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

Tanja Paul, Stephan Ledderose, Harald Bartsch, Na Sun, Sarah Soliman, Bruno Märkl, Viktoria Ruf, Jochen Herms, Marcel Stern, Oliver T. Keppler, Claire Delbridge, Susanna Müller, Guido Piontek, Yuki Schneider Kimoto, Franziska Schreiber, Tracy Ann Williams, Jens Neumann, Thomas Knösel, Heiko Schulz, Ria Spallek, Matthias Graw, Thomas Kirchner, Axel Walch and Martina Rudelius ()
Additional contact information
Tanja Paul: Ludwig-Maximilians University Munich
Stephan Ledderose: Ludwig-Maximilians University Munich
Harald Bartsch: Ludwig-Maximilians University Munich
Na Sun: Research Unit Analytical Pathology, German Research Center for Environmental Health, Helmholtz Zentrum München
Sarah Soliman: Ludwig-Maximilians University Munich
Bruno Märkl: University of Augsburg
Viktoria Ruf: Ludwig-Maximilians University Munich
Jochen Herms: Ludwig-Maximilians University Munich
Marcel Stern: Ludwig-Maximilians University Munich
Oliver T. Keppler: Ludwig-Maximilians University Munich
Claire Delbridge: Technical University Munich
Susanna Müller: Ludwig-Maximilians University Munich
Guido Piontek: Ludwig-Maximilians University Munich
Yuki Schneider Kimoto: Ludwig-Maximilians University Munich
Franziska Schreiber: Ludwig-Maximilians University Munich
Tracy Ann Williams: Klinikum der University Munich
Jens Neumann: Ludwig-Maximilians University Munich
Thomas Knösel: Ludwig-Maximilians University Munich
Heiko Schulz: Ludwig-Maximilians University Munich
Ria Spallek: Technical University Munich
Matthias Graw: Ludwig-Maximilians University Munich
Thomas Kirchner: Ludwig-Maximilians University Munich
Axel Walch: Research Unit Analytical Pathology, German Research Center for Environmental Health, Helmholtz Zentrum München
Martina Rudelius: Ludwig-Maximilians University Munich

Nature Communications, 2022, vol. 13, issue 1, 1-12

Abstract: 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.

Date: 2022
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DOI: 10.1038/s41467-022-29145-3

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