Pathophysiology and possible treatments for olfactory-gustatory disorders in patients affected by COVID-19.
Pathophysiology and possible treatments for olfactory-gustatory disorders in patients affected by COVID-19.
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DOI：
10.1016/j.crphar.2021.100035
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发表时间：
2021
影响因子：
--
通讯作者：
Guzen FP
中科院分区：
文献类型：
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作者：
Neta FI;Fernandes ACL;Vale AJM;Pinheiro FI;Cobucci RN;Azevedo EP;Guzen FP
SARS-CoV-2主要通过病毒的刺突蛋白与病毒受体即血管紧张素转换酶2（ACE 2）和跨膜丝氨酸蛋白酶2（TMPRSS 2）之间的相互作用感染宿主细胞。两者都在胃肠道、鼻和支气管上皮以及II型肺泡上皮细胞中高度表达。本综述的目的是报告来自COVID-19患者嗅觉-味觉障碍的病理生理学和可用治疗方法的科学文献证据。这些疾病的机制尚不清楚，具体治疗方法的研究也很少。然而，已经假设感觉神经元的敏感性降低以及肺泡上皮细胞中ACE 2和TMPRSS 2的共表达是嗅觉-味觉障碍的主要原因。文献中描述的COVID-19患者味觉变化的可能机制包括嗅觉障碍和COVID-19对味蕾中ACE 2受体的竞争活性。此外，SARS-CoV-2可以与味蕾中的唾液酸受体结合。总的来说，证据表明，对于SARS-CoV-2引起的嗅觉-味觉障碍没有特异性的治疗方法，尽管已经使用了一些治疗方法并显示出一些有希望的结果，例如嗅觉训练，柠檬酸钠和维生素A的鼻内应用，以及omega-3和锌的全身使用。皮质类固醇也被用作治疗嗅觉功能障碍患者的药理学方法，但结果相互矛盾。了解SARS-CoV-2影响感觉系统的机制以及有效的治疗方法如何治疗嗅觉和味觉的丧失，将对嗅觉-味觉障碍的理解和临床管理产生重要影响。
SARS-CoV-2 infects host cells mainly through the interaction between the virus's Spike protein and the viral receptors namely Angiotensin-Converting Enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Both are highly expressed in the gastrointestinal tract, in the nasal and bronchial epithelium, as well as in the type II alveolar epithelial cells. The aim of this review is to report the evidences from the scientific literature on the pathophysiology and the available treatments for olfactory-gustatory disorders in patients with COVID-19. The mechanisms involved in these disorders are still unclear and studies on specific therapies are scarce. However, it has been hypothesized that a decrease in the sensitivity of the sensory neurons as well as the co-expression of ACE2 and TMPRSS2 in the alveolar epithelial cells are the main causes of olfactory-gustatory disorders. The possible mechanisms described in the literature for changes in taste perception in patients with COVID-19 include olfactory disorders and a competitive activity of COVID-19 on ACE2 receptors in the taste buds. In addition, SARS-CoV-2 can bind to sialic acid receptors in the taste buds. In general, evidences show that there is no specific treatment for olfactory-taste disorders induced by SARS-CoV-2, even though some treatments have been used and have shown some promising results, such as olfactory training, intranasal application of sodium citrate and vitamin A, as well as systemic use of omega-3 and zinc. Corticosteroids have also been used as a pharmacological approach to treat patients with olfactory dysfunction with some contradictory results. The knowledge of the mechanisms by which SARS-CoV-2 influences the sensory systems and how effective therapies can treat the loss of smell and taste will have important implications on the understanding and clinical management of olfactory-taste disorders.