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

TY - JOUR

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

N1 - Publisher Copyright: © 2022, The Author(s).

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.

UR - https://www.scopus.com/pages/publications/85127042607

U2 - 10.1038/s41467-022-29145-3

DO - 10.1038/s41467-022-29145-3

M3 - Article

C2 - 35332140

AN - SCOPUS:85127042607

SN - 2041-1723

VL - 13

JO - Nature Communications

JF - Nature Communications

M1 - 1589

ER -