Lung Pathology of COVID-19 in Moscow

Самсонова, М. В.; Mikhalyova, L.M.; Zayratyants, O. V.; Varyasin, V.V.; Быканова, А. В.; Od, Mishnev; Berezovsky, Yu.S.; Tishkevitch, O.A.; Gomzikova, E.A.; Chernyayev, A. L.; Khovanskaya, T.N.

doi:10.17116/patol20208204132

Cited by 25 publications

(10 citation statements)

References 19 publications

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“…Samsonova M.V. et al showed [46] single megakaryocytes in the capillaries of the interalveolar septa in the lungs of those who died from COVID-19 in the first week of the disease. Intensity of VWF immunohistochemical staining in the endothelium according to the results of our study is noted at later stages of the disease.…”

Section: Discussionmentioning

confidence: 99%

The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19

Babkina

Острова

Yadgarov

et al. 2022

Viruses

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The increased plasma levels of von Willebrand factor (VWF) in patients with COVID-19 was reported in many studies, and its correlation with disease severity and mortality suggest its important role in the pathogenesis of thrombosis in COVID-19. We performed histological and immunohistochemical studies of the lungs of 29 patients who died from COVID-19. We found a significant increase in the intensity of immunohistochemical reaction for VWF in the pulmonary vascular endothelium when the disease duration was more than 10 days. In the patients who had thrombotic complications, the VWF immunostaining in the pulmonary vascular endothelium was significantly more intense than in nonsurvivors without thrombotic complications. Duration of disease and thrombotic complications were found to be independent predictors of increased VWF immunostaining in the endothelium of pulmonary vessels. We also revealed that bacterial pneumonia was associated with increased VWF staining intensity in pulmonary arterial, arteriolar, and venular endothelium, while lung ventilation was an independent predictor of increased VWF immunostaining in arterial endothelium. The results of the study demonstrated an important role of endothelial VWF in the pathogenesis of thrombus formation in COVID-19.

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Section: Discussionmentioning

confidence: 99%

The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19

Babkina

Острова

Yadgarov

et al. 2022

Viruses

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“…Обнаруженные нами изменения в кровеносных сосудах (полнокровие, феномен сладжа эритроцитов, формирование тромбов, набухание стенок) и строме (диапедезные и массивные кровоизлияния) лимфатических узлов сходны с явлениями, описанными отечест венными и зарубежными авторами в ткани легких, а также в селезенке и лимфоузлах [11][12][13]34], и иллюстрируют эндотелиальные нарушения и изменения сис темы свертываемости крови, которые определяются лабораторно. Часто наблюдаемое развитие гиперкоагуляционного синдрома у пациентов с COVID-19 непосредственно связано с патогенезом заболевания: одним из основных предполагаемых механизмов считается связывание вирусом рецептора АПФ2 (молекулярная мишень для SARS-CoV-2) при его проникновении в эндотелиоциты и, как следствие, нарушение метаболизма ангиотензина II, приводящее к активации эндотелия, выбросу провоспалительных цитокинов, нарушению проницаемости стенки сосудов разного калибра и их целостности, формированию эндотелиита и тромбоваскулитов [18,19,34].…”

Section: Discussionunclassified

“…В то же время наши знания о взаимодействии вируса SARS-CoV-2 с клетками иммунного ответа и его влияние на лимфоидную ткань до сих пор весьма ограничены. Так, на протяжении месяцев исследований основное внимание при изучении патогенеза COVID-19 уделялось механизмам проникновения вируса в клетки-мишени (несут на мембране рецептор -АПФ2), цитопатическому действию вируса на клетки-мишени и местной иммунной дисфункции, а именно развитию синдрома активации макрофагов и нерегулируемого выброса цитокинов и хемокинов («цитокиновый шторм») в органах-мишенях, в первую очередь легких [11][12][13][14][15][16]. На сегодняшний день доказана важная роль в патогенезе тяжелого течения COVID-19 гиперкоагуляционного и ДВС-синдромов [17][18][19].…”

Section: Introductionunclassified

“…B. Diao et al показали, что происходит не только деплеция циркулирующих Т-клеток, но и их функциональное истощение, что подтверждается повышенной экспрессией на их мембране PD-1 [24]. Кроме того, получены данные о динамике лимфоидной инфильтрации в легочной ткани на разных этапах развития поражения легких [11,12,20]. Вместе с тем детальный анализ морфологического субстрата изменений иммунного статуса, в том числе особенностей лимфоидной ткани в лимфатических узлах, практически не проводился.…”

Section: Introductionunclassified

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Pathomorphological and immunohistochemical features of lymph nodes in COVID-19 patients (autopsy study)

Kovrigina¹,

Shalamova²,

Berezovsky³

et al. 2020

Clin. Exp. Morphology

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Introduction. The pathogenesis of the novel coronavirus infection COVID-19 is being actively studied. Nevertheless, our up-to-date knowledge of lymphoid tissue response in the secondary immune organs dur-ing severe COVID-19 remains extremely limited. The aim of the study was to evaluate patterns of immu-nomorphological alterations in lymph nodes in patients with severe COVID-19 and to assess lymphocytes functional activity in them. Materials and methods. Lymph node tissue (autopsy material) from 17 deceased patients with severe COVID-19 was examined by histological and immunohistochemical methods using antibodies to CD4, CD8, CD20, CD30, CD123, CD138, PD-1. Results. Examined lymph nodes demonstrated lymphoid follicles reduction and paracortex expansion with reactive plasmacytosis and extrafollicular B-cell activation as well as sinus histiocytosis, variable hemophago-cytic cells, and blood vessel congestion. Red thrombi were observed in some lymph nodes. Hemorrhages in the stroma were frequent, and massive hemorrhages were found in individual nodes. Immunohistochemical study revealed CD4+ T-helpers predominance in the paracortex andcytotoxic CD8+ lymphocytes depletion together with an increase in the expression of both the PD-1 suppressor protein and the CD30 activation anti-gen on the lymphocyte surface. CD123-positive plasmacytoid dendritic cells resided in sinuses in abundance. Conclusion. Demonstrated B-associated zone reduction and cytotoxic T-lymphocytes depletion with an up-regulation of PD-1 expression in the lymph nodes in patients with severe COVID-19 indicate immune response exhaustion. At the same time, observed significant reactive plasmacytosis with the presence of numerous T-helper cells constitutes a morphological substrate of the humoral immunity. These findings might indicate the ineffec-tiveness of the humoral response at late stages of COVID-19 infection in context of cytotoxic immunity failure. Keywords: novel coronavirus infection, SARS-CoV-2, COVID-19, B- and T- immune response, lymph node

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“…[5], Borczuk, A.C. et al [8] and Samsonova М.V. et al [9] reported about autopsy investigation in COVID-19 patients but the information is still limited. More data is available from the SARS-CoV-1 coronavirus epidemic that happened in 2003 when the autopsy showed diff use alveolar damage (DAD), which included edema, hyaline membranes, pneumocytes and fi broblast proliferation [5,10].…”

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confidence: 99%

Covid-19 Pulmonary Pathology: A Multi-Institutional Autopsy Cohort From Lviv and Lviv Region

Kuzyk

Gavrilyuk²,

Semko³

et al. 2022

PSSS MS

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Introduction. Worldwide, more than 182 million cases of COVID-19 and more than 3.9 million deaths have been confi rmed since the virus was fi rst identifi ed. Advanced age and some comorbid conditions, such as diabetes and cardiovascular diseases, are considered risk factors for the adverse course of the discussed pathology. In recent years, several reports have been published about the results of the pathological examination of patients with COVID-19. Most often, in fatal cases, diff use alveolar damage is described, which is characterized by intraalveolar edema, the appearance of "hyaline" membranes and the proliferation of pneumocytes and fi broblasts. However, the nature of the damage caused by SARS-CoV-2 remains unclear. The study of pathomorphological changes in severe fatal cases of COVID-19 is important for a better understanding of pathogenetic mechanisms of the development of pulmonary complications and the development of new eff ective methods of antiviral treatment.The aim of the current study is to evaluate the gross and microscopic fi ndings in COVID-19 patients' autopsy to investigate the clinicopathologic basis for adverse outcomes with a fatal course of the disease. Methods.A retrospective analysis of 1036 consecutive autopsies associated with COVID-19 in 2020 was conducted based on Lviv Regional Offi ce for Autopsy and Lviv Railway Clinical Hospital. The diagnosis of COVID-19 was confi rmed by clinical signs of viral pneumonia, nasopharyngeal smear analysis, and radiological changes. A statistical study was performed with IBM SPSS Statistics 24.0.Results. The majority (72.4%) were elderly (60+) males (54.1±1.5%) and females (45.9±1.5%), with an age range from 19 to 93 years (mean age 66.9 ± 0.4 years). All examined patients had pneumonia, which was detected during a clinical examination with CT diagnosis and confi rmed at autopsy. The acute exudative phase of pneumonia was diagnosed in 18.5±1.2% of cases, proliferative phase -in 18.5±1.2%, and fi brotic phase -in 5.9±0.7%. And in 53.5±1.5% of cases, signs of progressive fi brosis associated with exudative lesions prevailed. COVID-19 was the single original cause of death in 88.7±1.0% of cases. The following were identifi ed in the lungs: typical virus-induced changes in epithelial cells of the trachea, bronchi, bronchioles and alveoli (100%, n=1036); diff erent phases of diff use alveolar damage in the majority of cases (96.5±0.6%); manifestations of innate immunity were described; pathological changes in the microvasculature (large vessel thrombi were detected in 37.9±1.5%). Conclusion.Our study results prove the importance of pathological examination of tissues during autopsies to determine the pathophysiological mechanisms and underlying causes of death of patients with COVID-19.

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Lung Pathology of COVID-19 in Moscow

Cited by 25 publications

References 19 publications

The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19

The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19

Pathomorphological and immunohistochemical features of lymph nodes in COVID-19 patients (autopsy study)

Covid-19 Pulmonary Pathology: A Multi-Institutional Autopsy Cohort From Lviv and Lviv Region

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