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Doratt BM, Sureshchandra S, True H, Rincon M, Marshall N, Messaoudi I. Mild/Asymptomatic Maternal SARS-CoV-2 Infection Leads to Immune Paralysis in Fetal Circulation and Immune Dysregulation in Fetal-Placental Tissues. bioRxiv 2023:2023.05.10.540233. [PMID: 37214938 PMCID: PMC10197637 DOI: 10.1101/2023.05.10.540233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Few studies have addressed the impact of maternal mild/asymptomatic SARS-CoV-2 infection on the developing neonatal immune system. In this study, we analyzed umbilical cord blood and placental chorionic villi from newborns of unvaccinated mothers with mild/asymptomatic SARSCoV-2 infection during pregnancy using flow cytometry, single-cell transcriptomics, and functional assays. Despite the lack of vertical transmission, levels of inflammatory mediators were altered in cord blood. Maternal infection was also associated with increased memory T, B cells, and non-classical monocytes as well as increased activation. However, ex vivo responses to stimulation were attenuated. Finally, within the placental villi, we report an expansion of fetal Hofbauer cells and infiltrating maternal macrophages and rewiring towards a heightened inflammatory state. In contrast to cord blood monocytes, placental myeloid cells were primed for heightened antiviral responses. Taken together, this study highlights dysregulated fetal immune cell responses in response to mild maternal SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Brianna M. Doratt
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
| | - Suhas Sureshchandra
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
| | - Heather True
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington KY 40536
| | - Monica Rincon
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland OR 97239
| | - Nicole Marshall
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland OR 97239
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
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Abstract
OBJECTIVES In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. METHODS We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. RESULTS COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. CONCLUSIONS Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality.
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Affiliation(s)
- Esin Koç
- Department of Neonatology, Chief of Neonatology Division, Gazi University, Gazi School of Medicine, Chief of Turkish Neonatal Society, Ankara, Türkiye
| | - Dilek Dilli
- Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, University of Health Sciences of Türkiye, Ankara, Türkiye
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Gee S, Chandiramani M, Seow J, Pollock E, Modestini C, Das A, Tree T, Doores KJ, Tribe RM, Gibbons DL. The legacy of maternal SARS-CoV-2 infection on the immunology of the neonate. Nat Immunol 2021; 22:1490-1502. [PMID: 34616036 DOI: 10.1038/s41590-021-01049-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Despite extensive studies into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the effect of maternal infection on the neonate is unclear. To investigate this, we characterized the immunology of neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy. Here we show that maternal SARS-CoV-2 infection affects the neonatal immune system. Despite similar proportions of B cells, CD4+ T cells and CD8+ T cells, increased percentages of natural killer cells, Vδ2+ γδ T cells and regulatory T cells were detected in neonates born to mothers with recent or ongoing infection compared with those born to recovered or uninfected mothers. Increased plasma cytokine levels were also evident in neonates and mothers within the recent or ongoing infection group. Cytokine functionality was enhanced in neonates born to SARS-CoV-2-exposed mothers, compared to those born to uninfected mothers. In most neonates, this immune imprinting was nonspecific, suggesting vertical transmission of SARS-CoV-2 is limited, a finding supported by a lack of SARS-CoV-2-specific IgM in neonates despite maternal IgG transfer.
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Affiliation(s)
- Sarah Gee
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Manju Chandiramani
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Emily Pollock
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Carlotta Modestini
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Abhishek Das
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Timothy Tree
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK
| | - Deena L Gibbons
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK.
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Wu H, Liao S, Wang Y, Guo M, Lin X, Wu J, Wang R, Lv D, Wu D, He M, Hu B, Long R, Peng J, Yang H, Yin H, Wang X, Huang Z, Lan K, Zhou Y, Zhang W, Xiao Z, Zhao Y, Deng D, Wang H. Molecular evidence suggesting the persistence of residual SARS-CoV-2 and immune responses in the placentas of pregnant patients recovered from COVID-19. Cell Prolif 2021; 54:e13091. [PMID: 34291856 PMCID: PMC8420381 DOI: 10.1111/cpr.13091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Recent studies have shown the presence of SARS-CoV-2 in the tissues of clinically recovered patients and persistent immune symptoms in discharged patients for up to several months. Pregnant patients were shown to be a high-risk group for COVID-19. Based on these findings, we assessed SARS-CoV-2 nucleic acid and protein retention in the placentas of pregnant women who had fully recovered from COVID-19 and cytokine fluctuations in maternal and foetal tissues. MATERIALS AND METHODS Remnant SARS-CoV-2 in the term placenta was detected using nucleic acid amplification and immunohistochemical staining of the SARS-CoV-2 protein. The infiltration of CD14+ macrophages into the placental villi was detected by immunostaining. The cytokines in the placenta, maternal plasma, neonatal umbilical cord, cord blood and amniotic fluid specimens at delivery were profiled using the Luminex assay. RESULTS Residual SARS-CoV-2 nucleic acid and protein were detected in the term placentas of recovered pregnant women. The infiltration of CD14+ macrophages into the placental villi of the recovered pregnant women was higher than that in the controls. Furthermore, the cytokine levels in the placenta, maternal plasma, neonatal umbilical cord, cord blood and amniotic fluid specimens fluctuated significantly. CONCLUSIONS Our study showed that SARS-CoV-2 nucleic acid (in one patient) and protein (in five patients) were present in the placentas of clinically recovered pregnant patients for more than 3 months after diagnosis. The immune responses induced by the virus may lead to prolonged and persistent symptoms in the maternal plasma, placenta, umbilical cord, cord blood and amniotic fluid.
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Affiliation(s)
- Hao Wu
- State Key Laboratory of Stem Cell and Reproductive BiologyInstitute of ZoologyChinese Academy of SciencesBeijingChina
- Institute for Stem Cell and RegenerationChinese Academy of SciencesBeijingChina
- University of Chinese Academy of SciencesBeijingChina
- Beijing Institute for Stem Cell and Regenerative MedicineBeijingChina
| | - Shujie Liao
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yiming Wang
- State Key Laboratory of Stem Cell and Reproductive BiologyInstitute of ZoologyChinese Academy of SciencesBeijingChina
- Institute for Stem Cell and RegenerationChinese Academy of SciencesBeijingChina
- University of Chinese Academy of SciencesBeijingChina
- Beijing Institute for Stem Cell and Regenerative MedicineBeijingChina
| | - Ming Guo
- State Key Laboratory of VirologyModern Virology Research CenterCollege of Life SciencesWuhan UniversityWuhanChina
| | - Xingguang Lin
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jianli Wu
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Renjie Wang
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Dan Lv
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Di Wu
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Mengzhou He
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Bai Hu
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Rui Long
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei ProvinceTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hui Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei ProvinceTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Heng Yin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei ProvinceTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xin Wang
- State Key Laboratory of VirologyModern Virology Research CenterCollege of Life SciencesWuhan UniversityWuhanChina
| | - Zhixiang Huang
- State Key Laboratory of VirologyModern Virology Research CenterCollege of Life SciencesWuhan UniversityWuhanChina
| | - Ke Lan
- State Key Laboratory of VirologyModern Virology Research CenterCollege of Life SciencesWuhan UniversityWuhanChina
| | - Yanbin Zhou
- Department of Obstetrics and GynecologyPeople’s Hospital of Huangmei CountryHuanggang CityChina
| | - Wei Zhang
- Zhongnan HospitalWuhan UniversityWuhanChina
| | - Zhenyu Xiao
- State Key Laboratory of Stem Cell and Reproductive BiologyInstitute of ZoologyChinese Academy of SciencesBeijingChina
- Institute for Stem Cell and RegenerationChinese Academy of SciencesBeijingChina
- Beijing Institute for Stem Cell and Regenerative MedicineBeijingChina
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei ProvinceTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Dongrui Deng
- Department of Gynecology and ObstetricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hongmei Wang
- State Key Laboratory of Stem Cell and Reproductive BiologyInstitute of ZoologyChinese Academy of SciencesBeijingChina
- Institute for Stem Cell and RegenerationChinese Academy of SciencesBeijingChina
- University of Chinese Academy of SciencesBeijingChina
- Beijing Institute for Stem Cell and Regenerative MedicineBeijingChina
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Sureshchandra S, Zulu MZ, Doratt B, Jankeel A, Tifrea D, Edwards R, Rincon M, Marshall NE, Messaoudi I. Deep immune profiling of the maternal-fetal interface with mild SARS-CoV-2 infection. bioRxiv 2021:2021.08.23.457408. [PMID: 34462741 PMCID: PMC8404883 DOI: 10.1101/2021.08.23.457408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pregnant women are an at-risk group for severe COVID-19, though the majority experience mild/asymptomatic disease. Although severe COVID-19 has been shown to be associated with immune activation at the maternal-fetal interface even in the absence of active viral replication, the immune response to asymptomatic/mild COVID-19 remains unknown. Here, we assessed immunological adaptations in both blood and term decidua from 9 SARS-exposed pregnant women with asymptomatic/mild disease and 15 pregnant SARS-naive women. In addition to selective loss of tissue-resident decidual macrophages, we report attenuation of antigen presentation and type I IFN signaling but upregulation of inflammatory cytokines and chemokines in blood monocyte derived decidual macrophages. On the other hand, infection was associated with remodeling of the T cell compartment with increased frequencies of activated CD69+ tissue-resident T cells and decreased abundance of Tregs. Interestingly, frequencies of cytotoxic CD4 and CD8 T cells increased only in the blood, while CD8 effector memory T cells were expanded in the decidua. In contrast to decidual macrophages, signatures of type I IFN signaling were increased in decidual T cells. Finally, T cell receptor diversity was significantly reduced with infection in both compartments, albeit to a much greater extent in the blood. The resulting aberrant immune activation in the placenta, even with asymptomatic disease may alter the exquisitely sensitive developing fetal immune system, leading to long-term adverse outcomes for offspring.
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Affiliation(s)
- Suhas Sureshchandra
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
| | - Michael Z Zulu
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
| | - Brianna Doratt
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
| | - Allen Jankeel
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine CA 92697
| | - Delia Tifrea
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine CA 92697
| | - Robert Edwards
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine CA 92697
| | - Monica Rincon
- Maternal-Fetal Medicine, Oregon Health and Sciences University, Portland OR 97239
| | - Nicole E. Marshall
- Maternal-Fetal Medicine, Oregon Health and Sciences University, Portland OR 97239
| | - Ilhem Messaoudi
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
- Center for Virus Research, University of California, Irvine CA 92697
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