COVID-19 and the pituitary.

BACKGROUND: Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. AIM: To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. CONCLUSIONS: Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

A G1-lineage H9N2 virus with oviduct tropism causes chronic pathological changes in the infundibulum and a long-lasting drop in egg production.

Since 1997, G1-lineage H9N2 avian influenza viruses have been circulating in Asia and later on in the Middle East, and they have been associated to mild respiratory disease, drops in egg production and moderate mortality in chickens, in particular in the presence of concurrent infections. In this study, we investigated the importance of the G1-lineage H9N2 A/chicken/Israel/1163/2011 virus as a primary pathogen in layers, analyzing its tropism and binding affinity for the oviduct tissues, and investigating the long-term impact on egg production. Besides causing a mild respiratory infection, the virus replicated in the oviduct of 60% of the hens causing different degrees of salpingitis throughout the organ, in particular at the level of the infundibulum, where the detection of the virus was associated with severe heterophilic infiltrate, and necrosis of the epithelium. Binding affinity assays confirmed that the infundibulum was the most receptive region of the oviduct. The drop in egg production was at its peek at 2 weeks post-infection (pi) (60% decrease) and continued up to 80 days pi (35% decrease). On day 80 pi, non-laying birds showed egg yolk peritonitis, and histopathological analyses described profound alteration of the infundibulum architecture, duct ectasia and thinning of the epithelium, while the rest of the oviduct and ovary appeared normal. Our results show that this H9N2 virus is a primary pathogen in layer hens, and that its replication in the infundibulum is responsible for acute and chronic lesions that limits the effective functionality of the oviduct, compromising the commercial life of birds.

Activation and regulation of endogenous retroviral genes in the human pituitary gland and related endocrine tumours.

AIMS: Adenohypophysis (AH) hormone-producing cells represent the origin of diverse groups of pituitary adenomas (PA). Deregulation of hypothalamic hormone receptors, growth factors and cAMP signalling have been implicated in the aetiology of PA. Endogenous retroviruses (ERVs) are derived from past exogenous retroviral infections and represent more than 8% of the human genome. Some ERV genes encode open reading frames and produce functional proteins, for example, the ERVW-1 envelope gene Syncytin-1, essential for placentogenesis, but also deregulated in human tumours. Data concerning ERV expression in the AH and related endocrine tumours are missing. METHODS: Syncytin-1 protein was analysed in normal AH (n = 15) and compared with five PA subtypes (n = 117) by immunohistochemistry. Absolute gene expression of 20 ERV functional envelope genes and ERVW-5 gag was measured. PA tissues were examined for Syncytin-1 and the cAMP signalling marker phospho-CREB-Ser133 using immunohistochemistry. Isolated primary human PA cells were treated with different hormones. Murine embryonic and adult pituitary gland ERV expressions were compared with human AH. RESULTS: Syncytin-1 protein colocalized with corticotropic cells of AH. In contrast, all PA demonstrated significant Syncytin-1 protein overexpression, supporting deregulation. All other ERV genes showed significant up-regulations in different PA subtypes. Phospho-CREB-Ser133 and Syncytin-1 colocalized in PA cells. Cultivated primary PA cells with ACTH or CRH induced their respective receptors and ERV genes. Syncytin-A/-B, murine orthologues to human Syncytin-1/-2, localized to embryonic and adult pituitary glands demonstrating functional mammalian conservation. CONCLUSIONS: Deregulated ERV genes may contribute to PA development via cAMP signalling.

Studies on in vivo gene transfer in pituitary tumors using herpes-derived and adenoviral vectors.

Suicide gene therapy has met limited success for the treatment of rat pituitary tumors. In order to determine the cause of primary pituitary tumor resistance to suicide gene therapy, we studied the transgene expression of an adenoviral (Ad.RSV.beta gal.nls) and a herpes simplex virus-derived (tsK/beta-gal) vector, both harboring the beta-galactosidase reporter gene in rat prolactinomas. Rats carrying experimental prolactinomas received bilateral 1 microl intrapituitary injections of either saline (saline group), 5 x 10(5) plaque-forming units (pfu) tsK/beta-gal (HSV Group) or 5 x 10(5) pfu Ad.RSV.beta gal.nls (RAd Group). Two or seven days later the tumors were examined. Macroscopic inspection of glands injected with either vector showed that the tissue expressing beta-gal was concentrated at the ventral area around the site reached by the tip of the needle. Almost no transgene expression was observed in other sites. Cellularity and lactotrophic cell density was not affected by saline or virus injection. In the injected areas, apoptotic levels were (x +/-S.E.M.): 9.3+/-0.5, 22.1+/-1.1 and 31.7+/-1.4%, for the saline, RAd and HSV groups, respectively. Serum prolactin and growth hormone levels were not affected by virus injection. We conclude that the low diffusibility of viral suspensions in the pituitary tissue may constitute a significant obstacle for achieving full remission of in situ pituitary tumors in rats.

Herpes simplex virus types 1 and 2 infect the mouse pituitary gland and induce apoptotic cell death.

Herpes simplex virus (HSV) infected the anterior lobe of the pituitary gland resulting in cytopathic changes following intravenous (i.v.) inoculation of male mice. Both HSV type 1 (HSV-1) and type 2 (HSV-2) were isolated from pituitary gland following i.v. infection, but not after intraperitoneal inoculation. HSV-infected pituitary cells were microscopically visible beginning at 24 h or 48 h following i.v. inoculation and were localized in the anterior pituitary. In both HSV-1 and -2 infections the pituitary lesions were apoptotic, as determined by light and electron microscopy, TUNEL, and DNA gel electrophoresis. However, the pituitary infection does not appear to be life-threatening since pituitary lesions were also observed following i.v. infection with HSV-1 strain -GC which possesses low virulence. These results suggest that the pituitary gland is one of the target organs of HSV infection.

Hypophyseal hemorrhage and panhypopituitarism during Puumala Virus Infection: Magnetic Resonance Imaging and detection of viral antigen in the hypophysis.

We describe 3 cases of nephropathia epidemica (NE) that confirm that Puumala virus infection may cause hypophyseal injury. Autopsy revealed a hemorrhagic hypophysis positive for Puumala virus antigen in both neuroendocrine stromal and vascular endothelial cells in 1 patient, and 2 patients developed hypophyseal hemorrhage (diagnosed with magnetic resonance imaging) during or shortly after acute NE, both of whom developed panhypopituitarism.

Is pituitary gene therapy realistic?

Current therapies for pituitary tumours are moderately successful in many cases but still suffer from significant limitations, with relatively poor long-term rates of endocrine cure from surgery, and long-term hypopituitarism after radiotherapy. Even in the case of the most readily treatable tumours, prolactinomas, medical therapy with dopamine agonists is limited by lack of response or side-effects in up to 10% of patients. This has led to increasing interest in the application of our knowledge of pituitary cell and molecular biology to evaluate the potential of gene therapy. Various vectors are available to facilitate gene delivery, and recombinant adenoviruses have been studied in detail because of their ability to transduce the postmitotic, nondividing cells of the pituitary gland. Various studies with reporter genes such as beta-galactosidase have demonstrated high efficiency and long lasting expression of adenoviral transgenes in cultured pituitary cells in vitro. The feasibility of high level transgene expression has also been shown in vivo, but so far this requires stereotaxic intrapituitary injection to achieve adequate transduction. Ablation of pituitary cells has been demonstrated in cultured cell lines and in subcutaneous tumours in nude mice, though alternative animal models will be required to evaluate efficacy in more slowly proliferating tumours as found in man. Inflammatory responses have been documented in the pituitary gland as in other tissues, and this will require the evaluation of modified vectors to avoid significant adverse effects before human applications can be considered. In summary, gene therapy for pituitary disease is likely to be feasible in the future, but will require careful and extensive evaluation of efficacy and safety, using a variety of possible methods of gene delivery.

Immortalized human pituitary cells express glycoprotein alpha-subunit and thyrotropin beta (TSH beta).

A major problem in the study of human pituitary cells is their lack of proliferative capacity in vitro. To address this issue, we have infected normal human, postmortem pituitary cells in monolayer culture with a temperature-sensitive (tsA58) mutant of SV40 large T antigen. Several epithelial-like colonies were isolated; and one, designated CHP2, has been studied in detail to identify its functional characteristics. CHP2 cells have undergone more than 150 culture passages and retain an epithelial morphology. They exhibit tight temperature-dependent growth, in the presence and absence of serum, with cell division at 33 C and growth inhibition at 39 C. CHP2 cells, at both temperatures, showed diffuse immunostaining for human alpha-subunit and focal staining for TSH beta. Gene expression was confirmed by RT-PCR and sequencing. TRH and GnRH receptors were not detectable, and their absence was confirmed by their lack of effects on intracellular calcium and inositol phospholipids. Cytogenetic analysis showed that the cells had a modal peak in the diploid range and a smaller peak in the tetraploid range. There was also a consistent loss of chromosome 22 and a normal chromosome 2 homologue, the latter being replaced by one of two chromosome 2 markers, M2A or M2B. In conclusion, we have immortalized human pituitary cells using SV40 tsT, from which we have cloned a cell line expressing alpha-subunit and TSH beta.

Detection of polyomaviral DNA sequences in normal and adenomatous human pituitary tissues using the polymerase chain reaction.

BACKGROUND: Tumor viruses are known to have a role in the pathogenesis of many types of benign and malignant human tumors. The possible roles of these viruses in the development of human pituitary tumors have not been investigated. METHODS: The polymerase chain reaction was used to screen human pituitary tumors for human papillomaviral (HPV) and Polyomaviral DNA sequences. Sets of consensus primers, which are capable of amplifying HPV Types 16, 18, and 33 and polyomavirus BK, JC, and SV40, were used in these experiments. RESULTS: Amplification products were not detected using HPV consensus primers in 30 tumors. Twenty-six of 30 tumors demonstrated an amplification product with polyomaviral primers that hybridized to SV40 and BK internal probes and was confirmed to be SV40 in one tumor by direct sequencing. Ten normal postmortem pituitary samples then were examined similarly with Polyomaviral consensus primers; 8 of 10 normal samples demonstrated a similar amplification product that also hybridized with SV40 and BK internal probes by Southern blotting. Polyomaviral DNA sequences in normal and tumor samples were not present at levels detectable by genomic Southern blotting. Expressed viral protein (large T antigen) was not demonstrated in positive samples by Western blot analysis. CONCLUSIONS: These findings, that polyomaviral DNA sequences are detectable at low levels in certain normal tissues, are in agreement with those of other groups and, to the authors' knowledge, serve as the first report of polyomaviral latency in human pituitary tissue. A role for polyomaviruses in pituitary tumorigenesis could not be established in this analysis.