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Deprecated: Implicit conversion from float 269.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Gastroenterology 2021 ; 160 (7): 2435-2450.e34 Nephropedia Template TP
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Intestinal Host Response to SARS-CoV-2 Infection and COVID-19 Outcomes in Patients With Gastrointestinal Symptoms #MMPMID33676971
Livanos AE; Jha D; Cossarini F; Gonzalez-Reiche AS; Tokuyama M; Aydillo T; Parigi TL; Ladinsky MS; Ramos I; Dunleavy K; Lee B; Dixon RE; Chen ST; Martinez-Delgado G; Nagula S; Bruce EA; Ko HM; Glicksberg BS; Nadkarni G; Pujadas E; Reidy J; Naymagon S; Grinspan A; Ahmad J; Tankelevich M; Bram Y; Gordon R; Sharma K; Houldsworth J; Britton GJ; Chen-Liaw A; Spindler MP; Plitt T; Wang P; Cerutti A; Faith JJ; Colombel JF; Kenigsberg E; Argmann C; Merad M; Gnjatic S; Harpaz N; Danese S; Cordon-Cardo C; Rahman A; Schwartz RE; Kumta NA; Aghemo A; Bjorkman PJ; Petralia F; van Bakel H; Garcia-Sastre A; Mehandru S
Gastroenterology 2021[Jun]; 160 (7): 2435-2450.e34 PMID33676971show ga
BACKGROUND & AIMS: Given that gastrointestinal (GI) symptoms are a prominent extrapulmonary manifestation of COVID-19, we investigated intestinal infection with SARS-CoV-2, its effect on pathogenesis, and clinical significance. METHODS: Human intestinal biopsy tissues were obtained from patients with COVID-19 (n = 19) and uninfected control individuals (n = 10) for microscopic examination, cytometry by time of flight analyses, and RNA sequencing. Additionally, disease severity and mortality were examined in patients with and without GI symptoms in 2 large, independent cohorts of hospitalized patients in the United States (N = 634) and Europe (N = 287) using multivariate logistic regressions. RESULTS: COVID-19 case patients and control individuals in the biopsy cohort were comparable for age, sex, rates of hospitalization, and relevant comorbid conditions. SARS-CoV-2 was detected in small intestinal epithelial cells by immunofluorescence staining or electron microscopy in 15 of 17 patients studied. High-dimensional analyses of GI tissues showed low levels of inflammation, including down-regulation of key inflammatory genes including IFNG, CXCL8, CXCL2, and IL1B and reduced frequencies of proinflammatory dendritic cells compared with control individuals. Consistent with these findings, we found a significant reduction in disease severity and mortality in patients presenting with GI symptoms that was independent of sex, age, and comorbid illnesses and despite similar nasopharyngeal SARS-CoV-2 viral loads. Furthermore, there was reduced levels of key inflammatory proteins in circulation in patients with GI symptoms. CONCLUSIONS: These data highlight the absence of a proinflammatory response in the GI tract despite detection of SARS-CoV-2. In parallel, reduced mortality in patients with COVID-19 presenting with GI symptoms was observed. A potential role of the GI tract in attenuating SARS-CoV-2-associated inflammation needs to be further examined.