![]() ![]() Our findings provide new evidence on pathological changes associated with COVID-19 and suggest clinical approaches against the disease.Ĭlinical characteristics of the COVID-19 autopsy casesĪ total of 12 autopsy cases in this study included seven males (58.3%) and five females (41.7%). To profile pathological changes underlying the severe respiratory distress syndrome and immune dysfunction in critically ill COVID-19 patients, we performed systematic autopsy and comprehensive pathological analyses of 12 deceased patients with COVID-19. While clinical observations supported that most of the critically ill COVID-19 patients manifested severe immune disorders, which might result in damages to the lungs and multiple extrapulmonary organs, the changes of immune cell signature in the lungs and lymphatic organs such as the spleen and lymph nodes have not been fully investigated. Recent investigations through full autopsy or minimally invasive autopsy of COVID-19 decedents by us and other laboratories, revealed that SARS-CoV-2 hijacked angiotensin converting enzyme 2 (ACE2) for entry into target cells to cause severe pathologic changes in the lungs and multiple extrapulmonary organs/tissues. However, COVID-19-associated pathological alterations and the underlying translational relevance are still to be elucidated. Thus, the virological, epidemiological and clinical characteristics of COVID-19 have been extensively investigated and the clinical features profiled. Although COVID-19 is generally an acute self-limited disease featured with pneumonia, approximately 15% of COVID-19 patients, especially those of an older age and with pre-existing medical conditions, can rapidly develop fatal systematic conditions, such as acute respiratory distress syndrome and severe cardiovascular or renal injuries, among which 5%–6% of cases may progress into critical status with high mortality. ![]() Since the end of 2019, COVID-19, caused by a novel coronavirus SARS-CoV-2, has caused a global pandemic. ![]() Although most coronaviruses cause mild respiratory diseases in humans, the epidemics of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) and the Middle East respiratory syndrome-associated coronavirus (MERS-CoV) totaled over 10 000 cumulative cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV. These findings provide pathological evidence that links injuries of the lungs and lymphatic organs with the fatal systematic respiratory and immune malfunction in critically ill COVID-19 patients.Ĭoronaviruses are non-segmented positive-sense RNA viruses that are constantly transmitted from animals to humans. The spleen and hilar lymph nodes contained lesions with tissue structure disruption and immune cell dysregulation, including lymphopenia and macrophage accumulation. Here we show that the major pulmonary alterations included diffuse alveolar damage, interstitial fibrosis and exudative inflammation featured with extensive serous and fibrin exudates, macrophage infiltration and abundant production of inflammatory factors (IL-6, IP-10, TNFα and IL-1β). In this study, we report the autopsy findings from the lungs and lymphatic organs of 12 COVID-19 decedents-findings that evaluated histopathological changes, immune cell signature and inflammatory factor expression in the lungs, spleen and lymph nodes. Systematic autopsy and comprehensive pathological analyses of COVID-19 decedents should provide insights into the disease characteristics and facilitate the development of novel therapeutics. ![]()
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