COVID-19: unravelling the clinical progression of nature's virtually perfect biological weapon.
Identifieur interne : 000723 ( Main/Exploration ); précédent : 000722; suivant : 000724COVID-19: unravelling the clinical progression of nature's virtually perfect biological weapon.
Auteurs : Giuseppe Lippi [Italie] ; Fabian Sanchis-Gomar [Espagne, États-Unis] ; Brandon M. Henry [États-Unis]Source :
- Annals of translational medicine [ 2305-5839 ] ; 2020.
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has shocked the world and caused morbidity and mortality on an unprecedented level in the era of modern medicine. Evidence generated to-date on the virulence and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that COVID-19 may be considered a perfect storm, caused by a nature's virtually perfect biological weapon. This conclusion is supported by an updated analysis of pathogenesis and clinical progression of this infectious disease. It is now readily apparent that COVID-19 is not a clear-cut disorder, but is instead a gradually evolving pathology, characterized by a series of stages sustained by different molecular and biological mechanisms. The disease can hence be divided in at least five different phases (incubation, respiratory, pro-inflammatory, pro-thrombotic, and death or remission). Whilst the virus triggers direct cytopathic injury during the initial stage of illness, in the following evolving phases, it is the host itself that undergoes an almost suicidal reaction, sustained, amplified and maintained by the immune, complement and hemostatic systems. Another peculiar property making SARS-CoV-2 a devious and vicious pathogen is the biophysical structure of its receptor biding domain, which needs to be primed by human proteases, thus being less efficiently targetable by the host immune system. The unique pathophysiology of COVID-19 requires the customization of therapy by individual patient characteristics and according to the phase-specific, evolving derangement of the multiple biological pathways.
DOI: 10.21037/atm-20-3989
PubMed: 32617313
PubMed Central: PMC7327324
Affiliations:
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Henry</name><affiliation wicri:level="2"><nlm:affiliation>Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32617313</idno><idno type="pmid">32617313</idno><idno type="doi">10.21037/atm-20-3989</idno><idno type="pmc">PMC7327324</idno><idno type="wicri:Area/Main/Corpus">000544</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000544</idno><idno type="wicri:Area/Main/Curation">000544</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000544</idno><idno type="wicri:Area/Main/Exploration">000544</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">COVID-19: unravelling the clinical progression of nature's virtually perfect biological weapon.</title><author><name sortKey="Lippi, Giuseppe" sort="Lippi, Giuseppe" uniqKey="Lippi G" first="Giuseppe" last="Lippi">Giuseppe Lippi</name><affiliation wicri:level="1"><nlm:affiliation>Section of Clinical Biochemistry, University of Verona, Verona, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Clinical Biochemistry, University of Verona, Verona</wicri:regionArea><wicri:noRegion>Verona</wicri:noRegion></affiliation></author><author><name sortKey="Sanchis Gomar, Fabian" sort="Sanchis Gomar, Fabian" uniqKey="Sanchis Gomar F" first="Fabian" last="Sanchis-Gomar">Fabian Sanchis-Gomar</name><affiliation wicri:level="1"><nlm:affiliation>Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia</wicri:regionArea><wicri:noRegion>Valencia</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Henry, Brandon M" sort="Henry, Brandon M" uniqKey="Henry B" first="Brandon M" last="Henry">Brandon M. Henry</name><affiliation wicri:level="2"><nlm:affiliation>Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j">Annals of translational medicine</title><idno type="ISSN">2305-5839</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Coronavirus disease 2019 (COVID-19) pandemic has shocked the world and caused morbidity and mortality on an unprecedented level in the era of modern medicine. Evidence generated to-date on the virulence and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that COVID-19 may be considered a perfect storm, caused by a nature's virtually perfect biological weapon. This conclusion is supported by an updated analysis of pathogenesis and clinical progression of this infectious disease. It is now readily apparent that COVID-19 is not a clear-cut disorder, but is instead a gradually evolving pathology, characterized by a series of stages sustained by different molecular and biological mechanisms. The disease can hence be divided in at least five different phases (incubation, respiratory, pro-inflammatory, pro-thrombotic, and death or remission). Whilst the virus triggers direct cytopathic injury during the initial stage of illness, in the following evolving phases, it is the host itself that undergoes an almost suicidal reaction, sustained, amplified and maintained by the immune, complement and hemostatic systems. Another peculiar property making SARS-CoV-2 a devious and vicious pathogen is the biophysical structure of its receptor biding domain, which needs to be primed by human proteases, thus being less efficiently targetable by the host immune system. The unique pathophysiology of COVID-19 requires the customization of therapy by individual patient characteristics and according to the phase-specific, evolving derangement of the multiple biological pathways.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32617313</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>28</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">2305-5839</ISSN><JournalIssue CitedMedium="Print"><Volume>8</Volume><Issue>11</Issue><PubDate><Year>2020</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Annals of translational medicine</Title><ISOAbbreviation>Ann Transl Med</ISOAbbreviation></Journal><ArticleTitle>COVID-19: unravelling the clinical progression of nature's virtually perfect biological weapon.</ArticleTitle><Pagination><MedlinePgn>693</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.21037/atm-20-3989</ELocationID><Abstract><AbstractText>Coronavirus disease 2019 (COVID-19) pandemic has shocked the world and caused morbidity and mortality on an unprecedented level in the era of modern medicine. Evidence generated to-date on the virulence and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that COVID-19 may be considered a perfect storm, caused by a nature's virtually perfect biological weapon. This conclusion is supported by an updated analysis of pathogenesis and clinical progression of this infectious disease. It is now readily apparent that COVID-19 is not a clear-cut disorder, but is instead a gradually evolving pathology, characterized by a series of stages sustained by different molecular and biological mechanisms. The disease can hence be divided in at least five different phases (incubation, respiratory, pro-inflammatory, pro-thrombotic, and death or remission). Whilst the virus triggers direct cytopathic injury during the initial stage of illness, in the following evolving phases, it is the host itself that undergoes an almost suicidal reaction, sustained, amplified and maintained by the immune, complement and hemostatic systems. Another peculiar property making SARS-CoV-2 a devious and vicious pathogen is the biophysical structure of its receptor biding domain, which needs to be primed by human proteases, thus being less efficiently targetable by the host immune system. The unique pathophysiology of COVID-19 requires the customization of therapy by individual patient characteristics and according to the phase-specific, evolving derangement of the multiple biological pathways.</AbstractText><CopyrightInformation>2020 Annals of Translational Medicine. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lippi</LastName><ForeName>Giuseppe</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Section of Clinical Biochemistry, University of Verona, Verona, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sanchis-Gomar</LastName><ForeName>Fabian</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Henry</LastName><ForeName>Brandon M</ForeName><Initials>BM</Initials><AffiliationInfo><Affiliation>Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Ann Transl Med</MedlineTA><NlmUniqueID>101617978</NlmUniqueID><ISSNLinking>2305-5839</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Coronavirus disease 2019 (COVID-19)</Keyword><Keyword MajorTopicYN="N">coagulation</Keyword><Keyword MajorTopicYN="N">coronavirus</Keyword><Keyword MajorTopicYN="N">inflammation</Keyword><Keyword MajorTopicYN="N">pathogenesis</Keyword></KeywordList><CoiStatement>Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3989). GL serves as an unpaid executive editor-in-chief of Annals of Translational Medicine from Jan 2016 to Jan 2022. FSG serves as an unpaid editorial board member of Annals of Translational Medicine from Mar 2019 to Feb 2021. BMH has no conflicts of interest to declare.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>7</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>7</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>7</Month><Day>4</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32617313</ArticleId><ArticleId IdType="doi">10.21037/atm-20-3989</ArticleId><ArticleId IdType="pii">atm-08-11-693</ArticleId><ArticleId IdType="pmc">PMC7327324</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>J Am Coll Radiol. 2020 Jun;17(6):701-709</Citation><ArticleIdList><ArticleId IdType="pubmed">32283052</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2020 Apr 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