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SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers.
Mod Pathol. 2020 11; 33(11):2092-2103.MP

Abstract

Congenital infection of SARS-CoV-2 appears to be exceptionally rare despite many cases of COVID-19 during pregnancy. Robust proof of placental infection requires demonstration of viral localization within placental tissue. Only two of the few cases of possible vertical transmission have demonstrated placental infection. None have shown placental expression of the ACE2 or TMPRSS2 protein, both required for viral infection. We examined 19 COVID-19 exposed placentas for histopathologic findings, and for expression of ACE2, and TMPRSS2 by immunohistochemistry. Direct placental SARS-CoV-2 expression was studied by two methods-nucleocapsid protein expression by immunohistochemistry, and RNA expression by in situ hybridization. ACE2 membranous expression in the syncytiotrophoblast (ST) of the chorionic villi is predominantly in a polarized pattern with expression highest on the stromal side of the ST. In addition, cytotrophoblast and extravillous trophoblast express ACE2. No ACE2 expression was detected in villous stroma, Hofbauer cells, or endothelial cells. TMPRSS2 expression was only present weakly in the villous endothelium and rarely in the ST. In 2 of 19 cases, SARS-CoV-2 RNA was present in the placenta focally in the ST and cytotrophoblast. There was no characteristic histopathology present in our cases including the two placental infections. We found that the placenta is capable of being infected but that this event is rare. We propose one explanation could be the polarized expression of ACE2 away from the maternal blood and pronounced paucity of TMPRSS2 expression in trophoblast.

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Authors+Show Affiliations

Hecht JL
Department of Pathology, The Beth Israel Deaconess Medical Center, Boston, MA, USA.
Quade B
Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Deshpande V
Department of Pathology, The Massachusetts General Hospital, Boston, MA, USA.
Mino-Kenudson M
Department of Pathology, The Massachusetts General Hospital, Boston, MA, USA.
Ting DT
Massachusetts Hospital Cancer Center, Boston, MA, USA. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Desai N
Massachusetts Hospital Cancer Center, Boston, MA, USA.
Dygulska B
Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Heyman T
Department of Obstetrics and Gynecology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Salafia C
Institute for Basic Research and Developmental Disabilities, Staten Island, NY, USA.
Shen D
Department of Pathology, Downey Medical Center, Southern California Permanente Medical Group, Downey, CA, USA.
Bates SV
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
Roberts DJ
Department of Pathology, The Massachusetts General Hospital, Boston, MA, USA. djroberts@mgh.harvard.edu.

MeSH

AdultAngiotensin-Converting Enzyme 2BetacoronavirusCOVID-19Coronavirus InfectionsFemaleHumansPandemicsPeptidyl-Dipeptidase APlacentaPneumonia, ViralPregnancyPregnancy Complications, InfectiousRNA, ViralSARS-CoV-2Serine Endopeptidases

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32741970

Citation

Hecht, Jonathon L., et al. "SARS-CoV-2 Can Infect the Placenta and Is Not Associated With Specific Placental Histopathology: a Series of 19 Placentas From COVID-19-positive Mothers." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 33, no. 11, 2020, pp. 2092-2103.
Hecht JL, Quade B, Deshpande V, et al. SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers. Mod Pathol. 2020;33(11):2092-2103.
Hecht, J. L., Quade, B., Deshpande, V., Mino-Kenudson, M., Ting, D. T., Desai, N., Dygulska, B., Heyman, T., Salafia, C., Shen, D., Bates, S. V., & Roberts, D. J. (2020). SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 33(11), 2092-2103. https://doi.org/10.1038/s41379-020-0639-4
Hecht JL, et al. SARS-CoV-2 Can Infect the Placenta and Is Not Associated With Specific Placental Histopathology: a Series of 19 Placentas From COVID-19-positive Mothers. Mod Pathol. 2020;33(11):2092-2103. PubMed PMID: 32741970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers. AU - Hecht,Jonathon L, AU - Quade,Bradley, AU - Deshpande,Vikram, AU - Mino-Kenudson,Mari, AU - Ting,David T, AU - Desai,Niyati, AU - Dygulska,Beata, AU - Heyman,Taryn, AU - Salafia,Carolyn, AU - Shen,Dejun, AU - Bates,Sara V, AU - Roberts,Drucilla J, Y1 - 2020/08/02/ PY - 2020/06/19/received PY - 2020/07/24/accepted PY - 2020/07/24/revised PY - 2020/8/4/pubmed PY - 2020/10/30/medline PY - 2020/8/4/entrez SP - 2092 EP - 2103 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 33 IS - 11 N2 - Congenital infection of SARS-CoV-2 appears to be exceptionally rare despite many cases of COVID-19 during pregnancy. Robust proof of placental infection requires demonstration of viral localization within placental tissue. Only two of the few cases of possible vertical transmission have demonstrated placental infection. None have shown placental expression of the ACE2 or TMPRSS2 protein, both required for viral infection. We examined 19 COVID-19 exposed placentas for histopathologic findings, and for expression of ACE2, and TMPRSS2 by immunohistochemistry. Direct placental SARS-CoV-2 expression was studied by two methods-nucleocapsid protein expression by immunohistochemistry, and RNA expression by in situ hybridization. ACE2 membranous expression in the syncytiotrophoblast (ST) of the chorionic villi is predominantly in a polarized pattern with expression highest on the stromal side of the ST. In addition, cytotrophoblast and extravillous trophoblast express ACE2. No ACE2 expression was detected in villous stroma, Hofbauer cells, or endothelial cells. TMPRSS2 expression was only present weakly in the villous endothelium and rarely in the ST. In 2 of 19 cases, SARS-CoV-2 RNA was present in the placenta focally in the ST and cytotrophoblast. There was no characteristic histopathology present in our cases including the two placental infections. We found that the placenta is capable of being infected but that this event is rare. We propose one explanation could be the polarized expression of ACE2 away from the maternal blood and pronounced paucity of TMPRSS2 expression in trophoblast. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/32741970/SARS_CoV_2_can_infect_the_placenta_and_is_not_associated_with_specific_placental_histopathology:_a_series_of_19_placentas_from_COVID_19_positive_mothers_ DB - PRIME DP - Unbound Medicine ER -