1
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Das A, Meng W, Liu Z, Hasib MM, Galloway H, Ramos da Silva S, Chen L, Sica GL, Paniz-Mondolfi A, Bryce C, Grimes Z, Mia Sordillo E, Cordon-Cardo C, Paniagua Rivera K, Flores M, Chiu YC, Huang Y, Gao SJ. Molecular and immune signatures, and pathological trajectories of fatal COVID-19 lungs defined by in situ spatial single-cell transcriptome analysis. J Med Virol 2023; 95:e29009. [PMID: 37563850 PMCID: PMC10442191 DOI: 10.1002/jmv.29009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Despite intensive studies during the last 3 years, the pathology and underlying molecular mechanism of coronavirus disease 2019 (COVID-19) remain poorly defined. In this study, we investigated the spatial single-cell molecular and cellular features of postmortem COVID-19 lung tissues using in situ sequencing (ISS). We detected 10 414 863 transcripts of 221 genes in whole-slide tissues and segmented them into 1 719 459 cells that were mapped to 18 major parenchymal and immune cell types, all of which were infected by SARS-CoV-2. Compared with the non-COVID-19 control, COVID-19 lungs exhibited reduced alveolar cells (ACs) and increased innate and adaptive immune cells. We also identified 19 differentially expressed genes in both infected and uninfected cells across the tissues, which reflected the altered cellular compositions. Spatial analysis of local infection rates revealed regions with high infection rates that were correlated with high cell densities (HIHD). The HIHD regions expressed high levels of SARS-CoV-2 entry-related factors including ACE2, FURIN, TMPRSS2 and NRP1, and co-localized with organizing pneumonia (OP) and lymphocytic and immune infiltration, which exhibited increased ACs and fibroblasts but decreased vascular endothelial cells and epithelial cells, mirroring the tissue damage and wound healing processes. Sparse nonnegative matrix factorization (SNMF) analysis of niche features identified seven signatures that captured structure and immune niches in COVID-19 tissues. Trajectory inference based on immune niche signatures defined two pathological routes. Trajectory A primarily progressed with increased NK cells and granulocytes, likely reflecting the complication of microbial infections. Trajectory B was marked by increased HIHD and OP, possibly accounting for the increased immune infiltration. The OP regions were marked by high numbers of fibroblasts expressing extremely high levels of COL1A1 and COL1A2. Examination of single-cell RNA-seq data (scRNA-seq) from COVID-19 lung tissues and idiopathic pulmonary fibrosis (IPF) identified similar cell populations consisting mainly of myofibroblasts. Immunofluorescence staining revealed the activation of IL6-STAT3 and TGF-β-SMAD2/3 pathways in these cells, likely mediating the upregulation of COL1A1 and COL1A2 and excessive fibrosis in the lung tissues. Together, this study provides a spatial single-cell atlas of cellular and molecular signatures of fatal COVID-19 lungs, which reveals the complex spatial cellular heterogeneity, organization, and interactions that characterized the COVID-19 lung pathology.
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Affiliation(s)
- Arun Das
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wen Meng
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhentao Liu
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Md Musaddaqul Hasib
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hugh Galloway
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Suzane Ramos da Silva
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Luping Chen
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabriel L Sica
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clare Bryce
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia Mia Sordillo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karla Paniagua Rivera
- Department of Electrical and Computer Engineering, KLESSE School of Engineering and Integrated Design, University of Texas at San Antonio, San Antonio, TX, USA
| | - Mario Flores
- Department of Electrical and Computer Engineering, KLESSE School of Engineering and Integrated Design, University of Texas at San Antonio, San Antonio, TX, USA
| | - Yu-Chiao Chiu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yufei Huang
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shou-Jiang Gao
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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2
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Radovic S, Meng W, Chen L, Mondolfi AEP, Bryce C, Grimes Z, Sordillo EM, Cordon-Cardo C, Guo H, Huang Y, Gao SJ. SARS-CoV-2 infection of kidney tissues from severe COVID-19 patients. J Med Virol 2023; 95:e28566. [PMID: 36756942 PMCID: PMC10388714 DOI: 10.1002/jmv.28566] [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: 01/13/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) manifests diverse clinical pathologies involving multiple organs. While the respiratory tract is the primary SARS-CoV-2 target, acute kidney injury is common in COVID-19 patients, displaying as acute tubular necrosis (ATN) resulting from focal epithelial necrosis and eosinophilia, glomerulosclerosis, and autolysis of renal tubular cells. However, whether any renal cells are infected by SARS-CoV-2 and the mechanism involved in the COVID-19 kidney pathology remain unclear. METHODS Kidney tissues obtained at autopsy from four severe COVID-19 patients and one healthy subject were examined by hematoxylin and eosin staining. Indirect immunofluorescent antibody assay was performed to detect SARS-CoV-2 spike protein S1 and nonstructural protein 8 (NSP8) together with markers of different kidney cell types and immune cells to identify the infected cells. RESULTS Renal parenchyma showed tissue injury comprised of ATN and glomerulosclerosis. Positive staining of S1 protein was observed in renal parenchymal and tubular epithelial cells. Evidence of viral infection was also observed in innate monocytes/macrophages and NK cells. Positive staining of NSP8, which is essential for viral RNA synthesis and replication, was confirmed in renal parenchymal cells, indicating the presence of active viral replication in the kidney. CONCLUSIONS In fatal COVID-19 kidneys, there are SARS-CoV-2 infection, minimally infiltrated innate immune cells, and evidence of viral replication, which could contribute to tissue damage in the form of ATN and glomerulosclerosis.
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Affiliation(s)
- Shawn Radovic
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wen Meng
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Luping Chen
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alberto E. Paniz Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Clare Bryce
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Emilia M. Sordillo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Haitao Guo
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yufei Huang
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Electrical and Computer Engineering, Swanson School and Engineering, Pittsburgh, Pennsylvania, USA
| | - Shou-Jiang Gao
- Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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3
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Meng W, Guo S, Cao S, Shuda M, Robinson‐McCarthy LR, McCarthy KR, Shuda Y, Paniz Mondolfi AE, Bryce C, Grimes Z, Sordillo EM, Cordon‐Cardo C, Li P, Zhang H, Perlman S, Guo H, Gao S, Chang Y, Moore PS. Development and characterization of a new monoclonal antibody against SARS-CoV-2 NSP12 (RdRp). J Med Virol 2023; 95:e28246. [PMID: 36271490 PMCID: PMC9874566 DOI: 10.1002/jmv.28246] [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: 09/18/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/29/2023]
Abstract
SARS-CoV-2 NSP12, the viral RNA-dependent RNA polymerase (RdRp), is required for viral replication and is a therapeutic target to treat COVID-19. To facilitate research on SARS-CoV-2 NSP12 protein, we developed a rat monoclonal antibody (CM12.1) against the NSP12 N-terminus that can facilitate functional studies. Immunoblotting and immunofluorescence assay (IFA) confirmed the specific detection of NSP12 protein by this antibody for cells overexpressing the protein. Although NSP12 is generated from the ORF1ab polyprotein, IFA of human autopsy COVID-19 lung samples revealed NSP12 expression in only a small fraction of lung cells including goblet, club-like, vascular endothelial cells, and a range of immune cells, despite wide-spread tissue expression of spike protein antigen. Similar studies using in vitro infection also generated scant protein detection in cells with established virus replication. These results suggest that NSP12 may have diminished steady-state expression or extensive posttranslation modifications that limit antibody reactivity during SARS-CoV-2 replication.
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Affiliation(s)
- Wen Meng
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Siying Guo
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- School of MedicineTsinghua UniversityBeijingChina
| | - Simon Cao
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Masahiro Shuda
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Lindsey R. Robinson‐McCarthy
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Kevin R. McCarthy
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Center for Vaccine ResearchUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Yoko Shuda
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Alberto E. Paniz Mondolfi
- Department of Pathology, Molecular and Cell‐Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Clare Bryce
- Department of Pathology, Molecular and Cell‐Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell‐Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Emilia M. Sordillo
- Department of Pathology, Molecular and Cell‐Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carlos Cordon‐Cardo
- Department of Pathology, Molecular and Cell‐Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Pengfei Li
- Department of Microbiology and ImmunologyUniversity of IowaIowa CityIowaUSA
| | - Hu Zhang
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Stanley Perlman
- Department of Microbiology and ImmunologyUniversity of IowaIowa CityIowaUSA
| | - Haitao Guo
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Shou‐Jiang Gao
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Yuan Chang
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Patrick S. Moore
- Cancer Virology ProgramUniversity of Pittsburgh Medical Center Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of Microbiology and Molecular GeneticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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4
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Pujadas E, Beaumont M, Shah H, Schrode N, Francoeur N, Shroff S, Bryce C, Grimes Z, Gregory J, Donnelly R, Fowkes ME, Beaumont KG, Sebra R, Cordon-Cardo C. Molecular Profiling of Coronavirus Disease 2019 (COVID-19) Autopsies Uncovers Novel Disease Mechanisms. Am J Pathol 2021; 191:2064-2071. [PMID: 34506752 PMCID: PMC8423774 DOI: 10.1016/j.ajpath.2021.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 01/06/2023]
Abstract
Current understanding of coronavirus disease 2019 (COVID-19) pathophysiology is limited by disease heterogeneity, complexity, and a paucity of studies assessing patient tissues with advanced molecular tools. Rapid autopsy tissues were evaluated using multiscale, next-generation RNA-sequencing methods (bulk, single-nuclei, and spatial transcriptomics) to provide unprecedented molecular resolution of COVID-19-induced damage. Comparison of infected/uninfected tissues revealed four major regulatory pathways. Effectors within these pathways could constitute novel therapeutic targets, including the complement receptor C3AR1, calcitonin receptor–like receptor, or decorin. Single-nuclei RNA sequencing of olfactory bulb and prefrontal cortex highlighted remarkable diversity of coronavirus receptors. Angiotensin-converting enzyme 2 was rarely expressed, whereas basigin showed diffuse expression, and alanyl aminopeptidase, membrane, was associated with vascular/mesenchymal cell types. Comparison of lung and lymph node tissues from patients with different symptoms (one had died after a month-long hospitalization with multiorgan involvement, and the other had died after a few days of respiratory symptoms) with digital spatial profiling resulted in distinct molecular phenotypes. Evaluation of COVID-19 rapid autopsy tissues with advanced molecular techniques can identify pathways and effectors, map diverse receptors at the single-cell level, and help dissect differences driving diverging clinical courses among individual patients. Extension of this approach to larger data sets will substantially advance the understanding of the mechanisms behind COVID-19 pathophysiology.
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Affiliation(s)
- Elisabet Pujadas
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Beaumont
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hardik Shah
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nadine Schrode
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nancy Francoeur
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sanjana Shroff
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Clare Bryce
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jill Gregory
- Academic Informatics and Technology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Donnelly
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary E Fowkes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristin G Beaumont
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Sebra
- Departments of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Sema4, Stamford, Connecticut
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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5
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Bryce C, Grimes Z, Pujadas E, Ahuja S, Beasley MB, Albrecht R, Hernandez T, Stock A, Zhao Z, AlRasheed MR, Chen J, Li L, Wang D, Corben A, Haines GK, Westra WH, Umphlett M, Gordon RE, Reidy J, Petersen B, Salem F, Fiel MI, El Jamal SM, Tsankova NM, Houldsworth J, Mussa Z, Veremis B, Sordillo E, Gitman MR, Nowak M, Brody R, Harpaz N, Merad M, Gnjatic S, Liu WC, Schotsaert M, Miorin L, Aydillo Gomez TA, Ramos-Lopez I, Garcia-Sastre A, Donnelly R, Seigler P, Keys C, Cameron J, Moultrie I, Washington KL, Treatman J, Sebra R, Jhang J, Firpo A, Lednicky J, Paniz-Mondolfi A, Cordon-Cardo C, Fowkes ME. Pathophysiology of SARS-CoV-2: the Mount Sinai COVID-19 autopsy experience. Mod Pathol 2021; 34:1456-1467. [PMID: 33795830 PMCID: PMC8015313 DOI: 10.1038/s41379-021-00793-y] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated clinical syndrome COVID-19 are causing overwhelming morbidity and mortality around the globe and disproportionately affected New York City between March and May 2020. Here, we report on the first 100 COVID-19-positive autopsies performed at the Mount Sinai Hospital in New York City. Autopsies revealed large pulmonary emboli in six cases. Diffuse alveolar damage was present in over 90% of cases. We also report microthrombi in multiple organ systems including the brain, as well as hemophagocytosis. We additionally provide electron microscopic evidence of the presence of the virus in our samples. Laboratory results of our COVID-19 cohort disclose elevated inflammatory markers, abnormal coagulation values, and elevated cytokines IL-6, IL-8, and TNFα. Our autopsy series of COVID-19-positive patients reveals that this disease, often conceptualized as a primarily respiratory viral illness, has widespread effects in the body including hypercoagulability, a hyperinflammatory state, and endothelial dysfunction. Targeting of these multisystemic pathways could lead to new treatment avenues as well as combination therapies against SARS-CoV-2 infection.
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Affiliation(s)
- Clare Bryce
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary Grimes
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sadhna Ahuja
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Randy Albrecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Aryeh Stock
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhen Zhao
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Joyce Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Li
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Diane Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Corben
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Jason Reidy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce Petersen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fadi Salem
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Zarmeen Mussa
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Michael Nowak
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Brody
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noam Harpaz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miriam Merad
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sacha Gnjatic
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wen-Chun Liu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Lisa Miorin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Ryan Donnelly
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Calvin Keys
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Robert Sebra
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Jhang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adolfo Firpo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Mary E Fowkes
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Ramos da Silva S, Ju E, Meng W, Paniz Mondolfi AE, Dacic S, Green A, Bryce C, Grimes Z, Fowkes M, Sordillo EM, Cordon-Cardo C, Guo H, Gao SJ. Broad Severe Acute Respiratory Syndrome Coronavirus 2 Cell Tropism and Immunopathology in Lung Tissues From Fatal Coronavirus Disease 2019. J Infect Dis 2021; 223:1842-1854. [PMID: 33837392 PMCID: PMC8083355 DOI: 10.1093/infdis/jiab195] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients manifest with pulmonary symptoms reflected by diffuse alveolar damage (DAD), excessive inflammation, and thromboembolism. The mechanisms mediating these processes remain unclear. METHODS We performed multicolor staining for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins and lineage markers to define viral tropism and lung pathobiology in 5 autopsy cases. RESULTS Lung parenchyma showed severe DAD with thromboemboli. Viral infection was found in an extensive range of cells including pneumocyte type II, ciliated, goblet, club-like, and endothelial cells. More than 90% of infiltrating immune cells were positive for viral proteins including macrophages, monocytes, neutrophils, natural killer (NK) cells, B cells, and T cells. Most but not all infected cells were angiotensin-converting enzyme 2 (ACE2) positive. The numbers of infected and ACE2-positive cells are associated with extensive tissue damage. Infected tissues exhibited high levels of inflammatory cells including macrophages, monocytes, neutrophils, and NK cells, and low levels of B cells but abundant T cells consisting of mainly T helper cells, few cytotoxic T cells, and no regulatory T cells. Robust interleukin-6 expression was present in most cells, with or without infection. CONCLUSIONS In fatal COVID-19 lungs, there are broad SARS-CoV-2 cell tropisms, extensive infiltrated innate immune cells, and activation and depletion of adaptive immune cells, contributing to severe tissue damage, thromboemboli, excess inflammation, and compromised immune responses.
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Affiliation(s)
- Suzane Ramos da Silva
- Cancer Virology Program, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Enguo Ju
- Cancer Virology Program, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Wen Meng
- Cancer Virology Program, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alberto E Paniz Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anthony Green
- Tissue and Research Pathology Core, University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Clare Bryce
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary Fowkes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia M Sordillo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Haitao Guo
- Cancer Virology Program, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shou-Jiang Gao
- Cancer Virology Program, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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7
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Vasquez-Bonilla WO, Orozco R, Argueta V, Sierra M, Zambrano LI, Muñoz-Lara F, López-Molina DS, Arteaga-Livias K, Grimes Z, Bryce C, Paniz-Mondolfi A, Rodríguez-Morales AJ. A review of the main histopathological findings in coronavirus disease 2019. Hum Pathol 2020; 105:74-83. [PMID: 32750378 PMCID: PMC7395947 DOI: 10.1016/j.humpath.2020.07.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has been declared by the World Health Organization as an emerging public health problem of global importance and classified as a pandemic. SARS-CoV-2 infection can result in diverse, multiorgan pathology, the most significant being in the lungs (diffuse alveolar damage in its different phases, microthrombi, bronchopneumonia, necrotizing bronchiolitis, viral pneumonia), heart (lymphocytic myocarditis), kidney (acute tubular injury), central nervous system (microthrombi, ischemic necrosis, acute hemorrhagic infarction, congestion, and vascular edema), lymph nodes (hemophagocytosis and histiocytosis), bone marrow (hemophagocytosis), and vasculature (deep vein thrombosis). An understanding of the spectrum and frequency of histologic findings in COVID-19 is essential for gaining a better understanding of disease pathophysiology and its ongoing impact on public health. To this end, we conducted a systematic meta-analysis of histopathologic observations to date and review the reported findings.
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Affiliation(s)
- Walter O Vasquez-Bonilla
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia
| | - Roberto Orozco
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala
| | - Víctor Argueta
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala
| | - Manuel Sierra
- Central American Technological University, Francisco Morazán, Distrito Central, Tegucigalpa, 11101 Honduras
| | - Lysien I Zambrano
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Department of Morphological Sciences, School of Medical, Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, 11101, Honduras
| | - Fausto Muñoz-Lara
- Department of Internal Medicine, Hospital Escuela, Tegucigalpa, 11101, Honduras; Department of Internal Medicine, School of Medical, Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, 11101, Honduras
| | - Dennis Salomón López-Molina
- Institute Pasteur, Paris, 75008, France; Health Biology: Microbiology and Immunology, Faculté de Sciences, Université de Montpellier, 34000, France
| | - Kovy Arteaga-Livias
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco, 10160, Peru; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 15046, Peru
| | - Zachary Grimes
- Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA
| | - Clare Bryce
- Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA
| | - Alberto Paniz-Mondolfi
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA; Laboratorio de Señalización Celular y Bioquímica de Parásitos, Instituto de Estudios Avanzados (IDEA), Caracas, Caracas, 1020, Venezuela; Academia Nacional de Medicina, Caracas, 1010, Venezuela; Instituto de Investigaciones Biomedicas IDB / Incubadora Venezolana de la Ciencia, Cabudare, Edo. Lara, 3023, Venezuela
| | - Alfonso J Rodríguez-Morales
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 15046, Peru; Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, 660001, Colombia; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Americas, Pereira, Risaralda, 660003, Colombia.
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8
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Paniz-Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, Sordillo EM, Fowkes M. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol 2020; 92:699-702. [PMID: 32314810 PMCID: PMC7264598 DOI: 10.1002/jmv.25915] [Citation(s) in RCA: 643] [Impact Index Per Article: 160.8] [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: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS‐CoV‐2. The clinical spectrum of COVID-19 has expanded to include neurologic manifestations such as anosmia, ageusia, ataxia and seizures, suggesting that SARS-CoV-2 may also be neurotropic. Ultrastructural analysis of tissue from this case revealed the presence of viral-like particles in brain and capillary endothelium, which was further confirmed by molecular testing for SARS-CoV-2. This case provides first evidence for the potential direct propagation and presence of SARS-CoV-2 in human brain tissue. These findings have direct implications for neurologic clinical practice and should raise awareness amongst physicians managing SARS-CoV-2-infected patients with CNS symptoms.
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Affiliation(s)
- Alberto Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Clare Bryce
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Zachary Grimes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ronald E Gordon
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Jason Reidy
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - John Lednicky
- Department of Environmental and Global Health, College of Public Health and Health Professions, Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Emilia Mia Sordillo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Mary Fowkes
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
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Grimes Z, Bryce C, Sordillo EM, Gordon RE, Reidy J, Paniz Mondolfi AE, Fowkes M. Fatal Pulmonary Thromboembolism in SARS-CoV-2-Infection. Cardiovasc Pathol 2020; 48:107227. [PMID: 32718733 PMCID: PMC7214296 DOI: 10.1016/j.carpath.2020.107227] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Zachary Grimes
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clare Bryce
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronald E Gordon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason Reidy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Mary Fowkes
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Grimes Z, Boury N, Reid J, Wasendorf C, Couch B, James O, Seipelt‐Thiemann R. Development of an Assessment Tool for Evaluating Undergraduate Student Understanding of Pedigree Analysis. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.454.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zachary Grimes
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Joshua Reid
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Brock Couch
- Middle Tennessee State UniversityMurfreesboroTN
| | - Olena James
- Middle Tennessee State UniversityMurfreesboroTN
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11
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James O, Boury N, Grimes Z, Reid J, Wasendorf C, Couch B, Seipelt‐Thiemann R. Investigating Undergraduate Student Misconceptions Regarding Pedigree Analysis. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.454.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Olena James
- Middle Tennessee State UniversityMurfreesboroTN
| | | | - Zachary Grimes
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | - Joshua Reid
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Brock Couch
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
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Seipelt‐Thiemann R, Reid J, Grimes Z, Wasendorf C, Couch B, James O, Peters N, Boury N. Undergraduate Student (Mis)understandings of Mutations. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.454.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joshua Reid
- Math and Science EducationMTSUMurfreesboroTN
| | - Zachary Grimes
- Math and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Brock Couch
- Math and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | - Olena James
- Math and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | - Nick Peters
- Plant Pathology and MicrobiologyIowa State UniversityAmesIA
| | - Nancy Boury
- Plant Pathology and MicrobiologyIowa State UniversityAmesIA
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13
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Couch B, Seipelt‐Thiemann R, Reid J, Grimes Z, Wasendrof C, James O, Peters N, Boury N. Do Student Misconceptions about Mutations Persist throughout College Education? FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.454.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Brock Couch
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Joshua Reid
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | - Zachary Grimes
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
| | | | - Olena James
- Mathematics and Science EducationMiddle Tennessee State UniversityMurfreesboroTN
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Sandhu J, Winkler C, Yan X, Sharabi A, Grimes Z, Shantha Kumara HMC, Cekic V, Whelan R. Sclerotherapy needle injections can expand the subserosal and muscularis propria layers and cause a stable mucosal lift in ESD/EMR patients. Surg Endosc 2018; 33:949-958. [PMID: 30350104 PMCID: PMC6394666 DOI: 10.1007/s00464-018-6521-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023]
Abstract
Background A mucosal lift is needed for ESD and EMR. Most lifts are made via sclerotherapy needle injection. The firm push needed to penetrate the mucosa often leaves the needle tip in the deep wall. The needle is next withdrawn and fluid injected until a sharp lift (due to submucosal expansion) begins to form; the needle is then held steady and the injection finished. The initial injection may result in a subtle deep lift that resolves quickly. It was the authors’ belief that only submucosal expansion could lead to a stable mucosal lift. A colonic ESD case in which a polyp was inadvertently resected via needle knife in an expanded subserosal plane led to a questioning of this position. This study’s purpose was to determine if stable deep wall mucosal lifts can be generated via bowel wall injection. Methods Transmucosal and intramural injections into bovine large bowel were carried out. Stable lifts and lift cross sections were made and examined grossly and histologically to determine the location of the lift fluid. Clinical ESD videos were also reviewed. Results Over 200 intact and cross-sectioned lifts were assessed. Gross inspection revealed two types of lifts (superficial and deep), whereas cross sections and histologic analyses revealed examples of stable expansion of the submucosal, muscularis propria, and subserosal layers post injection. Clinical “deep” lifts were also found. Superficial lifts are more focal and taller, whereas deep wall lifts are broader and less prominent. Conclusion Stable deep wall mucosal lifts occur and are likely due to the deep starting point of the needle post insertion. If ESD/EMR are attempted with a deep lift, the chances of failure or perforation are high. Lifts must be carefully scrutinized before starting ESD/EMR. Other means of lift establishment should be evaluated and considered. Electronic supplementary material The online version of this article (10.1007/s00464-018-6521-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaspreet Sandhu
- Department of Surgery, Brookdale University Hospital & Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Carl Winkler
- Department of Surgery, Mount Sinai West Hospital, New York, NY, USA
| | - Xiaohong Yan
- Department of Surgery, Mount Sinai West Hospital, New York, NY, USA
| | | | - Zachary Grimes
- Department of Surgery, Mount Sinai West Hospital, New York, NY, USA
| | | | - Vesna Cekic
- Department of Surgery, Mount Sinai West Hospital, New York, NY, USA
| | - Richard Whelan
- Department of Surgery, Mount Sinai West Hospital, New York, NY, USA
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