Intest Res.  2021 Oct;19(4):379-385. 10.5217/ir.2020.00087.

An overview of the gut side of the SARS-CoV-2 infection

• Barbosa da Luz B
• de Oliveira NMT
• França dos Santos IW
• Paza LZ
• Braga LLVdM
• Platner FdS
• Werner MFdP
• Fernandes ES
• Maria-Ferreira D

• KMID: 2521601
• DOI: http://doi.org/10.5217/ir.2020.00087

Abstract

In late 2019, an outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initiated in Wuhan, Hubei province, China. The major clinical symptoms described for coronavirus disease (COVID-19) include respiratory distress and pneumonia in severe cases, and some patients may experience gastrointestinal impairments. In accordance, viral RNA or live infectious virus have been detected in feces of patients with COVID-19. Binding of SARS-CoV-2 to the angiotensin‐converting enzyme 2 (ACE2) is a vital pathway for the virus entry into human cells, including those of the respiratory mucosa, esophageal epithelium as well as the absorptive enterocytes from ileum and colon. The interaction between SARS-CoV-2 and ACE2 receptor may decrease the receptor expression and disrupt the function of B⁰AT1 transporter influencing the diarrhea observed in COVID-19 patients. In this context, a fecal-oral transmission route has been considered and points out a role for the digestive tract in disease transmission and severity. Here, in order to further understand the impact of COVID-19 in human physiology, the cellular and molecular mechanisms of SARS-CoV-2 infection and disease severity are discussed in the context of gastrointestinal disturbances.

Keyword

Coronavirus; COVID-19; Gastrointestinal manifestations; Gastroenterology; ACE2

Figure

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  Fig. 1. Mechanism suggested for diarrhea induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During coronavirus disease (COVID-19), SARS-CoV-2 uses the angiotensin-converting enzyme 2 (ACE2) receptor and cellular serine protease transmembrane protease serine 2 (TMPRSS2) for host cell entry. ACE2 is an important regulator of amino acid transport B0AT1. The interaction between SARS-CoV-2 and ACE2 receptor may decrease the receptor expression leading to B0AT1 disruption, influencing the diarrhea observed in COVID-19 patients.

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