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Maternal respiratory SARS-CoV-2 infection in pregnancy is associated with a robust inflammatory response at the maternal-fetal interface.


ABSTRACT:

Background

Pregnant women are at increased risk for severe outcomes from coronavirus disease 2019 (COVID-19), but the pathophysiology underlying this increased morbidity and its potential effect on the developing fetus is not well understood.

Methods

We assessed placental histology, ACE2 expression, and viral and immune dynamics at the term placenta in pregnant women with and without respiratory severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Findings

The majority (13 of 15) of placentas analyzed had no detectable viral RNA. ACE2 was detected by immunohistochemistry in syncytiotrophoblast cells of the normal placenta during early pregnancy but was rarely seen in healthy placentas at full term, suggesting that low ACE2 expression may protect the term placenta from viral infection. Using immortalized cell lines and primary isolated placental cells, we found that cytotrophoblasts, the trophoblast stem cells and precursors to syncytiotrophoblasts, rather than syncytiotrophoblasts or Hofbauer cells, are most vulnerable to SARS-CoV-2 infection in vitro. To better understand potential immune mechanisms shielding placental cells from infection in vivo, we performed bulk and single-cell transcriptomics analyses and found that the maternal-fetal interface of SARS-CoV-2-infected women exhibited robust immune responses, including increased activation of natural killer (NK) and T cells, increased expression of interferon-related genes, as well as markers associated with pregnancy complications such as preeclampsia.

Conclusions

SARS-CoV-2 infection in late pregnancy is associated with immune activation at the maternal-fetal interface even in the absence of detectable local viral invasion.

Funding

NIH (T32GM007205, F30HD093350, K23MH118999, R01AI157488, U01DA040588) and Fast Grant funding support from Emergent Ventures at the Mercatus Center.

SUBMITTER: Lu-Culligan A 

PROVIDER: S-EPMC8084634 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Publications

Maternal respiratory SARS-CoV-2 infection in pregnancy is associated with a robust inflammatory response at the maternal-fetal interface.

Lu-Culligan Alice A   Chavan Arun R AR   Vijayakumar Pavithra P   Irshaid Lina L   Courchaine Edward M EM   Milano Kristin M KM   Tang Zhonghua Z   Pope Scott D SD   Song Eric E   Vogels Chantal B F CBF   Lu-Culligan William J WJ   Campbell Katherine H KH   Casanovas-Massana Arnau A   Bermejo Santos S   Toothaker Jessica M JM   Lee Hannah J HJ   Liu Feimei F   Schulz Wade W   Fournier John J   Muenker M Catherine MC   Moore Adam J AJ   Konnikova Liza L   Neugebauer Karla M KM   Ring Aaron A   Grubaugh Nathan D ND   Ko Albert I AI   Morotti Raffaella R   Guller Seth S   Kliman Harvey J HJ   Iwasaki Akiko A   Farhadian Shelli F SF  

Med (New York, N.Y.) 20210430 5


<h4>Background</h4>Pregnant women are at increased risk for severe outcomes from coronavirus disease 2019 (COVID-19), but the pathophysiology underlying this increased morbidity and its potential effect on the developing fetus is not well understood.<h4>Methods</h4>We assessed placental histology, ACE2 expression, and viral and immune dynamics at the term placenta in pregnant women with and without respiratory severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.<h4>Findings</h  ...[more]

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