Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies?
Creators: name: Jonigk, Danny
name: Werlein, Christopher
name: Acker, Till
name: Aepfelbacher, Martin
name: Amann, Kerstin U.
name: Baretton, Gustavo
name: Barth, Peter
name: Bohle, Rainer M.
name: Büttner, Andreas
name: Büttner, Reinhard
name: Dettmeyer, Reinhard
name: Eichhorn, Philip
name: Elezkurtaj, Sefer
name: Esposito, Irene
name: Evert, Katja
name: Evert, Matthias
name: Fend, Falko
name: Gaßler, Nikolaus
name: Gattenlöhner, Stefan
name: Glatzel, Markus
name: Göbel, Heike
name: Gradhand, Elise
name: Hansen, Torsten
name: Hartmann, Arndt
name: Heinemann, Axel
name: Heppner, Frank L.
name: Hilsenbeck, Julia
name: Horst, David
name: Kamp, Jan C.
name: Mall, Gita
name: Märkl, Bruno
name: Ondruschka, Benjamin
name: Pablik, Jessica
name: Pfefferle, Susanne
name: Quaas, Alexander
name: Radbruch, Helena
name: Röcken, Christoph
name: Rosenwald, Andreas
name: Roth, Wilfried
name: Rudelius, Martina
name: Schirmacher, Peter
name: Slotta-Huspenina, Julia
name: Smith, Kevin
name: Sommer, Linna
name: Stock, Konrad
name: Ströbel, Philipp
name: Strobl, Stephanie
name: Titze, Ulf
name: Weirich, Gregor
name: Weis, Joachim
name: Werner, Martin
name: Wickenhauser, Claudia
name: Wiech, Thorsten
name: Wild, Peter
name: Welte, Tobias
name: von Stillfried, Saskia
name: Boor, Peter
Publisher: name: Universität Regensburg
Year: 2022
Subjects: subject: SARS-COV-2; CELLS; MYOCARDITIS; NEUROPATHOLOGY; CORONAVIRUS; INFECTION; PATHOLOGY; COHORT; GROWTH; INJURY; SARS-CoV-2; Diffuse alveolar damage; Acute kidney damage; Immune response
subject: 610 Medizin

description: The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.