Highly ACE2 Expression in Pancreas May Cause Pancreas Damage After SARS-CoV-2 Infection

Abstract

The ongoing outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in the end of 2019 in China has triggered a global public health crisis. Previous studies have shown that SARS-CoV-2 infects cells by binding angiotensin-converting enzyme 2 (ACE2), which is the same as SARS-CoV. The expression and distribution of ACE2 in the pancreas are unknown. At the same time, the injury of pancreas after SARS-CoV-2 infection has not been concerned. Here, we collected public datasets (bulk RNA-seq and single-cell RNA-seq) to indicate the expression and the distribution of ACE2 in pancreas (in both exocrine glands and islets). And further, clinical data including mild and severe patients with COVID-19 demonstrated there existed mild pancreatitis. In the 67 severe cases, 11 patients (16.41%) showed elevated levels of both amylase and lipase, and 5 patients (7.46%) showed imaging alterations. Only one patient (1.85%) showed elevated levels of both amylase and lipase in 54 mild cases, without imaging changes. Our study revealed the phenomenon and possible cause of mild pancreatic injury in patients with COVID-19. This suggests that pancreatitis after SARS-CoV-2 infection should also be paid attention in clinical work.

Patients with COVID-19 Interstitial Pneumonia Exhibit Pancreatic Hyperenzymemia and Not Acute Pancreatitis

“…Pancreatic hyperenzymemia in these patients could result from various causes; pancreatic cells highly express angiotensin converting enzyme 2, the transmembrane protein required for SARS-CoV-2 entry [21], and the pancreatic renin-angiotensin system plays important endocrine and exocrine roles in hormone secretion [22] which could be the effect of drugs used for antiviral therapy. Even if no studies regarding the pancreas of COVID-19 patients have been found, a recent pathological report from China found that, even if the damage was located predominantly in the lungs, there were slight alterations in the pancreas, mainly represented by degeneration of some islet cells [23].…”

COVID-19 and the endocrine system: exploring the unexplored

“…The expression is seen on the exocrine pancreas as well as on the islets. Exocrine pancreatic injury is manifested as elevated serum amylase and/or lipase in 1-2% and 17% of patients with non-severe and severe COVID-19, respectively [2]. Although any major illness can be associated with stress-related hyperglycemia, Yang et al had reported that patients with SARS (caused by SARS-CoV, the 'cousin' of SARS-CoV-2) who had never received glucocorticoids had significantly higher fasting plasma glucose levels as compared to patients with non-SARS pneumonia [3].…”

“…This implies that apart from pneumocytes, the virus is freely available to interact with ACE2 expressed in other tissues. As a matter of fact, a number of endocrine organs do express ACE2, namely pancreas, thyroid, testis, ovary, adrenal glands and pituitary [2]. Even though one could expect endocrine repercussions due to interaction of SARS-CoV-2 with ACE2 expressed on these organs, there are no clinical/pre-clinical data as of yet.…”

Indications for Gastrointestinal Endoscopy during the COVID-19 Pandemic

“…There is some preliminary evidence that COVID-19 can cause pancreatic injury (in both exocrine glands and islets), as ACE2 is highly expressed in these cells. 35,36 COVID-19 infection can result in mild pancreatitis and abnormal blood glucose, and similarly severe acute respiratory syndrome (SARS) Corona virus can result in acute diabetes. [35][36][37] Therefore, it is a possibility that COVID-19 virus might be present in pancreatic fluid collections and can be potentially infectious.…”