Lung transplantation for patients with severe COVID-19.
Lung transplantation for patients with severe COVID-19.
复制标题
DOI：
10.1126/scitranslmed.abe4282
复制
发表时间：
2020-12-16
影响因子：
17.1
通讯作者：
Budinger GRS
中科院分区：
文献类型：
--
作者：
Bharat A;Querrey M;Markov NS;Kim S;Kurihara C;Garza-Castillon R;Manerikar A;Shilatifard A;Tomic R;Politanska Y;Abdala-Valencia H;Yeldandi AV;Lomasney JW;Misharin AV;Budinger GRS
一些重症新冠病毒肺炎（COVID - 19）患者会发展为终末期肺纤维化，肺移植可能是唯一的治疗方法。
尽管进行了最佳的药物治疗，一些重症COVID - 19患者仍会出现不可逆的肺损伤。对于这些无法脱离机械通气或体外生命支持的患者，肺移植可能是唯一的救命选择。巴拉特等人现在报告了3例新冠病毒相关呼吸衰竭患者肺移植的结果。在这些患者的移植肺中未检测到新冠病毒（SARS - CoV - 2）RNA，但观察到了类似肺纤维化患者肺部的纤维化病理和转录变化。
肺移植可能是治疗新冠病毒相关呼吸衰竭未缓解患者的一种潜在救命疗法。限制肺移植的担忧包括同种异体移植物中新冠病毒感染复发、病毒介导的原生肺损伤带来的技术挑战，以及原生肺中导致呼吸机相关性肺炎的病原体感染同种异体移植物的潜在风险。此外，原生肺可能会恢复，从而导致比移植更好的长期结果。在此，我们报告了3例新冠病毒相关呼吸衰竭未缓解患者肺移植的结果。我们进行了单分子荧光原位杂交（smFISH），以检测3例患者的移植肺组织以及其他对照肺组织样本中新冠病毒RNA的正负链。我们对3例接受移植的患者的移植肺组织以及2例死于新冠病毒相关肺炎的患者的热缺血死后肺活检进行了细胞外基质成像和单细胞RNA测序。通过smFISH检测，这5例新冠病毒长期感染患者的肺部没有新冠病毒，但病理显示有大量类似终末期肺纤维化的损伤和纤维化证据。利用机器学习，我们将晚期新冠病毒肺炎患者肺部的单细胞RNA测序数据与肺纤维化患者肺部的数据进行了比较，并确定了不同细胞谱系基因表达的相似性。我们的研究结果表明，一些重症COVID - 19患者会发展为纤维化肺病，肺移植是他们生存的唯一选择。
Some patients with severe COVID-19 develop end-stage pulmonary fibrosis for which lung transplantation may be the only treatment. Despite optimal medical therapy, some patients with severe COVID-19 develop irreversible lung injury. In these patients who cannot be weaned from mechanical ventilation or extracorporeal life support, lung transplantation may be the only life-saving option. Bharat et al. now report the results of lung transplantation in three patients who had COVID-19–associated respiratory failure. SARS-CoV-2 RNA could not be detected in the explanted lungs of these patients, but fibrotic pathology and transcriptional changes resembling those of lungs from patients with pulmonary fibrosis were observed. Lung transplantation can potentially be a life-saving treatment for patients with nonresolving COVID-19–associated respiratory failure. Concerns limiting lung transplantation include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and the potential risk for allograft infection by pathogens causing ventilator-associated pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to those of transplant. Here, we report the results of lung transplantation in three patients with nonresolving COVID-19–associated respiratory failure. We performed single-molecule fluorescence in situ hybridization (smFISH) to detect both positive and negative strands of SARS-CoV-2 RNA in explanted lung tissue from the three patients and in additional control lung tissue samples. We conducted extracellular matrix imaging and single-cell RNA sequencing on explanted lung tissue from the three patients who underwent transplantation and on warm postmortem lung biopsies from two patients who had died from COVID-19–associated pneumonia. Lungs from these five patients with prolonged COVID-19 disease were free of SARS-CoV-2 as detected by smFISH, but pathology showed extensive evidence of injury and fibrosis that resembled end-stage pulmonary fibrosis. Using machine learning, we compared single-cell RNA sequencing data from the lungs of patients with late-stage COVID-19 to that from the lungs of patients with pulmonary fibrosis and identified similarities in gene expression across cell lineages. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is their only option for survival.
登录
查看更多内容
影响因子：
11.3
作者：
Sola I;Almazán F;Zúñiga S;Enjuanes L
通讯作者：
Enjuanes L
DOI：
10.1084/jem.20162152
发表时间：
2017-08-07
期刊：
The Journal of experimental medicine
影响因子：
--
作者：
Misharin AV;Morales-Nebreda L;Reyfman PA;Cuda CM;Walter JM;McQuattie-Pimentel AC;Chen CI;Anekalla KR;Joshi N;Williams KJN;Abdala-Valencia H;Yacoub TJ;Chi M;Chiu S;Gonzalez-Gonzalez FJ;Gates K;Lam AP;Nicholson TT;Homan PJ;Soberanes S;Dominguez S;Morgan VK;Saber R;Shaffer A;Hinchcliff M;Marshall SA;Bharat A;Berdnikovs S;Bhorade SM;Bartom ET;Morimoto RI;Balch WE;Sznajder JI;Chandel NS;Mutlu GM;Jain M;Gottardi CJ;Singer BD;Ridge KM;Bagheri N;Shilatifard A;Budinger GRS;Perlman H
通讯作者：
Perlman H
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny
影响因子：
12.3
作者：
Wolf FA;Angerer P;Theis FJ
通讯作者：
Theis FJ
影响因子：
16.6
作者：
Strunz, Maximilian;Simon, Lukas M.;Schiller, Herbert B.
通讯作者：
Schiller, Herbert B.