Understanding yellow fever-associated myocardial injury: an autopsy study

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorGIUGNI, Fernando Rabioglio
dc.contributor.authorDEMARCHIAIELLO, Vera
dc.contributor.authorFARIA, Caroline Silverio
dc.contributor.authorPOUR, Shahab Zaki
dc.contributor.authorCUNHA, Marielton dos Passos
dc.contributor.authorGIUGNI, Melina Valdo
dc.contributor.authorPINESI, Henrique Trombini
dc.contributor.authorLEDESMA, Felipe Lourenco
dc.contributor.authorMORAIS, Carolina Esteves
dc.contributor.authorHO, Yeh-Li
dc.contributor.authorSZTAJNBOK, Jaques
dc.contributor.authorFERNEZLIAN, Sandra de Morais
dc.contributor.authorSILVA, Luiz Fernando Ferraz da
dc.contributor.authorMAUAD, Thais
dc.contributor.authorALVES, Venancio Avancini Ferreira
dc.contributor.authorSALDIVA, Paulo Hilario do Nascimento
dc.contributor.authorANTONANGELO, Leila
dc.contributor.authorDOLHNIKOFF, Marisa
dc.contributor.authorDUARTE-NETO, Amaro Nunes
dc.date.accessioned2023-12-15T18:56:25Z
dc.date.available2023-12-15T18:56:25Z
dc.date.issued2023
dc.description.abstractBackground Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF.Methods This retrospective autopsy study included cases from the Sao Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers.Findings Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test.Interpretation Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10.eng
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.sponsorshipFundacao de Amparo a Pesquisa do Estado de Sao Paulo
dc.description.sponsorshipBill and Melinda Gates Foundation
dc.description.sponsorshipConselho Nacional de Desenvolvimento Cientifico e Tecnologico
dc.description.sponsorshipCoordenacao de Aperfeicoamento dePessoal de Nivel Superior
dc.identifier.citationEBIOMEDICINE, v.96, article ID 104810, 15p, 2023
dc.identifier.doi10.1016/j.ebiom.2023.104810
dc.identifier.issn2352-3964
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/57527
dc.language.isoeng
dc.publisherELSEVIEReng
dc.relation.ispartofEbiomedicine
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIEReng
dc.subjectYellow fevereng
dc.subject17DDeng
dc.subjectYEL-AVDeng
dc.subjectMyocarditiseng
dc.subjectHeart conduction systemeng
dc.subjectVascular endotheliumeng
dc.subjectCytokineseng
dc.subjectChemokineseng
dc.subjectIP-10eng
dc.subjectAutopsyeng
dc.subject.othersepsiseng
dc.subject.otherdysfunctioneng
dc.subject.othervaccineeng
dc.subject.otherdiseaseeng
dc.subject.wosMedicine, General & Internaleng
dc.subject.wosMedicine, Research & Experimentaleng
dc.titleUnderstanding yellow fever-associated myocardial injury: an autopsy studyeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalPOUR, Shahab Zaki:Univ Sao Paulo, Inst Ciencias Biomed, Dept Microbiol, Lab Evolucao Mol & Bioinformat, Sao Paulo, SP, Brazil
hcfmusp.author.externalCUNHA, Marielton dos Passos:Univ Sao Paulo, Inst Ciencias Biomed, Dept Microbiol, Lab Evolucao Mol & Bioinformat, Sao Paulo, SP, Brazil
hcfmusp.author.externalSZTAJNBOK, Jaques:Inst Infectol Emilio Ribas, Sao Paulo, SP, Brazil
hcfmusp.citation.scopus0
hcfmusp.contributor.author-fmusphcFERNANDO RABIOGLIO GIUGNI
hcfmusp.contributor.author-fmusphcVERA DEMARCHI AIELLO
hcfmusp.contributor.author-fmusphcCAROLINE SILVERIO FARIA
hcfmusp.contributor.author-fmusphcMELINA DE OLIVEIRA VALDO
hcfmusp.contributor.author-fmusphcHENRIQUE TROMBINI PINESI
hcfmusp.contributor.author-fmusphcFELIPE LOURENCO LEDESMA
hcfmusp.contributor.author-fmusphcCAROLINA ESTEVES DE MORAIS
hcfmusp.contributor.author-fmusphcHO YEH LI
hcfmusp.contributor.author-fmusphcSANDRA DE MORAIS FERNEZLIAN
hcfmusp.contributor.author-fmusphcLUIZ FERNANDO FERRAZ DA SILVA
hcfmusp.contributor.author-fmusphcTHAIS MAUAD
hcfmusp.contributor.author-fmusphcVENANCIO AVANCINI FERREIRA ALVES
hcfmusp.contributor.author-fmusphcPAULO HILARIO NASCIMENTO SALDIVA
hcfmusp.contributor.author-fmusphcLEILA ANTONANGELO
hcfmusp.contributor.author-fmusphcMARISA DOLHNIKOFF
hcfmusp.contributor.author-fmusphcAMARO NUNES DUARTE NETO
hcfmusp.description.articlenumber104810
hcfmusp.description.volume96
hcfmusp.origemWOS
hcfmusp.origem.pubmed37757571
hcfmusp.origem.scopus2-s2.0-85171971862
hcfmusp.origem.wosWOS:001085240500001
hcfmusp.publisher.cityAMSTERDAMeng
hcfmusp.publisher.countryNETHERLANDSeng
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