TY - JOUR
T1 - COVID-19
T2 - immunopathology, pathophysiological mechanisms, and treatment options
AU - van Eijk, Larissa E.
AU - Binkhorst, Mathijs
AU - Bourgonje, Arno R.
AU - Offringa, Annette K.
AU - Mulder, Douwe J.
AU - Bos, Eelke M.
AU - Kolundzic, Nikola
AU - Abdulle, Amaal E.
AU - van der Voort, Peter H.J.
AU - Olde Rikkert, Marcel G.M.
AU - van der Hoeven, Johannes G.
AU - den Dunnen, Wilfred F.A.
AU - Hillebrands, Jan Luuk
AU - van Goor, Harry
N1 - Publisher Copyright:
© 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread globally despite the worldwide implementation of preventive measures to combat the disease. Although most COVID-19 cases are characterised by a mild, self-limiting disease course, a considerable subset of patients develop a more severe condition, varying from pneumonia and acute respiratory distress syndrome (ARDS) to multi-organ failure (MOF). Progression of COVID-19 is thought to occur as a result of a complex interplay between multiple pathophysiological mechanisms, all of which may orchestrate SARS-CoV-2 infection and contribute to organ-specific tissue damage. In this respect, dissecting currently available knowledge of COVID-19 immunopathogenesis is crucially important, not only to improve our understanding of its pathophysiology but also to fuel the rationale of both novel and repurposed treatment modalities. Various immune-mediated pathways during SARS-CoV-2 infection are relevant in this context, which relate to innate immunity, adaptive immunity, and autoimmunity. Pathological findings in tissue specimens of patients with COVID-19 provide valuable information with regard to our understanding of pathophysiology as well as the development of evidence-based treatment regimens. This review provides an updated overview of the main pathological changes observed in COVID-19 within the most commonly affected organ systems, with special emphasis on immunopathology. Current management strategies for COVID-19 include supportive care and the use of repurposed or symptomatic drugs, such as dexamethasone, remdesivir, and anticoagulants. Ultimately, prevention is key to combat COVID-19, and this requires appropriate measures to attenuate its spread and, above all, the development and implementation of effective vaccines.
AB - Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread globally despite the worldwide implementation of preventive measures to combat the disease. Although most COVID-19 cases are characterised by a mild, self-limiting disease course, a considerable subset of patients develop a more severe condition, varying from pneumonia and acute respiratory distress syndrome (ARDS) to multi-organ failure (MOF). Progression of COVID-19 is thought to occur as a result of a complex interplay between multiple pathophysiological mechanisms, all of which may orchestrate SARS-CoV-2 infection and contribute to organ-specific tissue damage. In this respect, dissecting currently available knowledge of COVID-19 immunopathogenesis is crucially important, not only to improve our understanding of its pathophysiology but also to fuel the rationale of both novel and repurposed treatment modalities. Various immune-mediated pathways during SARS-CoV-2 infection are relevant in this context, which relate to innate immunity, adaptive immunity, and autoimmunity. Pathological findings in tissue specimens of patients with COVID-19 provide valuable information with regard to our understanding of pathophysiology as well as the development of evidence-based treatment regimens. This review provides an updated overview of the main pathological changes observed in COVID-19 within the most commonly affected organ systems, with special emphasis on immunopathology. Current management strategies for COVID-19 include supportive care and the use of repurposed or symptomatic drugs, such as dexamethasone, remdesivir, and anticoagulants. Ultimately, prevention is key to combat COVID-19, and this requires appropriate measures to attenuate its spread and, above all, the development and implementation of effective vaccines.
KW - acute respiratory distress syndrome (ARDS)
KW - angiotensin-converting enzyme 2 (ACE2)
KW - autoimmunity
KW - coronavirus disease 2019 (COVID-19)
KW - diffuse alveolar damage (DAD)
KW - immunopathology
KW - pathology
KW - pathophysiology
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85103201390&partnerID=8YFLogxK
U2 - 10.1002/path.5642
DO - 10.1002/path.5642
M3 - Review article
C2 - 33586189
AN - SCOPUS:85103201390
SN - 0022-3417
VL - 254
SP - 307
EP - 331
JO - Journal of Pathology
JF - Journal of Pathology
IS - 4
ER -