Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2022; 28(6): 683-688
Published online Feb 14, 2022. doi: 10.3748/wjg.v28.i6.683
COVID-19, liver dysfunction and pathophysiology: A conceptual discussion
Jucier Gonçalves Júnior
Jucier Gonçalves Júnior, Department of Internal Medicine, Division of Rheumatology, São Paulo University, São Paulo 01246-903, State, Brazil
Author contributions: The author worked on all aspects of manuscript preparation and has read and approved the final manuscript; The author meets the criteria for authorship established by the International Committee of Medical Journal Editors.
Conflict-of-interest statement: The author declares no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jucier Gonçalves Júnior, MD, PhD, Academic Research, Department of Internal Medicine, Division of Rheumatology, São Paulo University, Av. Dr. Arnaldo, 455, 3º Andar-Sala 3131 Cerqueira César, São Paulo 01246-903, State, Brazil. juciergjunior@hotmail.com
Received: July 18, 2021
Peer-review started: July 18, 2021
First decision: August 15, 2021
Revised: August 21, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 14, 2022
Processing time: 205 Days and 11.5 Hours
Abstract

The intra and extracellular pathways of hepatic injury by coronavirus disease 2019 (COVID-19) are still being studied. Understanding them is important to treat this viral disease and other liver and biliary tract disorders. Thus, this paper aims to present three hypotheses about liver injury caused by COVID-19: (1) The interactions between severe acute respiratory syndrome coronavirus 2 spike protein and membrane receptors in the hepatocyte; (2) The dysbiosis and “gut-liver axis” disruption in patients with serious clinical presentations of COVID-19; and (3) The inflammatory response exacerbated through the production of interleukins such as interleukin-6. However, despite these new perspectives, the pathophysiological process of liver injury caused by COVID-19 is still complex and multifactorial. Thus, understanding all these variables is a challenge to science but also the key to propose individualized and effective patient therapies.

Keywords: COVID-19; Intracellular signaling peptides and proteins; Immunopathology; Liver diseases; Liver injury; SARS-CoV-2

Core Tip: This paper aimed to present new hypotheses on the pathophysiology of liver injury caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Interactions between SARS-CoV-2 spike protein and other membrane receptors in the liver; “gut-liver axis” disruption and dysbiosis; and increased inflammatory process mediated by interleukin-6 and AT1R-metalloprotease 17 seem to be factors that contribute to such injury.