COVID-19 and Liver Dysfunction
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The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has attracted increasing worldwide attention. Cases of liver damage or dysfunction (mainly characterized by moderately elevated serum aspartate aminotransferase levels) have been reported among patients with COVID-19.

However, it is currently uncertain whether the COVID-19- related liver damage/dysfunction is due mainly to the viral infection per se or other coexisting conditions, such as the use of potentially hepatotoxic drugs and the coexistence of systemic inflammatory response, respiratory distress syndrome induced hypoxia, and multiple organ dysfunction. Based on the current evidence from case reports and case series, this review article focuses on the treatment options for COVID-19 related liver dysfunction.

Treatment options for COVID-19-related liver dysfunction:

-Presently, there is no specific treatment for COVID-19 infection. Therefore, the cornerstone of COVID-19 management is patient isolation and supportive medical care where necessary, including pulmonary ventilation and prevention of the underlying inflammatory “storm” as well.32

-From the findings,Author believe that it is also reasonable to explore novel treatments for COVID-19 targeting of the ACE2 receptor. The ACE2 cellular receptor is highly expressed in human lung tissues, gastrointestinal tract, liver, vascular endothelial cells, and arterial smooth muscle cells.In addition, skin, nasal cavity, and oral mucosa basal cells also express the ACE2 receptor.

-All organs with high expression of the ACE2 receptor may be targeted by SARS-CoV-2 infection.Activation of the ACE2/Ang(1-7)/Mas signaling pathway or inhibition of the ACE/Ang II/ AT1R pathway could be potential pathways for the treatment of

-For SARS-CoV-2-infected patients, both ACE-inhibitorsand angiotensin-II-receptor antagonists might be used not only for treating high blood pressure but also for reducing systemic inflammatory response and improving patient mortality.

-Recently, Chen et al. reported that glycyrrhizic acid derivatives might also have antiviral activity against SARS-CoV-2.

-Glycyrrhizic acid is one of the first-line drugs for anti-inflammatory protection in liver disease, and it has been used in clinical practice for many years. In particular, glycyrrhizic
acid is a triterpene glycoside isolated from the root of the licorice plant.

-ACE2 is a cellular type I membrane protein that is mostly expressed in the lungs, heart, kidneys, and intestine.Full-length ACE2 consists of an N-terminal peptidase domain and a C-terminal collectrin-like domain that ends with a single trans-membrane helix and a ;40-residue intracellular segment.

-Glycyrrhizin has the potential to bind to ACE2 receptor with an estimated DG (kcal/mol) of -9, with the binding sites of ARG-559, GLN-388, ARG-393.

This list is a brief compilation of some of the key recommendations included in the document and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication in the document attached:
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