SARS-CoV-2 infection and pancreatic disease

Česká verzia

Authors: Dítě- P. ^{1 3}; Kunovsky L. ^1,4,5; Kupka T. ^2,3; Dolina J. ^1,5; Jabandžiev- P. ^{5 7}; Uvírová M. ⁸; Blaho M. ^2,3; Šenkyřík M. ^1,5; Martínek A. ^2,3
Authors place of work: Interní gastroenterologická klinika FN Brno ¹; Interní klinika FN Ostrava ²; Lékařská fakulta OU, Ostrava ³; Chirurgická klinika FN Brno ⁴; Lékařská fakulta MU, Brno ⁵; Pediatrická klinika FN Brno ⁶; CEITEC – Středoevropský technologický institut, Masarykova univerzita, Brno ⁷; CGB Laboratoř Ostrava ⁸
Published in the journal: Gastroent Hepatol 2021; 75(4): 286-290
Category: Clinical and Experimental Gastroenterology: Review Article
doi: https://doi.org/10.48095/ccgh2021286

Summary

SARS-CoV-2 is an etiological factor in several diseases that the WHO designated covid-19. Covid-19 infection may affect the digestive tract, including the pancreas. The main/most common symptoms of covid-19 include fever (71.6%), cough (68.9%) subjective feeling of shortness of breath (71.2%). The gastrointestinal symptoms include abdominal pain, nausea and vomiting and/or diarrhea. The relationship of covid-19 and pancreas affection is not clearly described. A common finding is hyperlipasemia, eventually hyperamylasemia. Both conditions are usually associated with either no or minimal histomorphological changes, i.e. changes referred to as edematous glandular infiltration. Rarely, a necrotic form was reported. Nevertheless, the mortality of patients with acute pancreatitis who were covid-19 positive was higher than in covid-19 negative individuals. The available data indicate there is a link between covid-19 infection and the pancreas presenting as an acute disorder of the gland. SARS-CoV-2 impairment of both exocrine and endocrine function of the pancreas is multifactorial. It is debatable whether the involvement of the gland is directly related to the presence of the virus or whether it is an epiphenomenon. Angiotensin-converting enzyme 2 (ACE-2) receptors, inflammatory changes (especially in pancreatic beta cells), together with high IL-18 levels, virus-induced lipotoxicity and immunological dysregulation play an important role in the induction of pancreatic damage. During the covid-19 pandemic, pancreatopathies represent a very lively topic and are being studied intensively.

Keywords:

Pancreas – COVID-19 – SARS-CoV-2 – acute pancreatitis – chronic pancreatitis – endoscopy

Zdroje

1. Zhu N, Zhang D, Wang W et al. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China 2019. N Engl J Med 2020; 382 (8): 727–733. doi: 10.1056/NEJMoa2001017.

2. Hoffmann M, Kleine-Weber H, Schroeder S et al. SARS-CoV-2 cell entry dependents on ACE-2 and TMPRSSE-2 and is blocked by a clinically proven protease inhibitor cell. Cel 2020; 181 (2): 271–280e8. doi: 10.1016/j.cell.2020.02. 052.

3. Xiao F, Temg Z, Zheng X et al. Evidence for gastrointestinal infection SARS-CoV2. Gastroenterology 2020; 158 (6): 831–833e3. doi: 10.1053/ j.gastro.2020.02.055.

4. Docherty B, Harrion EM, Green CA et al. Features of 20,133 UK patients of hospital with COVID-19 using ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369: m1985. doi: 10.1136/bmj.m1985.

5. Han C, Duan C, Zhang S et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115 (6): 916–923. doi: 10.14309/ajg.0000000000000664.

6. Cheung KS, Ivan FN, Hung M et al. Gastrointestinal manifestation of SARS-CoV2 infection and virus load in fecal samples a Hong-Kong cohort: systematic revue and meta-analysis. Gastroenterology 2020; 159 (1): 81–95. doi: 10.1053/j.gastro.2020.03.065.

7. Hunt RH, East JE, Lanas A et al. COVID-19 and gastrointestinal disease: Implications for the gastroenterologists. Dig Dis 2021; 39: 119–139. doi: 10.1159/000512152.

8. Inamdar S, Benias PC, Liu Y et al. Prevalence of risk factors and outcomes hospitalized patients with COVID-19 presenting in acute pancreatitis. Gastroenterology 2020; 159 (6): 2226-2228.e2. doi: 10.1053/j.gastro.2020.08.044.

9. Wang F, Wang H, Fan J et al. Pancreatic Injury Patterns in Patients With Coronavirus Disease 19 Pneumonia. Gastroenterology 2020; 159 (1): 367–370. doi: 10.1053/j.gastro.2020.03. 055.

10. Zippi M, Hong W, Traversa G et al. Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: a concise review. Infez Med 2020; 28 (4): 507–515.

11. Zippi M, Fiorino S, Occhigrossi G et al. Hypertransaminasemia in the course of infection with SARS-CoV-2: Incidence and pathogenetic hypothesis. World J Clin Cases 2020; 8 (8): 1385–1390. doi: 10.12998/wjcc.v8.i8.1385.

12. Wang J, Liu R, Qi H et al. The ACE2-angiotensin- (1-7) -Mas axis protects against pancreatic cell damage in cell culture. Pancreas 2015; 44 (2): 266–272. doi: 10.1097/MPA.0000000000000 247.

13. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020; 5 (4): 335–337. doi: 10.1016/S2468-1253 (20) 30048-0.

14. Wang W, Xu Y, Gao R et al. Detention of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020; 323 (18): 1843–1844. doi: 10.1001/jama.20203786.

15. Liu F, Long X, Zhang B et al. ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection. Clin Gastroenterol Hepatol 2020; 18 (9): 2128–2130.e2. doi: 10.1016/ j.cgh.2020.04.040.

16. Muus C, Luecken MD, Eraslan G et al. Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells. doi: http: //doi.org/10.1101/2020.0419.

17. Szatmary P, Arora A, Thomas Raraty MG et al. Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2-associated Pancreatitis. Gastroenterology 2020; 159 (4): 1551–1554. doi: 10.1053/j.gastro.2020.05.069.

18. Alovsius MM, Thatti A, Gupta A et al. COVID-19 presenting as acute pancreatitis. Pancreatology 2020; 20 (5): 1026–1027. doi: 10.1016/j.pan.2020.05.003.

19. Diweesh A, Li Y, Trikudanathan G, Mallery JS et al. Clinical outcomes of acute pancreatitis in patients with COVID-19. Gastroenterology 2020; 159 (5): 1972–1974. doi: 10.1053/ j.gastro.2020.07.038.

20. Hoffmann M, Kleine-Weber H, Schroeder S et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020; 181 (2): 271–280.e8. doi: 10.1016/j.cell.2020.02. 052.

21. Gubatan J, Levitte S, Patel A et al. Prevalence, risk factors and clinical outcomes of COVID-19 in patients with a history of pancreatitis in Northern California. Gut 2020; 70 (2): 440–441. doi: 10.1136/gutjnl-2020-321772.

22. Yao XH, Li TY, He ZC et al. A pathological report of three COVID-19 cases by minimally invasive autopsies. Zhonghua Bing Li Xue Za Zhi 2020; 49 (5): 411–417. doi: 10.3760/cma.j.cn1121 51-20200312-00193.

23. Ding Y, He L, Zhang Q et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol 2004; 203 (2): 622–630. doi: 10.1002/path. 1560.

24. Hanley B, Naresh KN, Roufosse C et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe 2020; 1 (6): e245–e253. doi: 10.1016/S2666-5247 (20) 30115-4.

25. Müller JA, Groß R, Conzelmann C et al. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pankreas. Nat Metab 2021; 3 (2): 149–165. doi: 10.1038/s4 2255-021-00347-1.

26. McNabb-Baltar J, Jin DX, Grover AS et al. Am J Gastroenterol 2020; 115 (8): 1286–1288. doi: 10.14309/ajg.0000000000000732.

27. Goyal H, Sachdeva S, Perisetti A et al. Hyperlipasemia and potential pancreatic injury patients in COVID-19: a marker of severity or innocent bystander? Gastroenterology 2021; 160: 946–948. doi: 10.1053/j.gastro.2020.10. 037.

28. Bruno G, Fabrizio C, Santoro CR et al. Pancreatic injury in the course of coronavirus disease 2019 (COVID-19): a not-so-rare occurrence. J Med Virol 2021; 93 (1): 74–75. doi: 10.1002/jmv.26134.

29. Machicado JD, Papachristou GI, Cote GA et al. Pancreaticobiliary endoscopy in the COVID-19 pandemic era. Pancreas 2020; 49: 29–32. doi: 10.1097/MPA.0000000000001580.