Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis

• Published in: The world journal of men's health Vol. 39; no. 1; pp. 65 - 74
• Main Authors: Achua, Justin K., Chu, Kevin Y., Ibrahim, Emad, Khodamoradi, Kajal, Delma, Katiana S., Iakymenko, Oleksii A., Kryvenko, Oleksandr N., Arora, Himanshu, Ramasamy, Ranjith
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society for Sexual Medicine and Andrology 01.01.2021; 대한남성과학회
• Subjects: Androgens; Autopsies; autopsy; Biopsy; coronavirus; Coronaviruses; COVID-19; Disease control; Disease transmission; Enzymes; Infertility; Medical examiners; Microscopy; Original; Patients; Severe acute respiratory syndrome coronavirus 2; Spermatogenesis; Testes; testis; Viruses; 비뇨기과학; United States > US; COVID-19; Testis; Coronavirus; Autopsy; Infertility
• ISSN: 2287-4208; 2287-4690
• DOI: 10.5534/wjmh.200170

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. 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). 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. 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.