Pulmonary stromal expansion and intra-alveolar coagulation are primary causes of COVID-19 death
Laszlo Szekely,
Bela Bozoky,
Matyas Bendek,
Masih Ostad,
Pablo Lavignasse,
Lars Haag,
Jieyu Wu,
Xu Jing,
Soham Gupta,
Elisa Saccon,
Anders Sönnerborg,
Yihai Cao,
Mikael Björnstedt,
Attila Szakos
Affiliations
Laszlo Szekely
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden; Corresponding author.
Bela Bozoky
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Matyas Bendek
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Masih Ostad
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Pablo Lavignasse
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Lars Haag
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Jieyu Wu
Microbiology and Tumor Biology Center, Karolinska Institutet, 171 77 Stockholm, Sweden
Xu Jing
Microbiology and Tumor Biology Center, Karolinska Institutet, 171 77 Stockholm, Sweden; The Second Hospital of Shandong University, Department of Clinical Laboratory, 250033 Jinan, China
Soham Gupta
Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institutet, 171 77 Stockholm, Sweden
Elisa Saccon
Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institutet, 171 77 Stockholm, Sweden
Anders Sönnerborg
Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institutet, 171 77 Stockholm, Sweden
Yihai Cao
Microbiology and Tumor Biology Center, Karolinska Institutet, 171 77 Stockholm, Sweden
Mikael Björnstedt
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Attila Szakos
Department of Pathology/Cytology, Karolinska University Laboratory, 141 86 Stockholm, Sweden
Most COVID-19 victims are old and die from unrelated causes. Here we present twelve complete autopsies, including two rapid autopsies of young patients where the cause of death was COVID-19 ARDS. The main virus induced pathology was in the lung parenchyma and not in the airways. Most coagulation events occurred in the intra-alveolar and not in the intra-vascular space and the few thrombi were mainly composed of aggregated thrombocytes. The dominant inflammatory response was the massive accumulation of CD163 + macrophages and the disappearance of T killer, NK and B-cells. The virus was replicating in the pneumocytes and macrophages but not in bronchial epithelium, endothelium, pericytes or stromal cells. The lung consolidations were produced by a massive regenerative response, stromal and epithelial proliferation and neovascularization. We suggest that thrombocyte aggregation inhibition, angiogenesis inhibition and general proliferation inhibition may have a roll in the treatment of advanced COVID-19 ARDS.
