Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19


The Lancet Respiratory Medicine

Contributing to research themes:

The lungs are the main site that is affected in severe COVID-19, and post-mortem lung tissue provides crucial insights into the pathophysiology of severe disease. From basic histology to state-of-the-art multiparameter digital pathology technologies, post-mortem lung tissue provides snapshots of tissue architecture, and resident and inflammatory cell phenotypes and composition at the time of death. Contrary to early assumptions that COVID-19 in the lungs is a uniform disease, post-mortem findings have established a high degree of disease heterogeneity. Classic diffuse alveolar damage represents just one phenotype, with disease divisible by early and late progression as well as by pathophysiological process. A distinct lung tissue state occurs with secondary infection; extrapulmonary causes of death might also originate from a pathological process in the lungs linked to microthrombosis. This heterogeneity of COVID-19 lung disease must be recognised in the management of patients and in the development of novel treatment strategies.

Author list:


  1. Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
  2. Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  3. York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
  4. Cellular Genetics Institute, Wellcome Sanger Institute, Cambridge, UK
  5. Innovation Methodology and Application Research Theme, Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
  6. Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U2


Luke Milross MD1, Joaquim Majo PhD2, Nigel Cooper MBBS2, Prof Paul M Kaye PhD3, Omer Bayraktar PhD4, Andrew Filby PhD5, Prof Andrew J Fisher PhD1,6,