The demonstration of SARS-CoV-2 actively infecting human enterocytes and the gastrointestinal symptomology implicate gastrointestinal tract pathophysiology in COVID-19 infection. The digestive system possesses the body's site of greatest relative expression of ACE2, which in the gut exists as a tetramer with B0AT1 (SLC6A19). The ACE2:B0AT1 complex in the gut acts as a central player in local gut RAS and regulates uptake of glucose, sodium, water, and amino acids. However, ACE2:B0AT1 complex internalization by SARS-CoV-2 destabilizes the gastrointestinal tract's role in diabetes and blood pressure regulation. B0AT1 (SLC6A19) is the intestine's primary epithelial apical membrane transporter serving Na+-coupled uptake of neutral amino acids, such as tryptophan (PMID: 32669391).
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