Ribeiro Dos Santos Miggiolaro Anna Flavia, da Silva Motta Junior Jarbas, Busatta Vaz de Paula Caroline, Nagashima Seigo, Alessandra Scaranello Malaquias Mineia, Baena Carstens Lucas, N Moreno-Amaral Andrea, Pellegrino Baena Cristina, de Noronha Lucia
Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil.
School of Medicine, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil.
Respir Med Case Rep. 2020;31:101292. doi: 10.1016/j.rmcr.2020.101292. Epub 2020 Nov 12.
The COVID-19 pandemic is a worldwide threat, and information on physiopathological aspects of the disease is limited. Despite efforts in searching treatment options, a better understanding of the SARS-CoV-2 pathways can contribute to managing severe cases. In this study, we aim to describe pathological and immunopathogenic findings of two different cases, both in the high-risk group. Post-mortem lung biopsies were analyzed by traditional and immunohistochemical methods. Tissue expression of innate and adaptive immune response biomarkers was tested. We observed a higher innate response in case 1 with an abundance of mast cells, scarce CD8 lymphocytes, high expression of TNF-alpha, and almost absent adaptative immune response. In case 2, the adaptative immune response was present, with numerous CD8 lymphocytes and higher levels of IL-4 and TGF-beta. Both cases converged to a prothrombotic state expressing high IL-6, followed by ICAM-1 expression and endotheliites leading to systemic inflammatory response syndrome. In conclusion, differences in age and comorbidities and immune response described here may be related to the SARS-CoV-2 delay in the adaptative immune response, evolution stage of diffuse alveolar damage, and progression for systemic inflammatory response syndrome.
新冠疫情是全球性威胁，关于该疾病生理病理学方面的信息有限。尽管在探寻治疗方案方面付出了努力，但对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）致病途径的深入了解有助于对重症病例的管理。在本研究中，我们旨在描述两例高危组不同病例的病理学和免疫病理学发现。通过传统方法和免疫组织化学方法对尸检肺活检组织进行分析。检测固有免疫和适应性免疫反应生物标志物的组织表达情况。我们观察到，病例1中固有免疫反应较高，有大量肥大细胞、稀少的CD8淋巴细胞、肿瘤坏死因子-α（TNF-α）高表达，且适应性免疫反应几乎缺失。在病例2中，存在适应性免疫反应，有大量CD8淋巴细胞以及较高水平的白细胞介素-4（IL-4）和转化生长因子-β（TGF-β）。两例均呈现促血栓形成状态，白细胞介素-6（IL-6）高表达，随后细胞间黏附分子-1（ICAM-1）表达以及血管炎，导致全身炎症反应综合征。总之，此处描述的年龄、合并症及免疫反应差异可能与SARS-CoV-2适应性免疫反应延迟、弥漫性肺泡损伤的演变阶段以及全身炎症反应综合征的进展有关。
