Histopathological impact of SARS-CoV-2 on the liver:Cellular damage and long-term complications  

作　　者：Alfonso Rodriguez-Espada Moises Salgado-de la Mora Briana Mariette Rodriguez-Paniagua Nathaly Limonde la Rosa Monica Itzel Martinez-Gutierrez Santiago Pastrana-Brandes Nalu Navarro-Alvarez 

机构地区：[1]Department of Molecular Biology,Universidad Panamericana School of Medicine,Campus México,Mexico 03920,Mexico [2]Department of Internal Medicine,Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,Mexico 14080,Mexico [3]Department of Surgery,University of Colorado Anschutz Medical Campus,Denver,CO 80045,United States [4]PECEM,Facultad de Medicina,Universidad Nacional Autónoma de México,Mexico 04360,Mexico [5]Department of Gastroenterology,Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,Mexico 14080,Mexico

出　　处：《World Journal of Gastroenterology》2024年第22期2866-2880,共15页世界胃肠病学杂志（英文版）

摘　　要：Coronavirus disease 2019(COVID-19),caused by the highly pathogenic severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),primarily impacts the respiratory tract and can lead to severe outcomes such as acute respiratory distress syndrome,multiple organ failure,and death.Despite extensive studies on the pathogenicity of SARS-CoV-2,its impact on the hepatobiliary system remains unclear.While liver injury is commonly indicated by reduced albumin and elevated bilirubin and transaminase levels,the exact source of this damage is not fully understood.Proposed mechanisms for injury include direct cytotoxicity,collateral damage from inflammation,drug-induced liver injury,and ischemia/hypoxia.However,evidence often relies on blood tests with liver enzyme abnormalities.In this comprehensive review,we focused solely on the different histopathological manifestations of liver injury in COVID-19 patients,drawing from liver biopsies,complete autopsies,and in vitro liver analyses.We present evidence of the direct impact of SARS-CoV-2 on the liver,substantiated by in vitro observations of viral entry mechanisms and the actual presence of viral particles in liver samples resulting in a variety of cellular changes,including mitochondrial swelling,endoplasmic reticulum dilatation,and hepatocyte apoptosis.Additional ly,we describe the diverse liver pathology observed during COVID-19 infection,encompassing necrosis,steatosis,cholestasis,and lobular inflammation.We also discuss the emergence of long-term complications,notably COVID-19-related secondary sclerosing cholangitis.Recognizing the histopathological liver changes occurring during COVID-19 infection is pivotal for improving patient recovery and guiding decision-making.

关 键 词：LIVER SARS-CoV-2 COVID-19 Angiotensin-converting enzyme 2 HISTOPATHOLOGY Liver biopsies Liver autopsy In vitro 

分 类 号：R563.1[医药卫生—呼吸系统] R575[医药卫生—内科学]