Article ; Online: Protein expression of angiotensin-converting enzyme 2, a SARS-CoV-2-specific receptor, in fetal and placental tissues throughout gestation: new insight for perinatal counseling.
2020 Volume 57, Issue 2, Page(s) 242–247
Abstract: ... to low expression of the membrane receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2 ... fetal organs from pregnancies not infected with SARS-CoV-2.: Methods: In May 2020, using samples ... positive for SARS-CoV-2 delivered by Cesarean section at 34 weeks. Samples were paraffin-embedded and organ ...
| Abstract | Objective: Pregnant women can be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), yet the incidence of perinatal infection is low. We hypothesized that this could be related to low expression of the membrane receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), in the fetoplacental unit. We evaluated protein expression of ACE2 at various gestational ages in both placentae and fetal organs from pregnancies not infected with SARS-CoV-2. Methods: In May 2020, using samples from a registered biobank, we performed immunohistochemical analysis for ACE2 in tissue samples from fetal organs and placentae from five cases of second- or third-trimester medical termination of pregnancy in healthy women (performed between 15 and 38 weeks' gestation), as well as a further two placentae, one from a 7-week spontaneous miscarriage in a non-infected woman and one from a symptomatic pregnant woman positive for SARS-CoV-2 delivered by Cesarean section at 34 weeks. Samples were paraffin-embedded and organ tissues included kidney, brain, lung, intestinal tract, heart and testis. Matching tissues (kidney, intestinal tract, lung and testis) from autopsies of four 8-year-old children were tested as controls. Tissue sections were incubated with rabbit monoclonal anti-ACE2, and protein expression of ACE2 was detected by immunohistochemistry. Results: ACE2 expression was detected in fetal kidney, rectum and ileum samples from 15 weeks onwards and in the pediatric controls. It was barely detectable in fetal lung samples at 15 + 5 weeks' gestation and not detectable thereafter, and, in the pediatric controls, ACE2 was detectable only in type-2 pneumocytes. No ACE2 expression was found in the cerebral ependymal or parenchymal tissues or in cardiac tissues. ACE2 was expressed in placental syncytiotrophoblast and cytotrophoblast samples, but not in the amnion, from 7 weeks onwards. The intensity and distribution of ACE2 staining in the placenta from the symptomatic SARS-CoV-2 woman was similar to that in the non-infected placentae. Conclusions: Marked placental expression of ACE2 provides a rationale for vertical transmission at the cellular level. Absence of ACE2 expression in the fetal brain and heart is reassuring regarding the risk of congenital malformation. Clinical follow-up of infected pregnant women and their children is needed to validate these observations. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. |
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| MeSH term(s) | Adult ; Angiotensin-Converting Enzyme 2/biosynthesis ; COVID-19/enzymology ; COVID-19/transmission ; COVID-19/virology ; Case-Control Studies ; Child ; Female ; Fetus/enzymology ; Humans ; Infectious Disease Transmission, Vertical ; Male ; Placenta/enzymology ; Pregnancy ; Pregnancy Complications, Infectious/enzymology ; Pregnancy Complications, Infectious/virology ; Proteomics/methods ; SARS-CoV-2/metabolism ; Trophoblasts/metabolism |
| Chemical Substances | ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-09-09 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 1073183-0 |
| ISSN | 1469-0705 ; 0960-7692 |
| ISSN (online) | 1469-0705 |
| ISSN | 0960-7692 |
| DOI | 10.1002/uog.22178 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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