World J Mens Health.
2021 Jan;39(1):65-74. 10.5534/wjmh.200170.
Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis
- Achua JK
1 - Chu KY1
- Ibrahim E1
- Khodamoradi K1
- Delma KS2
- Iakymenko OA2
- Kryvenko ON1,2
- Arora H1,3,4
- Ramasamy R1,3
- Affiliations
-
- 1Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
- 2Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA.
- 3The Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
- 4John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA.
- KMID: 2509581
- DOI: http://doi.org/10.5534/wjmh.200170
Abstract
- Purpose
To evaluate the presence and analyze the pathological changes within the testes of patients who died or recovered from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications.
Materials and Methods
Testis tissue was collected from autopsies of COVID-19 positive (n=6) and negative men (n=3).Formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E) and subjected to immunofluorescence for angiotensin-converting enzyme 2 (ACE-2) expression. Fluorescent-labeled tissue slides were imaged on a quantitative pathology scope with various zoom levels allowing for qualitative and quantitative interpretation. Tissue from four COVID-19 positive autopsy cases and a live seroconverted patient was imaged with transmission electron microscopy (TEM).
Results
H&E histomorphology showed three of the six COVID-19 biopsies had normal spermatogenesis while the remaining three had impaired spermatogenesis. TEM showed the COVID-19 virus in testis tissue of one COVID-19 positive autopsy case and the live biopsy, H&E stain on the same autopsy case demonstrated interstitial macrophage and leukocyte infiltration.Immunofluorescent stained slides from six COVID-19 positive men demonstrated a direct association between increased quantitative ACE-2 levels and impairment of spermatogenesis.
Conclusions
The novel COVID-19 has an affinity for ACE-2 receptors. Since ACE-2 receptor expression is high in the testes, we hypothesized that COVID-19 is prevalent in testes tissue of infected patients. This study suggests the male reproductive tract, specifically the testes, may be targets of COVID-19 infection. We found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism of how COVID-19 can cause infertility.
