Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection
Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection
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DOI：
10.1016/j.ijid.2020.04.027
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发表时间：
2020-07-01
影响因子：
8.4
通讯作者：
Dai, Zhi-Ming
中科院分区：
文献类型：
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作者：
Zhang, Hui;Li, Hong-Bao;Dai, Zhi-Ming
2019冠状病毒病（COVID-19）首次在中国武汉报告，并于2019年12月在其他国家迅速传播。受感染的病人出现发烧、呼吸道症状，有时伴有消化道和其他全身症状，有些人发展为严重急性呼吸系统综合征，甚至死亡。在患者中经常观察到相关的消化道症状，其意义和机制尚不清楚。ACE 2作为2019年新型冠状病毒（2019-nCoV）的主要已知功能受体引起了我们的关注。我们从已发表的研究中收集了2019-nCoV感染患者的临床数据，并提取了有关胃肠道症状发生率的数据。此外，我们使用在线数据集来分析ACE 2在不同人体器官中的表达，特别是在小肠中，以探索ACE 2表达模式与临床症状之间的关系。我们发现，腹泻占COVID-19患者的比例显著，从8. 0%到12. 9%不等。结果表明，ACE 2 mRNA和蛋白在小肠上皮细胞中高表达，而在杯状细胞和肠免疫细胞中不表达。ACE 2在消化道表面细胞的高表达可能导致胃肠道症状和炎症易感性。总体而言，消化道症状在COVID-19患者中很常见。ACE 2在小肠表面细胞的表达可能介导病毒的侵袭和扩增以及胃肠道炎症的激活。这是COVID-19患者消化系统症状的一种可能机制，并解释了患者粪便样本中病毒的存在。该研究还强调了为疑似患者采集粪便样本的必要性，以帮助早期诊断和评估疾病状态。(C)2020作者（S）由Elsevier Ltd代表国际传染病学会出版。
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. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.