Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that devastated the world. While this is a respiratory virus, one feature of the SARS-CoV-2 infection was recognized to cause pathogenesis of other organs. Because the membrane fusion...

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Main Authors: Sergiy G. Gychka, Sofiia I. Nikolaienko, Nataliia V. Shults, Volodymyr M. Vasylyk, Bohdan O. Pasichnyk, Iryna V. Kagan, Yulia V. Dibrova, Muin Tuffaha, Yuichiro J. Suzuki
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:COVID
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Online Access:https://www.mdpi.com/2673-8112/5/6/79
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author Sergiy G. Gychka
Sofiia I. Nikolaienko
Nataliia V. Shults
Volodymyr M. Vasylyk
Bohdan O. Pasichnyk
Iryna V. Kagan
Yulia V. Dibrova
Muin Tuffaha
Yuichiro J. Suzuki
author_facet Sergiy G. Gychka
Sofiia I. Nikolaienko
Nataliia V. Shults
Volodymyr M. Vasylyk
Bohdan O. Pasichnyk
Iryna V. Kagan
Yulia V. Dibrova
Muin Tuffaha
Yuichiro J. Suzuki
author_sort Sergiy G. Gychka
collection DOAJ
description Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that devastated the world. While this is a respiratory virus, one feature of the SARS-CoV-2 infection was recognized to cause pathogenesis of other organs. Because the membrane fusion protein of SARS-CoV-2, the spike protein, binds to its major host cell receptor angiotensin-converting enzyme 2 (ACE2), which regulates a critical mediator of cardiovascular diseases, angiotensin II, COVID-19 is largely associated with vascular pathologies. The present study examined the pulmonary vasculature of COVID-19 patients using large sample sizes and provides mechanistic information through histological observations. We studied 56 postmortal lung samples from COVID-19 patients. The comparative group consisted of 17 postmortal lung samples from patients who died of influenza A virus subtype H1N1. The examination of 56 autopsy lung samples showed thickened vascular walls of small pulmonary arteries after 14 days of disease compared to H1N1 influenza patients who died before the COVID-19 pandemic started. Pulmonary vascular remodeling in COVID-19 patients was associated with hypertrophy of the smooth muscle layer, perivascular fibrosis, edema and lymphostasis, inflammatory infiltration, perivascular hemosiderosis, and neoangiogenesis. We found a correlation between the duration of hospital stay and the thickness of the muscular layer of the pulmonary arterial walls. These results demonstrate that COVID-19 significantly affected the pulmonary vasculature in fatal-course patients, also suggesting the need for careful follow-up in non-fatal cases, at risk of pulmonary hypertension.
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spelling doaj-art-6601e5d6e65a435d8593ba6d627187d42025-08-20T03:26:52ZengMDPI AGCOVID2673-81122025-05-01567910.3390/covid5060079Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy CasesSergiy G. Gychka0Sofiia I. Nikolaienko1Nataliia V. Shults2Volodymyr M. Vasylyk3Bohdan O. Pasichnyk4Iryna V. Kagan5Yulia V. Dibrova6Muin Tuffaha7Yuichiro J. Suzuki8Department of Pathological Anatomy, Bogomolets National Medical University, 13 Tarasa Shevchenko Boulevard, 01601 Kyiv, UkraineDepartment of Pathological Anatomy, Bogomolets National Medical University, 13 Tarasa Shevchenko Boulevard, 01601 Kyiv, UkraineDepartment of Biology, Georgetown University, 6411 Tondorf Rd, Washington, DC 20057, USAIvano-Frankivsk Regional Clinical Hospital, 91 Fedkovycha Street, 76000 Ivano-Frankivsk, UkraineDepartment of Pathological Anatomy, Bogomolets National Medical University, 13 Tarasa Shevchenko Boulevard, 01601 Kyiv, UkraineDepartment of Pathological Anatomy, Bogomolets National Medical University, 13 Tarasa Shevchenko Boulevard, 01601 Kyiv, UkraineDepartment of Pathological Anatomy, Bogomolets National Medical University, 13 Tarasa Shevchenko Boulevard, 01601 Kyiv, UkraineMedizinische Universität Lausitz-Carl Thiem, Thiemstraße 111, 03048 Cottbus, GermanyDepartment of Pharmacology and Physiology, Georgetown University Medical Center, 3900 Reservoir Road NW, Washington, DC 20057, USASevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that devastated the world. While this is a respiratory virus, one feature of the SARS-CoV-2 infection was recognized to cause pathogenesis of other organs. Because the membrane fusion protein of SARS-CoV-2, the spike protein, binds to its major host cell receptor angiotensin-converting enzyme 2 (ACE2), which regulates a critical mediator of cardiovascular diseases, angiotensin II, COVID-19 is largely associated with vascular pathologies. The present study examined the pulmonary vasculature of COVID-19 patients using large sample sizes and provides mechanistic information through histological observations. We studied 56 postmortal lung samples from COVID-19 patients. The comparative group consisted of 17 postmortal lung samples from patients who died of influenza A virus subtype H1N1. The examination of 56 autopsy lung samples showed thickened vascular walls of small pulmonary arteries after 14 days of disease compared to H1N1 influenza patients who died before the COVID-19 pandemic started. Pulmonary vascular remodeling in COVID-19 patients was associated with hypertrophy of the smooth muscle layer, perivascular fibrosis, edema and lymphostasis, inflammatory infiltration, perivascular hemosiderosis, and neoangiogenesis. We found a correlation between the duration of hospital stay and the thickness of the muscular layer of the pulmonary arterial walls. These results demonstrate that COVID-19 significantly affected the pulmonary vasculature in fatal-course patients, also suggesting the need for careful follow-up in non-fatal cases, at risk of pulmonary hypertension.https://www.mdpi.com/2673-8112/5/6/79coronavirusCOVID-19pulmonary hypertensionspike proteinvascular remodeling
spellingShingle Sergiy G. Gychka
Sofiia I. Nikolaienko
Nataliia V. Shults
Volodymyr M. Vasylyk
Bohdan O. Pasichnyk
Iryna V. Kagan
Yulia V. Dibrova
Muin Tuffaha
Yuichiro J. Suzuki
Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
COVID
coronavirus
COVID-19
pulmonary hypertension
spike protein
vascular remodeling
title Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
title_full Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
title_fullStr Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
title_full_unstemmed Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
title_short Comparative Histopathological Evaluation of Pulmonary Arterial Remodeling in Fatal COVID-19 and H1N1 Influenza Autopsy Cases
title_sort comparative histopathological evaluation of pulmonary arterial remodeling in fatal covid 19 and h1n1 influenza autopsy cases
topic coronavirus
COVID-19
pulmonary hypertension
spike protein
vascular remodeling
url https://www.mdpi.com/2673-8112/5/6/79
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