SARS-CoV-2 in carotid body

Lambermont, Bernard; Davenne, Eric; Maclot, François; Delvenne, Philippe

doi:10.1007/s00134-021-06351-z

Cited by 27 publications

(16 citation statements)

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“…Conversely, in Cases 2, 3 and 4, virological and immuno-histochemical analyses confirmed the direct invasion of SARS-CoV-2 in the CB. Lambermont et al also detected SARS-CoV-2 RNA in the CB of a COVID-19 case through RT-PCR ( 9 ) but these are the first demonstrations of CB invasion through an integrated approach, including molecular (RT-PCR) and immuno-histochemical (nucleocapsid and Spike) methods. In these cases, bilateral CB involvement was found.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from these perspective articles, few empirical data are available about CB in COVID-19 patients. Lambermont et al detected SARS-CoV-2 in the CB of a 42-year-old COVID-19 patient, through Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) performed on paraffin-embedded sections after glomus tissue microdissection ( 9 ). However, histopathological and SARS-CoV-2 immunohistochemical findings were not reported.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: The Carotid Body in COVID-19: Histopathological and Virological Analyses of an Autopsy Case Series

et al. 2021

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Various authors have hypothesized carotid body (CB) involvement in Coronavirus Disease 2019 (COVID-19), through direct invasion or indirect effects by systemic stimuli (‘cytokine storm’, angiotensin-converting enzyme [ACE]1/ACE2 imbalance). However, empirical evidence is limited or partial. Here, we present an integrated histopathological and virological analysis of CBs sampled at autopsy from four subjects (2 males and 2 females; age: >70 years old) who died of COVID-19. Histopathological, immunohistochemical and molecular investigation techniques were employed to characterize Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV2) viral invasion and inflammatory reaction. SARS-CoV2 RNA was detected in the CBs of three cases through Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR). In these cases, positive immunostaining for Nucleocapsid and Spike protein were also demonstrated, mainly at the level of large roundish cells consistent with type I cells, confirming direct CB invasion. In these cases, T lymphocytes showed focal aggregations in the CBs, suggestive of local inflammatory reaction. Blood congestion and microthrombosis were also found in one of the positive cases. Intriguingly, microthrombosis, blood congestion and microhaemorrages were also bilaterally detected in the CBs of the negative case, supporting the possibility of COVID-19 effects on the CB even in the absence of its direct invasion. SARS-CoV-2 direct invasion of the CB is confirmed through both immunohistochemistry and RT-PCR, with likely involvement of different cell types. We also reported histopathological findings which could be ascribed to local and/or systemic actions of SARS-CoV-2 and which could potentially affect chemoreception.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: The Carotid Body in COVID-19: Histopathological and Virological Analyses of an Autopsy Case Series

et al. 2021

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“…In all these chemoreceptor systems, ACE2 receptors are present and warrant the entry of SARS-CoV2 [ 62 , 63 ]. Moreover, in one patient, SARS-CoV2 was detected in the carotid body at autopsy [ 64 ].…”

Section: A Hypothesis On Chemosensory Involvement In Covid-19mentioning

confidence: 99%

Are Multiple Chemosensory Systems Accountable for COVID-19 Outcome?

Caretta

Mucignat‐Caretta

2021

JCM

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Chemosensory systems (olfaction, taste, trigeminus nerve, solitary chemoreceptor cells, neuroendocrine pulmonary cells, and carotid body, etc.) detect molecules outside or inside our body and may share common molecular markers. In addition to the impairment of taste and olfaction, the detection of the internal chemical environment may also be incapacitated by COVID-19. If this is the case, different consequences can be expected. (1) In some patients, hypoxia does not trigger distressing dyspnea (“silent” hypoxia): Long-term follow-up may determine whether silent hypoxia is related to malfunctioning of carotid body chemoreceptors. Moreover, taste/olfaction and oxygen chemoreceptors may be hit simultaneously: Testing olfaction, taste, and oxygen chemoreceptor functions in the early stages of COVID-19 allows one to unravel their connections and trace the recovery path. (2) Solitary chemosensory cells are also involved in the regulation of the innate mucosal immune response: If these cells are affected in some COVID-19 patients, the mucosal innate immune response would be dysregulated, opening one up to massive infection, thus explaining why COVID-19 has lethal consequences in some patients. Similar to taste and olfaction, oxygen chemosensory function can be easily tested with a non-invasive procedure in humans, while functional tests for solitary chemosensory or pulmonary neuroendocrine cells are not available, and autoptic investigation is required to ascertain their involvement.

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“…Mortality in COVID-19 patients requiring mechanical ventilation, and in the severest cases, extracorporeal membrane oxygenation (ECMO), has improved over the course of 2020 but remains high, particularly for patients with certain comorbidities [ 1 ]. Early independent prognosticators of 90-day mortality from COVID-19 are older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO 2 /FiO 2 ratio, and a shorter time between first symptoms and ICU admission [ 2 ]. Although life sustaining, mechanical ventilation can cause further injury to lung tissue already damaged by COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Severe Hypercapnic Respiratory Failure Caused by SARS-CoV-2 Lung Injury with ECCO2R Using the Hemolung Respiratory Assist System

Saavedra-Romero

Paz

Litell

et al. 2021

Case Reports in Critical Care

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Acute respiratory distress syndrome (ARDS) due to COVID-19 leads to a high rate of mortality in the intensive care unit (ICU). A lung-protective mechanical ventilation strategy using low tidal volumes is a cornerstone to management, but uncontrolled hypercapnia is a life-threatening consequence among severe cases. A mechanism to prevent progressive hypercapnia may offset hemodynamic instability among patients who develop hypercapnia. We present the case of a woman in her mid-60’s with severe acute hypercapnic respiratory failure secondary to COVID-19 pneumonia who was successfully treated with early implementation of lung-protective ventilation facilitated by extracorporeal carbon dioxide removal (ECCO2R). This patient’s multiple comorbid conditions included obesity, hypertension, type 2 diabetes mellitus, and hypercholesterolemia. On her fifth day of admission at the referring hospital, her worsening hypoxemia prompted endotracheal intubation during which she developed pneumothorax. She was transferred to our institution for advanced care where upon arrival, she had profound hypercapnia and respiratory acidosis. She met the criteria for treatment with an investigational ECCO2R device (Hemolung Respiratory Assist System) available through FDA Emergency Use Authorization. ECCO2R is similar to extracorporeal membrane oxygenation (ECMO) but operates at much lower blood flows (350–550 mL/min) through a smaller 15.5 French central venous catheter. Standard heparinization was provided intravenously to achieve appropriate levels of anticoagulation during ECCO2R therapy. Unlike ECMO, ECCO2R does not provide clinically meaningful oxygenation but is simpler to implement and manage. The use of ECCO2R successfully corrected and controlled the patient’s hypercapnia and acidosis and enabled meaningful reductions in ventilator tidal volumes, respiratory rates, and mean airway pressures. The patient was weaned from ECCO2R after 17 days and from mechanical ventilation 10 days later. With low tidal volume ventilation facilitated by expeditious implementation of ECCO2R, the patient survived to discharge despite her many risk factors for a poor outcome and an extended duration of invasive mechanical ventilation.

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SARS-CoV-2 in carotid body

Cited by 27 publications

References 0 publications

Case Report: The Carotid Body in COVID-19: Histopathological and Virological Analyses of an Autopsy Case Series

Case Report: The Carotid Body in COVID-19: Histopathological and Virological Analyses of an Autopsy Case Series

Are Multiple Chemosensory Systems Accountable for COVID-19 Outcome?

Treatment of Severe Hypercapnic Respiratory Failure Caused by SARS-CoV-2 Lung Injury with ECCO2R Using the Hemolung Respiratory Assist System

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