Korteweg Christine, Gu Jiang
Department of Pathology, School of Basic Medical Sciences, Infectious Disease Center, Peking (Beijing) University, 38 Xueyuan Rd., Beijing, China 100083.
Am J Pathol. 2008 May;172(5):1155-70. doi: 10.2353/ajpath.2008.070791. Epub 2008 Apr 10.
H5N1 avian influenza is a highly fatal infectious disease that could cause a potentially devastating pandemic if the H5N1 virus mutates into a form that spreads efficiently among humans. Recent findings have led to a basic understanding of cell and organ histopathology caused by the H5N1 virus. Here we review the pathology of H5N1 avian influenza reported in postmortem and clinical studies and discuss the key pathogenetic mechanisms. Specifically, the virus infects isolated pulmonary epithelial cells and causes diffuse alveolar damage and hemorrhage in the lungs of infected patients. In addition, the virus may infect other organs, including the trachea, the intestines, and the brain, and it may penetrate the placental barrier and infect the fetus. Dysregulation of cytokines and chemokines is likely to be one of the key mechanisms in the pathogenesis of H5N1 influenza. We also review the various molecular determinants of increased pathogenicity that have been identified in recent years and the role of avian and human influenza virus receptors in relation to the transmissibility of the H5N1 virus. A comprehensive appreciation of H5N1 influenza pathogenetic mechanisms should aid in the design of effective strategies for prevention, diagnosis, and treatment of this emerging disease.
H5N1禽流感是一种高致死性传染病，如果H5N1病毒变异为能在人际间有效传播的形式，可能引发潜在的毁灭性大流行。最近的研究结果使人们对H5N1病毒引起的细胞和器官组织病理学有了基本认识。在此，我们综述尸检和临床研究中报告的H5N1禽流感病理学情况，并讨论关键的发病机制。具体而言，该病毒感染孤立的肺上皮细胞，导致受感染患者肺部出现弥漫性肺泡损伤和出血。此外，该病毒可能感染其他器官，包括气管、肠道和大脑，还可能穿透胎盘屏障感染胎儿。细胞因子和趋化因子失调可能是H5N1流感发病机制的关键机制之一。我们还综述了近年来已确定的致病性增强的各种分子决定因素，以及禽流感病毒和人流感病毒受体在H5N1病毒传播方面的作用。全面了解H5N1流感发病机制应有助于设计出预防、诊断和治疗这种新出现疾病的有效策略。
