Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2021; 27(15): 1531-1552
Published online Apr 21, 2021. doi: 10.3748/wjg.v27.i15.1531
Impact of cytokine storm and systemic inflammation on liver impairment patients infected by SARS-CoV-2: Prospective therapeutic challenges
Fares E M Ali, Zuhair M Mohammedsaleh, Mahmoud M Ali, Osama M Ghogar
Fares E M Ali, Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
Zuhair M Mohammedsaleh, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
Mahmoud M Ali, Osama M Ghogar, Pre-graduated students, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
Author contributions: Ali FEM designed and critical wrote the manuscript; Mohammedsaleh ZM performed the manuscript proof editing and revision; Ali MM and Ghogar OM collected data and drafting the manuscript.
Conflict-of-interest statement: No potential conflicts of interest and financial support for this work.
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:
Corresponding author: Fares E M Ali, MSc, PhD, Lecturer, Research Scientist, Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Al-Azhar University Street, Assiut 71524, Egypt.
Received: January 26, 2021
Peer-review started: January 27, 2021
First decision: February 10, 2021
Revised: February 17, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: April 21, 2021

Coronavirus disease 2019 (COVID-19) is a devastating worldwide pandemic infection caused by a severe acute respiratory syndrome namely coronavirus 2 (SARS-CoV-2) that is associated with a high spreading and mortality rate. On the date this review was written, SARS-CoV-2 infected about 96 million people and killed about 2 million people. Several arguments disclosed the high mortality of COVID-19 due to acute respiratory distress syndrome or change in the amount of angiotensin-converting enzyme 2 (ACE2) receptor expression or cytokine storm strength production. In a similar pattern, hepatic impairment patients co-infected with SARS-CoV-2 exhibited overexpression of ACE2 receptors and cytokine storm overwhelming, which worsens the hepatic impairment and increases the mortality rate. In this review, the impact of SARS-CoV-2 on hepatic impairment conditions we overviewed. Besides, we focused on the recent studies that indicated cytokine storm as well as ACE2 as the main factors for high COVID-19 spreading and mortality while hinting at the potential therapeutic strategies.

Keywords: COVID-19, Hepatic impairment, SARS-CoV-2, Cytokine storm, Immuno-modulators receptors

Core Tip: Implications of fast coronavirus disease 2019 (COVID-19) outbreak are huge annoying problems that affected countries' health and economies around the world. Patients associated with hepatic impairment are considered at a high-risk target for severe acute respiratory syndrome namely coronavirus 2 severity and mortality. A good understanding of virus machinery provides excellent ideas about how to combat this monster. We provide detailed information about the recent mechanisms of COVID-19 pathogenesis, implications on several hepatic disorders, and potential therapeutic strategies.