COVID-19 in normal, diseased and transplanted liver

Abstract

Starting from December 2019 the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has extended in the entire world giving origin to a pandemic. Although the respiratory system is the main apparatus involved by the infection, several other organs may suffer coronavirus disease 2019 (COVID-19)-related injuries. The human tissues expressing angiotensin-converting enzyme 2 (ACE2) are all possible targets of viral damage. In fact myocarditis, meningo-encephalitis, acute kidney injury and other complications have been described with regard to SARS-CoV-2 infection. The liver has a central role in the body homeostasis contributing to detoxification, catabolism and also synthesis of important factor such as plasma proteins. ACE2 is significantly expressed just by cholangiocytes within the liver, however transaminases are increased in more than one third of COVID-19 patients, at hospital admission. The reasons for liver impairment in the course of this infection are not completely clear at present and multiple factors such as: Direct viral effect, release of cytokines, ischemic damage, use of hepatotoxic drugs, sepsis, and others, may contribute to damage. While COVID-19 seems to elicit just a transient alteration of liver function tests in subjects with normal hepatic function, of concern, more severe sequelae are frequently observed in patients with a reduced hepatic reserve. In this review we report data regarding SARS-CoV-2 infection in subjects with normal or diseased liver. In addition the risks of COVID-19 in immunosuppressed patients (either transplanted or suffering for autoimmune liver diseases) are also described.

Patterns of liver profile disturbance in patients with COVID-19

“…Regarding direct cytotoxicity, as SARS-CoV-2 binds to target cells through angiotensin-converting enzyme receptor-2 (ACE2), ACE2 receptors are found abundantly in the cholangiocytes (59.7%) as compared with the hepatocytes (2.6%). Thus, the liver is a potential target for direct viral infection[ 8 ].…”

A single-nucleus and spatial transcriptomic atlas of the COVID-19 liver reveals topological, functional, and regenerative organ disruption in patients

“…Multiple factors may underlie the COVID-19 liver phenotype, including the impact of direct infection given the expression of SARS-CoV-2 entry factors in major hepatic cell classes 3,8,9 , systemic inflammation, drug-induced injury, and hypoxia 3,10 . Some studies suggest the presence of subclinical liver damage, especially in the liver vasculature 11 , with short- and potentially long-term implications.…”

Liver drug damage: possibilities of polyionic succinate-methioninic complex during the pandemic of new coronavirus infection (COVID-19)

“…Пандемия новой коронавирусной инфекции (COVID-19), обусловленная вирусом SARS-CoV-2, стала вызовом системам здравоохранения всех стран мира. Приобретенный за прошедший год мировой клинический опыт ведения пациентов с новой коронавирусной инфекцией позволяет выделить ряд актуальных клинических аспектов, одним из которых является ЛПП, связанное с лечением COVID-19, что нашло отражение в зарубежных [33][34][35][36][37][38][39][40][41][42][43][44] и отечественных [18,45,46] обзорах.…”

“…Так, установлено, что вирус SARS-CoV-2 может непосредственно поражать клетки печени, что подтверждается обнаружением повышенной экспрессии рецепторов ангиотензинпревращающего фермента-2 (АПФ2) в клетках желчных протоков [67]. Уровень экспрессии АПФ2 в холангиоцитах значительно выше, чем в гепатоцитах и сопоставим с его уровнем в альвеолярных клетках 2-го типа в легких, что делает печень потенциальной мишенью для вируса [67] и предполагает развитие прямой цитоксичности в результате активной репликации вируса в клетках печени с участием АПФ2 в качестве рецепторов для внедрения в клетку [42].…”