Liver Histopathological Analysis of 24 Postmortem Findings of Patients With COVID-19 in China

Although the pathologic investigation of liver injury was observed in a couple of cases in China, the detailed description of liver histopathologic and ultrastructural changes in a relatively larger series of liver tissues from COVID-19 patients is lacking. Samples from the liver were obtained from 24 COVID-19 cases from February 1 to April 1, 2020. Light microscopy showed that all liver sections had different degrees of liver injury manifested as swelling of the hepatocytes, hepatocellular necrosis, steatosis, lobular inflammation, portal inflammation, dilatation of sinusoids, and so on. SARS-CoV-2 induced liver injury might be independent of pre-existing Schistosoma infection or obstructive cholestasis. Patients combined with respiratory failure had more severe hepatocellular necrosis and male patients were more susceptible to liver injury. Although coronavirus particles or viral inclusions were not detected in the liver tissues for all cases, vacuolar degenerations in hepatocytes, edematous of mitochondria with the disruption of cristae, and expansions of the endoplasmic reticulum were observed. In conclusion, pathologic changes of liver tissues provide us a further understanding of liver injury in COVID-19 patients. Changes in the liver seem to be related to the underlying diseases/conditions.

Induction of Surgical Obstructive Cholestasis in rats: morphological, biochemical and immunohistochemical changes

Objective: To detail an easy approach for surgical induction of obstructive cholestasis in a rat model. Additionally, to assess the role of serum and tissue biomarkers for determination of the extent of cholestasis induced hepatocellular injury and to quantify the apoptotic liver cell using fluorescein-labeled Annexin V. Design: Randomized controlled experimental study. Animals: Sixty-five healthy Male Sprague- Dawley rats weighing 268.18 ± 23.3 grams. Procedures: The rats were randomly allocated into two main groups: 1) sham group (SO; n= 15) and 2) bile duct ligation group (BL; n= 50). Three SO rats and 8 BL rats were euthanized at 10, 20, 30, 45 and 60 post-surgery. Blood and liver samples were collected for serum and tissue biochemical analysis. Liver apoptosis was quantified using Annexin V, meanwhile liver fibrosis was quantified using both TNF-β and histological examination. Results: There was a tendency towards less complications and higher surgeon satisfaction when the common bile duct was approached by the stomach approach. Serum biochemical analysis revealed a significant time-dependent decreases in hepatic serum biomarkers (alanine aminotransferease, aspartate aminotransferase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, gamma-glutamyltransferase, serum albumin, the concentration of total bilirubin, and direct bilirubin) after induced obstructive cholestasis (P = 0.01-0.001), whereas AST: ALT ratio conversely was elevated (p < 0.05 value). Flow cytometer analysis revealed time-dependent significant increase in the percent of apoptotic cells after BL (P < 0.001) and consequently the state of oxidative stress (malondialdehyde) was (P < 0.001). The antioxidant tissue markers (superoxide dismutase, Catalase and glutathione reductase) were significantly decreased (P < 0.05), meanwhile TNF-β, the fibrosis marker showed time dependent significant increases (P = 0.001). Conclusion and clinical relevance: Stomach approach provided an easy, fast and reliable procedure for induction of obstructive cholestasis in rats. Liver Annexin V and TGF-β were diagnostic tools in further apoptosis and fibrosis.

Comparative studying of biochemical indices of the blood in experimental acute biliary pancreatitis and obstructive cholestasis

Objective. Comparative studying of levels of some biochemical indices in experimental acute biliary pancreatitis and obstructive cholestasis. Materials and methods. An acute biliary pancreatitis was simulated on 32 rats and obstructive cholestasis – on 23. On the first, third and 7th days after the blood indices of general bilirubin, albumin and the urea, as well as activity of alaninaminotranspherase, aspartataminotranspherase, alkaline phosphatase and amylase were studied. Results. In the acute biliary pancreatitis on the second day of the experiment 10 (31.3%) rats have deceased, and in obstructive cholestasis - 1 (4.3%) rat (p < 0.01). In both groups of laboratory animals the signs of cholestasis were determined, and in the acute biliary pancreatitis – signs of pancreatitis. On the first day in acute biliary pancreatitis in comparison with acute cholestasis there were noted the enhanced values of the amylase activity (p < 0.001) and the urea content (p < 0.05); on the third day – the lower values of the general bilirubin content (p < 0.001), higher values of the alaninaminotranspherase activity (p < 0.05), the urea content (p < 0.01) and activity of amylase (p < 0.05); on the 7-th day – lower values of general bilirubin (p < 0.05), higher values of activity of alkaline phosphatase and aspartataminotranspherase (p < 0.05). Conclusion. More severe hyperbilirubinemia is observed in obstructive cholestasis. In the acute biliary pancreatitis the trustworthy enhanced values of the alaninaminotranspherase (on the third day) and aspartataminotranspherase (on the 7-th day) activities, the urea content (on the third day), as well as activity of alkaline phosphatase (on the 7th day) are noted.