The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity
Authors/Creators
- Osuchowski, MF
- Winkler, MS
- Skirecki, T
- Cajander, S
- Shankar-Hari, M
- Lachmann, G
- Monneret, G
- Venet, F
- Bauer, M
- Brunkhorst, FM
- Weis, S
-
Garcia-Salido, A1
- Kox, M
- Cavaillon, JM
- Uhle, F
- Weigand, MA
- Flohé, SB
- Wiersinga, WJ
- Almansa, R
- de la Fuente, A
- Martin-Loeches, I
- Meisel, C
- Spinetti, T
- Schefold, JC
- Cilloniz, C
- Torres, A
- Giamarellos-Bourboulis, EJ
- Ferrer, R
- Girardis, M
- Cossarizza, A
- Netea, MG
- van der Poll, T
- Bermejo-Martín, JF
- Rubio, I
-
1.
Hospital Infantil Universitario Niño Jesús
Description
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.
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