tetano
Editor, Senior Moderator
Arch Pathol Lab Med
. 2021 Jul 23.
doi: 10.5858/arpa.2021-0296-SA. Online ahead of print.
Hofbauer cells and coronavirus disease 2019 (COVID-19) in pregnancy: Molecular pathology analysis of villous macrophages, endothelial cells, and placental findings from 22 placentas infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without fetal transmission
David A Schwartz[SUP] 1 [/SUP], Marcella Baldewijns[SUP] 2 [/SUP], Alexandra Benachi[SUP] 3 [/SUP], Mattia Bugatti[SUP] 4 [/SUP], Gaetano Bulfamante[SUP] 5 [/SUP], Ke Cheng[SUP] 6 [/SUP], Rebecca R J Collins[SUP] 7 [/SUP], Larisa Debelenko[SUP] 8 [/SUP], Danièle De Luca[SUP] 9 [/SUP], Fabio Facchetti[SUP] 10 [/SUP], Brendan Fitzgerald[SUP] 11 [/SUP], Daniel Levitan[SUP] 12 [/SUP], Rebecca L Linn[SUP] 13 [/SUP], Lukas Marcelis[SUP] 14 [/SUP], Denise Morotti[SUP] 15 [/SUP], Raffaella Morotti[SUP] 16 [/SUP], Luisa Patanè[SUP] 17 [/SUP], Sophie Prevot[SUP] 18 [/SUP], Bianca Pulinx[SUP] 19 [/SUP], Ali G Saad[SUP] 20 [/SUP], Sam Schoenmakers[SUP] 21 [/SUP], David Strybol[SUP] 22 [/SUP], Kristen Thomas[SUP] 23 [/SUP], Delfina Tosi[SUP] 24 [/SUP], Valentina Toto[SUP] 25 [/SUP], Lotte E van der Meeren[SUP] 26 [/SUP], Robert M Verdijk[SUP] 27 [/SUP], Alexandre J Vivanti[SUP] 28 [/SUP], Mehreen Zaigham[SUP] 29 [/SUP]
Affiliations
Abstract
Context: - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown.
Objective: - To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants.
Design: - Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells.
Results: - Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2.
Conclusions: - SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.
. 2021 Jul 23.
doi: 10.5858/arpa.2021-0296-SA. Online ahead of print.
Hofbauer cells and coronavirus disease 2019 (COVID-19) in pregnancy: Molecular pathology analysis of villous macrophages, endothelial cells, and placental findings from 22 placentas infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without fetal transmission
David A Schwartz[SUP] 1 [/SUP], Marcella Baldewijns[SUP] 2 [/SUP], Alexandra Benachi[SUP] 3 [/SUP], Mattia Bugatti[SUP] 4 [/SUP], Gaetano Bulfamante[SUP] 5 [/SUP], Ke Cheng[SUP] 6 [/SUP], Rebecca R J Collins[SUP] 7 [/SUP], Larisa Debelenko[SUP] 8 [/SUP], Danièle De Luca[SUP] 9 [/SUP], Fabio Facchetti[SUP] 10 [/SUP], Brendan Fitzgerald[SUP] 11 [/SUP], Daniel Levitan[SUP] 12 [/SUP], Rebecca L Linn[SUP] 13 [/SUP], Lukas Marcelis[SUP] 14 [/SUP], Denise Morotti[SUP] 15 [/SUP], Raffaella Morotti[SUP] 16 [/SUP], Luisa Patanè[SUP] 17 [/SUP], Sophie Prevot[SUP] 18 [/SUP], Bianca Pulinx[SUP] 19 [/SUP], Ali G Saad[SUP] 20 [/SUP], Sam Schoenmakers[SUP] 21 [/SUP], David Strybol[SUP] 22 [/SUP], Kristen Thomas[SUP] 23 [/SUP], Delfina Tosi[SUP] 24 [/SUP], Valentina Toto[SUP] 25 [/SUP], Lotte E van der Meeren[SUP] 26 [/SUP], Robert M Verdijk[SUP] 27 [/SUP], Alexandre J Vivanti[SUP] 28 [/SUP], Mehreen Zaigham[SUP] 29 [/SUP]
Affiliations
- PMID: 34297794
- DOI: 10.5858/arpa.2021-0296-SA
Abstract
Context: - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown.
Objective: - To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants.
Design: - Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells.
Results: - Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2.
Conclusions: - SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.