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The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity

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 phenotype...

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Main Authors: Osuchowski, Marcin (Author) , Winkler, Martin Sebastian (Author) , Skirecki, Tomasz (Author) , Cajander, Sara (Author) , Shankar-Hari, Manu (Author) , Lachmann, Gunnar (Author) , Monneret, Guillaume (Author) , Venet, Fabienne (Author) , Bauer, Michael (Author) , Brunkhorst, Frank M (Author) , Weis, Sebastian (Author) , Garcia-Salido, Alberto (Author) , Kox, Matthijs (Author) , Cavaillon, Jean-Marc (Author) , Uhle, Florian (Author) , Weigand, Markus A. (Author) , Flohé, Stefanie B (Author) , Wiersinga, W Joost (Author) , Almansa, Raquel (Author) , de la Fuente, Amanda (Author) , Martin-Loeches, Ignacio (Author) , Meisel, Christian (Author) , Spinetti, Thibaud (Author) , Schefold, Joerg C (Author) , Cilloniz, Catia (Author) , Torres, Antoni (Author) , Giamarellos-Bourboulis, Evangelos J (Author) , Ferrer, Ricard (Author) , Girardis, Massimo (Author) , Cossarizza, Andrea (Author) , Netea, Mihai G (Author) , van der Poll, Tom (Author) , Bermejo-Martín, Jesús F (Author) , Rubio, Ignacio (Author)
Format: Article (Journal)
Language:English
Published: June 2021
In: The lancet. Respiratory medicine
Year: 2021, Volume: 9, Issue: 6, Pages: 622-642
ISSN:2213-2619
DOI:10.1016/S2213-2600(21)00218-6
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/S2213-2600(21)00218-6
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S2213260021002186
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Author Notes:Marcin F Osuchowski, Martin S Winkler, Tomasz Skirecki, Sara Cajander, Manu Shankar-Hari, Gunnar Lachmann, Guillaume Monneret, Fabienne Venet, Michael Bauer, Frank M Brunkhorst, Sebastian Weis, Alberto Garcia-Salido, Matthijs Kox, Jean-Marc Cavaillon, Florian Uhle, Markus A Weigand, Stefanie B Flohé, W Joost Wiersinga, Raquel Almansa, Amanda de la Fuente, Ignacio Martin-Loeches, Christian Meisel, Thibaud Spinetti, Joerg C Schefold, Catia Cilloniz, Antoni Torres, Evangelos J Giamarellos-Bourboulis, Ricard Ferrer, Massimo Girardis, Andrea Cossarizza, Mihai G Netea, Tom van der Poll, Jesús F Bermejo-Martín, Ignacio Rubio
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Summary: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.
Item Description:Available online 6 May 2021
Gesehen am 09.08.2021
Physical Description:Online Resource
ISSN:2213-2619
DOI:10.1016/S2213-2600(21)00218-6

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