Histopathology and genetic susceptibility in COVID‐19 pneumonia

• Published in: European journal of clinical investigation Vol. 50; no. 7; pp. e13259 - n/a
• Main Authors: von der Thüsen, Jan, Eerden, Menno
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.07.2020; John Wiley and Sons Inc
• Subjects: Age Factors; Angiotensin-Converting Enzyme 2; Betacoronavirus; Complications; Coronavirus Infections - epidemiology; Coronavirus Infections - genetics; Coronavirus Infections - immunology; Coronavirus Infections - pathology; Coronaviruses; COVID-19; Cytokine Release Syndrome - immunology; Damage patterns; Diabetes mellitus; Diabetes Mellitus - epidemiology; Edema - pathology; Fibrosis; Genetic Predisposition to Disease; Genetics; Genotyping; Histopathology; HLA Antigens - genetics; Humans; Hypertension; Hypertension - epidemiology; Illnesses; Inflammation - immunology; Inflammation - pathology; Influenza; Influenza, Human - pathology; Obesity - epidemiology; Original; Pandemics; Pathogenesis; Peptidyl-Dipeptidase A - genetics; Phenotyping; Pneumonia; Pneumonia, Viral - epidemiology; Pneumonia, Viral - genetics; Pneumonia, Viral - immunology; Pneumonia, Viral - pathology; Polymorphism, Genetic; pulmonary histopathology; Respiratory diseases; Respiratory Mucosa - immunology; Respiratory Mucosa - pathology; Respiratory System - pathology; Risk analysis; Risk Factors; SARS-CoV-2; Serine Endopeptidases - genetics; Severe Acute Respiratory Syndrome - pathology; Thrombosis - pathology; Ventilation; Viral diseases; COVID-19; pulmonary histopathology; genetics
• ISSN: 0014-2972; 1365-2362; 1365-2362
• DOI: 10.1111/eci.13259

Background The clinical features of COVID‐19 pneumonia range from a mild illness to patients with a very severe illness with acute hypoxemic respiratory failure requiring ventilation and Intensive Care Unit admission. Aims To provide a brief overview of the existing evidence for such differences in host response and outcome, and generate hypotheses for divergent patterns and avenues for future research, by highlighting similarities and differences in histopathological appearance between COVID‐19 and influenza as well as previous coronavirus outbreaks, and by discussing predisposition through genetics and underlying disease. Materials and Method We assessed the available early literature for histopathological patterns of COVID‐19 pneumonia and underlying risk factors. Result The histopathological spectrum of COVID‐19 pneumonia includes variable patterns of epithelial damage, vascular complications, fibrosis and inflammation. Risk factors for a fatal disease include older age, respiratory disease, diabetes mellitus, obesity and hypertension. Discussion While some risk factors and their potential role in COVID‐19 pneumonia are increasingly recognized, little is known about the mechanisms behind episodes of sudden deterioration or the infrequent idiosyncratic clinical demise in otherwise healthy and young subjects. Conclusion The answer to many of the remaining questions regarding COVID‐19 pneumonia pathogenesis may in time be provided by genotyping as well careful clinical, serological, radiological and histopathological phenotyping.