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Philippens IHCHM, Böszörményi KP, Wubben JAM, Fagrouch ZC, van Driel N, Mayenburg AQ, Lozovagia D, Roos E, Schurink B, Bugiani M, Bontrop RE, Middeldorp J, Bogers WM, de Geus-Oei LF, Langermans JAM, Verschoor EJ, Stammes MA, Verstrepen BE. Brain Inflammation and Intracellular α-Synuclein Aggregates in Macaques after SARS-CoV-2 Infection. Viruses 2022; 14:v14040776. [PMID: 35458506 PMCID: PMC9025893 DOI: 10.3390/v14040776] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2 causes acute respiratory disease, but many patients also experience neurological complications. Neuropathological changes with pronounced neuroinflammation have been described in individuals after lethal COVID-19, as well as in the CSF of hospitalized patients with neurological complications. To assess whether neuropathological changes can occur after a SARS-CoV-2 infection, leading to mild-to-moderate disease, we investigated the brains of four rhesus and four cynomolgus macaques after pulmonary disease and without overt clinical symptoms. Postmortem analysis demonstrated the infiltration of T-cells and activated microglia in the parenchyma of all infected animals, even in the absence of viral antigen or RNA. Moreover, intracellular α-synuclein aggregates were found in the brains of both macaque species. The heterogeneity of these manifestations in the brains indicates the virus’ neuropathological potential and should be considered a warning for long-term health risks, following SARS-CoV-2 infection.
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Affiliation(s)
- Ingrid H. C. H. M. Philippens
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Kinga P. Böszörményi
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Jacqueline A. M. Wubben
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Zahra C. Fagrouch
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Nikki van Driel
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Amber Q. Mayenburg
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Diana Lozovagia
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Eva Roos
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Bernadette Schurink
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Ronald E. Bontrop
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Department of Biology, Theoretical Biology and Bioinformatics, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Jinte Middeldorp
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Willy M. Bogers
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
- Biomedical Photonic Imaging Group, University of Twente, 7522 ND Enschede, The Netherlands
| | - Jan A. M. Langermans
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Ernst J. Verschoor
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Correspondence:
| | - Marieke A. Stammes
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Babs E. Verstrepen
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
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2
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Abstract
Purpose and context. Angiotensin-converting enzyme 2 is the entry receptor for SARS-CoV and SARS-CoV-2. Variations in ACE2 expression might explain age-related symptomatology of COVID-19, that is, more gastro-intestinal symptoms and less pulmonary complaints. This study qualitatively investigated ACE2 protein expression in various organs from the fetal to the young adolescent stage. Method. Autopsy samples from lung, heart, liver, stomach, small intestine, pancreas, kidney, adrenals, and brain (when available) were obtained from twenty subjects aged 24 weeks gestational age through 28 years. Formalin-fixed paraffin-embedded 4-um-thick tissue sections were stained against ACE2. Key results. We showed that the extent of ACE2 expression is age-related. With age, expression increases in lungs and decreases in intestines. In the other examined organs, ACE2 protein expression did not change with age. In brain tissue, ACE2 was expressed in astrocytes and endothelial cells. Conclusions. Age-related ACE2 expression differences could be one substrate of the selective clinical vulnerability of the respiratory and gastro-intestinal system to SARS-CoV-2 infection during infancy.
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Affiliation(s)
- Bernadette Schurink
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands,Bernadette Schurink, Department of
Pathology, Department of Pathology, Amsterdam University Medical Centers, VU
University, de Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands.
| | - Eva Roos
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands
| | - Wim Vos
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands
| | - Marjolein Breur
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands
| | - Paul van der Valk
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centers, VU University,
Amsterdam, the Netherlands
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3
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Grootemaat AE, van der Niet S, Scholl ER, Roos E, Schurink B, Bugiani M, Miller SE, Larsen P, Pankras J, Reits EA, van der Wel NN. Lipid and Nucleocapsid N-Protein Accumulation in COVID-19 Patient Lung and Infected Cells. Microbiol Spectr 2022; 10:e0127121. [PMID: 35171025 PMCID: PMC8849100 DOI: 10.1128/spectrum.01271-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
The pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global outbreak and prompted an enormous research effort. Still, the subcellular localization of the coronavirus in lungs of COVID-19 patients is not well understood. Here, the localization of the SARS-CoV-2 proteins is studied in postmortem lung material of COVID-19 patients and in SARS-CoV-2-infected Vero cells, processed identically. Correlative light and electron microscopy on semithick cryo-sections demonstrated induction of electron-lucent, lipid-filled compartments after SARS-CoV-2 infection in both lung and cell cultures. In lung tissue, the nonstructural protein 4 and the stable nucleocapsid N-protein were detected on these novel lipid-filled compartments. The induction of such lipid-filled compartments and the localization of the viral proteins in lung of patients with fatal COVID-19 may explain the extensive inflammatory response and provide a new hallmark for SARS-CoV-2 infection at the final, fatal stage of infection. IMPORTANCE Visualization of the subcellular localization of SARS-CoV-2 proteins in lung patient material of COVID-19 patients is important for the understanding of this new virus. We detected viral proteins in the context of the ultrastructure of infected cells and tissues and discovered that some viral proteins accumulate in novel, lipid-filled compartments. These structures are induced in Vero cells but, more importantly, also in lung of patients with COVID-19. We have characterized these lipid-filled compartments and determined that this is a novel, virus-induced structure. Immunogold labeling demonstrated that cellular markers, such as CD63 and lipid droplet marker PLIN-2, are absent. Colocalization of lipid-filled compartments with the stable N-protein and nonstructural protein 4 in lung of the last stages of COVID-19 indicates that these compartments play a key role in the devastating immune response that SARS-CoV-2 infections provoke.
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Affiliation(s)
- Anita E. Grootemaat
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Sanne van der Niet
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Edwin R. Scholl
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Eva Roos
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, the Netherlands
| | - Bernadette Schurink
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, the Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, the Netherlands
| | - Sara E. Miller
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Per Larsen
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, the Netherlands
| | - Jeannette Pankras
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, the Netherlands
| | - Eric A. Reits
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Nicole N. van der Wel
- Electron Microscopy Centre Amsterdam, Medical Biology, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
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4
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Guo L, Schurink B, Roos E, Nossent EJ, Duitman JW, Vlaar APJ, van der Valk P, Vaz FM, Yeh SR, Geeraerts Z, Dijkhuis A, van Vught L, Bugiani M, Lutter R, van Agtmael M, Algera AG, Appelman B, van Baarle F, Bax D, Beudel M, Bogaard HJ, Bomers M, Bonta P, Bos L, Botta M, de Brabander J, Bree G, de Bruin S, Bugiani M, Bulle E, Chouchane O, Cloherty A, David BTP, de Rotte MCFJ, Dijkstra M, Dongelmans DA, Dujardin RWG, Elbers P, Fleuren L, Geerlings S, Geijtenbeek T, Girbes A, Goorhuis B, Grobusch MP, Hafkamp F, Hagens L, Hamann J, Hamann J, Harris V, Hemke R, Hermans SM, Heunks L, Hollmann M, Horn J, Hovius JW, de Jong MD, Koning R, Lim EHT, van Mourik N, Nellen J, Nossent EJ, Paulus F, Peters E, Piña-Fuentes DAI, van der Poll T, Preckel B, Prins JM, Raasveld J, Reijnders T, Schinkel M, Schrauwen FAP, Schultz MJ, Schuurmans A, Schuurmans J, Sigaloff K, Slim MA, Smit M, Stijnis CS, Stilma W, Teunissen C, Thoral P, Tsonas AM, Tsonas A, van der Valk M, Veelo D, Volleman C, de Vries H, Vught LA, van Vugt M, Wouters D, Zwinderman AHK, Brouwer MC, Wiersinga WJ, Vlaar APJ, van de Beek D. Indoleamine 2,3-dioxygenase (IDO)-1 and IDO-2 activity and severe course of COVID-19. J Pathol 2021; 256:256-261. [PMID: 34859884 PMCID: PMC8897979 DOI: 10.1002/path.5842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
COVID-19 is a pandemic with high morbidity and mortality. In an autopsy cohort of COVID-19 patients, we found extensive accumulation of the tryptophan degradation products 3-hydroxy anthranilic acid and quinolinic acid in lungs, heart, and brain. This was not related to the expression of the tryptophan-catabolizing indoleamine 2,3-dioxygenase (IDO)-1, but rather to that of its isoform IDO-2, which otherwise is expressed rarely. Bioavailability of tryptophan is an absolute requirement for proper cell functioning and synthesis of hormones, whereas its degradation products can cause cell death. Markers of apoptosis and severe cellular stress were associated with IDO-2 expression in large areas of lung and heart tissue, whereas affected areas in brain were more restricted. Analyses of tissue, cerebrospinal fluid, and sequential plasma samples indicate early initiation of the kynurenine/aryl-hydrocarbon receptor/IDO-2 axis as a positive feedback loop, potentially leading to severe COVID-19 pathology. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lihui Guo
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette Schurink
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Eva Roos
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Esther J Nossent
- Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Jan Willem Duitman
- Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Dept. Intensive Care and Center for Experimental Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul van der Valk
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Core Facility Metabolomics, Department of Clinical Chemistry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Syun-Ru Yeh
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Zachary Geeraerts
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Annemiek Dijkhuis
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van Vught
- Dept. Intensive Care and Center for Experimental Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marianna Bugiani
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - René Lutter
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands.,Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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5
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Wu L, Baylan U, van der Leeden B, Schurink B, Roos E, Schalkwijk CG, Bugiani M, van der Valk P, van Rossum AC, Zeerleder SS, Heunks LMA, Boon RA, de Boer OJ, van der Wal AC, Niessen HWM, Krijnen PAJ. Cardiac inflammation and microvascular procoagulant changes are decreased in second wave compared to first wave deceased COVID-19 patients. Int J Cardiol 2021; 349:157-165. [PMID: 34871622 PMCID: PMC8641429 DOI: 10.1016/j.ijcard.2021.11.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
Background Compelling evidence has shown cardiac involvement in COVID-19 patients. However, the overall majority of these studies use data obtained during the first wave of the pandemic, while recently differences have been reported in disease course and mortality between first- and second wave COVID-19 patients. The aim of this study was to analyze and compare cardiac pathology between first- and second wave COVID-19 patients. Methods Autopsied hearts from first- (n = 15) and second wave (n = 10) COVID-19 patients and from 18 non-COVID-19 control patients were (immuno)histochemically analyzed. CD45+ leukocyte, CD68+ macrophage and CD3+ T lymphocyte infiltration, cardiomyocyte necrosis and microvascular thrombosis were quantified. In addition, the procoagulant factors Tissue Factor (TF), Factor VII (FVII), Factor XII (FXII), the anticoagulant protein Dipeptidyl Peptidase 4 (DPP4) and the advanced glycation end-product N(ε)-Carboxymethyllysine (CML), as markers of microvascular thrombogenicity and dysfunction, were quantified. Results Cardiac inflammation was significantly decreased in second wave compared to first wave COVID-19 patients, predominantly related to a decrease in infiltrated lymphocytes and the occurrence of lymphocytic myocarditis. This was accompanied by significant decreases in cardiomyocyte injury and microvascular thrombosis. Moreover, microvascular deposits of FVII and CML were significantly lower in second wave compared to first wave COVID-19 patients. Conclusions These results show that in our cohort of fatal COVID-19 cases cardiac inflammation, cardiomyocyte injury and microvascular thrombogenicity were markedly decreased in second wave compared to first wave patients. This may reflect advances in COVID-19 treatment related to an increased use of steroids in the second COVID-19 wave.
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Affiliation(s)
- Linghe Wu
- Dept. of Pathology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centre (AUMC), location VUmc, De Boelelaan 1017, 1081HV Amsterdam, the Netherlands
| | - Umit Baylan
- Dept. of Pathology and ACS, AUMC, location VUmc, the Netherlands
| | - Britt van der Leeden
- Dept. of Pathology and Amsterdam institute for Infection and Immunity, AUMC, the Netherlands
| | | | - Eva Roos
- Dept. of Pathology, AUMC, location VUmc, the Netherlands
| | - Casper G Schalkwijk
- Dept. of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Marianna Bugiani
- Dept. of Pathology, AUMC, location VUmc and AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | | | - Sacha S Zeerleder
- Dept. of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland; Dept. for BioMedical Research, University of Bern, Murtenstrasse 35, 3008 Bern, Switzerland
| | - Leo M A Heunks
- Dept. Intensive Care Medicine, AUMC, location VUmc, the Netherlands
| | - Reinier A Boon
- Department of Physiology, AUMC, location VUmc, Amsterdam, the Netherlands; Institute for Cardiovascular Regeneration, Centre for Molecular Medicine and German center for Cardiovascular Research (DZHK), Goethe University, Frankfurt am Main, Germany
| | - Onno J de Boer
- Dept. of Pathology and ACS, AUMC, location VUmc, the Netherlands
| | | | - Hans W M Niessen
- Dept. of Pathology and ACS and Dept. of Cardiac Surgery, AUMC, location VUmc, the Netherlands
| | - Paul A J Krijnen
- Dept. of Pathology and ACS, AUMC, location VUmc, the Netherlands.
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6
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Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, van den Berk IAH, Britstra R, Stoker J, Vonk Noordegraaf A, van der Valk P, Thunnissen E, Bugiani M, Bogaard HJ, Radonic T. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology 2021; 26:869-877. [PMID: 34159661 PMCID: PMC8447040 DOI: 10.1111/resp.14101] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 06/02/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with coronavirus disease 2019 (COVID-19) pneumonia present with typical findings on chest computed tomography (CT), but the underlying histopathological patterns are unknown. Through direct regional correlation of imaging findings to histopathological patterns, this study aimed to explain typical COVID-19 CT patterns at tissue level. METHODS Eight autopsy cases were prospectively selected of patients with PCR-proven COVID-19 pneumonia with varying clinical manifestations and causes of death. All had been subjected to chest CT imaging 24-72 h prior to death. Twenty-seven lung areas with typical COVID-19 patterns and two radiologically unaffected pulmonary areas were correlated to histopathological findings in the same lung regions. RESULTS Two dominant radiological patterns were observed: ground-glass opacity (GGO) (n = 11) and consolidation (n = 16). In seven of 11 sampled areas of GGO, diffuse alveolar damage (DAD) was observed. In four areas of GGO, the histological pattern was vascular damage and thrombosis, with (n = 2) or without DAD (n = 2). DAD was also observed in five of 16 samples derived from areas of radiological consolidation. Seven areas of consolidation were based on a combination of DAD, vascular damage and thrombosis. In four areas of consolidation, bronchopneumonia was found. Unexpectedly, in samples from radiologically unaffected lung parenchyma, evidence was found of vascular damage and thrombosis. CONCLUSION In COVID-19, radiological findings of GGO and consolidation are mostly explained by DAD or a combination of DAD and vascular damage plus thrombosis. However, the different typical CT patterns in COVID-19 are not related to specific histopathological patterns. Microvascular damage and thrombosis are even encountered in the radiologically normal lung.
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Affiliation(s)
- Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Roos
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernadette Schurink
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Pulmonary Medicine, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Rieneke Britstra
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul van der Valk
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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7
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Cleypool CGJ, Mackaaij C, Lotgerink Bruinenberg D, Schurink B, Bleys RLAW. Sympathetic nerve distribution in human lymph nodes. J Anat 2021; 239:282-289. [PMID: 33677834 PMCID: PMC8273593 DOI: 10.1111/joa.13422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/01/2022] Open
Abstract
Various lymph node functions are regulated by the sympathetic nervous system as shown in rodent studies. If human lymph nodes show a comparable neural regulation, their afferent nerves could represent a potential therapeutic target to treat, for example, infectious or autoimmune disease. Little information is available on human lymph node innervation and the aim of this study is to establish a comprehensive and accurate representation of the presence and location of sympathetic nerves in human lymph nodes. Since previous studies mention sympathetic paravascular nerves to occasionally extent into T cell‐rich regions, the relation of these nerves with T cells was studied as well. A total number of 15 inguinal lymph nodes were resected from six donated human cadavers. Lymph node sections were stained with HE and a double T/B cell staining for evaluation of their morphology and to screen for general pathologies. A triple stain was used to identify blood vessels, sympathetic nerves and T cells, and, to study the presence and location of sympathetic nerves and their relation to T cells. To evaluate whether the observed nerves were en route to other structures or were involved in local processes, adjacent slides were stained with a marker for varicosities (synaptophysin), which presence is suggestive for synaptic activity. All lymph nodes contained sympathetic nerves, both as paravascular and discrete structures. In 15/15 lymph nodes, nerves were observed in their capsule, medulla and hilum, whereas only 13/15 lymph nodes contained nerves in their cortex. The amount of sympathetic nerves varied between compartments and between and within individuals. In general, if a lymph node contained more paravascular nerves in a specific compartment, more discrete nerves were observed as well. Occasionally, discrete nerves were observed in relation to T cells in lymphoid tissues of the cortex and medulla. Furthermore, discrete nerves were frequently present in the capsule and hilum. The presence of varicosities in a portion of these nerves, independently to their compartment, suggested a local regulatory function for these nerves. Human lymph nodes contain sympathetic nerves in their capsule, trabeculae, cortex, medulla and hilum, both as paravascular or as discrete structures. Discrete nerves were observed in relation to T cells and non‐T cell‐rich areas such as the hilar and capsular connective tissue. The presence of discrete structures suggests neural regulation of structures other than blood vessels, which was further supported by the presence of varicosities in a portion of these nerves. These observations are of relevance in further understanding neural regulation of lymph node immune responses and in the development of neuromodulatory immune therapies.
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Affiliation(s)
- Cindy G J Cleypool
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Claire Mackaaij
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dyonne Lotgerink Bruinenberg
- Experimental Vascular Biology, Department of Medical Biochemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Bernadette Schurink
- Department of Pathology, Amsterdam University Medical Centre, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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8
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Lutter R, Schurink B, Roos E, Guo L, van der Valk P, Bugiani M. Neutrophils as a pallbearer for SARS-CoV-2 disease burden - Authors' reply. Lancet Microbe 2021; 2:e57. [PMID: 33655232 PMCID: PMC7906741 DOI: 10.1016/s2666-5247(21)00001-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- René Lutter
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.,Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Bernadette Schurink
- Department of Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Eva Roos
- Department of Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Lihui Guo
- Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Paul van der Valk
- Department of Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
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9
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Schurink B, Roos E, Radonic T, Barbe E, Bouman CSC, de Boer HH, de Bree GJ, Bulle EB, Aronica EM, Florquin S, Fronczek J, Heunks LMA, de Jong MD, Guo L, du Long R, Lutter R, Molenaar PCG, Neefjes-Borst EA, Niessen HWM, van Noesel CJM, Roelofs JJTH, Snijder EJ, Soer EC, Verheij J, Vlaar APJ, Vos W, van der Wel NN, van der Wal AC, van der Valk P, Bugiani M. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe 2020; 1:e290-e299. [PMID: 33015653 PMCID: PMC7518879 DOI: 10.1016/s2666-5247(20)30144-0] [Citation(s) in RCA: 358] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets multiple organs and causes severe coagulopathy. Histopathological organ changes might not only be attributable to a direct virus-induced effect, but also the immune response. The aims of this study were to assess the duration of viral presence, identify the extent of inflammatory response, and investigate the underlying cause of coagulopathy. METHODS This prospective autopsy cohort study was done at Amsterdam University Medical Centers (UMC), the Netherlands. With informed consent from relatives, full body autopsy was done on 21 patients with COVID-19 for whom autopsy was requested between March 9 and May 18, 2020. In addition to histopathological evaluation of organ damage, the presence of SARS-CoV-2 nucleocapsid protein and the composition of the immune infiltrate and thrombi were assessed, and all were linked to disease course. FINDINGS Our cohort (n=21) included 16 (76%) men, and median age was 68 years (range 41-78). Median disease course (time from onset of symptoms to death) was 22 days (range 5-44 days). In 11 patients tested for SARS-CoV-2 tropism, SARS-CoV-2 infected cells were present in multiple organs, most abundantly in the lungs, but presence in the lungs became sporadic with increased disease course. Other SARS-CoV-2-positive organs included the upper respiratory tract, heart, kidneys, and gastrointestinal tract. In histological analyses of organs (sampled from nine to 21 patients per organ), an extensive inflammatory response was present in the lungs, heart, liver, kidneys, and brain. In the brain, extensive inflammation was seen in the olfactory bulbs and medulla oblongata. Thrombi and neutrophilic plugs were present in the lungs, heart, kidneys, liver, spleen, and brain and were most frequently observed late in the disease course (15 patients with thrombi, median disease course 22 days [5-44]; ten patients with neutrophilic plugs, 21 days [5-44]). Neutrophilic plugs were observed in two forms: solely composed of neutrophils with neutrophil extracellular traps (NETs), or as aggregates of NETs and platelets.. INTERPRETATION In patients with lethal COVID-19, an extensive systemic inflammatory response was present, with a continued presence of neutrophils and NETs. However, SARS-CoV-2-infected cells were only sporadically present at late stages of COVID-19. This suggests a maladaptive immune response and substantiates the evidence for immunomodulation as a target in the treatment of severe COVID-19. FUNDING Amsterdam UMC Corona Research Fund.
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Affiliation(s)
- Bernadette Schurink
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Eva Roos
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Ellis Barbe
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Catherine S C Bouman
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hans H de Boer
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, Netherlands
| | - Godelieve J de Bree
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Esther B Bulle
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora M Aronica
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Judith Fronczek
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lihui Guo
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Romy du Long
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rene Lutter
- Department of Pulmonary Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Pam C G Molenaar
- Department of Pulmonary Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - E Andra Neefjes-Borst
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
- Department of Cardiac Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Carel J M van Noesel
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Eric J Snijder
- Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Eline C Soer
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Wim Vos
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Nicole N van der Wel
- Electron Microscopy Center Amsterdam, Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul van der Valk
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centers (UMC), VU University Amsterdam, Amsterdam, Netherlands
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Cleypool CGJ, Mackaaij C, Schurink B, Bleys RLAW. Morphological hallmarks facilitating distinction of omental milky spots and lymph nodes: an exploratory study on their discriminative capacity. Histol Histopathol 2020; 35:1275-1284. [PMID: 32926399 DOI: 10.14670/hh-18-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Omental milky spots (OMSs) are the primary lymphoid structures of the greater omentum. However, the presence of lymph nodes (LNs) has occasionally been mentioned as well. Understanding which lymphoid structures are present is of significance, especially in gastric tumor metastasis; tumor deposits in omental LNs suggest local lymphatic spread, whereas tumor deposits in OMSs suggest peritoneal spread and hence extensive disease. Since LNs and OMSs share morphological characteristics and OMSs might be wrongly identified as LNs, reliable hallmarks facilitating easy discrimination are needed. MATERIALS AND METHOD A series of microscopic morphological hallmarks unique to LNs were selected as potential candidates and were assessed for their discriminative capacity: 1) capsule, 2) trabeculae, 3) subcapsular sinus, 4) afferent lymphatic vessels, 5) distinct B- and T cell regions, and 6) a layered organization with, from the outside in a capsule, cortex, paracortex, and medulla. These hallmarks were visualized by multiple staining techniques. RESULTS Hallmarks 1, 2 5 and 6 were shown to be the most efficient as these were consistent and discriminative. They were best visualized by Picrosirius red, smooth muscle actin and a B-cell / T-cell double staining. CONCLUSION The presence of a capsule, trabeculae, distinct B- and T-cell regions and a layered organization represent consistent and reliable morphological features which allow to easily distinguish LNs from OMSs, especially when applied in combination.
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Affiliation(s)
- Cindy G J Cleypool
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Claire Mackaaij
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bernadette Schurink
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Pathology, Amsterdam University Medical Centre, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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11
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Schurink B, Mazza E, Ruurda JP, Roeling TAP, Bleys RLAW, van Hillegersberg R. Metastatic incidence of (PET)CT positive lung hilar and retroperitoneal lymph nodes in esophageal cancer patients. Surg Oncol 2020; 33:170-176. [PMID: 32561084 DOI: 10.1016/j.suronc.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Extra-regional lymph node metastases strongly determine treatment options in patients with esophageal cancer. Staging modalities such as (FDG-PET) CT scanning frequently show activity in retroperitoneal and lung hilar lymph nodes. This study evaluated the incidence of histologically confirmed metastases, treatment approach and recurrence patterns in patients with (FDG-PET) CT positivity in these regions. METHODS All patients with (FDG-PET-) CT positive hilar and/or retroperitoneal lymph nodes at primary staging or restaging discussed at a multidisciplinary tumor board meeting for staging of esophageal cancer between January 2012-December 2017 were included. Biopsies and follow-up were evaluated to determine the presence of metastases and progression rates. RESULTS From 2012 to 2017, 65 of 857 patients (7.6%) were selected with positive retroperitoneal and/or hilar lymph nodes. A total of 47/65 (72.3%) patients had positive retroperitoneal lymph nodes, which contained metastases in 19 (29.2%). When no biopsy was performed and curative treatment was given (n = 14), 9 patients had progression or locoregional and distant recurrence. Positive hilar lymph nodes were identified in 21 (32.3%) patients; 4 were biopsied and none contained metastases. In these patients no recurrence of disease was seen during follow-up. CONCLUSIONS The majority of biopsied (PET)CT-positive retroperitoneal lymph nodes at staging contained metastases, while biopsied (PET)CT-positive hilar nodes did not. Histological evaluation of (PET)CT -positive retroperitoneal lymph nodes at staging imaging is recommended, while based on this small series, (PET)CT-positive hilar lymph nodes most likely represent reactive lymphadenopathy.
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Affiliation(s)
- B Schurink
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands.
| | - E Mazza
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - T A P Roeling
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
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Abstract
Omental milky spots (OMSs), small lymphoid structures positioned in the greater omentum, are involved in peritoneal immune homeostasis and the formation of omental metastases. Sympathetic nerve activity is known to regulate immune function in other lymphoid organs (e.g. spleen and lymph nodes) and to create a favourable microenvironment for various tumour types. However, it is still unknown whether OMSs receive sympathetic innervation. Therefore, the aim of this study was to establish whether OMSs of the adult human greater omentum receive sympathetic innervation. A total of 18 OMSs were isolated from five omenta, which were removed from 3% formaldehyde-perfused cadavers (with a median age of 84 years, ranging from 64 to 94). OMSs were embedded in paraffin, cut and stained with a general (PGP9.5) and sympathetic nerve marker (TH and DBH), and evaluated by bright field microscopy. A T-cell, B-cell, and macrophage staining was performed to confirm OMS identity. In 50% of the studied OMSs, sympathetic nerve fibres were observed at multiple levels of the same OMS. Nerve fibres were represented as dots or elongated structures and often observed in relation to small vessels and occasionally as individual structures residing between lymphoid cells. The current study shows that 50% of the investigated OMSs contain sympathetic nerve fibres. These findings may contribute to our understanding of neural regulation of peritoneal immune response and the involvement of OMSs in omental metastases.
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Affiliation(s)
- Cindy G. J. Cleypool
- Department of AnatomyDivision of Surgical SpecialtiesUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Bernadette Schurink
- Department of AnatomyDivision of Surgical SpecialtiesUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Dorinde E. M. van der Horst
- Department of AnatomyDivision of Surgical SpecialtiesUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Ronald L. A. W. Bleys
- Department of AnatomyDivision of Surgical SpecialtiesUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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13
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Schurink B, Mazza E, Ruurda JP, Roeling TA, Steenhagen E, Bleys RL, van Hillegersberg R. Low-Fat Tube Feeding After Esophagectomy Is Associated With a Lower Incidence of Chylothorax. Ann Thorac Surg 2019; 108:184-189. [DOI: 10.1016/j.athoracsur.2019.02.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 12/22/2022]
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14
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Schurink B, Cleypool CGJ, Bleys RLAW. A rapid and simple method for visualizing milky spots in large fixed tissue samples of the human greater omentum. Biotech Histochem 2019; 94:429-434. [PMID: 30896309 DOI: 10.1080/10520295.2019.1583375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Milky spots are unique lymphoid structures in the greater omentum that participate in both immune homeostasis of the peritoneal cavity and formation of omental metastases. We developed a rapid and simple staining method to enable macro- or stereomicroscopic identification of these miniscule structures in large samples of fixed human greater omentum. By immersing approximately 6 × 4 cm samples of omental tissue in hematoxylin, these samples could be evaluated quickly for the presence of milky spots. We used an alum hematoxylin variant containing 1 g hematoxylin, 50 g aluminium ammonium sulfate, 0.2 g sodium iodide, 1 g citric acid and 50 g chloral hydrate. This staining method enabled us to determine the number, location, dimensions and topographical relation of milky spots to other structures. Our method also facilitates isolation of milky spots for further investigation. Hematoxylin imparts a blue color to the milky spots, which remains in place during further processing for paraffin embedding. This enabled easy recognition of milky spots during transfer through various solutions and permitted selection of relevant paraffin slides prior to additional staining.
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Affiliation(s)
- B Schurink
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, the Netherlands , Utrecht , The Netherlands
| | - C G J Cleypool
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, the Netherlands , Utrecht , The Netherlands
| | - R L A W Bleys
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, the Netherlands , Utrecht , The Netherlands
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15
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Schurink B, Defize IL, Mazza E, Ruurda JP, Brosens LAA, Roeling TAP, Bleys RLAW, van Hillegersberg R. Two-Field Lymphadenectomy During Esophagectomy: The Presence of Thoracic Duct Lymph Nodes. Ann Thorac Surg 2018; 106:435-439. [PMID: 29580778 DOI: 10.1016/j.athoracsur.2018.02.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct. METHODS A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically. RESULTS Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present. CONCLUSIONS This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.
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Affiliation(s)
- Bernadette Schurink
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ingmar L Defize
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elena Mazza
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tom A P Roeling
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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16
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Defize IL, Schurink B, Weijs TJ, Roeling TAP, Ruurda JP, van Hillegersberg R, Bleys RLAW. The anatomy of the thoracic duct at the level of the diaphragm: A cadaver study. Ann Anat 2018; 217:47-53. [PMID: 29510243 DOI: 10.1016/j.aanat.2018.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/11/2018] [Accepted: 02/01/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Injury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm. BASIC PROCEDURES The thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers. The level of origin of the thoracic duct and the points where tributaries entered the thoracic duct were measured using landmarks easily identified during surgery: the aortic and esophageal hiatus and the arch of the azygos vein. MAIN FINDINGS The thoracic duct was formed in the thoracic cavity by the union of multiple abdominal tributaries in 6 cadavers. In 3 cadavers partially duplicated systems were present that communicated with interductal branches. The thoracic duct was formed by a median of 3 (IQR: 3-5) abdominal tributaries merging 8.3cm (IQR: 7.3-9.3cm) above the aortic hiatus, 1.8cm (IQR: -0.4 to 2.4cm) above the esophageal hiatus, and 12.3cm (IQR: 14.0 to -11.0cm) below the arch of the azygos vein. CONCLUSION This study challenges the paradigm that abdominal lymphatics join in the abdomen to pass the diaphragm as a single thoracic duct. In this study, this occurred in 1/7 cadavers. Although small, the results of this series suggest that the formation of the thoracic duct above the diaphragm is more common than previously thought. This knowledge may be vital to prevent and treat post-operative chyle leakage.
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Affiliation(s)
- Ingmar L Defize
- Department of Anatomy, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85060, 3508 AB Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Bernadette Schurink
- Department of Anatomy, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85060, 3508 AB Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Teus J Weijs
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tom A P Roeling
- Department of Anatomy, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85060, 3508 AB Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85060, 3508 AB Utrecht, The Netherlands.
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