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Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19
Citation:
Clerbaux, L., S. Mayasich, A. Munoz, H. Soares, M. Petrillo, M. Cristina Albertini, N. Lanthier, L. Grenga, AND M. Amorim. Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19. Journal of Clinical Medicine. MDPI, Basel, Switzerland, 11(19):5691, (2022). https://doi.org/10.3390/jcm11195691
Impact/Purpose:
The Modelling the Pathogenesis of COVID-19 Using the Adverse Outcome Pathway (AOP) Framework (CIAO) working group has been developing AOPs to better understand and organize the information needed to treat COVID-19, support new research to defeat the disease, and prevent future pandemics. This paper is a review article describing the case for the gastrointestinal tract as an alternative entry route for SARS-CoV-2 in the structure used to develop an AOP. The impact of this type of article is threefold: it provides a literature review of COVID-19 infection in the gut, it promotes the organization of the information in the well-developed AOP framework reaching a wider audience, and highlights knowledge gaps that can be addressed by researchers.
Description:
The gut has been proposed as a potential alternative entry route for SARS-CoV-2. This was mainly based on the high levels of SARS-CoV-2 receptor expressed in the gastrointestinal (GI) tract, the observations of GI disorders (such as diarrhea) in some COVID-19 patients and the detection of SARS-CoV-2 RNA in feces. However, the underlying mechanisms remain poorly understood. It has been proposed that SARS-CoV-2 can productively infect enterocytes, damaging the intestinal barrier and contributing to inflammatory response, which might lead to GI manifestations, including diarrhea. Here, we report a methodological approach to assess the evidence supporting the sequence of events driving SARS-CoV-2 enteric infection up to gut adverse outcomes. Exploring evidence permits to highlight knowledge gaps and current inconsistencies in the literature and to guide further research. Based on the current insights on SARS-CoV-2 intestinal infection and transmission, we then discuss the potential implication on clinical practice, including on long COVID. A better understanding of the GI implication in COVID-19 is still needed to improve disease management and could help identify innovative therapies or preventive actions targeting the GI tract.
URLs/Downloads:
DOI: Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19
FINAL PUBLISHED MANUSCRIPT.PDF (PDF, NA pp, 1166.53 KB, about PDF)
https://pubmed.ncbi.nlm.nih.gov/36233559/