The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity.
СтатьяПоддержка исследования: вне правительства СШАОбзорНазвание и аннотация: Перевод в очереди
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Osuchowski Marcin F, Winkler Martin S, Skirecki Tomasz, Cajander Sara, Shankar-Hari Manu, Lachmann Gunnar, Monneret Guillaume, Venet Fabienne, Bauer Michael, Brunkhorst Frank M, Weis Sebastian, Garcia-Salido Alberto, Kox Matthijs, Cavaillon Jean-Marc, Uhle Florian, Weigand Markus A, Flohé Stefanie B, Wiersinga W Joost, Almansa Raquel, de la Fuente Amanda, Martin-Loeches Ignacio, Meisel Christian, Spinetti Thibaud, Schefold Joerg C, Cilloniz Catia, Torres Antoni, Giamarellos-Bourboulis Evangelos J, Ferrer Ricard, Girardis Massimo, Cossarizza Andrea, Netea Mihai G, van der Poll Tom, Bermejo-Martín Jesús F, Rubio Ignacio
Аннотация
The zoonotic SARS-CoV-2 virus that causes COVID-19 continues to spread worldwide, with devastating consequences. While the medical community has gained insight into the epidemiology of COVID-19, important questions remain about the clinical complexities and underlying mechanisms of disease phenotypes. Severe COVID-19 most commonly involves respiratory manifestations, although other systems are also affected, and acute disease is often followed by protracted complications. Such complex manifestations suggest that SARS-CoV-2 dysregulates the host response, triggering wide-ranging immuno-inflammatory, thrombotic, and parenchymal derangements. We review the intricacies of COVID-19 pathophysiology, its various phenotypes, and the anti-SARS-CoV-2 host response at the humoral and cellular levels. Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.