Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection
Autor
Zhang, Hui
Li, Hong-Bao
Lyu, Jian-Rui
Lei, Xiao-Ming
Li, Wei
Wu, Gang
Lyu, Jun
Da, Zhi-Ming
Institución
Resumen
The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China and rapidly spread in other
countries in December 2019. The infected patients presented with fever, respiratory symptoms,
sometimes with digestive and other systemic manifestations, and some progressed with a severe acute
respiratory syndrome or even death. Associated digestive symptoms were frequently observed in the
patients, with an unknown significance and mechanism. ACE2, as the major known functional receptor of
the 2019 novel coronavirus (2019-nCoV) attracted our attention. We collected the clinical data of the
2019-nCoV-infected patients from published studies and extracted the data about the incidence of
gastrointestinal symptoms. Furthermore, we used online datasets to analyze ACE2 expression in different
human organs, especially in the small intestine, to explore the relationship between ACE2 expression
patterns and clinical symptoms. We found that diarrhea accounted for a notable proportion of COVID-19
patients, ranging from 8.0% to 12.9%. The results reveal that ACE2 mRNA and protein are highly expressed
in the small intestinal enterocytes but not in the goblet cells or intestinal immune cells. High expression
of ACE2 on the surface cells in the digestive tract may lead to gastrointestinal symptoms and
inflammation susceptibility. Overall, digestive symptoms were common in the COVID-19 patients. ACE2
expression on surface cells of the small intestine may mediate the invasion and amplification of the virus
and activation of gastrointestinal inflammation. It is a possible mechanism of digestive symptoms in the
COVID-19 patients and explains the presence of the virus in patients’ stool samples. The study also
highlights the necessity of taking stool samples for suspected patients to help in early diagnosis and
assessment of disease status.