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Wagner E, Bień K, Łomża A, Grunwald A, Kimber-Trojnar Ż, Libera A, Leszczyńska-Gorzelak B. Stress of Prematurity in the Experience of the COVID-19 Pandemic-Current State of Knowledge. Life (Basel) 2023; 13:1757. [PMID: 37629614 PMCID: PMC10455823 DOI: 10.3390/life13081757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Stress is a process that triggers various physiological, hormonal and psychological mechanisms in response to a threat, which significantly affects the health of an individual. The COVID-19 pandemic introduced a lot of social changes that required constant adaptation to unfavorable conditions. The aim of the study was to assess the impact of stress related to this pandemic on pregnant women, mothers of premature infants and their families, and on obstetric complications, particularly preterm birth. A comprehensive literature review was performed using electronic databases such as Pubmed, Science Direct and Google Scholar. Keywords such as: "prematurity"; "pregnancy"; "stress"; "COVID-19" and various combinations of the above were used. Maternal stress and anxiety increase the levels of corticotropin-releasing hormone (CRH) in the placenta, which in turn affects the incidence of preterm birth and many other related maternal and neonatal complications. In addition, it was found that SARS-CoV-2 infection may increase the risk of this phenomenon. The COVID-19 pandemic has adversely affected preterm birth rates and the mental health of mothers of preterm infants, exacerbating their negative experience of having a premature baby. More research is needed to demonstrate the long-term effects of COVID-19 stress on prematurity.
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Affiliation(s)
| | | | | | | | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (E.W.); (K.B.); (A.Ł.); (A.G.); (A.L.); (B.L.-G.)
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Tosto V, Meyyazhagan A, Alqasem M, Tsibizova V, Di Renzo GC. SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic. J Pers Med 2023; 13:jpm13040699. [PMID: 37109085 PMCID: PMC10142804 DOI: 10.3390/jpm13040699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic.
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Affiliation(s)
- Valentina Tosto
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
| | - Arun Meyyazhagan
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
- Perinatology Research Branch, Wayne State University, Detroit, MI 48202, USA
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru 560029, India
| | - Malek Alqasem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak 61710, Jordan
| | | | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
- PREIS International School, 50122 Firenze, Italy
- Department of Obstetrics and Gynecology, IM Sechenov First State University, 19c1, Moscow 119991, Russia
- Almazov National Medical Research Centre, St Petersburg 197341, Russia
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3
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The Histopathological "Placentitis Triad" Is Specific for SARS-CoV-2 Infection, and Its Acute Presentation Can Be Associated with Poor Fetal Outcome. Life (Basel) 2023; 13:life13020479. [PMID: 36836836 PMCID: PMC9963180 DOI: 10.3390/life13020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: Placental histological lesions reported in relation with SARS-CoV-2 infection are various, with potential consequences such as fetal growth retardation, prematurity or stillbirth/neonatal death. We report here on a placental pathological association which could be specific for SARS-CoV-2 infection and associated with poor fetal outcome; (2) Methods: We collected all the placental pathological examinations performed in Brest University Hospital (France) since the beginning of COVID-19 pandemic with a known maternal SARS-CoV-2 infection and a poor pregnancy outcome. In these cases, we described the pathological lesions and we searched for these lesions in a large series of placentas collected and examined in the same institution before the SARS-CoV-2 pandemic; (3) Results: Three cases with severe fetal outcome (tardive abortion, prematurity, neonatal death), from the first to the third trimesters of pregnancy, were included. The three cases showed features of massive and acute "placentitis triad" consisting in massive perivillous fibrin deposition, sub-acute intervillositis and trophoblastic necrosis. This association was not encountered in any of 8857 placentas analyzed during the period between 2002 and 2012 in our institution; (4) Conclusions: The "placentitis triad" appears to be specific for SARS-CoV-2 infection and, in case of massive and acute presentation, could result in poor fetal outcome.
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Carvajal J, Casanello P, Toso A, Farías M, Carrasco-Negue K, Araujo K, Valero P, Fuenzalida J, Solari C, Sobrevia L. Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166582. [PMID: 36273675 PMCID: PMC9581789 DOI: 10.1016/j.bbadis.2022.166582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022]
Abstract
The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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Affiliation(s)
- Jorge Carvajal
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Paola Casanello
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands
| | - Alberto Toso
- Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karina Carrasco-Negue
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Kenny Araujo
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Javiera Fuenzalida
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Caterina Solari
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston 4029, Queensland, Australia; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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5
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Ayala-Ramírez P, González M, Escudero C, Quintero-Arciniegas L, Giachini FR, Alves de Freitas R, Damiano AE, García-Robles R. Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Pregnancy. A Non-systematic Review of Clinical Presentation, Potential Effects of Physiological Adaptations in Pregnancy, and Placental Vascular Alterations. Front Physiol 2022; 13:785274. [PMID: 35431989 PMCID: PMC9005899 DOI: 10.3389/fphys.2022.785274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
In December 2019, the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) rapidly spread to become a pandemic. To date, increasing evidence has described the potential negative impact of SARS-CoV-2 infection on pregnant women. Although the pathophysiology of coronavirus disease 2019 (COVID-19) is not entirely understood, there is emerging evidence that it causes a severe systemic inflammatory response associated with vascular alterations that could be of special interest considering some physiological changes in pregnancy. Additionally, these alterations may affect the physiology of the placenta and are associated with pregnancy complications and abnormal histologic findings. On the other hand, data about the vaccine against SARS-CoV-2 are limited, but the risks of administering COVID-19 vaccines during pregnancy appear to be minimal. This review summarizes the current literature on SARSCoV2 virus infection, the development of COVID-19 and its relationship with physiological changes, and angiotensin-converting enzyme 2 (ACE2) function during pregnancy. We have particularly emphasized evidence coming from Latin American countries.
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Affiliation(s)
- Paola Ayala-Ramírez
- School of Medicine, Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
- *Correspondence: Paola Ayala-Ramírez,
| | - Marcelo González
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Marcelo González,
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratory of Vascular Physiology, Department of Basic Sciences, Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile
| | - Laura Quintero-Arciniegas
- Perinatal Medicine Seedbed, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernanda R. Giachini
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
| | | | - Alicia E. Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Cátedra de Biología Celular y Molecular, Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Reggie García-Robles
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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6
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Khalil A, Blakeway H, Samara A, O'Brien P. COVID-19 and stillbirth: direct vs indirect effect of the pandemic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:288-295. [PMID: 34951732 DOI: 10.1002/uog.24846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - H Blakeway
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Samara
- Division of Clinical Paediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
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7
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Newton SM, Reeves EL, O’Malley Olsen E, Woodworth KR, Farr SL, Galang RR, Reynolds MR, Harvey E, Shi J, Nestoridi E, Barton J, Ngo VP, Lush M, Longcore ND, Dzimira P, Im LK, Sokale A, Siebman S, Delgado López C, Chen T, Mobley EL, Khuwaja S, Romitti PA, Fredette C, Ellis EM, Silcox K, Hall AJ, Azziz-Baumgartner E, Gilboa SM, Shapiro-Mendoza CK, Tong VT. Preterm birth among pregnant persons with severe acute respiratory syndrome Coronavirus 2 infection. J Perinatol 2022; 42:1328-1337. [PMID: 35927486 PMCID: PMC9362668 DOI: 10.1038/s41372-022-01467-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. STUDY DESIGN We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. RESULT Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. CONCLUSION Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons.
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Affiliation(s)
- Suzanne M. Newton
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Emily L. Reeves
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Emily O’Malley Olsen
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Kate R. Woodworth
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Sherry L. Farr
- grid.453445.70000 0004 0540 3431Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA USA
| | - Romeo R. Galang
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Megan R. Reynolds
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Elizabeth Harvey
- grid.416951.e0000 0004 0437 4464Tennessee Department of Health, Nashville, TN USA ,grid.416781.d0000 0001 2186 5810Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA USA
| | - Jing Shi
- grid.238434.a0000 0000 9369 8268New Jersey Department of Health, Trenton, NJ USA
| | - Eirini Nestoridi
- grid.416511.60000 0004 0378 6934Massachusetts Department of Public Health, Boston, MA USA
| | - Jerusha Barton
- grid.420388.50000 0004 4692 4364Georgia Department of Public Health, Atlanta, GA USA
| | - Van P. Ngo
- grid.416097.d0000 0004 0428 8718Los Angeles County Department of Public Health, Los Angeles, CA USA
| | - Mamie Lush
- grid.280417.80000 0004 0420 6102Nebraska Department of Health and Human Services, Lincoln, NE USA
| | - Nicole D. Longcore
- grid.238491.50000 0004 0367 6866New York State Department of Health, Albany, NY USA
| | - Paula Dzimira
- grid.280365.a0000 0004 0455 0659Pennsylvania Department of Health, Harrisburg, PA USA
| | - Lucille K. Im
- grid.413881.70000 0004 0499 951XArkansas Department of Health, Little Rock, AR USA
| | - Ayomide Sokale
- grid.280512.c0000 0004 0453 7577Philadelphia Department of Public Health, Philadelphia, PA USA
| | - Samantha Siebman
- grid.280248.40000 0004 0509 1853Minnesota Department of Health, Saint Paul, MN USA
| | | | - Tiffany Chen
- grid.1658.a0000 0004 0509 9775Washington State Department of Health, Tumwater, WA USA
| | - Evan L. Mobley
- grid.280361.e0000 0004 0414 5063Missouri Department of Health and Senior Services, Jefferson City, MO USA
| | | | - Paul A. Romitti
- grid.214572.70000 0004 1936 8294University of Iowa College of Public Health, Iowa City, IA USA
| | - Carolyn Fredette
- grid.422654.30000 0004 0382 4064New Hampshire Department of Health and Human Services, Concord, NH USA
| | | | - Kristin Silcox
- grid.416491.f0000 0001 0709 8547Maryland Department of Health, Baltimore, MD USA
| | - Aron J. Hall
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Eduardo Azziz-Baumgartner
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Suzanne M. Gilboa
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
| | - Carrie K. Shapiro-Mendoza
- grid.416781.d0000 0001 2186 5810Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA USA
| | - Van T. Tong
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention COVID-19 Response, Epidemiology Task Force, Atlanta, GA USA
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8
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Beesley MA, Davidson JR, Panariello F, Shibuya S, Scaglioni D, Jones BC, Maksym K, Ogunbiyi O, Sebire NJ, Cacchiarelli D, David AL, De Coppi P, Gerli MFM. COVID-19 and vertical transmission: assessing the expression of ACE2/TMPRSS2 in the human fetus and placenta to assess the risk of SARS-CoV-2 infection. BJOG 2022; 129:256-266. [PMID: 34735736 PMCID: PMC8652560 DOI: 10.1111/1471-0528.16974] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pregnant women have been identified as a potentially at-risk group concerning COVID-19 infection, but little is known regarding the susceptibility of the fetus to infection. Co-expression of ACE2 and TMPRSS2 has been identified as a prerequisite for infection, and expression across different tissues is known to vary between children and adults. However, the expression of these proteins in the fetus is unknown. METHODS We performed a retrospective analysis of a single cell data repository. The data were then validated at both gene and protein level by performing RT-qPCR and two-colour immunohistochemistry on a library of second-trimester human fetal tissues. FINDINGS TMPRSS2 is present at both gene and protein level in the predominantly epithelial fetal tissues analysed. ACE2 is present at significant levels only in the fetal intestine and kidney, and is not expressed in the fetal lung. The placenta also does not co-express the two proteins across the second trimester or at term. INTERPRETATION This dataset indicates that the lungs are unlikely to be a viable route of SARS-CoV2 fetal infection. The fetal kidney, despite presenting both the proteins required for the infection, is anatomically protected from the exposure to the virus. However, the gastrointestinal tract is likely to be susceptible to infection due to its high co-expression of both proteins, as well as its exposure to potentially infected amniotic fluid. TWEETABLE ABSTRACT This work provides detailed mechanistic insight into the relative protection & vulnerabilities of the fetus & placenta to SARS-CoV-2 infection by scRNAseq & protein expression analysis for ACE2 & TMPRSS2. The findings help to explain the low rate of vertical transmission.
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Affiliation(s)
- MA Beesley
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - JR Davidson
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- EGA Institute for Women’s HealthUniversity College LondonUK
| | - F Panariello
- Telethon Institute of Genetics and Medicine (TIGEM)Armenise/Harvard Laboratory of Integrative GenomicsPozzuoliItaly
| | - S Shibuya
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - D Scaglioni
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - BC Jones
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - K Maksym
- EGA Institute for Women’s HealthUniversity College LondonUK
| | - O Ogunbiyi
- NIHR Great Ormond Street Biomedical Research CentreLondonUK
| | - NJ Sebire
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- Department of Translational MedicineUniversity of Naples ‘Federico II’NaplesItaly
| | - D Cacchiarelli
- Telethon Institute of Genetics and Medicine (TIGEM)Armenise/Harvard Laboratory of Integrative GenomicsPozzuoliItaly
- Department of Translational MedicineUniversity of Naples ‘Federico II’NaplesItaly
| | - AL David
- EGA Institute for Women’s HealthUniversity College LondonUK
- Fetal Medicine UnitUniversity College London NHS Foundation TrustLondonUK
| | - P De Coppi
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- NIHR Great Ormond Street Biomedical Research CentreLondonUK
- Great Ormond Street Hospital for ChildrenLondonUK
| | - MFM Gerli
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- UCL Division of Surgery and Interventional ScienceRoyal Free HospitalLondonUK
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