PD62-05 SARS-COV-2 ENDOTHELIAL DYSFUNCTION CAN CAUSE ERECTILE DYSFUNCTION: HISTOPATHOLOGICAL, IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL STUDY OF THE HUMAN PENIS

INTRODUCTION AND OBJECTIVE: To describe the histopathological features of penile tissue of patients who recovered from symptomatic COVID-19 infection and subsequently developed severe erectile dysfunction (ED). METHODS: After providing informed consent, penile tissue was collected from patients undergoing surgery for inflatable penile prosthesis due to severe ED under an IRB approved protocol. Two specimens were obtained from men with a history of COVID-19 infection and two specimens were obtained from men with no history of infection (all men tested negative immediately before surgery). Formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E) and subjected to immunohistochemical analysis for endothelial Nitric Oxide Synthase (eNOS) expression (marker of endothelial function). Tissue from COVID-19 (+) and COVID-19 (-) specimens were imaged with transmission electron microscopy (TEM). Endothelial progenitor cells (EPC) function was assessed ex vivo by determination of endothelial colony forming units from blood samples collected from the COVID-19 (+) and COVID (-) men with severe ED. RESULTS: TEM showed extracellular viral particles w100 nm in diameter with prominent peplomers (spikes) near penile vascular endothelial cells of the COVID-19 (+) patient (Figure 1A + 1B) and the absence of viral particles in control tissue. Immunohistochemistry showed eNOS expression in the corpus cavernosum of COVID (+) men was significantly decreased compared to COVID (-) men suggesting endothelial dysfunction (Figure 1C). Mean EPC levels from the COVID-19 (+) patients were lower (0.72 cells/well) compared to mean EPCs from men with severe ED and no history of COVID-19 (4.04 cells/well) suggesting impaired endothelial function. CONCLUSIONS: Our study is the first to demonstrate the presence of COVID-19 virus in the penis long after the initial infection in humans. Our study also suggests that widespread endothelial cell dysfunction from COVID19 infection can contribute to resultant erectile dysfunction. Our future studies will evaluate novel molecular mechanisms of how COVID-19 infection leads to ED. (Figure Presented).