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严重致命 COVID-19 患者死后病例系列中 SARS-CoV-2 的肾上腺嗜性和肾上腺表现。

Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19.

机构信息

Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians University Munich, Munich, Germany.

Research Unit Analytical Pathology, German Research Center for Environmental Health, Helmholtz Zentrum München, Munich, Germany.

出版信息

Nat Commun. 2022 Mar 24;13(1):1589. doi: 10.1038/s41467-022-29145-3.

DOI:10.1038/s41467-022-29145-3
PMID:35332140
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8948269/
Abstract

Progressive respiratory failure and hyperinflammatory response is the primary cause of death in the coronavirus disease 2019 (COVID-19) pandemic. Despite mounting evidence of disruption of the hypothalamus-pituitary-adrenal axis in COVID-19, relatively little is known about the tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to adrenal glands and associated changes. Here we demonstrate adrenal viral tropism and replication in COVID-19 patients. Adrenal glands showed inflammation accompanied by inflammatory cell death. Histopathologic analysis revealed widespread microthrombosis and severe adrenal injury. In addition, activation of the glycerophospholipid metabolism and reduction of cortisone intensities were characteristic for COVID-19 specimens. In conclusion, our autopsy series suggests that SARS-CoV-2 facilitates the induction of adrenalitis. Given the central role of adrenal glands in immunoregulation and taking into account the significant adrenal injury observed, monitoring of developing adrenal insufficiency might be essential in acute SARS-CoV-2 infection and during recovery.

摘要

进行性呼吸衰竭和过度炎症反应是 2019 年冠状病毒病（COVID-19）大流行死亡的主要原因。尽管有越来越多的证据表明 COVID-19 中断了下丘脑-垂体-肾上腺轴，但对于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）对肾上腺的趋向性及其相关变化知之甚少。在这里，我们证明了 COVID-19 患者中肾上腺的病毒趋向性和复制。肾上腺表现出炎症伴炎症细胞死亡。组织病理学分析显示广泛的微血栓形成和严重的肾上腺损伤。此外，甘油磷脂代谢的激活和皮质酮强度的降低是 COVID-19 标本的特征。总之，我们的尸检系列表明，SARS-CoV-2 有助于诱导肾上腺炎。鉴于肾上腺在免疫调节中的核心作用，并考虑到观察到的显著肾上腺损伤，在急性 SARS-CoV-2 感染和恢复期监测潜在的肾上腺功能不全可能至关重要。

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