The spatial landscape of lung pathology during COVID-19 progression.

TitleThe spatial landscape of lung pathology during COVID-19 progression.
Publication TypeJournal Article
Year of Publication2021
AuthorsRendeiro AF, Ravichandran H, Bram Y, Chandar V, Kim J, Meydan C, Park J, Foox J, Hether T, Warren S, Kim Y, Reeves J, Salvatore S, Mason CE, Swanson EC, Borczuk AC, Elemento O, Schwartz RE
Date Published2021 05
KeywordsAlveolar Epithelial Cells, COVID-19, Disease Progression, Humans, Inflammation, Lung, Macrophages, Neutrophils, SARS-CoV-2, Single-Cell Analysis, Time Factors, Viral Tropism

Recent studies have provided insights into the pathology of and immune response to COVID-19. However, a thorough investigation of the interplay between infected cells and the immune system at sites of infection has been lacking. Here we use high-parameter imaging mass cytometry that targets the expression of 36 proteins to investigate the cellular composition and spatial architecture of acute lung injury in humans (including injuries derived from SARS-CoV-2 infection) at single-cell resolution. These spatially resolved single-cell data unravel the disordered structure of the infected and injured lung, alongside the distribution of extensive immune infiltration. Neutrophil and macrophage infiltration are hallmarks of bacterial pneumonia and COVID-19, respectively. We provide evidence that SARS-CoV-2 infects predominantly alveolar epithelial cells and induces a localized hyperinflammatory cell state that is associated with lung damage. We leverage the temporal range of fatal outcomes of COVID-19 in relation to the onset of symptoms, which reveals increased macrophage extravasation and increased numbers of mesenchymal cells and fibroblasts concomitant with increased proximity between these cell types as the disease progresses-possibly as a result of attempts to repair the damaged lung tissue. Our data enable us to develop a biologically interpretable landscape of lung pathology from a structural, immunological and clinical standpoint. We use this landscape to characterize the pathophysiology of the human lung from its macroscopic presentation to the single-cell level, which provides an important basis for understanding COVID-19 and lung pathology in general.

Alternate JournalNature
PubMed ID33780969
PubMed Central IDPMC8204801
Grant ListT32 CA203702 / CA / NCI NIH HHS / United States
R01 CA194547 / CA / NCI NIH HHS / United States
R01 CA234614 / CA / NCI NIH HHS / United States
R03 DK117252 / DK / NIDDK NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States
R01 DK121072 / DK / NIDDK NIH HHS / United States
R01 AI107301 / AI / NIAID NIH HHS / United States
Related Faculty: 
Steven P. Salvatore, M.D.


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