Gut as an alternative entry route for SARS-CoV-2: current evidence and uncertainties of productive enteric infection in COVID-19

Evidence suggests that the gut could be 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 impact on clinical practices. A better understanding of the GI implication in COVID-19 is needed to improve disease management, and could help identify innovative therapies or preventive actions targeting the GI tract.

CLERBAUX Laure-Alix;  MAYASICH Sally A.;  MUNOZ-PINEIRO Maria Amalia;  SOARES Helena;  PETRILLO Mauro;  ALBERTINI Maria Cristina;  LANTHIER Nicolas;  GRENGA Lucia;  AMORIM Maria Joao; 

2022-10-24

MDPI

JRC129970

2077-0383 (online),   

https://www.mdpi.com/2077-0383/11/19/5691,    https://publications.jrc.ec.europa.eu/repository/handle/JRC129970,   

10.3390/jcm11195691 (online),