Deep spatial proteomics reveals region-specific features of severe COVID-19-related pulmonary injury

As a primary target of SARS-CoV-2, lung exhibits heterogeneous histopathological changes following infection. However, comprehensive insight into their protein basis with spatial resolution remains deficient, which hinders further understanding of COVID-19-related pulmonary injury. Here, we generated a region-resolved proteomic atlas of hallmark pathological pulmonary structures by integrating histological examination, laser microdissection, and ultrasensitive proteomics. Over 10,000 proteins were quantified across 71 post-mortem specimens. We identified a spectrum of pathway dysregulations in alveolar epithelium, bronchial epithelium, and blood vessels comparing with non-COVID-19 controls, providing evidence for transitional-state pneumocyte hyperplasia. Additionally, our data revealed the region-specific enrichment of functional markers in bronchiole mucus plug, pulmonary fibrosis, airspace inflammation, and alveolar type 2 cells, uncovering their distinctive features. Furthermore, we detected increased protein expression associated with viral entry and inflammatory response across multiple regions, suggesting potential therapeutic targets. Collectively, this study provides a unique perspective for deciphering COVID-19-caused pulmonary dysfunction by spatial proteomics.