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Savoia P, Valente Yamada Sawamura M, de Almeida Monteiro RA, Nunes Duarte-Neto A, Morais Martin MDG, Dolhnikoff M, Mauad T, Nascimento Saldiva PH, da Costa Leite C, Ferraz da Silva LF, Cardoso EF. Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method. Eur J Radiol Open 2024; 12:100546. [PMID: 38293283 PMCID: PMC10825618 DOI: 10.1016/j.ejro.2024.100546] [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: 10/16/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Objectives Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results There was a positive correlation between patient mean CT and histopathological severity score indexes - Pearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground-glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between ground-glass opacities extension and exudative diffuse alveolar damage in histological slides (R=-0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =-0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p ≥ 0.10). Conclusions A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground-glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.
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Affiliation(s)
- Paulo Savoia
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Marcio Valente Yamada Sawamura
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Renata Aparecida de Almeida Monteiro
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Amaro Nunes Duarte-Neto
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Maria da Graça Morais Martin
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Thais Mauad
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Claudia da Costa Leite
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Ellison Fernando Cardoso
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05652-900, Morumbi, São Paulo, SP, Brazil
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Ramos YÁL, Pereira NV, Aoki V, Sotto MN, Kawakami JT, da Silva LFF, Sato MN, Orfali RL. Cutaneous inflammasome driving ASC / gasdermin-D activation and IL-1β-secreting macrophages in severe atopic dermatitis. Arch Dermatol Res 2024; 316:156. [PMID: 38734816 DOI: 10.1007/s00403-024-02899-0] [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: 12/23/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
Atopic dermatitis (AD) is an inflammatory skin disease with intense pruritus, and chronic skin colonization by Staphylococcus aureus. To understand the inflammatory status in AD, we investigated the inflammasome complex, that activates ASC (Apoptosis-associated speck-like protein containing a CARD), caspase-1 and GSDMD (gasdermin-D), and production of IL-1β and IL-18. We aimed to evaluate the expression of the inflammasome pathway in the skin of adults with AD. Thirty patients with moderate to severe AD and 20 healthy controls were enrolled in the study. We performed the analysis of the inflammasome components NLRP1, NLRP3, AIM-2, IL-1β, IL-18, Caspase-1, ASC, GSDMD, and CD68 expression (macrophage marker) by immunohistochemistry and immunofluorescence. The main findings included increased expression of NLRP3, NLRP1 and AIM-2 at dermal level of severe AD; augmented IL-18 and IL-1β expression at epidermis of moderate and severe patients, and in the dermis of severe AD; augmented expression of ASC, caspase-1 and GSDMD in both epidermis and dermis of moderate and severe AD. We detected positive correlation between caspase-1, GSDMD and IL-1β (epidermis) and caspase-1 (dermis) and AD severity; NLRP3, AIM-2 and IL-1β, and NLRP3 with IL-18 in the epidermis; ASC, GSDMD and IL-1β, and NLRP3, AIM-2, caspase-1, and IL-18 in the dermis. We also evidenced the presence of CD68+ macrophages secreting GSDMD, ASC and IL-1β in moderate and severe AD. Cutaneous macrophages, early detected in moderate AD, have its role in the disease inflammatory mechanisms. Our study indicates a canonical activation pathway of inflammasomes, reinforced by the chronic status of inflammation in AD. The analysis of the inflammasome complex evidenced an imbalance in its regulation, with increased expression of the evaluated components, which is remarkably in severe AD, emphasizing its relevance as potential disease biomarkers and targets for immunomodulatory interventions.
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Affiliation(s)
- Yasmim Álefe Leuzzi Ramos
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies (LIM-56), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 3o. andar ICHC, Sala, Sao Paulo-SP, Cerqueira Cesar, 3016, CEP- 05403-002, Brazil
| | - Naiura Vieira Pereira
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies (LIM-56), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 3o. andar ICHC, Sala, Sao Paulo-SP, Cerqueira Cesar, 3016, CEP- 05403-002, Brazil
| | - Valeria Aoki
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies (LIM-56), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 3o. andar ICHC, Sala, Sao Paulo-SP, Cerqueira Cesar, 3016, CEP- 05403-002, Brazil
| | - Mírian Nacagami Sotto
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce Tiyeko Kawakami
- Laboratory of Heart Pathology, Heart Institute (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Maria Notomi Sato
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies (LIM-56), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 3o. andar ICHC, Sala, Sao Paulo-SP, Cerqueira Cesar, 3016, CEP- 05403-002, Brazil
| | - Raquel Leão Orfali
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies (LIM-56), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 3o. andar ICHC, Sala, Sao Paulo-SP, Cerqueira Cesar, 3016, CEP- 05403-002, Brazil.
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de Souza Xavier Costa N, da Costa Sigrist G, Schalch AS, Belotti L, Dolhnikoff M, da Silva LFF. Lung tissue expression of epithelial injury markers is associated with acute lung injury severity but does not discriminate sepsis from ARDS. Respir Res 2024; 25:129. [PMID: 38500106 PMCID: PMC10949726 DOI: 10.1186/s12931-024-02761-x] [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: 09/12/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients, and diffuse alveolar damage (DAD) is considered its histological hallmark. Sepsis is one of the most common aetiology of ARDS with the highest case-fatality rate. Identifying ARDS patients and differentiate them from other causes of acute respiratory failure remains a challenge. To address this, many studies have focused on identifying biomarkers that can help assess lung epithelial injury. However, there is scarce information available regarding the tissue expression of these markers. Evaluating the expression of elafin, RAGE, and SP-D in lung tissue offers a potential bridge between serological markers and the underlying histopathological changes. Therefore, we hypothesize that the expression of epithelial injury markers varies between sepsis and ARDS as well as according to its severity. METHODS We compared the post-mortem lung tissue expression of the epithelial injury markers RAGE, SP-D, and elafin of patients that died of sepsis, ARDS, and controls that died from non-pulmonary causes. Lung tissue was collected during routine autopsy and protein expression was assessed by immunohistochemistry. We also assessed the lung injury by a semi-quantitative analysis. RESULTS We observed that all features of DAD were milder in septic group compared to ARDS group. Elafin tissue expression was increased and SP-D was decreased in the sepsis and ARDS groups. Severe ARDS expressed higher levels of elafin and RAGE, and they were negatively correlated with PaO2/FiO2 ratio, and positively correlated with bronchopneumonia percentage and hyaline membrane score. RAGE tissue expression was negatively correlated with mechanical ventilation duration in both ARDS and septic groups. In septic patients, elafin was positively correlated with ICU admission length, SP-D was positively correlated with serum lactate and RAGE was correlated with C-reactive protein. CONCLUSIONS Lung tissue expression of elafin and RAGE, but not SP-D, is associated with ARDS severity, but does not discriminate sepsis patients from ARDS patients.
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Affiliation(s)
| | - Giovana da Costa Sigrist
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, LIM-05, Brazil
| | - Alexandre Santos Schalch
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, LIM-05, Brazil
| | - Luciano Belotti
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, LIM-05, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, LIM-05, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, LIM-05, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
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Mochetti MM, Silva EGP, Correa AAF, Cabette MR, Perissinotti IN, E Silva LOJ, Pessoa ADS, de Oliveira RC, da Silva LFF, de Souza HP, de Alencar JCG. Neuron-specific enolase at admission as a predictor for stroke volume, severity and outcome in ischemic stroke patients: a prognostic biomarker review. Sci Rep 2024; 14:2688. [PMID: 38302568 PMCID: PMC10834412 DOI: 10.1038/s41598-024-53080-6] [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: 09/03/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential findings. This work aims to determine whether NSE levels at Emergency Department (ED) admission correlate with stroke severity, infarcted brain volume, functional outcome, and/or death rates. A systematic literature review was performed using PubMed, Embase, and Scopus databases. Each reviewer independently assessed all published studies identified as potentially relevant. All relevant original observational studies (cohort, case-control, and cross-sectional studies) were included. Eleven studies (1398 patients) met the inclusion criteria. Among these, six studies reported a significant correlation between NSE levels and stroke severity, while only one found no association. Four studies indicated a positive relationship between infarcted brain volume assessed by imaging and NSE levels, in contrast to the findings of only one study. Four studies identified an association related to functional outcome and death rates, while three others did not reach statistical significance in their findings. These data highlight that NSE levels at ED admissions proved to be a promising tool for predicting the outcome of ischemic stroke patients in most studies. However, they presented high discrepancies and low robustness. Therefore, further research is necessary to establish and define the role of NSE in clinical practice.
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Affiliation(s)
- Matheus Menão Mochetti
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil.
| | | | | | | | - Iago Navas Perissinotti
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Adriano de Souza Pessoa
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | - Rodrigo Cardoso de Oliveira
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | | | - Heraldo Possolo de Souza
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Júlio César Garcia de Alencar
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Diniz AMB, Gualberto IJN, Lima LA, Cirino MLDA, Murakami RK, Ishikiriama BLC, Ruano R, da Silva LFF, Tirapelli D, Sbragia L. miRNA-143 expression is associated with inflammation and time of exposure to amniotic fluid in experimental gastroschisis. Clinics (Sao Paulo) 2023; 78:100311. [PMID: 38008037 PMCID: PMC10757286 DOI: 10.1016/j.clinsp.2023.100311] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Gastroschisis (GS) is a congenital anomaly in the abdominal wall with the intestinal loops exiting laterally to the umbilicus. The contact of the loops with Amniotic Fluid (AF) causes an inflammatory process in the exposed part, leading to an extended hospital stay and an increased risk of morbidity due to alterations related to intestinal motility. The authors aimed to evaluate the time of exposure to the AF in the experimental GS and to search for potential biomarkers of intestinal inflammation by measuring microRNAs. METHODS Rat fetuses were divided into three groups: a) CONTROL, b) GS reared on day 18 (GS = 18), and c) GS reared on day 19.5 (GS = 19) (term = 22 days). On day 21.5, the fetuses were removed for biometric parameters and biochemical analyses: 1) Biometrics: Body and Intestinal Weight (BW, IW), and intestinal-body weight ratio (IW/BW); 2) Descriptive histopathology and 3) miR-143 quantification by real-time Polymerase Chain Reaction (PCR). RESULTS BW was higher in CONTROL than GS 18 and G19 (p < 0.05). IW, IW/BW, intestinal water, and mRNA-143 were higher in GS 18 and GS 19 than in CONTROL, and GS 18 was higher than GS 19 (p < 0.05). The average of the inflammation score from the intestinal wall with mucosal inflammation and intra-epithelial lymphocytes shows worst in GS 18 and GS 19 vs. CONTROL (p < 0.05). CONCLUSIONS The tissue expression of mRNA-143 and the morphological changes in the intestine of GS worsened according to the time of exposure to AF, which could be a possible marker of fetal intestinal damage.
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Affiliation(s)
- Ana Maria Bicudo Diniz
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Igor José Nogueira Gualberto
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Luiza Almeida Lima
- Division of Maternal Fetal Medicine, Jackson Fetal Care, Department Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mucio Luiz de Assis Cirino
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Rodrigo Kendi Murakami
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Bella Luna Colombini Ishikiriama
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Rodrigo Ruano
- Division of Maternal Fetal Medicine, Jackson Fetal Care, Department Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo Death Verification Service (SVO), São Paulo, SP, Brazil
| | - Daniela Tirapelli
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Lourenço Sbragia
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil.
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de Souza Xavier Costa N, Ribeiro Júnior G, do Nascimento ECT, de Brito JM, Antonangelo L, Faria CS, Monteiro JS, Setubal JC, Pinho JRR, Pereira RV, Seelaender M, de Castro GS, Lima JDCC, de Almeida Monteiro RA, Duarte-Neto AN, Saldiva PHN, Ferraz da Silva LF, Dolhnikoff M, Mauad T. COVID-19 induces more pronounced extracellular matrix deposition than other causes of ARDS. Respir Res 2023; 24:281. [PMID: 37964271 PMCID: PMC10648646 DOI: 10.1186/s12931-023-02555-7] [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: 08/07/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Lung fibrosis is a major concern in severe COVID-19 patients undergoing mechanical ventilation (MV). Lung fibrosis frequency in post-COVID syndrome is highly variable and even if the risk is proportionally small, many patients could be affected. However, there is still no data on lung extracellular matrix (ECM) composition in severe COVID-19 and whether it is different from other aetiologies of ARDS. METHODS We have quantified different ECM elements and TGF-β expression in lung tissue of 28 fatal COVID-19 cases and compared to 27 patients that died of other causes of ARDS, divided according to MV duration (up to six days or seven days or more). In COVID-19 cases, ECM elements were correlated with lung transcriptomics and cytokines profile. RESULTS We observed that COVID-19 cases presented significant increased deposition of collagen, fibronectin, versican, and TGF-β, and decreased decorin density when compared to non-COVID-19 cases of similar MV duration. TGF-β was precociously increased in COVID-19 patients with MV duration up to six days. Lung collagen was higher in women with COVID-19, with a transition of upregulated genes related to fibrillogenesis to collagen production and ECM disassembly along the MV course. CONCLUSIONS Fatal COVID-19 is associated with an early TGF-β expression lung environment after the MV onset, followed by a disordered ECM assembly. This uncontrolled process resulted in a prominent collagen deposition when compared to other causes of ARDS. Our data provides pathological substrates to better understand the high prevalence of pulmonary abnormalities in patients surviving COVID-19.
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Affiliation(s)
| | - Gabriel Ribeiro Júnior
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Jôse Mara de Brito
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leila Antonangelo
- Laboratório de Investigação Médica (LIM03), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Divisão de Patologia Clínica, Departamento de Patologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline Silvério Faria
- Laboratório de Investigação Médica (LIM03), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - João Carlos Setubal
- Departamento de Bioquímica, Instituto de Química Universidade de São Paulo, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Laboratório de Investigação Médica (LIM03), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Verciano Pereira
- Laboratório de Investigação Médica (LIM03), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
- Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Gabriela Salim de Castro
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
- Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Joanna D C C Lima
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
- Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Amaro Nunes Duarte-Neto
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia (LIM 05), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Departamento de Patologia, Laboratório de Patologia Ambiental (LIM- 05), Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
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Duarte-Neto AN, Gonçalves AM, Eliodoro RHDA, Martins WD, Claro IM, Valença IN, Paes VR, Teixeira R, Sztajnbok J, França E Silva ILA, Leite LAF, Malaque CMS, Borges LMS, Gonzalez MP, Barra LAC, Junior LCP, Mello CF, Queiroz W, Atomya AN, Fernezlian SDM, Alves VAF, Leite KRM, Ferreira CR, Saldiva PHN, Mauad T, da Silva LFF, Faria NR, Mendes Corrêa MCJ, Sabino EC, Sotto MN, Dolhnikoff M. Main autopsy findings of visceral involvement by fatal mpox in patients with AIDS: necrotising nodular pneumonia, nodular ulcerative colitis, and diffuse vasculopathy. Lancet Infect Dis 2023; 23:1218-1222. [PMID: 37827188 DOI: 10.1016/s1473-3099(23)00574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Ana Maria Gonçalves
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Wilker Dias Martins
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ingra Morales Claro
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK
| | - Ian Nunes Valença
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK
| | - Vitor Ribeiro Paes
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; and Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nuno R Faria
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK; University of Oxford, Department of Zoology, Oxford, UK
| | - Maria Cássia Jacinto Mendes Corrêa
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mirian Nacagami Sotto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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8
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Giugni FR, Aiello VD, Faria CS, Pour SZ, Cunha MDP, Giugni MV, Pinesi HT, Ledesma FL, Morais CE, Ho YL, Sztajnbok J, de Morais Fernezlian S, Ferraz da Silva LF, Mauad T, Ferreira Alves VA, Hilário do Nascimento Saldiva P, Antonangelo L, Dolhnikoff M, Duarte-Neto AN. Understanding yellow fever-associated myocardial injury: an autopsy study. EBioMedicine 2023; 96:104810. [PMID: 37757571 PMCID: PMC10550587 DOI: 10.1016/j.ebiom.2023.104810] [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: 04/16/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF. METHODS This retrospective autopsy study included cases from the São Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers. FINDINGS Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test. INTERPRETATION Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10. FUNDING This study was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo, Bill and Melinda Gates Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
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Affiliation(s)
- Fernando Rabioglio Giugni
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Caroline Silverio Faria
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Shahab Zaki Pour
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Marielton Dos Passos Cunha
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Melina Valdo Giugni
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Henrique Trombini Pinesi
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felipe Lourenço Ledesma
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carolina Esteves Morais
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yeh-Li Ho
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Serviço de Verificação de Óbitos da Capital (SVOC), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Leila Antonangelo
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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9
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Negri EM, Benchimol M, Mauad T, Duarte-Neto AN, Gottardi M, da Silva LFF, Saldiva PHN, Dolhnikoff M, Souza WD, Garcia Caldini E. Ultrastructural characterization of alveolar microvascular damage in severe COVID-19 respiratory failure. J Appl Physiol (1985) 2023; 135:950-955. [PMID: 37675474 DOI: 10.1152/japplphysiol.00424.2023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
Endothelial dysfunction is a key phenomenon in COVID-19, induced by direct viral endothelial infection and secondary inflammation, mainly affecting the microvascular circulation. However, few studies described the subcellular aspects of the lung microvasculature and the associated thrombotic phenomena, which are widely present in severe COVID-19 cases. To that end, in this transversal observational study we performed transmission and scanning electron microscopy in nine lung samples of patients who died due to COVID-19, obtained via minimally invasive autopsies in Sao Paulo, Brazil, in 2020. All patients died due to acute respiratory failure and had microvascular thrombosis at histology. Electron microscopy revealed areas of endothelial damage with basal lamina disruption and virus infection in endothelial cells. In the capillary lumens, the ultrastructure of the thrombi is depicted, with red blood cells stacking, dysmorphism and hemolysis, fibrin meshworks, and extracellular traps. Our description illustrates the complex pathophysiology of microvascular thrombosis at the cellular level, which leads to some of the peculiar characteristics of severe COVID-19.NEW & NOTEWORTHY In this study, electron microscopy was used to explain the pathophysiology of respiratory failure in severe COVID-19. Before the advent of vaccination, as the virus entered the respiratory system, it rapidly progressed to the alveolar capillary network and, before causing exudative alveolar edema, it caused mainly thrombosis of the pulmonary microcirculation with preserved lung compliance explaining "happy hypoxia." Timing of anticoagulation is of pivotal importance in this disease.
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Affiliation(s)
- Elnara Marcia Negri
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marlene Benchimol
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Centro Nacional de Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade do Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maiara Gottardi
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Centro Nacional de Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade do Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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10
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Geber Júnior JC, Monteiro RADA, Rocha JWPD, Duarte ELT, Nicodemo E, Munhoz O, Paiva EFD, Mauad T, Silva LFFD, Saldiva PHN, Dolhnikoff M, Duarte-Neto AN. What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar. Rev Inst Med Trop Sao Paulo 2023; 65:e36. [PMID: 37283411 DOI: 10.1590/s1678-9946202365036] [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] [Received: 12/16/2022] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.
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Affiliation(s)
- João Carlos Geber Júnior
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | | | - João Wilson Pedro da Rocha
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Edson Luiz Társia Duarte
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Elizabete Nicodemo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Olavo Munhoz
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Edison Ferreira de Paiva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
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11
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Cunha MDP, Duarte-Neto AN, Pour SZ, Pereira BBDS, Ho YL, Perondi B, Sztajnbok J, Alves VAF, da Silva LFF, Dolhnikoff M, Saldiva PHN, Zanotto PMDA. Phylogeographic patterns of the yellow fever virus around the metropolitan region of São Paulo, Brazil, 2016–2019. PLoS Negl Trop Dis 2022; 16:e0010705. [PMID: 36149846 PMCID: PMC9506654 DOI: 10.1371/journal.pntd.0010705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/13/2021] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
From 2016 to 2019, the largest outbreak caused by the Yellow Fever virus (YFV) in the 21st century in the Americas occurred in southeastern Brazil. A sylvatic cycle of transmission was reported near densely populated areas, such as the large metropolitan area of the city of São Paulo. Here, we describe the origin, spread, and movement of the YFV throughout the state of São Paulo. Whole-genome sequences were obtained from tissues of two patients who died due to severe yellow fever, during 2018–2019. Molecular analysis indicated that all analyzed tissues were positive for YFV RNA, with the liver being the organ with the highest amount of viral RNA. Sequence analysis indicates that genomes belonged to the South American genotype I and were grouped in the epidemic clade II, which includes sequences from the states of Goiás, Minas Gerais, and São Paulo of previous years. The analysis of viral dispersion indicates that the outbreak originated in Goiás at the end of 2014 and reached the state of São Paulo through the state of Minas Gerais after 2016. When the virus reached near the urban area, it spread towards both the east and south regions of the state, not establishing an urban transmission cycle in the metropolitan region of São Paulo. The virus that moved towards the east met with YFV coming from the south of the state of Rio de Janeiro, and the YFV that was carried to the south reached the Brazilian states located in the south region of the country. The Yellow Fever virus (YFV) has caused serious public health issues in Africa and the Americas. YFV infections can vary from asymptomatic to severe clinical conditions, which may culminate in death. In Brazil, the main viral origin of YFV outbreaks is the states located in the Amazon Basin. In the present study, we detected YFV RNA in several tissues, including the heart, lung, brain, kidney, spleen, pancreas, liver, and testicle in two human cases. The YFV characterized in the present study belong to the South American genotype I, clade II, and they are associated with viral spread throughout the state of São Paulo after intense viral circulation in the metropolitan region in 2018. Future investigations are necessary for a better understanding of the complex ecological factors involved in viral dispersion from the Amazon Basin.
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Affiliation(s)
- Marielton dos Passos Cunha
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Shahab Zaki Pour
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Bárbara Brito de Souza Pereira
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit, Division of Clinical Infectious and Parasitic Diseases, Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Beatriz Perondi
- Yellow Fever Crisis Committee, Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Luiz Fernando Ferraz da Silva
- Pathology Department, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Verification of Deaths of the Capital–University of São Paulo, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Pathology Department, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Paolo Marinho de Andrade Zanotto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
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12
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Erjefält JS, de Souza Xavier Costa N, Jönsson J, Cozzolino O, Dantas KC, Clausson CM, Siddhuraj P, Lindö C, Alyamani M, Lombardi SCFS, Mendroni Júnior A, Antonangelo L, Faria CS, Duarte-Neto AN, de Almeida Monteiro RA, Rebello Pinho JR, Gomes-Gouvêa MS, Verciano Pereira R, Monteiro JS, Setubal JC, de Oliveira EP, Theodoro Filho J, Sanden C, Orengo JM, Sleeman MA, da Silva LFF, Saldiva PHN, Dolhnikoff M, Mauad T. Diffuse alveolar damage patterns reflect the immunological and molecular heterogeneity in fatal COVID-19. EBioMedicine 2022; 83:104229. [PMID: 36027872 PMCID: PMC9398470 DOI: 10.1016/j.ebiom.2022.104229] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Severe COVID-19 lung disease exhibits a high degree of spatial and temporal heterogeneity, with different histological features coexisting within a single individual. It is important to capture the disease complexity to support patient management and treatment strategies. We provide spatially decoded analyses on the immunopathology of diffuse alveolar damage (DAD) patterns and factors that modulate immune and structural changes in fatal COVID-19. Methods We spatially quantified the immune and structural cells in exudative, intermediate, and advanced DAD through multiplex immunohistochemistry in autopsy lung tissue of 18 COVID-19 patients. Cytokine profiling, viral, bacteria, and fungi detection, and transcriptome analyses were performed. Findings Spatial DAD progression was associated with expansion of immune cells, macrophages, CD8+ T cells, fibroblasts, and (lymph)angiogenesis. Viral load correlated positively with exudative DAD and negatively with disease/hospital length. In all cases, enteric bacteria were isolated, and Candida parapsilosis in eight cases. Cytokines correlated mainly with macrophages and CD8+T cells. Pro-coagulation and acute repair were enriched pathways in exudative DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Interpretation Unraveling the spatial and molecular immunopathology of COVID-19 cases exposes the responses to SARS-CoV-2-induced exudative DAD and subsequent immune-modulatory and remodeling changes in proliferative/advanced DAD that occur side-by-side together with secondary infections in the lungs. These complex features have important implications for disease management and the development of novel treatments. Funding CNPq, Bill and Melinda Gates Foundation, HC-Convida, FAPESP, Regeneron Pharmaceuticals, and the Swedish Heart & Lung Foundation.
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Affiliation(s)
- Jonas S Erjefält
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden; Department of Allergology and Respiratory Medicine, Lund University, Sweden
| | - Natália de Souza Xavier Costa
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Olga Cozzolino
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Katia Cristina Dantas
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carl-Magnus Clausson
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Premkumar Siddhuraj
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | | | - Manar Alyamani
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Suzete Cleusa Ferreira Spina Lombardi
- Divisão de Pesquisa & Medicina Transfusional, Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Laboratório Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alfredo Mendroni Júnior
- Divisão de Pesquisa & Medicina Transfusional, Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Laboratório Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leila Antonangelo
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Divisão de Patologia Clínica - Departamento de Patologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline Silvério Faria
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - João Renato Rebello Pinho
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michele Soares Gomes-Gouvêa
- Departamento de Gastroenterologia (LIM-07), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Verciano Pereira
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - João Carlos Setubal
- Departamento de Bioquímica, Instituto de Química Universidade de São Paulo, São Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jair Theodoro Filho
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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13
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Crunfli F, Carregari VC, Veras FP, Silva LS, Nogueira MH, Antunes ASLM, Vendramini PH, Valença AGF, Brandão-Teles C, Zuccoli GDS, Reis-de-Oliveira G, Silva-Costa LC, Saia-Cereda VM, Smith BJ, Codo AC, de Souza GF, Muraro SP, Parise PL, Toledo-Teixeira DA, Santos de Castro ÍM, Melo BM, Almeida GM, Firmino EMS, Paiva IM, Silva BMS, Guimarães RM, Mendes ND, Ludwig RL, Ruiz GP, Knittel TL, Davanzo GG, Gerhardt JA, Rodrigues PB, Forato J, Amorim MR, Brunetti NS, Martini MC, Benatti MN, Batah SS, Siyuan L, João RB, Aventurato ÍK, Rabelo de Brito M, Mendes MJ, da Costa BA, Alvim MKM, da Silva Júnior JR, Damião LL, de Sousa IMP, da Rocha ED, Gonçalves SM, Lopes da Silva LH, Bettini V, Campos BM, Ludwig G, Tavares LA, Pontelli MC, Viana RMM, Martins RB, Vieira AS, Alves-Filho JC, Arruda E, Podolsky-Gondim GG, Santos MV, Neder L, Damasio A, Rehen S, Vinolo MAR, Munhoz CD, Louzada-Junior P, Oliveira RD, Cunha FQ, Nakaya HI, Mauad T, Duarte-Neto AN, Ferraz da Silva LF, Dolhnikoff M, Saldiva PHN, Farias AS, Cendes F, Moraes-Vieira PMM, Fabro AT, Sebollela A, Proença-Modena JL, Yasuda CL, Mori MA, Cunha TM, Martins-de-Souza D. Morphological, cellular, and molecular basis of brain infection in COVID-19 patients. Proc Natl Acad Sci U S A 2022. [DOI: 10.1073/pnas.2200960119 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Although increasing evidence confirms neuropsychiatric manifestations associated mainly with severe COVID-19 infection, long-term neuropsychiatric dysfunction (recently characterized as part of “long COVID-19” syndrome) has been frequently observed after mild infection. We show the spectrum of cerebral impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, ranging from long-term alterations in mildly infected individuals (orbitofrontal cortical atrophy, neurocognitive impairment, excessive fatigue and anxiety symptoms) to severe acute damage confirmed in brain tissue samples extracted from the orbitofrontal region (via endonasal transethmoidal access) from individuals who died of COVID-19. In an independent cohort of 26 individuals who died of COVID-19, we used histopathological signs of brain damage as a guide for possible SARS-CoV-2 brain infection and found that among the 5 individuals who exhibited those signs, all of them had genetic material of the virus in the brain. Brain tissue samples from these five patients also exhibited foci of SARS-CoV-2 infection and replication, particularly in astrocytes. Supporting the hypothesis of astrocyte infection, neural stem cell–derived human astrocytes in vitro are susceptible to SARS-CoV-2 infection through a noncanonical mechanism that involves spike–NRP1 interaction. SARS-CoV-2–infected astrocytes manifested changes in energy metabolism and in key proteins and metabolites used to fuel neurons, as well as in the biogenesis of neurotransmitters. Moreover, human astrocyte infection elicits a secretory phenotype that reduces neuronal viability. Our data support the model in which SARS-CoV-2 reaches the brain, infects astrocytes, and consequently, leads to neuronal death or dysfunction. These deregulated processes could contribute to the structural and functional alterations seen in the brains of COVID-19 patients.
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Affiliation(s)
- Fernanda Crunfli
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Victor C. Carregari
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Flavio P. Veras
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Lucas S. Silva
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Mateus Henrique Nogueira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | | | - Pedro Henrique Vendramini
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | | | - Caroline Brandão-Teles
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Giuliana da Silva Zuccoli
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Guilherme Reis-de-Oliveira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Lícia C. Silva-Costa
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Verônica Monteiro Saia-Cereda
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Bradley J. Smith
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Ana Campos Codo
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Gabriela F de Souza
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Stéfanie P. Muraro
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Pierina Lorencini Parise
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Daniel A. Toledo-Teixeira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | | | - Bruno Marcel Melo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Glaucia M. Almeida
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | | | - Isadora Marques Paiva
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | | | - Rafaela Mano Guimarães
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Niele D. Mendes
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Raíssa L. Ludwig
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Gabriel P. Ruiz
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Thiago L. Knittel
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Gustavo G. Davanzo
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Jaqueline Aline Gerhardt
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Patrícia Brito Rodrigues
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Julia Forato
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Mariene Ribeiro Amorim
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Natália S. Brunetti
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Matheus Cavalheiro Martini
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Maíra Nilson Benatti
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Sabrina S. Batah
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Li Siyuan
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Rafael B. João
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Ítalo K. Aventurato
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Mariana Rabelo de Brito
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Maria J. Mendes
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Beatriz A. da Costa
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Marina K. M. Alvim
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - José Roberto da Silva Júnior
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Lívia L. Damião
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Iêda Maria P. de Sousa
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Elessandra D. da Rocha
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Solange M. Gonçalves
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Luiz H. Lopes da Silva
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Vanessa Bettini
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Brunno M. Campos
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Guilherme Ludwig
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Lucas Alves Tavares
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | | | | | - Ronaldo B. Martins
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Andre Schwambach Vieira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | | | - Eurico Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | | | - Marcelo Volpon Santos
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Luciano Neder
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - André Damasio
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Stevens Rehen
- D'Or Institute for Research and Education, 04502001, Brazil
- Institute of Biomedical Science, Federal University of Rio de Janeiro, Rio de Janeiro, 21941590, Brazil
| | - Marco Aurélio Ramirez Vinolo
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | | | - Paulo Louzada-Junior
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Renê Donizeti Oliveira
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Fernando Q. Cunha
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | | | - Thais Mauad
- University of São Paulo, São Paulo, 05508-220, Brazil
| | | | | | | | | | - Alessandro S. Farias
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Fernando Cendes
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Pedro Manoel M. Moraes-Vieira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Alexandre T. Fabro
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Adriano Sebollela
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - José L. Proença-Modena
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Clarissa L. Yasuda
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Marcelo A. Mori
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
| | - Thiago M. Cunha
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049900, Brazil
| | - Daniel Martins-de-Souza
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, 13083862, Brazil
- D'Or Institute for Research and Education, 04502001, Brazil
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14
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de André CDS, Bierrenbach AL, Barroso LP, de André PA, Justo LT, Pereira LAA, Taniguchi MT, Minto CM, Takecian PL, Kamaura LT, Ferreira JE, Hazard RH, Mclaughlin D, Riley I, Lopez AD, Ramos AMDO, de Souza MDFM, França EB, Saldiva PHN, da Silva LFF. Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil. BMC Public Health 2022; 22:748. [PMID: 35421964 PMCID: PMC9008898 DOI: 10.1186/s12889-022-13081-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard.
Methods
The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level.
Results
There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49.
Conclusions
The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.
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15
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Farias-Itao DS, Pasqualucci CA, de Andrade RA, da Silva LFF, Yahagi-Estevam M, Lage SHG, Leite REP, Campo AB, Suemoto CK. Macrophage Polarization in the Perivascular Fat Was Associated With Coronary Atherosclerosis. J Am Heart Assoc 2022; 11:e023274. [PMID: 35229617 PMCID: PMC9075275 DOI: 10.1161/jaha.121.023274] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Inflammation of the perivascular adipose tissue (PvAT) may be related to atherosclerosis; however, the association of polarized macrophages in the pericoronary PvAT with measurements of atherosclerosis components in humans has not been fully investigated. Methods and Results Coronary arteries were dissected with surrounding PvAT. We evaluated the percentage of arterial obstruction, intima-media thickness, fibrous cap thickness, plaque components, and the number of vasa vasorum. The number of proinflammatory (M1) and anti-inflammatory (M2) macrophages in the periplaque and control PvAT were evaluated using immunohistochemistry. Regression models adjusted for sociodemographic and clinical variables were used. In 319 segments from 82 individuals, we found a correlation of the M1/M2 macrophage density ratio with an increase in arterial obstruction (P=0.02) and lipid content (P=0.01), and a decrease in smooth muscle cells (P=0.02). M1 and the ratio of M1/M2 macrophages were associated with an increased risk of thrombosis (P=0.03). In plaques with thrombosis, M1 macrophages were correlated with a decrease in fibrous cap thickness (P=0.006), an increase in lipid content (P=0.008), and the number of vasa vasorum in the adventitia layer (P=0.001). M2 macrophages were correlated with increased arterial obstruction (P=0.01), calcification (P=0.02), necrosis (P=0.03) only in plaques without thrombosis, and decrease of the number of vasa vasorum in plaques with thrombosis (P=0.003). Conclusions M1 macrophages in the periplaque PvAT were associated with a higher risk of coronary thrombosis and were correlated with histological components of plaque progression and destabilization. M2 macrophages were correlated with plaque size, calcification, necrotic content, and a decrease in the number of vasa vasorum in the adventitia layer.
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Affiliation(s)
| | | | - Renato Araújo de Andrade
- Control and Automation Engineering Federal Institute of Education, Science and Technology of Sao Paulo Sao Paulo Brazil
| | | | | | | | | | - Alexandre Brincalepe Campo
- Control and Automation Engineering Federal Institute of Education, Science and Technology of Sao Paulo Sao Paulo Brazil
| | - Claudia Kimie Suemoto
- Department of Pathology University of Sao Paulo Medical School Sao Paulo Brazil.,Discipline of Geriatrics University of Sao Paulo Medical School Sao Paulo Brazil
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16
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Martin MDGM, Paes VR, Cardoso EF, Neto CEBP, Kanamura CT, Leite CDC, Otaduy MCG, Monteiro RADA, Mauad T, da Silva LFF, Castro LHM, Saldiva PHN, Dolhnikoff M, Duarte-Neto AN. Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects. Insights Imaging 2022; 13:7. [PMID: 35032223 PMCID: PMC8760871 DOI: 10.1186/s13244-021-01144-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions. RESULTS Seven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%). CONCLUSIONS Despite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.
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Affiliation(s)
- Maria da Graça Morais Martin
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil.
| | - Vitor Ribeiro Paes
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ellison Fernando Cardoso
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil
| | | | | | - Claudia da Costa Leite
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo, LIM 44 HCFMUSP, São Paulo, Brazil
| | - Maria Concepcion Garcia Otaduy
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil
| | | | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Servico de Verificaçao de Óbitos de São Paulo (SVO), São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Instituto Adolfo Lutz, São Paulo, Brazil
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17
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Hart JD, de André PA, de André CDS, Adair T, Barroso LP, Valongueiro S, Bierrenbach AL, de Carvalho PI, Antunes MBDC, de Oliveira CM, Pereira LAA, Minto CM, Bezerra TMDS, Costa SP, de Azevedo BA, de Lima JRA, Mota DSDM, Ramos AMDO, de Souza MDFM, da Silva LFF, França EB, McLaughlin D, Riley ID, Saldiva PHN. Validation of SmartVA using conventional autopsy: A study of adult deaths in Brazil. Lancet Reg Health Am 2022; 5:100081. [PMID: 36776454 PMCID: PMC9904092 DOI: 10.1016/j.lana.2021.100081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. METHODS This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. FINDINGS The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for "Other NCDs" (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. INTERPRETATION The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.
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Affiliation(s)
- John D. Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | | | | | - Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Lucia Pereira Barroso
- University of São Paulo, Institute of Mathematics and Statistics, São Paulo, São Paulo, Brazil
| | | | - Ana Luiza Bierrenbach
- Sírio-Libanês Hospital, São Paulo, São Paulo, Brazil
- Vital Strategies, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Ana Maria de Oliveira Ramos
- Federal University of Rio Grande do Norte, Health Sciences Center, Natal, Rio Grande do Norte, Brazil
- Natal Autopsy Service, Natal, Rio Grande do Norte, Brazil
| | | | - Luiz Fernando Ferraz da Silva
- University of São Paulo, School of Medicine, São Paulo, São Paulo, Brazil
- São Paulo Autopsy Service, University of São Paulo, Sao Paulo, Brazil
| | | | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ian D. Riley
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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18
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Rodrigues MG, da Silva LFF, Araujo-Filho VJFD, Mosca LDM, Araujo-Neto VJFD, Kowalski LP, Carneiro PC. Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases. Clinics (Sao Paulo) 2022; 77:100022. [PMID: 35306374 PMCID: PMC8941178 DOI: 10.1016/j.clinsp.2022.100022] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. METHODS Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. RESULTS A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). CONCLUSION Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.
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Affiliation(s)
- Mariana Gonçalves Rodrigues
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Letícia de Moraes Mosca
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Paulo Kowalski
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Campos Carneiro
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
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19
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Duarte-Neto AN, Ferraz da Silva LF, Monteiro RADA, Theodoro Filho J, Leite TLLF, de Moura CS, Gomes-Gouvêa MS, Pinho JRR, Kanamura CT, de Oliveria EP, Bispo KCS, Arruda C, Dos Santos AB, Aquino FCG, Caldini EG, Mauad T, Saldiva PHN, Dolhnikoff M. Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020. Clin Infect Dis 2021; 73:S442-S453. [PMID: 34910174 PMCID: PMC8672862 DOI: 10.1093/cid/ciab885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Minimally invasive autopsies, also known as minimally invasive tissue sampling (MITS), have proven to be an alternative to complete diagnostic autopsies (CDAs) in places or situations where this procedure cannot be performed. During the coronavirus disease 2019 (COVID-19) pandemic, CDAs were suspended by March 2020 in Brazil to reduce biohazard. To contribute to the understanding of COVID-19 pathology, we have conducted ultrasound (US)-guided MITS as a strategy. METHODS This case series study includes 80 autopsies performed in patients with COVID-19 confirmed by laboratorial tests. Different organs were sampled using a standardized MITS protocol. Tissues were submitted to histopathological analysis as well as immunohistochemical and molecular analysis and electron microscopy in selected cases. RESULTS US-guided MITS proved to be a safe and highly accurate procedure; none of the personnel were infected, and accuracy ranged from 69.1% for kidney, up to 90.1% for lungs, and reaching 98.7% and 97.5% for liver and heart, respectively. US-guided MITS provided a systemic view of the disease, describing the most common pathological findings and identifying viral and other infectious agents using ancillary techniques, and also allowed COVID-19 diagnosis confirmation in 5% of the cases that were negative in premortem and postmortem nasopharyngeal/oropharyngeal swab real-time reverse-transcription polymerase chain reaction. CONCLUSIONS Our data showed that US-guided MITS has the capacity similar to CDA not only to identify but also to characterize emergent diseases.
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Affiliation(s)
- Amaro Nunes Duarte-Neto
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto Adolfo Lutz, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Aparecida de Almeida Monteiro
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jair Theodoro Filho
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thabata Larissa Luciano Ferreira Leite
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Catia Sales de Moura
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Kely Cristina Soares Bispo
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cássia Arruda
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aline Brito Dos Santos
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Flavia Cristina Gonçalves Aquino
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elia Garcia Caldini
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Departamento de Patologia, Laboratório de Investigação Médica 59, São Paulo, Brazil
| | - Thais Mauad
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Brazilian Image Autopsy Study Group, Departamento de Patologia, Laboratório de Investigação Médica 05, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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20
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Matuck BF, Dolhnikoff M, Duarte-Neto AN, Maia G, Gomes SC, Sendyk DI, Zarpellon A, de Andrade NP, Monteiro RA, Pinho JRR, Gomes-Gouvêa MS, Souza SC, Kanamura C, Mauad T, Saldiva PHN, Braz-Silva PH, Caldini EG, da Silva LFF. Salivary glands are a target for SARS-CoV-2: a source for saliva contamination. J Pathol 2021; 254:239-243. [PMID: 33834497 PMCID: PMC8250228 DOI: 10.1002/path.5679] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 10/14/2020] [Revised: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 01/05/2023]
Abstract
The ability of the new coronavirus SARS-CoV-2 to spread and contaminate is one of the determinants of the COVID-19 pandemic status. SARS-CoV-2 has been detected in saliva consistently, with similar sensitivity to that observed in nasopharyngeal swabs. We conducted ultrasound-guided postmortem biopsies in COVID-19 fatal cases. Samples of salivary glands (SGs; parotid, submandibular, and minor) were obtained. We analyzed samples using RT-qPCR, immunohistochemistry, electron microscopy, and histopathological analysis to identify SARS-CoV-2 and elucidate qualitative and quantitative viral profiles in salivary glands. The study included 13 female and 11 male patients, with a mean age of 53.12 years (range 8-83 years). RT-qPCR for SARS-CoV-2 was positive in 30 SG samples from 18 patients (60% of total SG samples and 75% of all cases). Ultrastructural analyses showed spherical 70-100 nm viral particles, consistent in size and shape with the Coronaviridae family, in the ductal lining cell cytoplasm, acinar cells, and ductal lumen of SGs. There was also degeneration of organelles in infected cells and the presence of a cluster of nucleocapsids, which suggests viral replication in SG cells. Qualitative histopathological analysis showed morphologic alterations in the duct lining epithelium characterized by cytoplasmic and nuclear vacuolization, as well as nuclear pleomorphism. Acinar cells showed degenerative changes of the zymogen granules and enlarged nuclei. Ductal epithelium and serous acinar cells showed intense expression of ACE2 and TMPRSS receptors. An anti-SARS-CoV-2 antibody was positive in 8 (53%) of the 15 tested cases in duct lining epithelial cells and acinar cells of major SGs. Only two minor salivary glands were positive for SARS-CoV-2 by immunohistochemistry. Salivary glands are a reservoir for SARS-CoV-2 and provide a pathophysiological background for studies that indicate the use of saliva as a diagnostic method for COVID-19 and highlight this biological fluid's role in spreading the disease. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Marisa Dolhnikoff
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil.,Adolfo Lutz Institute, Division of Pathology, São Paulo, Brazil
| | - Gilvan Maia
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sara Costa Gomes
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Isaac Sendyk
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Amanda Zarpellon
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Nathalia Paiva de Andrade
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Suzana Com Souza
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Thais Mauad
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Paulo H Braz-Silva
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elia Garcia Caldini
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil.,São Paulo Autopsy Service, University of São Paulo, São Paulo, Brazil
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21
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Hooper JE, Padera RF, Dolhnikoff M, da Silva LFF, Duarte-Neto AN, Kapp ME, Lacy JM, Mauad T, Saldiva PHN, Rapkiewicz AV, Wolf DA, Felix JC, Benson P, Shanes E, Gawelek KL, Marshall DA, McDonald MM, Muller W, Priemer DS, Solomon IH, Zak T, Bhattacharjee MB, Fu L, Gilbert AR, Harper HL, Litovsky S, Lomasney J, Mount SL, Reilly S, Sekulic M, Steffensen TS, Threlkeld KJ, Zhao B, Williamson AK. A Postmortem Portrait of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Large Multi-institutional Autopsy Survey Study. Arch Pathol Lab Med 2021; 145:529-535. [PMID: 33449998 DOI: 10.5858/arpa.2020-0786-sa] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
CONTEXT.— This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting. OBJECTIVE.— To accurately reflect the preexisting diseases and pathologic conditions of decedents with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection through autopsy. DESIGN.— Comprehensive data from 135 autopsy evaluations of COVID-19-positive decedents is presented, including histologic assessment. Postmortem examinations were performed by 36 pathologists at 19 medical centers or forensic institutions in the United States and Brazil. Data from each autopsy were collected through the online submission of multiple-choice and open-ended survey responses. RESULTS.— Patients dying of or with COVID-19 had an average of 8.89 pathologic conditions documented at autopsy, spanning a combination of prior chronic disease and acute conditions acquired during hospitalization. Virtually all decedents were cited as having more than 1 preexisting condition, encompassing an average of 2.88 such diseases each. Clinical conditions during terminal hospitalization were cited 395 times for the 135 autopsied decedents and predominantly encompassed acute failure of multiple organ systems and/or impaired coagulation. Myocarditis was rarely cited. CONCLUSIONS.— Cause-of-death statements in both autopsy reports and death certificates may not encompass the severity or spectrum of comorbid conditions in those dying of or with COVID-19. If supported by additional research, this finding may have implications for public health decisions and reporting moving forward through the pandemic.
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Affiliation(s)
- Jody E Hooper
- The Department of Pathology, Johns Hopkins University, Baltimore, Maryland (Hooper)
| | - Robert F Padera
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
| | - Meghan E Kapp
- The Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Kapp)
| | - J Matthew Lacy
- Snohomish County Medical Examiner's Office, Everett, Washington (Lacy)
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
| | - Paulo Hilario Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
| | - Amy V Rapkiewicz
- The Department of Pathology, NYU Long Island School of Medicine, Mineola, New York (Rapkiewicz)
| | - Dwayne A Wolf
- Harris County Institute of Forensic Sciences, Houston, Texas (Wolf)
| | - Juan C Felix
- The Department of Pathology, Medical College of Wisconsin, Milwaukee (Felix)
| | - Paul Benson
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
| | - Elisheva Shanes
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
| | - Kara L Gawelek
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
| | - Desiree A Marshall
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Marshall)
| | - Michelle M McDonald
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
| | - William Muller
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
| | - David S Priemer
- The Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Priemer)
| | - Isaac H Solomon
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
| | - Taylor Zak
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
| | - Meenakshi B Bhattacharjee
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
| | - Lucy Fu
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
| | - Andrea R Gilbert
- The Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, Long School of Medicine, San Antonio (Gilbert)
| | - Holly L Harper
- The Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Harper)
| | - Silvio Litovsky
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
| | - Jon Lomasney
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
| | - Sharon L Mount
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Mount, Threlkeld)
| | - Stephanie Reilly
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
| | - Miroslav Sekulic
- The Department of Pathology and Cell Biology, Columbia University, New York, New York (Sekulic)
| | - Thora S Steffensen
- The Department of Pathology, Tampa General Hospital, Tampa, Florida (Steffensen)
| | - Kirsten J Threlkeld
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Mount, Threlkeld)
| | - Bihong Zhao
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
| | - Alex K Williamson
- The Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Williamson)
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22
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Duarte-Neto AN, Caldini EG, Gomes-Gouvêa MS, Kanamura CT, de Almeida Monteiro RA, Ferranti JF, Ventura AMC, Regalio FA, Fiorenzano DM, Gibelli MABC, Carvalho WBD, Leal GN, Pinho JRR, Delgado AF, Carneiro-Sampaio M, Mauad T, Ferraz da Silva LF, Saldiva PHN, Dolhnikoff M. An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C. EClinicalMedicine 2021; 35:100850. [PMID: 33937731 PMCID: PMC8072136 DOI: 10.1016/j.eclinm.2021.100850] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 01/08/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease. METHODS Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). FINDINGS Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection: adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations: myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARS-CoV-2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis. Interpretation: SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the clinical manifestation varies amongst individuals. Two major patterns of severe COVID-19 were observed: a primarily pulmonary disease, with severe acute respiratory disease and diffuse alveolar damage, or a multisystem inflammatory syndrome with the involvement of several organs. The presence of SARS-CoV-2 in several organs, associated with cellular ultrastructural changes, reinforces the hypothesis that a direct effect of SARS-CoV-2 on tissues is involved in the pathogenesis of MIS-C. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Instituto Adolfo Lutz. Av. Dr. Arnaldo, 351, 01246-000 São Paulo, SP, Brasil
| | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Michele Soares Gomes-Gouvêa
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | | | | | - Juliana Ferreira Ferranti
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Andrea Maria Cordeiro Ventura
- Unidade de Terapia Intensiva Pediátrica, Departamento de Pediatria, Hospital Universitário da Universidade de São Paulo. Av. Prof. Lineu Prestes, 2565, 05508-000 São Paulo, SP, Brasil
| | - Fabiane Aliotti Regalio
- Divisão de Anestesia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Av. Dr Enéas de Carvalho Aguiar, 255, 01246-000 São Paulo, SP, Brasil
| | - Daniela Matos Fiorenzano
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Maria Augusta Bento Cicaroni Gibelli
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Werther Brunow de Carvalho
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Gabriela Nunes Leal
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - João Renato Rebello Pinho
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | - Artur Figueiredo Delgado
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Magda Carneiro-Sampaio
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 250, 05403-000 São Paulo, SP, Brasil
| | - Paulo Hilario Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Corresponding author at: Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia. Av. Dr. Arnaldo, 455, sala 1155 – Cerqueira Cesar, Sao Paulo, SP 01246-903, Brasil.
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23
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Menezes MCS, Pestana DVS, Gameiro GR, da Silva LFF, Baron Ė, Rouby JJ, Auler JOC. SARS-CoV-2 pneumonia-receptor binding and lung immunopathology: a narrative review. Crit Care 2021; 25:53. [PMID: 33557908 PMCID: PMC7870126 DOI: 10.1186/s13054-020-03399-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023]
Abstract
The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.
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Affiliation(s)
- Maria Clara Saad Menezes
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | - Diego Vinicius Santinelli Pestana
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | - Gustavo Rosa Gameiro
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | | | - Ėlodie Baron
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Sorbonne University, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Sorbonne University, Paris, France
| | - José Otavio Costa Auler
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil.
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24
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de Almeida Monteiro RA, Duarte-Neto AN, Ferraz da Silva LF, de Oliveira EP, do Nascimento ECT, Mauad T, Saldiva PHDN, Dolhnikoff M. Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings. Intensive Care Med 2021; 47:199-207. [PMID: 33392642 PMCID: PMC7779089 DOI: 10.1007/s00134-020-06328-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19. METHODS We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches. RESULTS Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD. CONCLUSION The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.
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Affiliation(s)
- Renata Aparecida de Almeida Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Caroline Toledo do Nascimento
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Paulo Hilário do Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil.
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Mauad T, Duarte-Neto AN, da Silva LFF, de Oliveira EP, de Brito JM, do Nascimento ECT, de Almeida Monteiro RA, Ferreira JC, de Carvalho CRR, do Nascimento Saldiva PH, Dolhnikoff M. Tracking the time course of pathological patterns of lung injury in severe COVID-19. Respir Res 2021; 22:32. [PMID: 33514373 PMCID: PMC7844838 DOI: 10.1186/s12931-021-01628-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 11/18/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. METHODS We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. RESULTS Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. CONCLUSION Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.
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Affiliation(s)
- Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil.,Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto Do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jose Mara de Brito
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
| | - Ellen Caroline Toledo do Nascimento
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
| | - Renata Aparecida de Almeida Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
| | - Juliana Carvalho Ferreira
- Departamento de Cardiopneumologia, Instituto Do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paulo Hilário do Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Cerqueira Cesar, São Paulo, Brazil
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Theodoro-Filho J, Monteiro RADA, Duarte-Neto AN, Mauad T, da Silva LFF, Saldiva PHN, Dolhnikoff M. Extended minimally invasive autopsy: Technical improvements for the investigation of cardiopulmonary events in COVID-19. Clinics (Sao Paulo) 2021; 76:e3543. [PMID: 34852147 PMCID: PMC8595572 DOI: 10.6061/clinics/2021/e3543] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19. METHOD US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart). RESULTS EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US. CONCLUSIONS Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.
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Affiliation(s)
- Jair Theodoro-Filho
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Renata Aparecida de Almeida Monteiro
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Amaro Nunes Duarte-Neto
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thais Mauad
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Fernando Ferraz da Silva
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Hilário Nascimento Saldiva
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marisa Dolhnikoff
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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da Silva PSD, Sawamura MVY, Monteiro RADA, Duarte-Neto AN, Martin MDGM, Dolhnikoff M, Mauad T, Saldiva PHN, Leite CC, da Silva LFF, Cardoso EF. Postmortem Chest Computed Tomography in Fatal COVID-19: A Valuable Diagnostic Tool for Minimally Invasive Autopsy. Clinics (Sao Paulo) 2021; 76:e3551. [PMID: 34909914 PMCID: PMC8612301 DOI: 10.6061/clinics/2021/e3551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Paulo Savoia Dias da Silva
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Fleury Group, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | | | | | | | | | - Marisa Dolhnikoff
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thais Mauad
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | | | - Ellison Fernando Cardoso
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
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Gomes VC, da Silva LFF, Silvestre GC, Queiroz A, Marques MA, Zyngier SP, da Silva ES. Biomechanical Properties of the Periaortic Abdominal Tissue: It is Not as Fragile as It Seems. Ann Vasc Surg 2020; 72:571-577. [PMID: 33385529 DOI: 10.1016/j.avsg.2020.11.028] [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] [Received: 10/06/2020] [Revised: 10/31/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The perivascular adipose tissue has been studied as a critical element that could influence physiological and disease processes of the vessel covered by it. In terms of anatomy, during the abdominal aorta's dissection, it is possible to identify the periaortic adipose tissue and the periaortic parietal peritoneum lying over it, sealing the retroperitoneal space. They seem to be fragile layers, with apparently no biomechanical role in the abdomen. However, it is well known that most cases of ruptured abdominal aortic aneurysms (AAAs) that reach the emergency department still alive present retroperitoneal bleeding contained by the previously mentioned two-layer combination, eventually allowing time for surgical treatment. In previous studies about aortic wall stress, tension, and AAA rupture prediction, only information concerning the vessel wall itself is highlighted. Therefore, the present work aims to study the biomechanical and histological properties of the periaortic tissue, comparing them to the same variables measured in aortic wall samples described in the medical literature. MATERIALS AND METHODS Samples of periaortic tissue were harvested from 27 individuals during necropsy. Smoking status and the presence of AAAs were observed. Biomechanical uniaxial destructive tests were performed up to samples' rupture. Values of failure stress, tension, and strain were obtained. Samples were also harvested for histological analysis. RESULTS Periaortic tissue presented less amount of collagen in smokers than in nonsmokers (P = 0.017). The periaortic tissue seems to be more elastic than aortic walls described in the literature (strain: 0.75 ± 0.37). Analyzing periaortic tissue failure stress (56.8 ± 101.26 N/cm2) and tension (7.65 ± 4.99 N/cm), it has at least 52% and 55%, respectively, of the stress and tension described in the medical literature for AAA walls. CONCLUSIONS The periaortic tissue presents less collagen fibers in smokers than in nonsmokers. The periaortic tissue seemed very delicate during an autopsy, but the study of its biomechanical properties showed that it presents more than half of the resistance of an AAA wall. This information suggests this tissue might have a mechanical protective role against massive bleeding when it comes to an aortic rupture. Therefore this tissue's biomechanical information should be included in computational models on enlargement and rupture prediction of AAAs.
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Affiliation(s)
- Vivian Carla Gomes
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02), University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil.
| | | | - Gina Camillo Silvestre
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02), University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Alexandre Queiroz
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02), University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Michele Alberto Marques
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02), University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Selene Perrotti Zyngier
- Department of Pathology, University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Erasmo Simão da Silva
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02), University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
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Fernandes Matuck B, Dolhnikoff M, Maia GVA, Isaac Sendyk D, Zarpellon A, Costa Gomes S, Duarte-Neto AN, Rebello Pinho JR, Gomes-Gouvêa MS, Sousa SCM, Mauad T, Saldiva PHDN, Braz-Silva PH, da Silva LFF. Periodontal tissues are targets for Sars-Cov-2: a post-mortem study. J Oral Microbiol 2020; 13:1848135. [PMID: 33391625 PMCID: PMC7717160 DOI: 10.1080/20002297.2020.1848135] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The ability of coronavirus SARS-CoV-2 to spread is one of the determinants of the COVID-19 pandemic status. Until June 2020, global COVID-19 cases surpassed 10 million. Asymptomatic patients, with no respiratory impairment, are believed to be responsible for more than 80% of the transmission. Other viruses have been consistently detected in periodontal tissues. Objective: The aim of this study was to investigate the presence of SARS-CoV-2 in periodontal tissue. Methods: We conducted video-endoscope minimally invasive post-mortem biopsy in seven fatal cases of COVID-19, using a regular endoscope video system associated with a smartphone to locate periodontal tissue. We analyzed the samples using RT-PCR, to identify the SARS-CoV-2 RNA and histopathological analysis. Results: The seven studied autopsies with positive laboratory tests for COVID-19 included 57.14% of female patients at the average age of 47.4 (range 8 to 74). In five cases, periodontal tissue was positive for SARS-CoV-2 (RT-PCR). Histopathologic analyses showed morphologic alterations in the keratinocytes of the junctional epithelium, a vacuolization of the cytoplasm and nucleus and nuclear pleomorphism. Conclusion: We presented a biomolecular analysis obtained from minimally invasive autopsies. This is the first study to demonstrate the presence of SARS-CoV-2 in periodontal tissue in COVID-19 positive patients.
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Affiliation(s)
| | - Marisa Dolhnikoff
- Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gilvan V. A. Maia
- Department of Otorhinolaryngology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel Isaac Sendyk
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Amanda Zarpellon
- Department of Stomatology, Division of Oral Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Sara Costa Gomes
- Department of Otorhinolaryngology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - João Renato Rebello Pinho
- Institute of Tropical Medicine of Sao Paulo, Department of Gastroenterology, LIM-07, University of Sao Paulo, Sao Paulo, Brazil
| | - Michele Soares Gomes-Gouvêa
- Institute of Tropical Medicine of Sao Paulo, Department of Gastroenterology, LIM-07, University of Sao Paulo, Sao Paulo, Brazil
| | - Suzana C.O. M. Sousa
- Department of Stomatology, Division of Oral Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Thais Mauad
- Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Paulo H. Braz-Silva
- Department of Stomatology, Division of General Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
- Institue of Tropical Medicine of São Paulo, University of Sao Paulo, Sao Paulo, Brazil
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Rossi RC, Annoni R, Ferreira DS, da Silva LFF, Mauad T. Correction to: Structural alterations and markers of endothelial activation in pulmonary and bronchial arteries in fatal asthma. Allergy Asthma Clin Immunol 2020; 16:91. [PMID: 33101425 PMCID: PMC7579919 DOI: 10.1186/s13223-020-00490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Renata Calciolari Rossi
- Department of Pathology, Universidade de São Paulo-School of Medicine, Avenida Dr. Arnaldo, 455, São Paulo, SP CEP 01246-903 Brazil.,Department of Pathology, Universidade Do Oeste Paulista, Presidente Prudente, São Paulo Brazil
| | - Raquel Annoni
- Department of Pathology, Universidade de São Paulo-School of Medicine, Avenida Dr. Arnaldo, 455, São Paulo, SP CEP 01246-903 Brazil.,Department of Physiotherapy, Universidade Federal Do Triângulo Mineiro, Uberaba, Minas Gerais Brazil
| | - Diogenes Seraphim Ferreira
- Department of Pathology, Universidade de São Paulo-School of Medicine, Avenida Dr. Arnaldo, 455, São Paulo, SP CEP 01246-903 Brazil.,Allergy and Immunology, Hospital das Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, Universidade de São Paulo-School of Medicine, Avenida Dr. Arnaldo, 455, São Paulo, SP CEP 01246-903 Brazil
| | - Thais Mauad
- Department of Pathology, Universidade de São Paulo-School of Medicine, Avenida Dr. Arnaldo, 455, São Paulo, SP CEP 01246-903 Brazil
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Gomes VC, Raghavan ML, Silva LFFD, Gomes J, Silvestre GC, Queiroz A, Marques MA, Zyngier SP, Kwang-Joon Chung T, Silva ESD. Experimental Study of Rupture Pressure and Elasticity of Abdominal Aortic Aneurysms Found at Autopsy. Ann Vasc Surg 2020; 70:517-527. [PMID: 32891747 DOI: 10.1016/j.avsg.2020.08.111] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resistance and elasticity of normal and aneurysmal aorta walls are directly associated with this vessel's growth and rupture. This study aims to experimentally analyze the biomechanical behavior of aneurysmal specimens found at autopsy, comparing them with normal diameter aortas removed from age-matched donors. METHODS Thirty-eight human aortas (30 normal aortas; 8 infrarenal abdominal aortic aneurysms) were harvested during autopsy. An apparatus was built with a digital gauge, plastic tray, connections, and hoses that conducted fluid (air) from a pump through the system. Specimens were dissected, and a flexible balloon was introduced in each of them to avoid leakage. The specimens were fastened on the test tray, and activation of the air pump enhanced system pressure up to their rupture. RESULTS All 8 aneurysms and all 30 normal aortas specimens evolved to rupture under inflation pressures above 590 mm Hg (mean ± standard deviation = 1,035 ± 375 mm Hg) and 840 mm Hg (mean ± SD = 1,405 ± 342 mm Hg), respectively. In the aneurysm group, 25% of specimens did not rupture in their most dilated region. Percentage of increment in diameter was higher in normal aortas (mean ± SD = 0.2106 ± 0.144) than in aneurysms (mean ± SD = 0.093 ± 0.070). CONCLUSIONS In the present experiment, unruptured infrarenal abdominal aortic aneurysms could support high pressures nearly as much as nonaneurysmal abdominal aortas. In some specimens, the most dilated part of the aneurysm was not the most vulnerable under pressure. Normal aortas presented higher elasticity than aneurysms.
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Affiliation(s)
- Vivian Carla Gomes
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02). University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil.
| | - Madhavan Lakshmi Raghavan
- Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA
| | | | - Jorge Gomes
- Shamah Engineering - Project Division - Av. Fagundes Filho, 361, room 11, São Paulo, São Paulo, Brazil
| | - Gina Camillo Silvestre
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02). University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Alexandre Queiroz
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02). University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Michele Alberto Marques
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02). University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Selene Perrotti Zyngier
- Department of Pathology, University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
| | - Timothy Kwang-Joon Chung
- Department of Biomedical Engineering, Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA
| | - Erasmo Simão da Silva
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory for Medical Investigation #2, (LIM 02). University of São Paulo School of Medicine (FMUSP), São Paulo, São Paulo, Brazil
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Dolhnikoff M, Ferreira Ferranti J, de Almeida Monteiro RA, Duarte-Neto AN, Soares Gomes-Gouvêa M, Viu Degaspare N, Figueiredo Delgado A, Montanari Fiorita C, Nunes Leal G, Rodrigues RM, Taverna Chaim K, Rebello Pinho JR, Carneiro-Sampaio M, Mauad T, Ferraz da Silva LF, Brunow de Carvalho W, Saldiva PHN, Garcia Caldini E. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. Lancet Child Adolesc Health 2020; 4:790-794. [PMID: 32828177 PMCID: PMC7440866 DOI: 10.1016/s2352-4642(20)30257-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | | | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Natália Viu Degaspare
- Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Regina Maria Rodrigues
- Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Khallil Taverna Chaim
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, da Silva LFF, de Oliveira EP, Saldiva PHN, Mauad T, Negri EM. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost 2020; 18:1517-1519. [PMID: 32294295 PMCID: PMC7262093 DOI: 10.1111/jth.14844] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elnara Marcia Negri
- LIM-59, Biologia Celular, Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Monteiro RADA, Duarte-Neto AN, da Silva LFF, de Oliveira EP, Filho JT, dos Santos GAB, de Oliveira IRS, Mauad T, Saldiva PHDN, Dolhnikoff M. Ultrasound-guided minimally invasive autopsies: A protocol for the study of pulmonary and systemic involvement of COVID-19. Clinics (Sao Paulo) 2020; 75:e1972. [PMID: 32490934 PMCID: PMC7233669 DOI: 10.6061/clinics/2020/e1972] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Renata Aparecida de Almeida Monteiro
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Amaro Nunes Duarte-Neto
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Fernando Ferraz da Silva
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ellen Pierre de Oliveira
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Cardiopneumologia, Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jair Theodoro Filho
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Glaucia Aparecida Bento dos Santos
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Radiologia e Oncologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Thais Mauad
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Hilário do Nascimento Saldiva
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marisa Dolhnikoff
- Brazilian Image Autopsy Study Group (BIAS), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Farias‐Itao DS, Pasqualucci CA, Nishizawa A, da Silva LFF, Campos FM, Bittencourt MS, da Silva KCS, Leite REP, Grinberg LT, Ferretti‐Rebustini REDL, Jacob‐Filho W, Suemoto CK. B Lymphocytes and Macrophages in the Perivascular Adipose Tissue Are Associated With Coronary Atherosclerosis: An Autopsy Study. J Am Heart Assoc 2019; 8:e013793. [PMID: 31818216 PMCID: PMC6951066 DOI: 10.1161/jaha.119.013793] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Macrophages and T lymphocytes in the perivascular adipose tissue (PvAT) were previously linked to coronary artery disease. However, the role of these cells and B lymphocytes in the human PvAT adjacent to unstable atherosclerotic plaques has not been investigated. Moreover, previous studies were inconclusive on whether PvAT inflammation was restricted to the surroundings of the atheroma plaque. Methods and Results Coronary arteries were freshly dissected with the surrounding PvAT. Atherosclerotic plaques were classified according to the internationally accepted anatomopathological criteria. Immune cells in the PvAT were detected using immunohistochemistry and then quantified. We used linear and logistic regressions with robust standard errors, adjusted for possible confounding factors. In 246 atherosclerotic plaques (205 stable and 41 unstable plaques) from 82 participants (mean age=69.0±14.4 years; 50% men), the percentage of arterial obstruction was positively correlated with the densities of CD68+ macrophages (P=0.003) and CD20+ B lymphocytes (P=0.03) in the periplaque PvAT. The number of cells was greater in the periplaque PvAT than in the distal PvAT (macrophages, P<0.001; B lymphocytes, P=0.04). In addition, the density of macrophages in the periplaque PvAT was greater in the presence of unstable plaques (P=0.03) and was also greater near unstable plaques than in the distal PvAT (P=0.001). CD3+ T lymphocytes were not associated with percentage of obstruction and stable/unstable plaque composition. Conclusions The density of CD20+ B lymphocytes and CD68+ macrophages in periplaque PvAT was increased with plaque size, and the CD68+ macrophages were greater near unstable atherosclerotic plaques than near stable lesions. This inflammation was more intense in the periplaque PvAT than in the PvAT distal to the atherosclerotic plaques.
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Affiliation(s)
| | | | - Aline Nishizawa
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | | | | | - Márcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research and Division of Internal MedicineUniversity HospitalUniversity of São PauloBrazil
- Preventive Medicine Center and Cardiology ProgramHospital Israelita Albert EinsteinSão PauloBrazil
| | | | - Renata Elaine Paraízo Leite
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
- Discipline of GeriatricsUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Lea Tenenholz Grinberg
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
- Department of Neurology, Memory and Aging CenterUniversity of CaliforniaSan FranciscoSan Francisco, CA
| | - Renata Eloah de Lucena Ferretti‐Rebustini
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
- Medical‐Surgical Nursing DepartmentUniversity of São Paulo School of NursingSão PauloBrazil
| | - Wilson Jacob‐Filho
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
- Discipline of GeriatricsUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Claudia Kimie Suemoto
- Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
- Discipline of GeriatricsUniversity of São Paulo Medical SchoolSão PauloBrazil
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Koteeswaran R, Dudrey E, da Silva LFF, Kreisle R, Manglik N, Olson K, Padilla O, Ruggiero F, Russell B, Saxena R, Williams N, Talmon G. Group for Research In Pathology Education (GRIPE) 2019 Annual Winter Meeting-Making Pathology Relevant for Millennials: Challenges in teaching the new generation of medical students, using technology tools and enhancing pathology education in the 21st century, 48th Annual Winter Meeting, Jan 24-26th, 2019, New Orleans, LA. Med Sci Educ 2019; 29:877-880. [PMID: 34457555 PMCID: PMC8368554 DOI: 10.1007/s40670-019-00748-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Ellen Dudrey
- Texas Tech University Health Science Center, El Paso, TX USA
| | | | | | - Niti Manglik
- Texas Tech University Health Science Center, El Paso, TX USA
| | | | - Osvaldo Padilla
- Texas Tech University Health Science Center, El Paso, TX USA
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Nascimento ECTD, Baldi BG, Mariani AW, Annoni R, Kairalla RA, Pimenta SP, da Silva LFF, Carvalho CRR, Dolhnikoff M. Immunohistological features related to functional impairment in lymphangioleiomyomatosis. Respir Res 2018; 19:83. [PMID: 29739412 PMCID: PMC5941479 DOI: 10.1186/s12931-018-0797-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/10/2017] [Accepted: 04/29/2018] [Indexed: 12/25/2022] Open
Abstract
Background Lymphangioleiomyomatosis (LAM) is a low-grade neoplasm characterized by the pulmonary infiltration of smooth muscle-like cells (LAM cells) and cystic destruction. Patients usually present with airway obstruction in pulmonary function tests (PFTs). Previous studies have shown correlations among histological parameters, lung function abnormalities and prognosis in LAM. We investigated the lung tissue expression of proteins related to the mTOR pathway, angiogenesis and enzymatic activity and its correlation with functional parameters in LAM patients. Methods We analyzed morphological and functional parameters of thirty-three patients. Two groups of disease severity were identified according to FEV1 values. Lung tissue from open biopsies or lung transplants was immunostained for SMA, HMB-45, mTOR, VEGF-D, MMP-9 and D2-40. Density of cysts, density of nodules and protein expression were measured by image analysis and correlated with PFT parameters. Results There was no difference in the expression of D2-40 between the more severe and the less severe groups. All other immunohistological parameters showed significantly higher values in the more severe group (p ≤ 0.002). The expression of VEGF-D, MMP-9 and mTOR in LAM cells was associated with the density of both cysts and nodules. The density of cysts and nodules as well as the expression of MMP-9 and VEGF-D were associated with the impairment of PFT parameters. Conclusions Severe LAM represents an active phase of the disease with high expression of VEGF-D, mTOR, and MMP-9, as well as LAM cell infiltration. Our findings suggest that the tissue expression levels of VEGF-D and MMP-9 are important parameters associated with the loss of pulmonary function and could be considered as potential severity markers in open lung biopsies of LAM patients.
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Affiliation(s)
- Ellen Caroline Toledo do Nascimento
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, room 1155, Cerqueira Cesar, CEP 01246-903, Sao Paulo, SP, Brazil.
| | - Bruno Guedes Baldi
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandro Wasum Mariani
- Departamento de Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Raquel Annoni
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, room 1155, Cerqueira Cesar, CEP 01246-903, Sao Paulo, SP, Brazil
| | - Ronaldo Adib Kairalla
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Suzana Pinheiro Pimenta
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, room 1155, Cerqueira Cesar, CEP 01246-903, Sao Paulo, SP, Brazil
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, room 1155, Cerqueira Cesar, CEP 01246-903, Sao Paulo, SP, Brazil
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Mosca L, da Silva LFF, Carneiro PC, Chacon DA, de Araujo-Neto VJF, de Araujo-Filho VJF, Cernea CR. Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB). Clinics (Sao Paulo) 2018; 73:e370. [PMID: 29846414 PMCID: PMC5960075 DOI: 10.6061/clinics/2018/e370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.
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Affiliation(s)
- Leticia Mosca
- Disciplina de Cirurgia de Cabeca e Pescoco, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Paulo Campos Carneiro
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Danielle Azevedo Chacon
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Claudio Roberto Cernea
- Disciplina de Cirurgia de Cabeca e Pescoco, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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de Souza Xavier Costa N, Ribeiro Júnior G, dos Santos Alemany AA, Belotti L, Zati DH, Frota Cavalcante M, Matera Veras M, Ribeiro S, Kallás EG, Nascimento Saldiva PH, Dolhnikoff M, Ferraz da Silva LF. Early and late pulmonary effects of nebulized LPS in mice: An acute lung injury model. PLoS One 2017; 12:e0185474. [PMID: 28953963 PMCID: PMC5617199 DOI: 10.1371/journal.pone.0185474] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 05/16/2017] [Accepted: 09/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background and objective Acute respiratory distress syndrome (ARDS) has a high mortality rate of 35–46% depending on its severity. Animal models are crucial to better understand the pathophysiology of diseases, including ARDS. This study presents a feasible animal model of acute lung injury (ALI) using nebulized lipopolysaccharide (LPS) in a non-invasive approach, focusing on its short and long-term effects. Methods Mice received nebulized LPS or vehicle only (control group). Blood, BALF and lung tissue were collected 24 hours (LPS 24h) or 5 weeks (LPS 5w) after the nebulized LPS-induced lung injury. Inflammatory cytokines were assessed in the blood serum, BALF and lung tissue. Stereological analyses and remodeling changes were assessed by histology and immunohistochemistry at the specified time points. Results The LPS 24h group showed increased pro-inflammatory cytokine levels, intense cell influx, increased total septal volume, septal thickening and decreased surface density of the alveolar septa. The LPS 5w group showed persistent lung inflammation, septal thickening, increased total lung volume, accentuated collagen deposition, especially of collagen type I, and decreased MMP-2 protein expression. Conclusion We present a feasible, reproducible and non-invasive nebulized-LPS animal model that allows the assessment of both the acute and late phases of acute lung injury. The presence of lung remodeling with collagen deposition after 5 weeks makes it useful to study the pathophysiology, complications, and possible therapeutic intervention studies that aim to understand and reduce pulmonary fibrosis in the late phases of ALI.
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Affiliation(s)
- Natália de Souza Xavier Costa
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Gabriel Ribeiro Júnior
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | | | - Luciano Belotti
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | - Douglas Hidalgo Zati
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | - Marcela Frota Cavalcante
- Biochemistry Laboratory, University of Sao Paulo–School of Pharmaceutical Sciences, São Paulo, São Paulo, Brazil
| | - Mariana Matera Veras
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | - Susan Ribeiro
- Laboratory of Clinical Immunology and Allergy (LIM60), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Esper Georges Kallás
- Laboratory of Clinical Immunology and Allergy (LIM60), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | | | - Marisa Dolhnikoff
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Laboratory of Experimental Air Pollution (LIM05), University of Sao Paulo—School of Medicine, São Paulo, São Paulo, Brazil
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Simão RR, Ferreira SG, Kudo GK, Armstrong Junior R, Silva LFFD, Sannomiya P, Breithaupt-Faloppa AC, Moreira LFP. Sex differences on solid organ histological characteristics after brain death1. Acta Cir Bras 2017; 31:278-85. [PMID: 27168541 DOI: 10.1590/s0102-865020160040000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/08/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate gender differences in the evolution of the inflammatory process in rats subjected to brain death (BD). METHODS Adult Wistar rats were divided into three groups: female; ovariectomized female; and male rats. BD was induced using intracranial balloon inflation and confirmed by maximal pupil dilatation, apnea, absence of reflex, and drop of mean arterial pressure. Six hours after BD, histological evaluation was performed in lungs, heart, liver and kidneys, and levels of inflammatory proteins, estrogen, progesterone, and corticosterone were determined in plasma. RESULTS In the lungs, females presented more leukocyte infiltration compared to males (p<0.01). Ovariectomized female rat lungs were more hemorrhagic compared to other groups (p<0.001). In the heart, females had higher leukocyte infiltration and tissue edema compared to males (p<0.05). In the liver and kidneys, there were no differences among groups. In female group estradiol and progesterone were sharply reduced 6 hours after BD (p<0.001) to values observed in ovariectomized females and males. Corticosterone levels were similar. CONCLUSIONS Sex hormones influence the development of inflammation and the status of organs. The increased inflammation in lungs and heart of female rats might be associated with the acute reduction in female hormones triggered by BD.
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Pinto FCG, Oliveira MFD, Prist R, Silva MRE, Silva LFFD, Capone Neto A. Effect of volume replacement during combined experimental hemorrhagic shock and traumatic brain injury in prostanoids, brain pathology and pupil status. Arq Neuropsiquiatr 2016; 73:499-505. [PMID: 26083885 DOI: 10.1590/0004-282x20150039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/03/2015] [Indexed: 11/21/2022]
Abstract
Traumatic brain injury (TBI) is the main cause of trauma-related deaths. Systemic hypotension and intracranial hypertension causes cerebral ischemia by altering metabolism of prostanoids. We describe prostanoid, pupilar and pathological response during resuscitation with hypertonic saline solution (HSS) in TBI. Method Fifteen dogs were randomized in three groups according to resuscitation after TBI (control group; lactated Ringer's (LR) group and HSS group), with measurement of thromboxane, prostaglandin, macroscopic and microscopic pathological evaluation and pupil evaluation.Result Concentration of prostaglandin is greater in the cerebral venous blood than in plasma and the opposite happens with concentration of thromboxane. Pathology revealed edema in groups with the exception of group treated with HSS.Discussion and conclusion There is a balance between the concentrations of prostaglandin and thromboxane. HSS prevented the formation of cerebral edema macroscopically detectable. Pupillary reversal occurred earlier in HSS group than in LR group.
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Affiliation(s)
| | | | - Ricardo Prist
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | | | - Antonio Capone Neto
- Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
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Zerbini T, da Silva LFF, Lobato Baptista PA, Ikari ES, Rodrigues de Araujo M, de André CDS, da Motta Singer J, da Rocha FMM, Junior EA, Pasqualucci CAG, Saldiva PHN. Estimation of post mortem interval by tomographic images of intra-cardiac hypostasis. J Forensic Leg Med 2016; 38:111-5. [DOI: 10.1016/j.jflm.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 11/25/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
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Breithaupt-Faloppa AC, Ferreira SG, Kudo GK, Armstrong R, Tavares-de-Lima W, da Silva LFF, Sannomiya P, Moreira LFP. Sex-related differences in lung inflammation after brain death. J Surg Res 2016; 200:714-21. [DOI: 10.1016/j.jss.2015.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/25/2015] [Accepted: 09/14/2015] [Indexed: 11/25/2022]
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Santos MM, Tannuri ACA, Coelho MCM, de Oliveira Gonçalves J, Serafini S, da Silva LFF, Tannuri U. Immediate expression of c-fos and c-jun mRNA in a model of intestinal autotransplantation and ischemia-reperfusion in situ. Clinics (Sao Paulo) 2015; 70:373-9. [PMID: 26039956 PMCID: PMC4449475 DOI: 10.6061/clinics/2015(05)12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/06/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Intestinal ischemia-reperfusion injury occurs in several clinical conditions and after intestinal transplantation. The aim of the present study was to investigate the phenomena of apoptosis and cell proliferation in a previously described intestinal ischemia-reperfusion injury autograft model using immunohistochemical markers. The molecular mechanisms involved in ischemia-reperfusion injury repair were also investigated by measuring the expression of the early activation genes c-fos and c-jun, which induce apoptosis and cell proliferation. MATERIALS AND METHODS Thirty adult male Wistar rats were subjected to surgery for a previously described ischemia-reperfusion model that preserved the small intestine, the cecum and the ascending colon. Following reperfusion, the cecum was harvested at different time points as a representative segment of the intestine. The rats were allocated to the following four subgroups according to the reperfusion time: subgroup 1: 5 min; subgroup 2: 15 min; subgroup 3: 30 min; and subgroup 4: 60 min. A control group of cecum samples was also collected. The expression of c-fos, c-jun and immunohistochemical markers of cell proliferation and apoptosis (Ki67 and TUNEL, respectively) was studied. RESULTS The expression of both c-fos and c-jun in the cecum was increased beginning at 5 min after ischemia-reperfusion compared with the control. The expression of c-fos began to increase at 5 min, peaked at 30 min, and exhibited a declining tendency at 60 min after reperfusion. A progressive increase in c-jun expression was observed. Immunohistochemical analyses confirmed these observations. CONCLUSION The early activation of the c-fos and c-jun genes occurred after intestinal ischemia-reperfusion injury, and these genes can act together to trigger cell proliferation and apoptosis.
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Vieira JE, Silva LFFD, Baracat EC. Medical education at the University of São Paulo Medical School. Clinics (Sao Paulo) 2015; 70:229-30. [PMID: 26017786 PMCID: PMC4418277 DOI: 10.6061/clinics/2015(04)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joaquim Edson Vieira
- Department of Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Edmund Chada Baracat
- Faculdade de Medicina, Department of Gynecology and Obstetrics, Universidade de São Paulo, São Paulo, SP, Brazil
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Zerbini T, Silva LFFD, Ferro ACG, Kay FU, Amaro Junior E, Pasqualucci CAG, Saldiva PHDN. Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case. Clinics (Sao Paulo) 2014; 69:683-7. [PMID: 25518020 PMCID: PMC4221313 DOI: 10.6061/clinics/2014(10)06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/27/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. METHOD Comparison between the findings of different methods: autopsy and postmortem computed tomography. RESULTS In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. CONCLUSIONS Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations.
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Affiliation(s)
- Talita Zerbini
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Fernando Uliana Kay
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edson Amaro Junior
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Cagnoni EF, Ferreira DS, Ferraz da Silva LF, Nicoletti Carvalho Petry AL, Gomes dos Santos AB, Rodrigues Medeiros MC, Dolhnikoff M, Rabe KF, Mauad T. Bronchopulmonary lymph nodes and large airway cell trafficking in patients with fatal asthma. J Allergy Clin Immunol 2014; 135:1352-7.e1-9. [PMID: 25262462 DOI: 10.1016/j.jaci.2014.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Immune responses in asthmatic patients involve coordinated cellular responses in the airways and lymph nodes (LNs). However, no studies have described the composition of different cell populations in the bronchopulmonary LNs of asthmatic patients. OBJECTIVE We sought to investigate the expression of dendritic cells (DCs) and costimulatory molecules, B cells, T cells, TH2-related cytokines, eosinophils, and vascular cell adhesion molecule in the bronchopulmonary LNs and large airways of asthmatic patients. METHODS Using histochemistry, immunohistochemistry, and image analysis, we investigated the expression of Factor XIIIa(+), CD1a(+), CD83(+), and CD207(+) DCs; CD4(+) and CD8(+) T cells; CD20(+) B cells; CD23(+) (FcεRII) cells; IL-4; IL-5; eosinophils, and vascular cell adhesion molecule 1 in the large airways and bronchopulmonary LNs of 11 nonsmokers who died from an asthma exacerbation (fatal asthma [FA]) in comparison with 8 nonasthmatic control subjects. In selected cases of FA, we analyzed the coexpression of HLA-DR, CD40, and CD80 in lung and LN eosinophils. RESULTS The LNs of asthmatic patients exhibited increased density of eosinophils. No other cells were expressed differently in the LNs of patients with FA. The large airways of patients with FA had increased expression of eosinophils in all layers and increased expression of Factor XIIIa(+) cells, CD4(+) and CD8(+) T cells, CD20(+) B cells, and CD23(+) cells in the outer layer. There was colocalization of HLA-DR, CD40, and CD80 in the eosinophils at both sites. CONCLUSIONS FA is associated with the increased presence of eosinophils in the LNs and large airways, which express HLA-DR and costimulatory molecules. The expression of Factor XIIIa(+) monocyte-derived DCs, CD4(+) and CD8(+) T cells, CD20(+) B cells, and CD23(+) cells was increased in the large airways without a corresponding increase in the expression of these cells in the bronchopulmonary LNs. These findings support the concept that eosinophils might act as antigen-presenting cells in patients with FA.
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Affiliation(s)
| | | | | | | | | | | | - Marisa Dolhnikoff
- Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Thais Mauad
- Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
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Judas GI, Ferreira SG, Simas R, Sannomiya P, Benício A, da Silva LFF, Moreira LFP. Intrathecal injection of human umbilical cord blood stem cells attenuates spinal cord ischaemic compromise in rats. Interact Cardiovasc Thorac Surg 2014; 18:757-62. [PMID: 24595249 DOI: 10.1093/icvts/ivu021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/27/2023] Open
Abstract
OBECTIVES Spinal cord ischaemia with resulting paraplegia remains a devastating and unpredictable complication after thoraco-abdominal aortic surgery. With the advent of stem cell therapy and its potential to induce nervous tissue regeneration processes, the interest in the use of these cells as a treatment for neurological disorders has increased. Human stem cells, derived from the umbilical cord, are one of the strong candidates used in cell therapy for spinal cord injury because of weak immunogenicity and ready availability. We sought to evaluate the use of human umbilical cord blood stem cells (HUCBSCs) to attenuate the neurological effects of spinal cord ischaemia induced by high thoracic aorta occlusion. METHODS Forty Wistar rats were randomized to receive intrathecal injection of 10 µl phosphate buffered saline (PBS) solution containing 1 × 10(4) HUCBSCs, 30 min before (Tpre group: n = 10) and 30 min after (Tpos group: n = 10) descending thoracic aorta occlusion by intraluminal balloon during 12 min. Control groups received only PBS solution (Cpre group: n = 10; and Cpos group: n = 10). During a 28-day observational period, motor function was assessed by a functional grading scale (Basso, Beattie and Bresnahan). Segments of thoracolumbar spinal cord specimens were analysed for histological and immunohistochemical assessment for detection and quantification of human haematopoietic cells (CD45(+)) and apoptosis (transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling). RESULTS Overall mortality was 12 animals (30%). Therefore, the observational sample was composed of 28 animals. All groups showed similar incidence of paraplegia and mortality. The mean motor function scores showed no difference during time between the animals of each group, excepting for the Tpos group, which improved from 8.14 (±8.6) to 14.28 (±9.8) (P < 0.01). A treatment-by-time interaction was detected among animals that received HUCBSCs 30 min after ischaemia, with BBB scores higher from Days 14 to 28 compared with the first observational day with statistical difference (P = 0.01). Number of viable neurons was higher in the Tpos group (P = 0.14) and the incidence of apoptosis was lower in the same animals (P = 0.048), but showed no difference with its respective control. We confirmed the presence of CD45(+) cells 4 weeks after intrathecal injection in both therapeutic groups but mainly in the Tpos group. CONCLUSIONS Intrathecal transplantation of HUCBSCs is feasible, and it improved spinal cord function, when they were delivered 30 min after spinal cord ischaemia, in a model of endovascular descending thoracic aorta occlusion in rats. Human umbilical cord blood is one of the potentially useful sources of stem cells for therapy of spinal cord ischaemia.
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Affiliation(s)
- Gustavo Ieno Judas
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Sueli Gomes Ferreira
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Rafael Simas
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Paulina Sannomiya
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Anderson Benício
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Luiz Felipe Pinho Moreira
- Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM 11), Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
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Andrade WDC, Silva LFFD, Coelho MCDM, Tannuri ACA, Alves VAF, Tannuri U. Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction in growing animals: immunohistochemical analysis of the expression of TGF-β and VEGF. Clinics (Sao Paulo) 2012; 67:1455-61. [PMID: 23295601 PMCID: PMC3521810 DOI: 10.6061/clinics/2012(12)17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/15/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE During the neonatal and infancy periods, some chronic liver diseases may lead to progressive hepatic fibrosis, which is a condition that can ultimately result in the loss of organ function and severe portal hypertension necessitating hepatic transplantation. In a previous report, pharmacological interventions were demonstrated to modulate hepatic fibrosis induced by bile duct ligation in young rats. The administration of pentoxifylline or prednisolone, or the combination of both, resulted in reduced fibrogenesis in portal spaces. The objectives of the present study were to evaluate the expression of transforming growth factor β and vascular endothelial growth factor after bile duct ligation in young rats and to assess the effect of those same drugs on cytokine expression. METHODS In this experimental study, 80 young rats (21 or 22 days old) were submitted either to laparotomy and common bile duct ligation or to sham surgery. The animals were allocated into four groups according to surgical procedure, and the following treatments were administered: (1) common bile duct ligation + distilled water, (2) sham surgery + distilled water, (3) common bile duct ligation + pentoxifylline, or (4) common bile duct ligation + prednisolone. After 30 days, a hepatic fragment was collected from each animal for immunohistochemical analysis using monoclonal antibodies against transforming growth factor β and vascular endothelial growth factor. Digital morphometric and statistical analyses were performed. RESULTS The administration of pentoxifylline reduced the transforming growth factor β-marked area and the amount of transforming growth factor β expressed in liver tissue. This effect was not observed after the administration of prednisolone. There was a significant reduction in vascular endothelial growth factor expression after the administration of either drug compared with the non-treatment group. CONCLUSIONS The administration of pentoxifylline to cholestatic young rats resulted in the diminished expression of transforming growth factor β and vascular endothelial growth factor in liver tissue. The administration of steroids resulted in the diminished expression of vascular endothelial growth factor only. These pathways may be involved in hepatic fibrogenesis in young rats submitted to bile duct ligation and exposed to pentoxifylline or prednisolone.
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Affiliation(s)
- Wagner de Castro Andrade
- Faculdade de Medicina da Universidade de São Paulo, Pediatric Surgery Division, Laboratory of Pediatric Surgery (LIM-30) and Laboratory of Hepatic Pathology (LIM-14), São Paulo/SP, Brazil.
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Reis Gonçalves CT, Reis Gonçalves CG, de Almeida FM, Lopes FDTQDS, dos Santos Durão ACC, dos Santos FA, da Silva LFF, Marcourakis T, Castro-Faria-Neto HC, Vieira RDP, Dolhnikoff M. Protective effects of aerobic exercise on acute lung injury induced by LPS in mice. Crit Care 2012; 16:R199. [PMID: 23078757 PMCID: PMC3682301 DOI: 10.1186/cc11807] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/18/2012] [Indexed: 01/12/2023]
Abstract
Introduction The regular practice of physical exercise has been associated with beneficial effects on various pulmonary conditions. We investigated the mechanisms involved in the protective effect of exercise in a model of lipopolysaccharide (LPS)-induced acute lung injury (ALI). Methods Mice were divided into four groups: Control (CTR), Exercise (Exe), LPS, and Exercise + LPS (Exe + LPS). Exercised mice were trained using low intensity daily exercise for five weeks. LPS and Exe + LPS mice received 200 µg of LPS intratracheally 48 hours after the last physical test. We measured exhaled nitric oxide (eNO); respiratory mechanics; neutrophil density in lung tissue; protein leakage; bronchoalveolar lavage fluid (BALF) cell counts; cytokine levels in BALF, plasma and lung tissue; antioxidant activity in lung tissue; and tissue expression of glucocorticoid receptors (Gre). Results LPS instillation resulted in increased eNO, neutrophils in BALF and tissue, pulmonary resistance and elastance, protein leakage, TNF-alpha in lung tissue, plasma levels of IL-6 and IL-10, and IL-1beta, IL-6 and KC levels in BALF compared to CTR (P ≤0.02). Aerobic exercise resulted in decreases in eNO levels, neutrophil density and TNF-alpha expression in lung tissue, pulmonary resistance and elastance, and increased the levels of IL-6, IL-10, superoxide dismutase (SOD-2) and Gre in lung tissue and IL-1beta in BALF compared to the LPS group (P ≤0.04). Conclusions Aerobic exercise plays important roles in protecting the lungs from the inflammatory effects of LPS-induced ALI. The effects of exercise are mainly mediated by the expression of anti-inflammatory cytokines and antioxidants, suggesting that exercise can modulate the inflammatory-anti-inflammatory and the oxidative-antioxidative balance in the early phase of ALI.
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