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; Martina Rudelius

doi:10.1038/s41467-022-29145-3

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 SpallekMatthias Graw, Thomas Kirchner, Axel Walch, Martina Rudelius

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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.

Original language	English
Article number	1589
Number of pages	12
Journal	Nature Communications
Volume	13
DOIs	https://doi.org/10.1038/s41467-022-29145-3
Publication status	Published - 24 Mar 2022

ASJC Scopus subject areas

General Chemistry
General Biochemistry,Genetics and Molecular Biology
General Physics and Astronomy

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10.1038/s41467-022-29145-3Licence: CC BY

Final published versionFinal published version, 4.95 MBLicence: CC BY

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Paul, T., Ledderose, S., Bartsch, H., Sun, N., Soliman, S., Märkl, B., Ruf, V., Herms, J., Stern, M., Keppler, O. T., Delbridge, C., Müller, S., Piontek, G., Kimoto, Y. S., Schreiber, F., Williams, T. A., Neumann, J., Knösel, T., Schulz, H., ... Rudelius, M. (2022). Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19. Nature Communications, 13, Article 1589. https://doi.org/10.1038/s41467-022-29145-3

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

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.",

author = "Tanja Paul and Stephan Ledderose and Harald Bartsch and Na Sun and Sarah Soliman and Bruno M{\"a}rkl and Viktoria Ruf and Jochen Herms and Marcel Stern and Keppler, {Oliver T.} and Claire Delbridge and Susanna M{\"u}ller and Guido Piontek and Kimoto, {Yuki Schneider} and Franziska Schreiber and Williams, {Tracy Ann} and Jens Neumann and Thomas Kn{\"o}sel and Heiko Schulz and Ria Spallek and Matthias Graw and Thomas Kirchner and Axel Walch and Martina Rudelius",

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year = "2022",

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doi = "10.1038/s41467-022-29145-3",

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Paul, T, Ledderose, S, Bartsch, H, Sun, N, Soliman, S, Märkl, B, Ruf, V, Herms, J, Stern, M, Keppler, OT, Delbridge, C, Müller, S, Piontek, G, Kimoto, YS, Schreiber, F, Williams, TA, Neumann, J, Knösel, T, Schulz, H, Spallek, R, Graw, M, Kirchner, T, Walch, A & Rudelius, M 2022, 'Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19', Nature Communications, vol. 13, 1589. https://doi.org/10.1038/s41467-022-29145-3

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T1 - Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19

AU - Paul, Tanja

AU - Ledderose, Stephan

AU - Bartsch, Harald

AU - Sun, Na

AU - Soliman, Sarah

AU - Märkl, Bruno

AU - Ruf, Viktoria

AU - Herms, Jochen

AU - Stern, Marcel

AU - Keppler, Oliver T.

AU - Delbridge, Claire

AU - Müller, Susanna

AU - Piontek, Guido

AU - Kimoto, Yuki Schneider

AU - Schreiber, Franziska

AU - Williams, Tracy Ann

AU - Neumann, Jens

AU - Knösel, Thomas

AU - Schulz, Heiko

AU - Spallek, Ria

AU - Graw, Matthias

AU - Kirchner, Thomas

AU - Walch, Axel

AU - Rudelius, Martina

PY - 2022/3/24

Y1 - 2022/3/24

N2 - 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.

AB - 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.

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SN - 2041-1723

VL - 13

JO - Nature Communications

JF - Nature Communications

M1 - 1589

ER -

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

Abstract

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