tetano
Editor, Senior Moderator
World J Mens Health
. 2020 Nov 3.
doi: 10.5534/wjmh.200170. Online ahead of print.
Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis
Justin K Achua[SUP] 1 [/SUP], Kevin Y Chu[SUP] 1 [/SUP], Emad Ibrahim[SUP] 1 [/SUP], Kajal Khodamoradi[SUP] 1 [/SUP], Katiana S Delma[SUP] 2 [/SUP], Oleksii A Iakymenko[SUP] 2 [/SUP], Oleksandr N Kryvenko[SUP] 1 2 [/SUP], Himanshu Arora[SUP] 1 3 4 [/SUP], Ranjith Ramasamy[SUP] 1 5 [/SUP]
Affiliations
Abstract
Purpose: To evaluate the presence and analyze the pathological changes within the testes of patients who died or recovered from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications.
Materials and methods: Testis tissue was collected from autopsies of COVID-19 positive (n=6) and negative men (n=3). Formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E) and subjected to immunofluorescence for angiotensin-converting enzyme 2 (ACE-2) expression. Fluorescent-labeled tissue slides were imaged on a quantitative pathology scope with various zoom levels allowing for qualitative and quantitative interpretation. Tissue from four COVID-19 positive autopsy cases and a live seroconverted patient was imaged with transmission electron microscopy (TEM).
Results: H&E histomorphology showed three of the six COVID-19 biopsies had normal spermatogenesis while the remaining three had impaired spermatogenesis. TEM showed the COVID-19 virus in testis tissue of one COVID-19 positive autopsy case and the live biopsy, H&E stain on the same autopsy case demonstrated interstitial macrophage and leukocyte infiltration. Immunofluorescent stained slides from six COVID-19 positive men demonstrated a direct association between increased quantitative ACE-2 levels and impairment of spermatogenesis.
Conclusions: The novel COVID-19 has an affinity for ACE-2 receptors. Since ACE-2 receptor expression is high in the testes, we hypothesized that COVID-19 is prevalent in testes tissue of infected patients. This study suggests the male reproductive tract, specifically the testes, may be targets of COVID-19 infection. We found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism of how COVID-19 can cause infertility.
Keywords: Autopsy; COVID-19; Coronavirus; Infertility; Testis.
. 2020 Nov 3.
doi: 10.5534/wjmh.200170. Online ahead of print.
Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis
Justin K Achua[SUP] 1 [/SUP], Kevin Y Chu[SUP] 1 [/SUP], Emad Ibrahim[SUP] 1 [/SUP], Kajal Khodamoradi[SUP] 1 [/SUP], Katiana S Delma[SUP] 2 [/SUP], Oleksii A Iakymenko[SUP] 2 [/SUP], Oleksandr N Kryvenko[SUP] 1 2 [/SUP], Himanshu Arora[SUP] 1 3 4 [/SUP], Ranjith Ramasamy[SUP] 1 5 [/SUP]
Affiliations
- PMID: 33151050
- DOI: 10.5534/wjmh.200170
Abstract
Purpose: To evaluate the presence and analyze the pathological changes within the testes of patients who died or recovered from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications.
Materials and methods: Testis tissue was collected from autopsies of COVID-19 positive (n=6) and negative men (n=3). Formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E) and subjected to immunofluorescence for angiotensin-converting enzyme 2 (ACE-2) expression. Fluorescent-labeled tissue slides were imaged on a quantitative pathology scope with various zoom levels allowing for qualitative and quantitative interpretation. Tissue from four COVID-19 positive autopsy cases and a live seroconverted patient was imaged with transmission electron microscopy (TEM).
Results: H&E histomorphology showed three of the six COVID-19 biopsies had normal spermatogenesis while the remaining three had impaired spermatogenesis. TEM showed the COVID-19 virus in testis tissue of one COVID-19 positive autopsy case and the live biopsy, H&E stain on the same autopsy case demonstrated interstitial macrophage and leukocyte infiltration. Immunofluorescent stained slides from six COVID-19 positive men demonstrated a direct association between increased quantitative ACE-2 levels and impairment of spermatogenesis.
Conclusions: The novel COVID-19 has an affinity for ACE-2 receptors. Since ACE-2 receptor expression is high in the testes, we hypothesized that COVID-19 is prevalent in testes tissue of infected patients. This study suggests the male reproductive tract, specifically the testes, may be targets of COVID-19 infection. We found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism of how COVID-19 can cause infertility.
Keywords: Autopsy; COVID-19; Coronavirus; Infertility; Testis.