Copyright ©The Author(s) 2021.
World J Gastroenterol. Sep 14, 2021; 27(34): 5630-5665
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5630
Figure 2
Figure 2 Possible mechanisms of acute liver damage by severe acute respiratory syndrome-coronavirus-2 infection. Direct damage to the hepatocyte is does not occur because it does not possess the viral entry receptor. However, indirect damage-associated with the immune response against viral antigens, cytokine storm, pre-existing liver diseases such as hepatitis A, B, and C viruses infection, and treatment with hepatotoxic drugs like acetaminophen, remdesivir, lopinavir, etc. has been characterized. In severely affected patients, oxygen deficiency can give rise to hypoxic hepatitis. Severe acute respiratory syndrome-coronavirus-2 damage to cholangiocytes has been documented, because they both possess the angiotensin-converting enzyme 2 and transmembrane protease serine 2 receptors. Created with ACE2: Angiotensin-converting enzyme 2; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DILI: Drug-induced liver injury; FA: Alkaline phosphatase; GGT: Gamma-glutamyl transferase;SARS-CoV-2: Severe acute respiratory syndrome-coronavirus-2; TBIL: Total bilirubin; TMPRSS2: Transmembrane protease serine 2.