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Kellum CL, Kirkland LG, Nelson TK, Jewett SM, Rytkin E, Efimov IR, Hoover DB, Benson PV, Wagener BM. Sympathetic remodeling and altered angiotensin-converting enzyme 2 localization occur in patients with cardiac disease but are not exacerbated by severe COVID-19. Auton Neurosci 2024; 251:103134. [PMID: 38101169 PMCID: PMC10872860 DOI: 10.1016/j.autneu.2023.103134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Remodeling of sympathetic nerves and ACE2 has been implicated in cardiac pathology, and ACE2 also serves as a receptor for SARS-CoV-2. However, there is limited histological knowledge about the transmural distribution of sympathetic nerves and the cellular localization and distribution of ACE2 in human left ventricles from normal or diseased hearts. Goals of this study were to establish the normal pattern for these parameters and determine changes that occurred in decedents with cardiovascular disease alone compared to those with cardiac pathology and severe COVID-19. METHODS We performed immunohistochemical analysis on sections of left ventricular wall from twenty autopsied human hearts consisting of a control group, a cardiovascular disease group, and COVID-19 ARDS, and COVID-19 non-ARDS groups. RESULTS Using tyrosine hydroxylase as a noradrenergic marker, we found substantial sympathetic nerve loss in cardiovascular disease samples compared to controls. Additionally, we found heterogeneous nerve loss in both COVID-19 groups. Using an ACE2 antibody, we observed robust transmural staining localized to pericytes in the control group. The cardiovascular disease hearts displayed regional loss of ACE2 in pericytes and regional increases in staining of cardiomyocytes for ACE2. Similar changes were observed in both COVID-19 groups. CONCLUSIONS Heterogeneity of sympathetic innervation, which occurs in cardiac disease and is not increased by severe COVID-19, could contribute to arrhythmogenesis. The dominant localization of ACE2 to pericytes suggests that these cells would be the primary target for potential cardiac infection by SARS-CoV-2. Regional changes in ACE2 staining by myocytes and pericytes could have complex effects on cardiac pathophysiology.
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Affiliation(s)
- Creighton L Kellum
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Logan G Kirkland
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Tasha K Nelson
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Seth M Jewett
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Eric Rytkin
- Department of Biomedical Engineering and Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Igor R Efimov
- Department of Biomedical Engineering and Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Donald B Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; Center of Excellence in Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Paul V Benson
- Department of Pathology, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Brant M Wagener
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35294, USA.
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Ali AE, Al-Balas A, Benson PV, Almehmi A. Fatal superior vena cava rupture complicating dialysis catheter exchange. J Vasc Access 2024:11297298231219288. [PMID: 38166439 DOI: 10.1177/11297298231219288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/04/2024] Open
Abstract
Central vein stenosis (CVS) is a common and challenging complication in hemodialysis patients with chronic central venous catheters (CVCs). CVS often remains asymptomatic and is discovered incidentally during follow-up imaging. CVS symptoms include arm swelling, venous hypertension, impaired dialysis flow rates, and development of collateral veins. However, these symptoms can be nonspecific and overlap with other conditions, making the diagnosis challenging. Timely recognition and appropriate intervention are crucial to prevent complications and optimize patient outcomes. Diagnostic tools commonly used include duplex ultrasonography and venography to assess the degree and location of stenosis. Management strategies for CVS encompass a multidisciplinary approach involving nephrologists, interventional radiologists, and vascular surgeons. Initial conservative measures may include anticoagulation therapy, along with pharmacological interventions such as antiplatelet agents and thrombolytics. The endovascular approach is the first line for managing CVS by using balloon angioplasty either alone or in combination with stent placement, but CVS typically recurs frequently, requiring repeated interventions with an increased risk of complications. Additionally, alternative vascular access options such as arteriovenous fistulas or grafts may be considered. In this report, we describe a case of a 25-year-old woman who presented with an extensive history of multiple dialysis access failure for left internal jugular vein central venous tunneled catheter exchange. The procedure was complicated by a fatal superior vena cava rupture likely related to the dislodgment of the guidewire causing perforation into the pericardium space with subsequent cardiopulmonary collapse. The post-mortem autopsy showed severe organized stenosis of SVC and transmural defect above the SVC/atrial junction.
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Affiliation(s)
- Ahmed E Ali
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alian Al-Balas
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul V Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Nargan K, Naidoo T, Msimang M, Nadeem S, Wells G, Hunter RL, Hutton A, Lumamba K, Glasgow JN, Benson PV, Steyn AJ. Detection of Mycobacterium tuberculosis in human tissue via RNA in situ hybridization. bioRxiv 2023:2023.10.04.560963. [PMID: 37873458 PMCID: PMC10592959 DOI: 10.1101/2023.10.04.560963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Rationale Accurate TB diagnosis is hampered by the variable efficacy of the widely-used Ziehl-Neelsen (ZN) staining method to identify Mycobacterium tuberculosis ( Mtb ) acid-fast bacilli (AFB). Here, we sought to circumvent this current limitation through direct detection of Mtb mRNA. Objectives To employ RNAscope to determine the spatial distribution of Mtb mRNA within tuberculous human tissue, to appraise ZN-negative tissue from confirmed TB patients, and to provide proof-of-concept of RNAscope as a platform to inform TB diagnosis and Mtb biology. Methods We examined ante- and postmortem human TB tissue using RNAscope to detect Mtb mRNA and a dual ZN/immunohistochemistry staining approach to identify AFB and bacilli producing antigen 85B (Ag85B). Measurements and main results We adapted RNAscope for Mtb and identified intact and disintegrated Mtb bacilli and intra- and extracellular Mtb mRNA. Mtb mRNA was distributed zonally within necrotic and non-necrotic granulomas. We also found Mtb mRNA within, and adjacent to, necrotic granulomas in ZN-negative lung tissue and in Ag85B-positive bronchial epithelium. Intriguingly, we observed accumulation of Mtb mRNA and Ag85B in the cytoplasm of host cells. Notably, many AFB were negative for Ag85B staining. Mtb mRNA was observed in ZN-negative antemortem lymph node biopsies. Conclusions RNAscope has diagnostic potential and can guide therapeutic intervention as it detects Mtb mRNA and morphology in ZN-negative tissues from TB patients, and Mtb mRNA in ZN-negative antemortem biopsies, respectively. Lastly, our data provide evidence that at least two phenotypically distinct populations of Mtb bacilli exist in vivo .
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4
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Khan RJ, Single SL, Simmons CS, Athar M, Liu Y, Bodduluri S, Benson PV, Goliwas KF, Deshane JS. Altered sphingolipid pathway in SARS-CoV-2 infected human lung tissue. Front Immunol 2023; 14:1216278. [PMID: 37868972 PMCID: PMC10585362 DOI: 10.3389/fimmu.2023.1216278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction The SARS-CoV-2 mediated COVID-19 pandemic has impacted millions worldwide. Hyper-inflammatory processes, including cytokine storm, contribute to long-standing tissue injury and damage in COVID-19. The metabolism of sphingolipids as regulators of cell survival, differentiation, and proliferation has been implicated in inflammatory signaling and cytokine responses. Sphingosine-kinase-1 (SK1) and ceramide-synthase-2 (CERS2) generate metabolites that regulate the anti- and pro-apoptotic processes, respectively. Alterations in SK1 and CERS2 expression may contribute to the inflammation and tissue damage during COVID-19. The central objective of this study is to evaluate structural changes in the lung post-SARS-CoV-2 infection and to investigate whether the sphingolipid rheostat is altered in response to SARS-CoV-2 infection. Methods Central and peripheral lung tissues from COVID-19+ or control autopsies and resected lung tissue from COVID-19 convalescents were subjected to histologic evaluation of airspace and collagen deposisiton, and immunohistochemical evaluation of SK1 and CERS2. Results Here, we report significant reduction in air space and increase in collagen deposition in lung autopsy tissues from patients who died from COVID-19 (COVID-19+) and COVID-19 convalescent individuals. SK1 expression increased in the lungs of COVID-19+ autopsies and COVID-19 convalescent lung tissue compared to controls and was mostly associated with Type II pneumocytes and alveolar macrophages. No significant difference in CERS2 expression was noted. SARS-CoV-2 infection upregulates SK1 and increases the ratio of SK1 to CERS2 expression in lung tissues of COVID-19 autopsies and COVID-19 convalescents. Discussion These data suggest an alteration in the sphingolipid rheostat in lung tissue during COVID-19, suggesting a potential contribution to the inflammation and tissue damage associated with viral infection.
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Affiliation(s)
- Rabisa J. Khan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Sierra L. Single
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christopher S. Simmons
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Mohammad Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yuelong Liu
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sandeep Bodduluri
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul V. Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kayla F. Goliwas
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessy S. Deshane
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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MacGowan T, McClinchey T, Parcha V, Vatta M, Litovsky S, Arora P, Benson PV. De novo heterozygous pathogenic FBN1 variant in an autopsy case of multiple aneurysms and right renal artery dissection: a case report. Front Cardiovasc Med 2023; 10:1170460. [PMID: 37378398 PMCID: PMC10291322 DOI: 10.3389/fcvm.2023.1170460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background Marfan syndrome is a potentially fatal inherited autosomal dominant condition impacting the cardiovascular and the skeletal system with an estimated 25% cases caused by sporadic genetic variations. Given the genetic inheritance pattern, an autopsy of probands with Marfan syndrome-associated mortality is critical to establish the phenotypic expression and clinical implications of the particular genetic variant, especially for first-degree relatives. We present the findings of a Marfan syndrome proband decedent presenting with sudden onset abdominal pain and unexplained retroperitoneal abdominal hemorrhage. Methods An autopsy was performed to inform the blood relatives of the phenotypic expression and penetrance of the potentially heritable condition. A clinical laboratory improvement amendment (CLIA)-certified clinical grade genetic sequencing was performed to identify pathogenic variants in genes associated with aortopathy. Results The autopsy showed intra-abdominal and retroperitoneal hemorrhage due to infarction of the right kidney caused by dissection of the right renal artery. Genetic testing identified a heterozygous pathogenic FBN1 gene variant. The specific variant is FBN1 NM_000138.4 c.2953G > A p.(Gly985Arg). Conclusions We report a case of a previously undiagnosed Marfan syndrome death due to a de novo FBN1 variant, c.2953G > A.
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Affiliation(s)
- Taylor MacGowan
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
- Tulane University Pathologists’ Assistant Program, Tulane University, New Orleans, LA, United States
| | - Taylor McClinchey
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vibhu Parcha
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matteo Vatta
- Invitae Corporation, San Francisco, CA, United States
| | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pankaj Arora
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul V. Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
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Butler JT, Chellappan R, Litovsky S, Leal SM, Benson PV. Coronary Stent Abscess in the Setting of Arteriovenous Graft Infection following COVID-19: An Autopsy Case Report. Case Rep Pathol 2023; 2023:9998749. [PMID: 37180570 PMCID: PMC10171982 DOI: 10.1155/2023/9998749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
While rare, coronary stent infections present with significant mortality-with most infections and further complications occurring within months of percutaneous coronary intervention (PCI). Here, we discuss a post-COVID-19 patient who presented approximately one year after PCI for declotting of an arteriovenous graft (AVG). Upon admission, the patient was found to be bacteremic with multilobar pneumonia and an infection of the AVG. Empiric antibiotics were started, and blood cultures were subsequently positive for MRSA. Removal of the AVG was unsuccessful, and two days after admission, the patient passed. Autopsy revealed a perivascular abscess in the RCA near the origin of the stent with a ground section of the RCA with stent revealing abundant calcific atherosclerosis and marked necrosis of the artery wall. The cause of death was determined to be sepsis complicating coronary artery disease and chronic renal failure.
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Affiliation(s)
| | | | - Silvio Litovsky
- University of Alabama at Birmingham School of Medicine, USA
- University of Alabama at Birmingham Department of Pathology, USA
| | - Sixto M. Leal
- University of Alabama at Birmingham School of Medicine, USA
- University of Alabama at Birmingham Department of Pathology, USA
| | - Paul V. Benson
- University of Alabama at Birmingham School of Medicine, USA
- University of Alabama at Birmingham Department of Pathology, USA
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7
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Kirkland LG, Garbe CG, Hadaya J, Benson PV, Wagener BM, Tankovic S, Hoover DB. Sympathetic innervation of human and porcine spleens: implications for between species variation in function. Bioelectron Med 2022; 8:20. [PMID: 36536461 PMCID: PMC9762010 DOI: 10.1186/s42234-022-00102-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The vagus nerve affects innate immune responses by activating spleen-projecting sympathetic neurons, which modulate leukocyte function. Recent basic and clinical research investigating vagus nerve stimulation to engage the cholinergic anti-inflammatory pathway (CAP) has shown promising therapeutic results for a variety of inflammatory diseases. Abundant sympathetic innervation occurs in rodent spleens, and use of these species has dominated mechanistic research investigating the CAP. However, previous neuroanatomical studies of human spleen found a more restricted pattern of innervation compared to rodents. Therefore, our primary goal was to establish the full extent of sympathetic innervation of human spleens using donor tissue with the shortest procurement to fixation time. Parallel studies of porcine spleen, a large animal model, were performed as a positive control and for comparison. METHODS Human and porcine spleen tissue were fixed immediately after harvest and prepared for immunohistochemistry. Human heart and porcine spleen were stained in conjunction as positive controls. Several immunohistochemical protocols were compared for best results. Tissue was stained for tyrosine hydroxylase (TH), a noradrenergic marker, using VIP purple chromogen. Consecutive tissue slices were stained for neuropeptide Y (NPY), which often co-localizes with TH, or double-labelled for TH and CD3, a T cell marker. High-magnification images and full scans of the tissue were obtained and analyzed for qualitative differences between species. RESULTS TH had dominant perivascular localization in human spleen, with negligible innervation of parenchyma, but such nerves were abundant throughout ventricular myocardium. In marked contrast, noradrenergic innervation was abundant in all regions of porcine spleen, with red pulp having more nerves than white pulp. NPY stain results were consistent with this pattern. In human spleen, noradrenergic nerves only ran close to T cells at the boundary of the periarterial lymphatic sheath and arteries. In porcine spleen, noradrenergic nerves were closely associated with T cells in both white and red pulp as well as other leukocytes in red pulp. CONCLUSION Sympathetic innervation of the spleen varies between species in both distribution and abundance, with humans and pigs being at opposite extremes. This has important implications for sympathetic regulation of neuroimmune interactions in the spleen of different species and focused targeting of the CAP in humans.
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Affiliation(s)
- Logan G. Kirkland
- grid.255381.80000 0001 2180 1673Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614 USA
| | - Chloe G. Garbe
- grid.255381.80000 0001 2180 1673Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614 USA
| | - Joseph Hadaya
- grid.19006.3e0000 0000 9632 6718UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095 USA ,grid.19006.3e0000 0000 9632 6718Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, CA USA
| | - Paul V. Benson
- grid.265892.20000000106344187Department of Pathology, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35249 USA
| | - Brant M. Wagener
- grid.265892.20000000106344187Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35249 USA
| | - Sanjin Tankovic
- grid.265892.20000000106344187Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35249 USA
| | - Donald B. Hoover
- grid.255381.80000 0001 2180 1673Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614 USA ,grid.255381.80000 0001 2180 1673Department of Biomedical Sciences, Quillen College of Medicine and Center of Excellence in Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN 37614 USA
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8
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Wells G, Glasgow JN, Nargan K, Lumamba K, Madansein R, Maharaj K, Perumal LY, Matthew M, Hunter RL, Pacl H, Peabody Lever JE, Stanford DD, Singh SP, Bajpai P, Manne U, Benson PV, Rowe SM, le Roux S, Sigal A, Tshibalanganda M, Wells C, du Plessis A, Msimang M, Naidoo T, Steyn AJC. A high-resolution 3D atlas of the spectrum of tuberculous and COVID-19 lung lesions. EMBO Mol Med 2022; 14:e16283. [PMID: 36285507 PMCID: PMC9641421 DOI: 10.15252/emmm.202216283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/01/2023] Open
Abstract
Our current understanding of the spectrum of TB and COVID-19 lesions in the human lung is limited by a reliance on low-resolution imaging platforms that cannot provide accurate 3D representations of lesion types within the context of the whole lung. To characterize TB and COVID-19 lesions in 3D, we applied micro/nanocomputed tomography to surgically resected, postmortem, and paraffin-embedded human lung tissue. We define a spectrum of TB pathologies, including cavitary lesions, calcium deposits outside and inside necrotic granulomas and mycetomas, and vascular rearrangement. We identified an unusual spatial arrangement of vasculature within an entire COVID-19 lobe, and 3D segmentation of blood vessels revealed microangiopathy associated with hemorrhage. Notably, segmentation of pathological anomalies reveals hidden pathological structures that might otherwise be disregarded, demonstrating a powerful method to visualize pathologies in 3D in TB lung tissue and whole COVID-19 lobes. These findings provide unexpected new insight into the spatial organization of the spectrum of TB and COVID-19 lesions within the framework of the entire lung.
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Affiliation(s)
- Gordon Wells
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Joel N Glasgow
- Department of MicrobiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Kievershen Nargan
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Kapongo Lumamba
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Rajhmun Madansein
- Inkosi Albert Luthuli Central Hospital and University of KwaZulu‐NatalDurbanSouth Africa
| | - Kameel Maharaj
- Inkosi Albert Luthuli Central Hospital and University of KwaZulu‐NatalDurbanSouth Africa
| | - Leon Y Perumal
- Perumal & Partners RadiologistsAhmed Al‐Kadi Private HospitalDurbanSouth Africa
| | - Malcolm Matthew
- Perumal & Partners RadiologistsAhmed Al‐Kadi Private HospitalDurbanSouth Africa
| | - Robert L Hunter
- Department of Pathology and Laboratory MedicineUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Hayden Pacl
- Medical Scientist Training ProgramUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Denise D Stanford
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Cystic Fibrosis Research CenterUniversity of Alabama at BirminghamBirminghamALUSA
| | - Satinder P Singh
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of RadiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Prachi Bajpai
- Department of PathologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Upender Manne
- Department of PathologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Paul V Benson
- Department of PathologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Steven M Rowe
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Cystic Fibrosis Research CenterUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Alex Sigal
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Muofhe Tshibalanganda
- Research Group 3D Innovation, Physics DepartmentStellenbosch UniversityStellenboschSouth Africa
| | - Carlyn Wells
- CT Scanner Facility, Central Analytical FacilitiesStellenbosch UniversityStellenboschSouth Africa
| | - Anton du Plessis
- Research Group 3D Innovation, Physics DepartmentStellenbosch UniversityStellenboschSouth Africa
- Object Research SystemsMontrealQCCanada
| | - Mpumelelo Msimang
- Department of Anatomical Pathology, National Health Laboratory ServiceInkosi Albert Luthuli Central HospitalDurbanSouth Africa
| | - Threnesan Naidoo
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
- Department of Anatomical Pathology, National Health Laboratory ServiceInkosi Albert Luthuli Central HospitalDurbanSouth Africa
- Department of Laboratory Medicine & PathologyWalter Sisulu UniversityEastern CapeSouth Africa
| | - Adrie J C Steyn
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
- Department of MicrobiologyUniversity of Alabama at BirminghamBirminghamALUSA
- Centers for AIDS Research and Free Radical BiologyUniversity of Alabama at BirminghamBirminghamALUSA
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9
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Burkett AE, Sher SB, Patel CR, Ildin-Eltoum I, Dhall D, Margaroli C, Peter S, Lee G, Bajpai P, Benson PV, Manne U, Al Diffalha S. Gastrointestinal Manifestations of COVID-19 Infection: Clinicopathologic Findings in Intestinal Resections Performed at Single Institution. Front Med (Lausanne) 2022; 9:811546. [PMID: 35237625 PMCID: PMC8884264 DOI: 10.3389/fmed.2022.811546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
It is now known that COVID-19 not only involves the lungs, but other organs as well including the gastrointestinal tract. Although clinic-pathological features are well-described in lungs, the histopathologic features of gastrointestinal involvement in resection specimens are not well characterized. Herein, we describe in detail the clinicopathologic features of intestinal resection specimens in four patients with COVID-19 infection. COVID-19 viral particles by in situ hybridization and immunofluorescence studies are also demonstrated. All four patients were males, aged 28–46 years, with comorbidities. They initially presented with a severe form of pulmonary COVID-19 and showed gastrointestinal symptoms, requiring surgical intervention. Histopathologic examination of resected GI specimens, mostly right colectomies, revealed a spectrum of disease, from superficial mucosal ischemic colitis to frank transmural ischemic colitis and associated changes consistent with pneumatosis cystoides intestinalis. Three patients were African American (75%), and one was Caucasian (25%); three patients died due to complications of their COVID-19 infection (75%), while one ultimately recovered from their GI complications (25%), but experienced prolonged sequela of COVID-19 infection including erectile dysfunction. In conclusion, COVID-19 infection, directly or indirectly, can cause ischemic gastrointestinal complications, with predilection for the right colon.
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Affiliation(s)
- Alison E. Burkett
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sophia B. Sher
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Chirag R. Patel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Isam Ildin-Eltoum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deepti Dhall
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Camilla Margaroli
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Shajan Peter
- Division of Gastroenterology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Goo Lee
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Prachi Bajpai
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul V. Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Upender Manne
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Compressive Cancer Center, Birmingham, AL, United States
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Compressive Cancer Center, Birmingham, AL, United States
- *Correspondence: Sameer Al Diffalha
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Benson PV, Litovsky SH, Steyn AJC, Margaroli C, Iriabho E, Anderson PG. Use of Telepathology to Facilitate COVID-19 Research and Education through an Online COVID-19 Autopsy Biorepository. J Pathol Inform 2021; 12:48. [PMID: 34934523 PMCID: PMC8652340 DOI: 10.4103/jpi.jpi_15_21] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/11/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has increased the use of technology for communication including departmental conferences, working remotely, and distance teaching. Methods to enable these activities should be developed and promulgated. Objective: To repurpose a preexisting educational website to enable the development of a COVID-19 autopsy biorepository to support distance teaching and COVID-19 research. Methods: After consent was obtained, autopsies were performed on patients with a confirmed positive severe acute respiratory syndrome coronavirus-2 reverse-transcriptase-polymerase-chain reaction test. Autopsies were performed according to a COVID-19 protocol, and all patients underwent both gross and microscopic examination. The H and E histology slides were scanned using a Leica Biosystems Aperio CS ScanScope whole slide scanner and the digital slide files were converted to deep zoom images that could be uploaded to the University of Alabama at Birmingham (UAB) Pathology Educational Instructional Resource website where virtual microscopy of the slides is available. Results: A total of 551 autopsy slides from 24 UAB COVID-19 cases, 1 influenza H1N1 case and 1 tuberculosis case were scanned and uploaded. Five separate COVID-19 research teams used the digital slides remotely with or without a pathologist on a Zoom call. The scanned slides were used to produce one published case report and one published research project. The digital COVID-19 autopsy biorepository was routinely used for educational conferences and research meetings locally, nationally and internationally. Conclusion: The repurposing of a pre-existing website enabled telepathology consultation for research and education purposes. Combined with other communication technology (Zoom) this achievement highlights what is possible using pre-existing technologies during a global pandemic.
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Affiliation(s)
- Paul V Benson
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Durban, South Africa, South Africa
| | - Silvio H Litovsky
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Durban, South Africa, South Africa
| | - Adrie J C Steyn
- Africa Health Research Institute, University of KwaZulu Natal, Durban, South Africa
| | - Camilla Margaroli
- Department of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Program in Protease and Matrix Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Egiebade Iriabho
- Division of Genomic Diagnostics & Bioinformatics, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter G Anderson
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sang CJ, Heindl B, Von Mering G, Brott B, Kopf RS, Benson PV, Rajapreyar I. Stress-Induced Cardiomyopathy Precipitated by COVID-19 and Influenza A Coinfection. JACC Case Rep 2020; 2:1356-1358. [PMID: 32835279 PMCID: PMC7280126 DOI: 10.1016/j.jaccas.2020.05.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 12/05/2022]
Abstract
Myocardial injury is associated with excess mortality in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infections, but the mechanisms of injury are diverse. We describe a case of stress-induced cardiomyopathy in the setting of SARS-CoV-2 and influenza A coinfection. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Charlie Joseph Sang
- Internal Medicine-Pediatrics Residency Program, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brittain Heindl
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory Von Mering
- Section of Interventional Cardiology, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brigitta Brott
- Section of Interventional Cardiology, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert S Kopf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul V Benson
- Division of Anatomic Pathology, Department of Clinical Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Section of Heart Failure and Transplantation Cardiology, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Boeding ED, Benson PV, LeGallo RD. Sudden Death Due to Ruptured Three-Vessel Giant Coronary Artery Aneurysm in a 28 Year Old Woman with Trisomy 21. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report a case of sudden death due to rupture of a giant right coronary artery aneurysm, likely a sequela of remote Kawasaki disease, in a young woman with Down syndrome. The decedent was a 28 year old female with trisomy 21 who was found deceased in the backyard pool. An autopsy disclosed an enlarged heart with 400 ml of clotted blood in the pericardial sac and undiagnosed giant coronary artery aneurysms involving the left anterior descending, left circumflex, and right coronary artery, with rupture of the latter artery. The histologic findings were consistent with remote Kawasaki disease. Giant coronary artery aneurysms are a rare complication of Kawasaki disease, infectious vasculitis, and atherosclerosis, among other causes. While Kawasaki disease is typically considered a disease of children, late-onset complications should be considered in the differential diagnosis of young adults with myocardial infarction, coronary aneurysm, or sudden death.
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Affiliation(s)
| | - Paul V. Benson
- UVA Health System Department of Pathology, Charlottesville, VA (RL)
| | - Robin D. LeGallo
- UVA Health System Department of Pathology, Charlottesville, VA (RL)
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Affiliation(s)
- Mani S Mahadevan
- Department of Pathology, University of Virginia, Charlottesville, VA 22908, USA.
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