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COVID-19 as a Vascular Disease: Lesson Learned from Imaging and Blood Biomarkers
Article

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression

1
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
2
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy
3
Dipartimento di Prevenzione ASL, 10121 Torino (To), Italy
4
Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy
5
Department of Law, Forensic Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
6
Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Sezione di Medicina Legale, Università di Messina, 98122 Messina, Italy
7
Anatomy, Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95121 Catania, Italy
8
Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
These authors shared last authorship.
Diagnostics 2020, 10(8), 575; https://doi.org/10.3390/diagnostics10080575
Received: 2 July 2020 / Revised: 5 August 2020 / Accepted: 7 August 2020 / Published: 9 August 2020
(This article belongs to the Special Issue Biomarkers of Vascular Diseases)
(1) Background: The current outbreak of COVID-19 infection is an ongoing challenge and a major threat to public health that requires surveillance, prompt diagnosis, as well as research efforts to understand the viral pathogenesis. Despite this, to date, very few studies have been performed concerning autoptic specimens. Therefore, this study aimed: (i) to reiterate the importance of the autoptic examination, the only method able to precisely define the cause of death; (ii) to provide a complete post-mortem histological and immunohistochemical investigation pattern capable of diagnosing death from COVID-19 infection. (2) Methods: In this paper, the lung examination of two subjects who died from COVID-19 are discussed, comparing the obtained data with those of the control, a newborn who died from pneumonia in the same pandemic period. (3) Results: The results of the present study suggest that COVID-19 infection can cause different forms of acute respiratory distress syndrome (ARDS), due to diffuse alveolar damage and diffuse endothelial damage. Nevertheless, different patterns of cellular and cytokine expression are associated with anti-COVID-19 antibody positivity, compared to the control case. Moreover, in both case studies, it is interesting to note that COVID-19, ACE2 and FVIII positivity was detected in the same fields. (4) Conclusions: COVID-19 infection has been initially classified as exclusively interstitial pneumonia with varying degrees of severity. Subsequently, vascular biomarkers showed that it can also be considered a vascular disease. The data on Factor VIII discussed in this paper, although preliminary and limited in number, seem to suggest that the thrombogenicity of Sars-CoV2 infection might be linked to widespread endothelial damage. In this way, it would be very important to investigate the pro-coagulative substrate both in all subjects who died and in COVID-19 survivors. This is because it may be hypothesized that the different patterns with which the pathology is expressed could depend on different individual susceptibility to infection or a different personal genetic-clinical background. In light of these findings, it would be important to perform more post-mortem investigations in order to clarify all aspects of the vascular hypothesis in the COVID-19 infection. View Full-Text
Keywords: forensic science; forensic pathology; COVID-19; autopsy; immunohistochemistry; post-mortem examination; COVID-19 diagnostic forensic science; forensic pathology; COVID-19; autopsy; immunohistochemistry; post-mortem examination; COVID-19 diagnostic
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MDPI and ACS Style

Cipolloni, L.; Sessa, F.; Bertozzi, G.; Baldari, B.; Cantatore, S.; Testi, R.; D’Errico, S.; Di Mizio, G.; Asmundo, A.; Castorina, S.; Salerno, M.; Pomara, C. Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression. Diagnostics 2020, 10, 575. https://doi.org/10.3390/diagnostics10080575

AMA Style

Cipolloni L, Sessa F, Bertozzi G, Baldari B, Cantatore S, Testi R, D’Errico S, Di Mizio G, Asmundo A, Castorina S, Salerno M, Pomara C. Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression. Diagnostics. 2020; 10(8):575. https://doi.org/10.3390/diagnostics10080575

Chicago/Turabian Style

Cipolloni, Luigi, Francesco Sessa, Giuseppe Bertozzi, Benedetta Baldari, Santina Cantatore, Roberto Testi, Stefano D’Errico, Giulio Di Mizio, Alessio Asmundo, Sergio Castorina, Monica Salerno, and Cristoforo Pomara. 2020. "Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression" Diagnostics 10, no. 8: 575. https://doi.org/10.3390/diagnostics10080575

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