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Rybakova MG, Myurzep AE. [Pathogenesis of pulmonary fibrosis]. Arkh Patol 2024; 86:58-63. [PMID: 39073544 DOI: 10.17116/patol20248604158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
A literature review reflects data on the mechanisms of pulmonary fibrosis after a novel coronavirus infection associated with the SARS-COV2 virus. Factors contributing to post-COVID lung remodeling are considered. According to the literature, in the mechanism of pulmonary fibrosis, during the course of the disease and during the recovery period, both direct viral damage and death of alveolocytes and endothelium, the development of a systemic inflammatory reaction due to inadequate secretion of cytokines, especially type 2, which are activators of the proliferation of fibroblasts and myofibroblasts, are important. The influence of angiogenesis disorders and vascular dysfunction on pneumofibrosis was noted. Attention is also paid to the relationship between the development of pulmonary fibrosis and abnormal activation of the renin-angiotensin-aldosterone system. In combination with the action of many factors, especially germinal ones, an imbalance between profibrogenic and antifibrogenic action develops and fibrosis occurs.
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Affiliation(s)
- M G Rybakova
- Academician I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - A E Myurzep
- Academician I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
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Soffritti I, D’Accolti M, Fabbri C, Passaro A, Manfredini R, Zuliani G, Libanore M, Franchi M, Contini C, Caselli E. Oral Microbiome Dysbiosis Is Associated With Symptoms Severity and Local Immune/Inflammatory Response in COVID-19 Patients: A Cross-Sectional Study. Front Microbiol 2021; 12:687513. [PMID: 34248910 PMCID: PMC8261071 DOI: 10.3389/fmicb.2021.687513] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
The human oral microbiome (HOM) is the second largest microbial community after the gut and can impact the onset and progression of several localized and systemic diseases, including those of viral origin, especially for viruses entering the body via the oropharynx. However, this important aspect has not been clarified for the new pandemic human coronavirus SARS-CoV-2, causing COVID-19 disease, despite it being one of the many respiratory viruses having the oropharynx as the primary site of replication. In particular, no data are available about the non-bacterial components of the HOM (fungi, viruses), which instead has been shown to be crucial for other diseases. Consistent with this, this study aimed to define the HOM in COVID-19 patients, to evidence any association between its profile and the clinical disease. Seventy-five oral rinse samples were analyzed by Whole Genome Sequencing (WGS) to simultaneously identify oral bacteria, fungi, and viruses. To correlate the HOM profile with local virus replication, the SARS-CoV-2 amount in the oral cavity was quantified by digital droplet PCR. Moreover, local inflammation and secretory immune response were also assessed, respectively by measuring the local release of pro-inflammatory cytokines (L-6, IL-17, TNFα, and GM-CSF) and the production of secretory immunoglobulins A (sIgA). The results showed the presence of oral dysbiosis in COVID-19 patients compared to matched controls, with significantly decreased alpha-diversity value and lower species richness in COVID-19 subjects. Notably, oral dysbiosis correlated with symptom severity (p = 0.006), and increased local inflammation (p < 0.01). In parallel, a decreased mucosal sIgA response was observed in more severely symptomatic patients (p = 0.02), suggesting that local immune response is important in the early control of virus infection and that its correct development is influenced by the HOM profile. In conclusion, the data presented here suggest that the HOM profile may be important in defining the individual susceptibility to SARS-CoV-2 infection, facilitating inflammation and virus replication, or rather, inducing a protective IgA response. Although it is not possible to determine whether the alteration in the microbial community is the cause or effect of the SARS-CoV-2 replication, these parameters may be considered as markers for personalized therapy and vaccine development.
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Affiliation(s)
- Irene Soffritti
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria D’Accolti
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Chiara Fabbri
- Section of Dentistry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Angela Passaro
- Unit of Internal Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Medical Clinic Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- Unit of Internal Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Libanore
- Unit of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy
| | - Maurizio Franchi
- Section of Dentistry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Contini
- Section of Infectious Diseases and Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Elisabetta Caselli
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
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Parra-Medina R, Herrera S, Mejia J. Systematic Review of Microthrombi in COVID-19 Autopsies. Acta Haematol 2021; 144:476-483. [PMID: 33873184 PMCID: PMC8089413 DOI: 10.1159/000515104] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Histopathological analysis can provide additional clues in COVID-19 understanding. During the last year, autopsy reports have revealed that diffuse alveolar damage (DAD) is the most significant observed finding. The aim of this study is to review cases in the literature about COVID-19 autopsies that reported microthrombi in different organs. METHODS We performed a systematic literature review in PubMed, Virtual Health Library (VHL), and Google Scholar. RESULTS In total, 151 autopsies were included, and 91 cases presented microthrombi in the lung (73%), heart (11.2%), kidney (24%), and liver (16.3%). The age range was between 27 and 96 years. Males were 64.8%. The patients with microthrombi had more comorbidities such as arterial hypertension (62%), obesity or overweight (64%), diabetes mellitus type 2 (51%), and heart disease (53%). The most common histopathological changes found in patients with lung microthrombosis were DAD in exudative phase (78%), pulmonary embolism (59%), and lung infarct (81%). Presence of microthrombi was associated with arterial hypertension (p < 0.0001) and DAD in exudative and proliferative phases (p = 0.02). DISCUSSION The analysis of these results shows that microthrombi in COVID-19 autopsies may be found in different organs and are more frequent in patients with comorbidities, pulmonary embolism, and lung infarct.
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Affiliation(s)
- Rafael Parra-Medina
- Research Institute, Pathology Department, Fundación Univeristaria de Ciencias de la Salud, Bogotá, Colombia
- Instituto Nacional de Cancerología, Pathology Department, Bogotá, Colombia
| | | | - Jaime Mejia
- Instituto de Patologia Mejia Jimenez, Department of Pathology, Cali, Colombia
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Marik PE, Iglesias J, Varon J, Kory P. A scoping review of the pathophysiology of COVID-19. Int J Immunopathol Pharmacol 2021; 35:20587384211048026. [PMID: 34569339 PMCID: PMC8477699 DOI: 10.1177/20587384211048026] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a highly heterogeneous and complex medical disorder; indeed, severe COVID-19 is probably amongst the most complex of medical conditions known to medical science. While enormous strides have been made in understanding the molecular pathways involved in patients infected with coronaviruses an overarching and comprehensive understanding of the pathogenesis of COVID-19 is lacking. Such an understanding is essential in the formulation of effective prophylactic and treatment strategies. Based on clinical, proteomic, and genomic studies as well as autopsy data severe COVID-19 disease can be considered to be the connection of three basic pathologic processes, namely a pulmonary macrophage activation syndrome with uncontrolled inflammation, a complement-mediated endothelialitis together with a procoagulant state with a thrombotic microangiopathy. In addition, platelet activation with the release of serotonin and the activation and degranulation of mast cells contributes to the hyper-inflammatory state. Auto-antibodies have been demonstrated in a large number of hospitalized patients which adds to the end-organ damage and pro-thrombotic state. This paper provides a clinical overview of the major pathogenetic mechanism leading to severe COVID-19 disease.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Front Line Covid-19 Critical Care Alliance
| | - Jose Iglesias
- Department of Nephrology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
- Front Line Covid-19 Critical Care Alliance
| | - Joseph Varon
- Department of Critical Care Medicine, United Memorial Medical Center, Houston, TX, USA
- Front Line Covid-19 Critical Care Alliance
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