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Cell Res ; 31(8): 836-846, 2021 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1275907

RESUMEN

Severe COVID-19 disease caused by SARS-CoV-2 is frequently accompanied by dysfunction of the lungs and extrapulmonary organs. However, the organotropism of SARS-CoV-2 and the port of virus entry for systemic dissemination remain largely unknown. We profiled 26 COVID-19 autopsy cases from four cohorts in Wuhan, China, and determined the systemic distribution of SARS-CoV-2. SARS-CoV-2 was detected in the lungs and multiple extrapulmonary organs of critically ill COVID-19 patients up to 67 days after symptom onset. Based on organotropism and pathological features of the patients, COVID-19 was divided into viral intrapulmonary and systemic subtypes. In patients with systemic viral distribution, SARS-CoV-2 was detected in monocytes, macrophages, and vascular endothelia at blood-air barrier, blood-testis barrier, and filtration barrier. Critically ill patients with long disease duration showed decreased pulmonary cell proliferation, reduced viral RNA, and marked fibrosis in the lungs. Permanent SARS-CoV-2 presence and tissue injuries in the lungs and extrapulmonary organs suggest direct viral invasion as a mechanism of pathogenicity in critically ill patients. SARS-CoV-2 may hijack monocytes, macrophages, and vascular endothelia at physiological barriers as the ports of entry for systemic dissemination. Our study thus delineates systemic pathological features of SARS-CoV-2 infection, which sheds light on the development of novel COVID-19 treatment.


Asunto(s)
COVID-19/patología , Pulmón/virología , SARS-CoV-2/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Autopsia , COVID-19/virología , China , Estudios de Cohortes , Enfermedad Crítica , Femenino , Fibrosis , Hospitalización , Humanos , Riñón/patología , Riñón/virología , Leucocitos Mononucleares/patología , Leucocitos Mononucleares/virología , Pulmón/patología , Masculino , Persona de Mediana Edad , ARN Viral/metabolismo , SARS-CoV-2/genética , Bazo/patología , Bazo/virología , Tráquea/patología , Tráquea/virología
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