Functional Immune Deficiency Syndrome via Intestinal Infection in COVID-19

Prates, Erica T.; Garvin, Michael R.; Pavicic, Mirko; Jones, Piet; Shah, Manesh; Alvarez, Christiane; Kainer, David; Demerdash, Omar; Amos, B Kirtley; Geiger, Armin; Pestian, John; Jin, Kang; Mitelpunkt, Alexis; Bardes, Eric; Aronow, Bruce; Jacobson, Daniel

Using a Systems Biology approach, we integrated genomic, transcriptomic, proteomic, and molecular structure information to provide a holistic understanding of the COVID-19 pandemic. The expression data analysis of the Renin Angiotensin System indicates mild nasal, oral or throat infections are likely and that the gastrointestinal tissues are a common primary target of SARS-CoV-2. Extreme symptoms in the lower respiratory system likely result from a secondary-infection possibly by a comorbidity-driven upregulation of ACE2 in the lung. The remarkable differences in expression of other RAS elements, the elimination of macrophages and the activation of cytokines in COVID-19 bronchoalveolar samples suggest that a functional immune deficiency is a critical outcome of COVID-19. We posit that using a non-respiratory system as a major pathway of infection is likely determining the unprecedented global spread of this coronavirus. One Sentence Summary A Systems Approach Indicates Non-respiratory Pathways of Infection as Key for the COVID-19 Pandemic