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World J Gastroenterol. Dec 14, 2021; 27(46): 7925-7942
Published online Dec 14, 2021. doi: 10.3748/wjg.v27.i46.7925
COVID-19 and gut immunomodulation
Koushik Roy, Sidra Agarwal, Rajib Banerjee, Manash K Paul, Prabhat K Purbey
Koushik Roy, Microbiology and Immunology, Department of Pathology, School of Medicine, University of Utah, Salt Lake City, UT 84112, United States
Sidra Agarwal, Department of Gastroenterology, Shadan Institute of Medical Sciences, Peeramcheru 500086, Telangana, India
Rajib Banerjee, Department of Electronics and Communication Engineering, Dr. B. C. Roy Engineering College, Durgapur 713206, West Bengal, India
Manash K Paul, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
Prabhat K Purbey, Department of Microbiology, Immunology and Molecular Genetics, University of California Los Angeles, Los Angeles, CA 90095, United States
Author contributions: Roy K and Agarwal S contributed equally; Roy K, Agarwal S, Banerjee R, Paul MK, and Purbey PK contributed to the draft preparation of the article; Paul MK and Purbey PK conceptualized and edited the article.
Conflict-of-interest statement: 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manash K Paul, PhD, Research Scientist, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, 700 Tiverton Ave (at Charles E. Young Dr. E.), Los Angeles, CA 90095, United States. manashp@ucla.edu
Received: February 18, 2021
Peer-review started: February 18, 2021
First decision: May 13, 2021
Revised: June 9, 2021
Accepted: November 29, 2021
Article in press: November 29, 2021
Published online: December 14, 2021
Processing time: 294 Days and 21.4 Hours
Core Tip

Core Tip: Coronavirus disease 2019 (COVID-19) is a global pandemic. Many COVID-19 patients either present gastrointestinal (GI) symptoms in addition to respiratory symptoms or just GI symptoms. Syndrome coronavirus 2 (SARS-CoV-2) directly infects GI epithelial cells as they express significant levels of angiotensin-converting enzyme-2 and transmembrane protease serine 2 protein, required for SARS-CoV-2 entry. This article reviews gut infection and GI immunomodulation by SARS-CoV-2, leading to spectrum of GI symptoms and pathogenesis in COVID-19-patients. Special emphases are given on the innate and acquired immune responses in the GI tract due to intestinal and non-intestinal SARS-CoV-2 infection, COVID-19 severity in people with pre-existing intestinal diseases, role of gut microbiota, and possible therapeutic interventions are discussed.