Two distinct immunopathological profiles in autopsy lungs of COVID-19

Ronny Nienhold, Yari Ciani, Viktor H. Koelzer, Alexandar Tzankov, Jasmin D. Haslbauer, Thomas Menter, Nathalie Schwab, Maurice Henkel, Angela Frank, Veronika Zsikla, Niels Willi, Werner Kempf, Thomas Hoyler, Mattia Barbareschi, Holger Moch, Markus Tolnay, Gieri Cathomas, Francesca Demichelis, Tobias Junt and Kirsten D. Mertz ()
Additional contact information
Ronny Nienhold: Cantonal Hospital Baselland
Yari Ciani: University of Trento
Viktor H. Koelzer: University Hospital Zurich
Alexandar Tzankov: University Hospital Basel
Jasmin D. Haslbauer: University Hospital Basel
Thomas Menter: University Hospital Basel
Nathalie Schwab: Cantonal Hospital Baselland
Maurice Henkel: Cantonal Hospital Baselland
Angela Frank: Cantonal Hospital Baselland
Veronika Zsikla: Cantonal Hospital Baselland
Niels Willi: Cantonal Hospital Baselland
Werner Kempf: Kempf und Pfaltz Histologische Diagnostik
Thomas Hoyler: Novartis Institutes for BioMedical Research (NIBR)
Mattia Barbareschi: Anatomia ed Istologia Patologica, Ospedale S. Chiara di Trento
Holger Moch: University Hospital Zurich
Markus Tolnay: University Hospital Basel
Gieri Cathomas: Cantonal Hospital Baselland
Francesca Demichelis: University of Trento
Tobias Junt: Novartis Institutes for BioMedical Research (NIBR)
Kirsten D. Mertz: Cantonal Hospital Baselland

Nature Communications, 2020, vol. 11, issue 1, 1-13

Abstract: Abstract Coronavirus Disease 19 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has grown to a worldwide pandemic with substantial mortality. Immune mediated damage has been proposed as a pathogenic factor, but immune responses in lungs of COVID-19 patients remain poorly characterized. Here we show transcriptomic, histologic and cellular profiles of post mortem COVID-19 (n = 34 tissues from 16 patients) and normal lung tissues (n = 9 tissues from 6 patients). Two distinct immunopathological reaction patterns of lethal COVID-19 are identified. One pattern shows high local expression of interferon stimulated genes (ISGhigh) and cytokines, high viral loads and limited pulmonary damage, the other pattern shows severely damaged lungs, low ISGs (ISGlow), low viral loads and abundant infiltrating activated CD8+ T cells and macrophages. ISGhigh patients die significantly earlier after hospitalization than ISGlow patients. Our study may point to distinct stages of progression of COVID-19 lung disease and highlights the need for peripheral blood biomarkers that inform about patient lung status and guide treatment.

Date: 2020
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DOI: 10.1038/s41467-020-18854-2

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