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Gray-Rodriguez S, Jensen MP, Otero-Jimenez M, Hanley B, Swann OC, Ward PA, Salguero FJ, Querido N, Farkas I, Velentza-Almpani E, Weir J, Barclay WS, Carroll MW, Jaunmuktane Z, Brandner S, Pohl U, Allinson K, Thom M, Troakes C, Al-Sarraj S, Sastre M, Gveric D, Gentleman S, Roufosse C, Osborn M, Alegre-Abarrategui J. Multisystem screening reveals SARS-CoV-2 in neurons of the myenteric plexus and in megakaryocytes. J Pathol 2022; 257:198-217. [PMID: 35107828 PMCID: PMC9325073 DOI: 10.1002/path.5878] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 10/15/2021] [Revised: 12/12/2021] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
SARS‐CoV‐2, the causative agent of COVID‐19, typically manifests as a respiratory illness, although extrapulmonary involvement, such as in the gastrointestinal tract and nervous system, as well as frequent thrombotic events, are increasingly recognised. How this maps onto SARS‐CoV‐2 organ tropism at the histological level, however, remains unclear. Here, we perform a comprehensive validation of a monoclonal antibody against the SARS‐CoV‐2 nucleocapsid protein (NP) followed by systematic multisystem organ immunohistochemistry analysis of the viral cellular tropism in tissue from 36 patients, 16 postmortem cases and 16 biopsies with polymerase chain reaction (PCR)‐confirmed SARS‐CoV‐2 status from the peaks of the pandemic in 2020 and four pre‐COVID postmortem controls. SARS‐CoV‐2 anti‐NP staining in the postmortem cases revealed broad multiorgan involvement of the respiratory, digestive, haematopoietic, genitourinary and nervous systems, with a typical pattern of staining characterised by punctate paranuclear and apical cytoplasmic labelling. The average time from symptom onset to time of death was shorter in positively versus negatively stained postmortem cases (mean = 10.3 days versus mean = 20.3 days, p = 0.0416, with no cases showing definitive staining if the interval exceeded 15 days). One striking finding was the widespread presence of SARS‐CoV‐2 NP in neurons of the myenteric plexus, a site of high ACE2 expression, the entry receptor for SARS‐CoV‐2, and one of the earliest affected cells in Parkinson's disease. In the bone marrow, we observed viral SARS‐CoV‐2 NP within megakaryocytes, key cells in platelet production and thrombus formation. In 15 tracheal biopsies performed in patients requiring ventilation, there was a near complete concordance between immunohistochemistry and PCR swab results. Going forward, our findings have relevance to correlating clinical symptoms with the organ tropism of SARS‐CoV‐2 in contemporary cases as well as providing insights into potential long‐term complications of COVID‐19. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Sandra Gray-Rodriguez
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Melanie P Jensen
- Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK
| | - Maria Otero-Jimenez
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Brian Hanley
- Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK.,Department of Immunology and Inflammation, Imperial College London, London, W12 0NN, UK
| | - Olivia C Swann
- Department of Infectious Disease, Imperial College London, London, UK
| | - Patrick A Ward
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Francisco J Salguero
- National Infection Service, United Kingdom Health Security Agency, Porton Down, Salisbury, UK
| | - Nadira Querido
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Ildiko Farkas
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | | | - Justin Weir
- Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College London, London, UK
| | - Miles W Carroll
- National Infection Service, United Kingdom Health Security Agency, Porton Down, Salisbury, UK.,Pandemic Sciences Centre, Nuffield Department of Medicine, Oxford University, OX3 7BN, UK
| | - Zane Jaunmuktane
- Department of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
| | - Sebastian Brandner
- Department of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
| | - Ute Pohl
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham/University Hospitals Birmingham, Birmingham, UK
| | - Kieren Allinson
- Department of Neuropathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maria Thom
- Department of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
| | - Claire Troakes
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Safa Al-Sarraj
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Magdalena Sastre
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Djordje Gveric
- Multiple Sclerosis and Parkinson's Tissue Bank, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Steve Gentleman
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK.,Multiple Sclerosis and Parkinson's Tissue Bank, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Candice Roufosse
- Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK.,Department of Immunology and Inflammation, Imperial College London, London, W12 0NN, UK
| | - Michael Osborn
- Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK
| | - Javier Alegre-Abarrategui
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK.,Department of Cellular Pathology, Northwest London Pathology, Charing Cross Hospital Campus, London, UK.,Multiple Sclerosis and Parkinson's Tissue Bank, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
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