Skeletal Muscles of Patients Infected with SARS-CoV-2 Develop Severe Myofiber Damage upon One Week of Admission on the Intensive Care Unit

S. Stevens, P. Hendrickx, T. Snijders, I. Lambrichts, B. Stessel, J. Dubois, L.J.C. van Loon, F. Vandenabeele*, A. Agten*

*Corresponding author for this work

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Many critically ill patients infected with SARS-CoV-2 have been submitted to an intensive care unit (ICU). Patients with a SARS-CoV-2 infection that survive critical illness are confronted with months of physical impairments. To maximize recovery, it is important to understand the musculoskeletal involvement in critically ill patients infected with SARS-CoV-2. The aim of the present study was to assess the myocellular changes in SARS-CoV-2 patients that occur throughout the first week of ICU admission. In n = 22 critically ill patients infected with SARS-CoV-2, a biopsy sample from the vastus lateralis muscle was obtained at day 1-3 and day 5-8 following ICU admission. Fluorescence microscopy was used to assess type I and type II muscle fiber size and distribution, myonuclear content, and muscle tissue capillarization. Transmission electron microscopy was used to support quantitative data at an ultrastructural level. Changes in type I and type II muscle fiber size showed large inter-individual variation. The average change in type I fiber size was +309 +/- 1834 mu m(2), ranging from -2129 mu m(2) (-31%) to +3375 mu m(2) (+73%). The average change in type II fiber size was -224 +/- 1256 mu m(2), ranging from -1410 mu m(2) (-36%) to +2592 mu m(2) (+48%). Ultrastructural observations showed myofibrillar and hydropic degeneration, and fiber necrosis. This study shows that ICU patients admitted with SARS-CoV-2 suffer from substantial muscle fiber damage during ICU admission. These results are a call for action towards more specialized rehabilitation programs for patients admitted to the ICU with SARS-CoV-2 infection.
Original languageEnglish
Article number7310
Number of pages18
JournalApplied Sciences
Issue number14
Publication statusPublished - 1 Jul 2022


  • severe acute respiratory syndrome virus
  • skeletal muscles
  • sepsis
  • respiratory distress syndrome
  • critical illness
  • COVID-19
  • ACE2

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