Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies?
Danny JonigkChristopher WerleinTill AckerMartin AepfelbacherKerstin U AmannGustavo BarettonPeter BarthRainer M BohleAndreas BüttnerReinhard BüttnerReinhard DettmeyerPhilip EichhornSefer ElezkurtajIrene EspositoKatja EvertMatthias EvertFalko FendNikolaus GaßlerStefan GattenlöhnerMarkus GlatzelHeike GöbelElise GradhandTorsten HansenArndt HartmannAxel HeinemannFrank L HeppnerJulia HilsenbeckDavid HorstJan C KampGita MallBruno MärklBenjamin OndruschkaJessica PablikSusanne PfefferleAlexander QuaasHelena RadbruchChristoph RöckenAndreas RosenwaldWilfried RothMartina RudeliusPeter SchirmacherJulia Slotta-HuspeninaKevin SmithLinna SommerKonrad StockPhilipp StröbelStephanie StroblUlf TitzeGregor WeirichJoachim WeisMartin WernerClaudia WickenhauserThorsten WiechPeter WildTobias WelteSaskia von StillfriedPeter BoorPublished in: Virchows Archiv : an international journal of pathology (2022)
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.
Keyphrases
- sars cov
- coronavirus disease
- respiratory syndrome coronavirus
- oxidative stress
- systematic review
- gene expression
- endothelial cells
- quality improvement
- induced apoptosis
- randomized controlled trial
- computed tomography
- single cell
- magnetic resonance imaging
- dna methylation
- endoplasmic reticulum stress
- genome wide
- sensitive detection
- low grade
- pulmonary embolism
- current status
- high grade