Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. May 25, 2021; 10(3): 86-96
Published online May 25, 2021. doi: 10.5501/wjv.v10.i3.86
Angiotensin-converting enzyme 2 receptors, chronic liver diseases, common medications, and clinical outcomes in coronavirus disease 2019 patients
Wattana Leowattana
Wattana Leowattana, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Author contributions: Leowattana W collected the data and wrote the paper.
Conflict-of-interest statement: The author declares no conflict of interest for this article.
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: Wattana Leowattana, BSc, MD, MSc, PhD, Associate Professor, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Rachatawee, Bangkok 10400, Thailand.
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: February 24, 2021
Revised: March 10, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: May 25, 2021

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), enters affected cells through the angiotensin-converting enzyme 2 (ACE2) receptor, which is highly expressed in type II alveolar cells, enterocytes, and cholangiocytes. SARS-CoV-2 infection causes fever, dry cough, and breathing difficulty, which can progress to respiratory distress due to interstitial pneumonia, and hepatobiliary injury due to COVID-19 is increasingly recognized. The hepatobiliary injury may be evident at presentation of the disease or develop during the disease progression. The development of more severe clinical outcomes in patients with chronic liver diseases (CLD) with or without cirrhosis infected with SARS-CoV-2 has not been elucidated. Moreover, there is limited data related to common medications that affect the disease severity of COVID-19 patients. Additionally, ACE2 receptor expression of hepatobiliary tissue related to the disease severity also have not been clarified. This review summarized the current situation regarding the clinical outcomes of COVID-19 patients with chronic liver diseases who were treated with common medications. Furthermore, the association between ACE2 receptor expression and disease severity in these patients is discussed.

Keywords: SARS-CoV-2, COVID-19, Hepatobiliary tissue, Angiotensin converting enzyme 2, Chronic liver disease, Common medications, Clinical outcome

Core Tip: With more than 100 million confirmed cases worldwide, hepatobiliary injury has been reported in many coronavirus disease 2019 (COVID-19) patients. The association between COVID-19 and hepatobiliary injury refers to any hepatobiliary damage during disease progression and treatment in COVID-19 patients with or without chronic liver diseases or common medications. Angiotensin-converting enzyme 2 receptor may be a significant factor in hepatobiliary derangement due to its high expression in cholangiocytes, and it is also an entry point of severe acute respiratory syndrome coronaviruses 2. Moreover, drug-induced liver injury and cytokine storm may be an added risk in severe clinical outcomes. Close monitoring of liver function in COVID-19 patients is mandatory.