On the whereabouts of SARS-CoV-2 in the human body: A systematic review

PLoS Pathog. 2020 Oct 30;16(10):e1009037. doi: 10.1371/journal.ppat.1009037. eCollection 2020 Oct.

Abstract

Since SARS-CoV-2 appeared in the human population, the scientific community has scrambled to gather as much information as possible to find good strategies for the containment and treatment of this pandemic virus. Here, we performed a systematic review of the current (pre)published SARS-CoV-2 literature with a focus on the evidence concerning SARS-CoV-2 distribution in human tissues and viral shedding in body fluids. In addition, this evidence is aligned with published ACE2 entry-receptor (single cell) expression data across the human body to construct a viral distribution and ACE2 receptor body map. We highlight the broad organotropism of SARS-CoV-2, as many studies identified viral components (RNA, proteins) in multiple organs, including the pharynx, trachea, lungs, blood, heart, vessels, intestines, brain, male genitals and kidneys. This also implicates the presence of viral components in various body fluids such as mucus, saliva, urine, cerebrospinal fluid, semen and breast milk. The main SARS-CoV-2 entry receptor, ACE2, is expressed at different levels in multiple tissues throughout the human body, but its expression levels do not always correspond with SARS-CoV-2 detection, indicating that there is a complex interplay between virus and host. Together, these data shed new light on the current view of SARS-CoV-2 pathogenesis and lay the foundation for better diagnosis and treatment of COVID-19 patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Antiviral Agents / pharmacology*
  • Betacoronavirus / drug effects*
  • Betacoronavirus / pathogenicity
  • COVID-19
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / virology
  • Female
  • Humans
  • Lung / metabolism
  • Lung / virology*
  • Male
  • Pandemics
  • Peptidyl-Dipeptidase A / drug effects
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / virology
  • Receptors, Virus / drug effects
  • Receptors, Virus / metabolism
  • SARS-CoV-2

Substances

  • Antiviral Agents
  • Receptors, Virus
  • Peptidyl-Dipeptidase A

Grants and funding

The authors would like to acknowledge the support of following research grants: FWO clinical mandate (LV, grant 1.8.020.09.N.00), Collen-Francqui Research Professor Mandate (LV), FWO postdoctoral researcher (JVC, grant 12ZB921N) and doctoral assistant mandate of the Department of Internal Medicine and Pediatrics, Ghent University (WT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.