Diffuse alveolar damage patterns reflect the immunological and molecular heterogeneity in fatal COVID-19.

BACKGROUND: Severe COVID-19 lung disease exhibits a high degree of spatial and temporal heterogeneity, with different histological features coexisting within a single individual. It is important to capture the disease complexity to support patient management and treatment strategies. We provide spatially decoded analyses on the immunopathology of diffuse alveolar damage (DAD) patterns and factors that modulate immune and structural changes in fatal COVID-19. METHODS: We spatially quantified the immune and structural cells in exudative, intermediate, and advanced DAD through multiplex immunohistochemistry in autopsy lung tissue of 18 COVID-19 patients. Cytokine profiling, viral, bacteria, and fungi detection, and transcriptome analyses were performed. FINDINGS: Spatial DAD progression was associated with expansion of immune cells, macrophages, CD8+ T cells, fibroblasts, and (lymph)angiogenesis. Viral load correlated positively with exudative DAD and negatively with disease/hospital length. In all cases, enteric bacteria were isolated, and Candida parapsilosis in eight cases. Cytokines correlated mainly with macrophages and CD8+T cells. Pro-coagulation and acute repair were enriched pathways in exudative DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. INTERPRETATION: Unraveling the spatial and molecular immunopathology of COVID-19 cases exposes the responses to SARS-CoV-2-induced exudative DAD and subsequent immune-modulatory and remodeling changes in proliferative/advanced DAD that occur side-by-side together with secondary infections in the lungs. These complex features have important implications for disease management and the development of novel treatments. FUNDING: CNPq, Bill and Melinda Gates Foundation, HC-Convida, FAPESP, Regeneron Pharmaceuticals, and the Swedish Heart & Lung Foundation.

Health and Sustainability in Public Meals-An Explorative Review.

The world is facing a number of challenges related to food consumption. These are, on the one hand, health effects and, on the other hand, the environmental impact of food production. Radical changes are needed to achieve a sustainable and healthy food production and consumption. Public and institutional meals play a vital role in promoting health and sustainability, since they are responsible for a significant part of food consumption, as well as their "normative influence" on peoples' food habits. The aim of this paper is to provide an explorative review of the scientific literature, focusing on European research including both concepts of health and sustainability in studies of public meals. Of >3000 papers, 20 were found to satisfy these criteria and were thus included in the review. The results showed that schools and hospitals are the most dominant arenas where both health and sustainability have been addressed. Three different approaches in combining health and sustainability have been found, these are: "Health as embracing sustainability", "Sustainability as embracing health" and "Health and sustainability as separate concepts". However, a clear motivation for addressing both health and sustainability is most often missing.