Potential Mechanisms of Cardiac Injury and Common Pathways of Inflammation in Patients With COVID-19
DOI:
10.1097/HPC.0000000000000227
Abstract
Due to the lack of prospective, randomized, controlled clinical
studies on inflammation and cardiovascular involvement, the exact
mechanism of cardiac injury among patients with COVID-19 still remains
uncertain. It was demonstrated that there is a high and significantly
positive linear correlation between troponin T and plasma
high-sensitivity C-reactive protein levels, biomarkers of cardiac injury
and systemic inflammation, respectively. Cardiac injury and
inflammation is a relatively common association among patients
hospitalized with COVID-19, and it is related to higher risk of
in-hospital mortality. In our literature search, we identified several
potential mechanisms of myocardial tissue damage, namely,
coronavirus-associated acute myocarditis, angiotensin-converting enzyme 2
receptor binding affinity to the virus Spike protein, increased
cytokine secretion, and hypoxia induced cardiac myocyte apoptosis.
Elucidation of the disease pathogenesis and prospective
histopathological studies are crucial for future proper treatment in
case of renewed outbreaks. Of interest is that with hundred of thousands
of bodies available for autopsy studies, no prospective investigation
has been reported so far. Strong efforts and continued research of the
cardiovascular complications and identification of risk factors for poor
prognosis in COVID-19 are steadily needed. The high morbidity and
mortality of COVID-19, its monumental economic burden and social impact,
the despair of a new pandemic outbreak, and the thread of potential
utilization of novel SARS-CoV2 as biologic weapons make it a
preponderant necessity to better comprehend the therapeutic management
of this lethal disease. Emerging as an acute infectious disease,
COVID-19 may become a chronic epidemic because of genetic recombination.
Therefore, we should be ready for the reemergence of COVID-19 or other
coronaviruses.
(2)
Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China.
(2)
Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China.
Kidney Int. 2020 Apr 9:S0085-2538(20)30369-0. doi: 10.1016/j.kint.2020.04.003. Online ahead of print.
PMID: 32327202
Free PMC article.
Although the respiratory and immune systems are the major targets
of Coronavirus Disease 2019 (COVID-19), acute kidney injury and
proteinuria have also been observed. Currently, detailed pathologic
examination of kidney damage in critically ill patients with COVID-19
has been lacking. To help define this we analyzed kidney abnormalities
in 26 autopsies of patients with COVID-19 by light microscopy,
ultrastructural observation and immunostaining. Patients were on average
69 years (19 male and 7 female) with respiratory failure associated
with multiple organ dysfunction syndrome as the cause of death. Nine of
the 26 showed clinical signs of kidney injury that included increased
serum creatinine and/or new-onset proteinuria. By light microscopy,
diffuse proximal tubule injury with the loss of brush border,
non-isometric vacuolar degeneration, and even frank necrosis was
observed. Occasional hemosiderin granules and pigmented casts were
identified. There were prominent erythrocyte aggregates obstructing the
lumen of capillaries without platelet or fibrinoid material. Evidence of
vasculitis, interstitial inflammation or hemorrhage was absent.
Electron microscopic examination showed clusters of coronavirus-like
particles with distinctive spikes in the tubular epithelium and
podocytes. Furthermore, the receptor of SARS-CoV-2, ACE2 was found to be
upregulated in patients with COVID-19, and immunostaining with SARS-CoV
nucleoprotein antibody was positive in tubules. In addition to the
direct virulence of SARS-CoV-2, factors contributing to acute kidney
injury included systemic hypoxia, abnormal coagulation, and possible
drug or hyperventilation-relevant rhabdomyolysis. Thus, our studies
provide direct evidence of the invasion of SARSCoV-2 into kidney tissue.
These findings will greatly add to the current understanding of
SARS-CoV-2 infection.
Keywords:
COVID-19; SARS-CoV-2; acute kidney injury; proteinuria; renal pathology.
Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved
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