key: cord-0725784-n5q2yi7j
authors: Ji, Dong; Qin, Enqiang; Xu, Jing; Zhang, Dawei; Cheng, Gregory; Wang, Yudong; Lau, George
title: Reply to: ‘No evidence for an increased liver uptake of SARS-CoV-2 in metabolic associated fatty liver disease’
date: 2020-05-06
journal: J Hepatol
DOI: 10.1016/j.jhep.2020.04.039
sha: f028caa5972c129025c36bbffd371e6fff3f89f6
doc_id: 725784
cord_uid: n5q2yi7j

nan

We declare no competing interests. Secondly, this is in keeping to our hypothesis that dysregulated hepatic innate immunity in patients with MAFLD contribute to the pathogenesis of COVID-19.

Apart from lung alveolar epithelial cells, the enterocytes of the small intestine also have abundant expression of ACE2 receptors and thus could be another portal of entry to COVID-19. In keeping with this, gastrointestinal manifestations, such as diarrhoea and abdominal pain occurred in up to one-quarter of the COVID-19 patients, without cough. Overall about half of the COVID-19 patients were tested positive for SARS-CoV-2 RNA in fecal and respiratory specimen concomitantly. 2 The liver is enriched with innate immune cells (such as macrophages, natural killer, natural killer T, and γδ T cells) 3 and due to its rich blood supply from the small bowel, circulation of the virus via the hepatic reticular system is expected. Hepatic innate immunity populations are potent cytokine producers and there are reports that obesity and NAFLD were associated with increased production of pro-inflammatory cytokines like TNF-α by adipose cells and Kupffer cells. 4, 5 This may lead to increased likelihood of symptomatic SARS-CoV-2 infections and the high prevalence of NAFLD in our study populations. Further studies are required to enhance our understanding

No evidence for an increased liver uptake of SARS-CoV-2 in metabolic associated fatty liver disease

Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis

Liver: An Organ with Predominant Innate Immunity

Impact of Obesity on Influenza A Virus Pathogenesis, Immune Response, and Evolution. Front Immunol

Macrophages in obesity and non-alcoholic fatty liver disease: Crosstalk with metabolism

Prediction for Progression Risk in Patients with COVID-19 Pneumonia: the CALL Score

We acknowledge all patients and health-care workers involved in the diagnosis and treatment of patients with COVID-19 in our hospitals.

of the link between the dysregulated hepatic innate immunity and COVID-19. Is this the missing link of the well-recognized comorbidity risk factors, diabetes mellitus, obesity, chronic liver diseases and age and outcome of COVID-19 in human? 6