Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies?

Acute kidney damage Diffuse alveolar damage Immune response SARS-CoV-2

Journal

Virchows Archiv : an international journal of pathology
ISSN: 1432-2307
Titre abrégé: Virchows Arch
Pays: Germany
ID NLM: 9423843

Informations de publication

Date de publication:
Aug 2022
Historique:
received: 24 01 2022
accepted: 25 03 2022
revised: 22 03 2022
pubmed: 3 4 2022
medline: 4 8 2022
entrez: 2 4 2022
Statut: ppublish

Résumé

The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.

Identifiants

pubmed: 35364700
doi: 10.1007/s00428-022-03319-2
pii: 10.1007/s00428-022-03319-2
pmc: PMC8975445
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

139-159

Subventions

Organisme : Bundesministerium für Bildung und Forschung
ID : 01KX2021
Organisme : Bundesministerium für Gesundheit
ID : ZMVI1-2520COR201

Informations de copyright

© 2022. The Author(s).

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Auteurs

Danny Jonigk (D)

Institute of Pathology, Hannover Medical School, Hannover, Germany. jonigk.danny@mh-hannover.de.

Christopher Werlein (C)

Institute of Pathology, Hannover Medical School, Hannover, Germany.

Till Acker (T)

Institute of Neuropathology, University Hospital Giessen and Marburg, Giessen, Germany.

Martin Aepfelbacher (M)

Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Kerstin U Amann (KU)

Department of Nephropathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.

Gustavo Baretton (G)

Department of Pathology, University Hospital Dresden, Dresden, Germany.

Peter Barth (P)

Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany.

Rainer M Bohle (RM)

Department of Pathology, University Hospital Saarland Homburg, Homburg, Germany.

Andreas Büttner (A)

Institute of Forensic Medicine, University Medical Center Rostock, Rostock, Germany.

Reinhard Büttner (R)

Department of Pathology, University Hospital Cologne, Cologne, Germany.

Reinhard Dettmeyer (R)

Department of Legal Medicine, University Hospital Giessen and Marburg, Giessen, Germany.

Philip Eichhorn (P)

Department of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.

Sefer Elezkurtaj (S)

Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Irene Esposito (I)

Department of Pathology, University Hospital Düsseldorf, Düsseldorf, Germany.

Katja Evert (K)

Department of Pathology, University Hospital Regensburg, Regensburg, Germany.

Matthias Evert (M)

Department of Pathology, University Hospital Regensburg, Regensburg, Germany.

Falko Fend (F)

Department of Pathology, University Hospital Tübingen, Tübingen, Germany.

Nikolaus Gaßler (N)

Department of Pathology, University Hospital Jena, Jena, Germany.

Stefan Gattenlöhner (S)

Department of Pathology, University Hospital Giessen and Marburg, Giessen, Germany.

Markus Glatzel (M)

Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Heike Göbel (H)

Department of Pathology, University Hospital Cologne, Cologne, Germany.

Elise Gradhand (E)

Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany.

Torsten Hansen (T)

Department of Pathology, University Hospital OWL of the Bielefeld University, Campus Lippe, Detmold, Germany.

Arndt Hartmann (A)

Department of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.

Axel Heinemann (A)

Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Frank L Heppner (FL)

Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
Cluster of Excellence, NeuroCure, Berlin, Germany.

Julia Hilsenbeck (J)

Department of Pathology, University Hospital Dresden, Dresden, Germany.

David Horst (D)

Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Jan C Kamp (JC)

Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Gita Mall (G)

Department of Legal Medicine, University Hospital Jena, Jena, Germany.

Bruno Märkl (B)

General Pathology and Molecular Diagnostics, University Hospital Augsburg, Augsburg, Germany.

Benjamin Ondruschka (B)

Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Jessica Pablik (J)

Department of Pathology, University Hospital Dresden, Dresden, Germany.

Susanne Pfefferle (S)

Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Alexander Quaas (A)

Department of Pathology, University Hospital Cologne, Cologne, Germany.

Helena Radbruch (H)

Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Christoph Röcken (C)

Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany.

Andreas Rosenwald (A)

Institute of Pathology, University of Würzburg, Würzburg, Germany.

Wilfried Roth (W)

Department of Pathology, University Medical Center Mainz, Mainz, Germany.

Martina Rudelius (M)

Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany.

Peter Schirmacher (P)

Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany.

Julia Slotta-Huspenina (J)

Department of Pathology, TUM School of Medicine of Technical University of Munich, Munich, Germany.

Kevin Smith (K)

Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany.

Linna Sommer (L)

Department of Pathology, University Hospital Dresden, Dresden, Germany.

Konrad Stock (K)

Department of Nephrology, TUM School of Medicine of Technical University of Munich, Munich, Germany.

Philipp Ströbel (P)

Department of Pathology, University Medical Center Göttingen, Göttingen, Germany.

Stephanie Strobl (S)

Department of Pathology, University Medical Center Mainz, Mainz, Germany.

Ulf Titze (U)

Department of Pathology, University Hospital OWL of the Bielefeld University, Campus Lippe, Detmold, Germany.

Gregor Weirich (G)

Department of Pathology, TUM School of Medicine of Technical University of Munich, Munich, Germany.

Joachim Weis (J)

Department of Neuropathology, University Hospital RWTH Aachen, Aachen, Germany.

Martin Werner (M)

Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany.

Claudia Wickenhauser (C)

Department of Pathology, University Hospital Halle (Saale), Halle (Saale), Germany.

Thorsten Wiech (T)

Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Peter Wild (P)

Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany.

Tobias Welte (T)

Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Saskia von Stillfried (S)

Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany.

Peter Boor (P)

Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany. pboor@ukaachen.de.
Department of Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany. pboor@ukaachen.de.

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