multiple organ failure.
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Affiliation(s)
- Angela M Takano
- Department of Anatomical pathology, Singapore General Hospital, Singapore
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Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, Pelosi P, Patroniti NA, De Lucia A, Orengo G, Gratarola A, Verda M, Cittadini G, Mastracci L, Fiocca R. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch 2020; 478:471-485. [PMID: 32989525 PMCID: PMC7521863 DOI: 10.1007/s00428-020-02934-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.
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Affiliation(s)
- Emanuela Barisione
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Lorenzo Ball
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Rita Bianchi
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Marco Grosso
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Patrizia Morbini
- Unit of Pathology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pelosi
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Nicolò Antonino Patroniti
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Arduino De Lucia
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Giovanni Orengo
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Angelo Gratarola
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Marta Verda
- Radiology, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Giuseppe Cittadini
- General Radiology, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy.
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy.
| | - Roberto Fiocca
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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