Relevance of enriched expression of SARS-CoV-2 binding receptor ACE2 in gastrointestinal tissue with pathogenesis of digestive symptoms, diabetes-associated mortality, and disease recurrence in COVID-19 patients

Ashutosh Kumar; Muneeb A. Faiq; Vikas Pareek; Khursheed Raza; Ravi K. Narayan; Pranav Prasoon; Pavan Kumar; Maheswari Kulandhasamy; Chiman Kumari; Kamla Kant; Himanshu N. Singh; Rizwana Qadri; Sada N. Pandey; Santosh Kumar

Existing literature on the role of ACE2 in regulation of the ion transporters which maintain secretion/absorption across intestinal epithelium provide a clue that digestive symptoms in COVID-19 may have an ACE2 based etiogenesis. [9] [10] [11] [12] Investigating the ACE2 expression pattern of digestive system components may also help to explain exacerbated diabetic complications and mortality in COVID-19 patients. Diabetes has been noted as a co-morbidity (16.2%) in COVID-19 and has contributed to increased mortality (22%). 13 Existing literature implicates ACE2 mediated dysregulation of sodium dependent glucose transporter (SGLT1 or SLC5A1) at intestinal epithelium in the pathogenesis of the diabetes mellitus. 14, 15 In this study, we aim at examining the plausibility (based on the tissue specific expression of ACE2) whether any of the digestive system components can be involved in the continued replication of the SARS-CoV-2 after pulmonary symptoms are relieved.