Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
- PMID: 32437596
- PMCID: PMC7412750
- DOI: 10.1056/NEJMoa2015432
Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
Abstract
Background: Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.
Methods: We examined 7 lungs obtained during autopsy from patients who died from Covid-19 and compared them with 7 lungs obtained during autopsy from patients who died from acute respiratory distress syndrome (ARDS) secondary to influenza A(H1N1) infection and 10 age-matched, uninfected control lungs. The lungs were studied with the use of seven-color immunohistochemical analysis, micro-computed tomographic imaging, scanning electron microscopy, corrosion casting, and direct multiplexed measurement of gene expression.
Results: In patients who died from Covid-19-associated or influenza-associated respiratory failure, the histologic pattern in the peripheral lung was diffuse alveolar damage with perivascular T-cell infiltration. The lungs from patients with Covid-19 also showed distinctive vascular features, consisting of severe endothelial injury associated with the presence of intracellular virus and disrupted cell membranes. Histologic analysis of pulmonary vessels in patients with Covid-19 showed widespread thrombosis with microangiopathy. Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza (P<0.001). In lungs from patients with Covid-19, the amount of new vessel growth - predominantly through a mechanism of intussusceptive angiogenesis - was 2.7 times as high as that in the lungs from patients with influenza (P<0.001).
Conclusions: In our small series, vascular angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection. The universality and clinical implications of our observations require further research to define. (Funded by the National Institutes of Health and others.).
Copyright © 2020 Massachusetts Medical Society.
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Comment in
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Covid-19, Angiogenesis, and ARDS Endotypes.N Engl J Med. 2020 Jul 9;383(2):182-183. doi: 10.1056/NEJMe2018629. Epub 2020 May 21. N Engl J Med. 2020. PMID: 32437597 No abstract available.
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Pericyte alteration sheds light on micro-vasculopathy in COVID-19 infection.Intensive Care Med. 2020 Sep;46(9):1777-1778. doi: 10.1007/s00134-020-06147-7. Epub 2020 Jun 12. Intensive Care Med. 2020. PMID: 32533198 Free PMC article. No abstract available.
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Pulmonary Vascular Pathology in Covid-19.N Engl J Med. 2020 Aug 27;383(9):886-887. doi: 10.1056/NEJMc2022068. Epub 2020 Jul 17. N Engl J Med. 2020. PMID: 32678531 No abstract available.
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Pulmonary Vascular Pathology in Covid-19.N Engl J Med. 2020 Aug 27;383(9):887. doi: 10.1056/NEJMc2022068. Epub 2020 Jul 17. N Engl J Med. 2020. PMID: 32678532 No abstract available.
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Pulmonary Vascular Pathology in Covid-19.N Engl J Med. 2020 Aug 27;383(9):887-888. doi: 10.1056/NEJMc2022068. Epub 2020 Jul 17. N Engl J Med. 2020. PMID: 32678533 No abstract available.
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In vivo demonstration of pulmonary microvascular involvement in COVID-19 using dual-energy computed tomography.Eur Respir J. 2020 Oct 29;56(4):2002608. doi: 10.1183/13993003.02608-2020. Print 2020 Oct. Eur Respir J. 2020. PMID: 32943402 Free PMC article.
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Alternate mechanisms of SARS-CoV-2-induced analgesia and additional pathological significance of SARS-CoV-2 spike protein interaction with vascular endothelial growth factor-A/neuropilin-1 receptor signaling.Pain. 2021 Dec 1;162(12):2956-2957. doi: 10.1097/j.pain.0000000000002447. Pain. 2021. PMID: 34793407 No abstract available.
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