SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas

Nat Metab. 2021 Feb;3(2):149-165. doi: 10.1038/s42255-021-00347-1. Epub 2021 Feb 3.

Abstract

Infection-related diabetes can arise as a result of virus-associated β-cell destruction. Clinical data suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19), impairs glucose homoeostasis, but experimental evidence that SARS-CoV-2 can infect pancreatic tissue has been lacking. In the present study, we show that SARS-CoV-2 infects cells of the human exocrine and endocrine pancreas ex vivo and in vivo. We demonstrate that human β-cells express viral entry proteins, and SARS-CoV-2 infects and replicates in cultured human islets. Infection is associated with morphological, transcriptional and functional changes, including reduced numbers of insulin-secretory granules in β-cells and impaired glucose-stimulated insulin secretion. In COVID-19 full-body postmortem examinations, we detected SARS-CoV-2 nucleocapsid protein in pancreatic exocrine cells, and in cells that stain positive for the β-cell marker NKX6.1 and are in close proximity to the islets of Langerhans in all four patients investigated. Our data identify the human pancreas as a target of SARS-CoV-2 infection and suggest that β-cell infection could contribute to the metabolic dysregulation observed in patients with COVID-19.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme 2 / biosynthesis
  • Angiotensin-Converting Enzyme 2 / genetics
  • COVID-19 / physiopathology
  • Cells, Cultured
  • Diabetes Mellitus
  • Female
  • Humans
  • Islets of Langerhans / cytology
  • Islets of Langerhans / physiopathology
  • Islets of Langerhans / virology*
  • Male
  • Pancreas, Exocrine / cytology
  • Pancreas, Exocrine / physiopathology
  • Pancreas, Exocrine / virology
  • Pancreatic Diseases / etiology
  • Pancreatic Diseases / virology
  • SARS-CoV-2 / growth & development*
  • Serine Endopeptidases / biosynthesis
  • Serine Endopeptidases / genetics
  • Virus Internalization
  • Virus Replication

Substances

  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • Serine Endopeptidases
  • TMPRSS2 protein, human