Jonigk, Danny, Werlein, Christopher, Acker, Till, Aepfelbacher, Martin, Amann, Kerstin U., Baretton, Gustavo, Barth, Peter, Bohle, Rainer M., Buettner, Andreas, Buettner, Reinhard, Dettmeyer, Reinhard, Eichhorn, Philip, Elezkurtaj, Sefer ORCID: 0000-0002-1699-1270, Esposito, Irene, Evert, Katja, Evert, Matthias, Fend, Falko, Gassler, Nikolaus, Gattenloehner, Stefan, Glatzel, Markus, Goebel, Heike ORCID: 0000-0002-0171-7025, Gradhand, Elise, Hansen, Torsten, Hartmann, Arndt, Heinemann, Axel, Heppner, Frank L., Hilsenbeck, Julia, Horst, David, Kamp, Jan C., Mall, Gita, Maerkl, Bruno, Ondruschka, Benjamin, Pablik, Jessica, Pfefferle, Susanne, Quaas, Alexander, Radbruch, Helena ORCID: 0000-0001-6941-3397, Roecken, Christoph, Rosenwald, Andreas, Roth, Wilfried, Rudelius, Martina, Schirmacher, Peter, Slotta-Huspenina, Julia, Smith, Kevin, Sommer, Linna ORCID: 0000-0002-5286-7920, Stock, Konrad, Stroebel, Philipp, Strobl, Stephanie, Titze, Ulf, Weirich, Gregor, Weis, Joachim, Werner, Martin, Wickenhauser, Claudia, Wiech, Thorsten, Wild, Peter, Welte, Tobias, von Stillfried, Saskia and Boor, Peter (2022). Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies? Virchows Arch., 481 (2). S. 139 - 160. NEW YORK: SPRINGER. ISSN 1432-2307

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Jonigk, DannyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Werlein, ChristopherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Acker, TillUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aepfelbacher, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Amann, Kerstin U.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baretton, GustavoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Barth, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bohle, Rainer M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buettner, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buettner, ReinhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dettmeyer, ReinhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eichhorn, PhilipUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Elezkurtaj, SeferUNSPECIFIEDorcid.org/0000-0002-1699-1270UNSPECIFIED
Esposito, IreneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Evert, KatjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Evert, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fend, FalkoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gassler, NikolausUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gattenloehner, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glatzel, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goebel, HeikeUNSPECIFIEDorcid.org/0000-0002-0171-7025UNSPECIFIED
Gradhand, EliseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hansen, TorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hartmann, ArndtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heinemann, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heppner, Frank L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hilsenbeck, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horst, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kamp, Jan C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mall, GitaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maerkl, BrunoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ondruschka, BenjaminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pablik, JessicaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfefferle, SusanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Quaas, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Radbruch, HelenaUNSPECIFIEDorcid.org/0000-0001-6941-3397UNSPECIFIED
Roecken, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosenwald, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roth, WilfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rudelius, MartinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schirmacher, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Slotta-Huspenina, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smith, KevinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sommer, LinnaUNSPECIFIEDorcid.org/0000-0002-5286-7920UNSPECIFIED
Stock, KonradUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stroebel, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Strobl, StephanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Titze, UlfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weirich, GregorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weis, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Werner, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wickenhauser, ClaudiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wiech, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wild, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Welte, TobiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Stillfried, SaskiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boor, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-698402
DOI: 10.1007/s00428-022-03319-2
Journal or Publication Title: Virchows Arch.
Volume: 481
Number: 2
Page Range: S. 139 - 160
Date: 2022
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1432-2307
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
SARS-COV-2; CELLS; MYOCARDITIS; NEUROPATHOLOGY; CORONAVIRUS; INFECTION; PATHOLOGY; GROWTH; INJURY; ACE2Multiple languages
PathologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69840

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