Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

Giacomo Fiacchini; Agnese Proietti; Anello Marcello Poma; Miriana Picariello; Iacopo Dallan; Fabio Guarracino; Francesco Forfori; Gabriella Fontanini; Luca Bruschini

doi:10.3389/fmicb.2022.851460

Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

Front Microbiol. 2022 Mar 16:13:851460. doi: 10.3389/fmicb.2022.851460. eCollection 2022.

Authors

Giacomo Fiacchini¹, Agnese Proietti², Anello Marcello Poma³, Miriana Picariello¹, Iacopo Dallan¹, Fabio Guarracino⁴, Francesco Forfori³, Gabriella Fontanini³, Luca Bruschini¹

Affiliations

¹ Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
² Unit of Pathological Anatomy, University Hospital of Pisa, Pisa, Italy.
³ Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
⁴ Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy.

Abstract

Purpose: An increasing number of laryngotracheal complications in mechanically ventilated COVID-19 patients has been reported in the last few months. Many etiopathogenetic hypotheses were proposed but no clear explanation of these complications was identified. In this paper we evaluated the possibility that the tracheal mucosa could be a high viral replication site that could weaken the epithelium itself.

Methods: Subjects for the COVID-19 group and the control group were selected retrospectively according to specific criteria. Patients' basic and clinical data were recorded and analyzed. Tracheal samples of both groups were collected during surgical tracheostomies and then analyzed from a histological and genetic-transcriptional point of view.

Results: Four COVID-19 patients were enrolled in this study and compared with four non-COVID-19 patients. No laryngotracheal complications were identified in both groups. The SARS-CoV-2 was detected in one out of four COVID-19 samples. A subepithelial inflammatory lymphomonocyte infiltrate was observed in all patients but two cases of the COVID-19 group showed vasculitis of small subepithelial vessels associated with foci of coagulative necrosis. Two gene sets (HALLMARK_INFLAMMATORY_RESPONSE and HALLMARK_ESTROGEN_RESPONSE_LATE) were significantly deregulated in COVID-19 patients compared to the control group.

Conclusion: The altered inflammatory response of the COVID-19 patients could be another possible explanation of the increasing number of laryngotracheal complications.

Keywords: COVID-19; SARS-CoV-2; prolonged mechanical ventilation; tracheal lesions; virus replication.