Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19

Luke Milross; Joaquim Majo; Nigel Cooper; Paul M Kaye; Omer Bayraktar; Andrew Filby; Andrew J Fisher

doi:10.1016/S2213-2600(21)00408-2

Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19

Luke Milross, Joaquim Majo, Nigel Cooper, Paul M Kaye, Omer Bayraktar, Andrew Filby, Andrew J Fisher

The Hull York Medical School

Research output: Contribution to journal › Review article › peer-review

Abstract

The lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.

Original language	English
Pages (from-to)	95-106
Number of pages	11
Journal	The Lancet. Respiratory medicine
Volume	10
Issue number	1
DOIs	https://doi.org/10.1016/S2213-2600(21)00408-2
Publication status	E-pub ahead of print - 3 Dec 2021

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10.1016/S2213-2600(21)00408-2

Cite this

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title = "Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19",

abstract = "The lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.",

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AU - Bayraktar, Omer

AU - Filby, Andrew

AU - Fisher, Andrew J

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AB - The lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.

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