Molecular pathology of emerging coronavirus infections

J Pathol. 2015 Jan;235(2):185-95. doi: 10.1002/path.4454.


Respiratory viruses can cause a wide spectrum of pulmonary diseases, ranging from mild, upper respiratory tract infections to severe and life-threatening lower respiratory tract infections, including the development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Viral clearance and subsequent recovery from infection require activation of an effective host immune response; however, many immune effector cells may also cause injury to host tissues. Severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus cause severe infection of the lower respiratory tract, with 10% and 35% overall mortality rates, respectively; however, >50% mortality rates are seen in the aged and immunosuppressed populations. While these viruses are susceptible to interferon treatment in vitro, they both encode numerous genes that allow for successful evasion of the host immune system until after high virus titres have been achieved. In this review, we discuss the importance of the innate immune response and the development of lung pathology following human coronavirus infection.

Keywords: ARDS; MERS-CoV; SARS-CoV; acute lung injury; acute respiratory distress syndrome; coronavirus; type II pneumocytes.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Antiviral Agents / therapeutic use
  • Biopsy
  • Communicable Diseases, Emerging*
  • Coronavirus / drug effects
  • Coronavirus / immunology
  • Coronavirus / isolation & purification
  • Coronavirus / pathogenicity*
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / immunology
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology*
  • Host-Pathogen Interactions
  • Humans
  • Immunity, Innate
  • Middle East Respiratory Syndrome Coronavirus / isolation & purification
  • Middle East Respiratory Syndrome Coronavirus / pathogenicity
  • Pathology, Molecular / methods*
  • Predictive Value of Tests
  • Respiratory System / drug effects
  • Respiratory System / immunology
  • Respiratory System / pathology
  • Respiratory System / virology*
  • Risk Factors
  • SARS Virus / isolation & purification
  • SARS Virus / pathogenicity
  • Severe Acute Respiratory Syndrome / drug therapy
  • Severe Acute Respiratory Syndrome / pathology
  • Severe Acute Respiratory Syndrome / virology
  • Virology / methods
  • Virulence


  • Antiviral Agents