Impact of SARS-CoV-2 Infection on Multiple Tissues: Insights from Cell-free Chromatin Analysis


Since the emergence of the COVID-19 pandemic, extensive research has been conducted to understand the impact of SARS-CoV-2 infection on the human body.

While the primary target of the virus is the respiratory system, it is now evident that the virus can cause damage to various other organs, including the heart, blood vessels, pancreas, kidneys, and liver.

The precise mechanisms underlying tissue damage during COVID-19 remain a subject of ongoing investigation. This article explores the multifaceted impact of SARS-CoV-2 infection on the human body and the challenges in predicting disease outcomes.

Diverse Tissue Damage During SARS-CoV-2 Infection

  • Respiratory System: The respiratory system is the primary target of SARS-CoV-2, leading to severe lung damage and respiratory distress. The virus invades the respiratory epithelial cells, causing inflammation and triggering the immune response. The interaction between viral replication and host immune response can result in significant lung injury.
  • Cardiovascular System: Emerging evidence suggests that SARS-CoV-2 infection can directly injure the heart, leading to various cardiovascular complications. The virus can infect cardiac cells, causing inflammation of the heart muscles (myocarditis) and disrupting the normal heart function. Additionally, the hyperinflammatory response triggered by the virus can contribute to further cardiovascular damage.
  • Blood Vessels: Endothelial cells lining blood vessels can be directly infected by the virus, leading to endothelial dysfunction and vascular inflammation. This vascular damage can increase the risk of blood clot formation (thrombosis) and contribute to severe complications such as strokes and pulmonary embolism.
  • Pancreas: The pancreas, an essential organ for regulating blood sugar levels, can also be affected by SARS-CoV-2 infection. The virus can directly infect pancreatic cells, leading to impaired insulin secretion and contributing to new-onset diabetes in some patients.
  • Kidneys: SARS-CoV-2 can infect kidney cells, causing acute kidney injury (AKI) in severe cases. The immune response to the virus can also induce inflammation in the kidneys, exacerbating the damage.
  • Liver: Liver injury has been observed in some COVID-19 patients, and the virus can directly infect liver cells. The immune response against the virus can also lead to liver inflammation and damage.

The Role of Immune Response

The immune response plays a crucial role in combating viral infections, including SARS-CoV-2. Both the innate and adaptive arms of the immune system are involved in the defense against the virus. However, in some cases, the immune response can become dysregulated, leading to severe inflammatory damage to various organs.

Clinical Heterogeneity and Long-COVID

The clinical course of COVID-19 can vary significantly among infected individuals. Some may experience fatal lung failure, while others may remain asymptomatic. This clinical heterogeneity during the acute phase can potentially account for the variation in late-onset clinical phenotypes, such as cardiovascular complications and new-onset diabetes.

Furthermore, the long-term effects of COVID-19, often referred to as “long COVID,” involve a diverse array of persistent symptoms that can last for months after the initial infection.

Cell-free Chromatin Analysis: A Novel Approach

Recent research has explored the use of cell-free chromatin fragments released from dying cells as a potential tool to understand tissue-specific damage during SARS-CoV-2 infection. These fragments contain valuable information about the identity of the cells and the gene expression programs that operated in them before their death.

Deep whole genome bisulfite sequencing (WGBS) of plasma cfDNA, followed by deconvolution using a comprehensive human methylome atlas, has provided crucial insights into tissue turnover in COVID-19 patients. Additionally, a highly sensitive targeted panel of tissue-specific methylation markers has been used to assess tissue contributions to cfDNA, enabling the detection of even small tissue amounts (less than 1%).


SARS-CoV-2 infection can directly injure the respiratory system and cause damage to multiple other tissues, leading to a wide range of clinical presentations. The immune response plays a pivotal role, but in some cases, it can lead to severe inflammatory damage. Cell-free chromatin analysis has emerged as a promising approach to understand tissue-specific damage during COVID-19, shedding light on the complexity of this viral infection.

Continued research in this field may eventually lead to better tools for predicting disease outcomes and identifying potential therapeutic targets to mitigate the long-term effects of COVID-19.

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