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Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19

Lookup NU author(s): Dr Luke Milross, Dr Joaquim Majo, Professor Andrew FilbyORCiD, Professor Andrew FisherORCiD


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© 2022 Elsevier LtdThe lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.

Publication metadata

Author(s): Milross L, Majo J, Cooper N, Kaye PM, Bayraktar O, Filby A, Fisher AJ

Publication type: Review

Publication status: Published

Journal: The Lancet Respiratory Medicine

Year: 2022

Volume: 10

Issue: 1

Pages: 95-106

Print publication date: 01/01/2022

Online publication date: 03/12/2021

Acceptance date: 02/04/2020

ISSN (print): 2213-2600

ISSN (electronic): 2213-2619

Publisher: Elsevier Ltd


DOI: 10.1016/S2213-2600(21)00408-2