Multiorgan and Renal Tropism of SARS-CoV-2: NEJM Review
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preferentially infects cells in the respiratory tract, but its direct affinity for organs other than the lungs remains poorly defined. This report presents data from an autopsy series of 27 patients that show that SARS-CoV-2 can be detected in multiple organs, including the lungs, pharynx, heart, liver, brain, and kidneys.

SARS-CoV-2 viral load was first quantified in autopsy tissue samples obtained from 22 patients who had died from Covid-19. Seventeen patients (77%) had more than two coexisting conditions, and a greater number of coexisting conditions was associated with SARS-CoV-2 tropism for the kidneys, even in patients without a history of chronic kidney disease. The highest levels of SARS-CoV-2 copies per cell were detected in the respiratory tract, and lower levels were detected the kidneys, liver, heart, brain, and blood. These findings indicate a broad organotropism of SARS-CoV-2.

Since the kidneys are among the most common targets of SARS-CoV-2, a silico analysis of publicly available data sets of single-cell RNA sequencing was performed. This analysis revealed that RNA for angiotensin-converting enzyme 2 (ACE2), transmembrane serine protease 2 (TMPRSS2), and cathepsin L (CTSL) — RNA of genes that are considered to facilitate SARS-CoV-2 infection — is enriched in multiple kidney-cell types from fetal development through adulthood. This enrichment may facilitate SARS-CoV-2–associated kidney injury, as previously suggested.

On the basis of these findings, renal tropism is a potential explanation of commonly reported new clinical signs of kidney injury in patients with Covid-19, even in patients with SARS-CoV-2 infection who are not critically ill. These results indicate that SARS-CoV-2 has an organotropism beyond the respiratory tract, including the kidneys, liver, heart, and brain, and we speculate that organotropism influences the course of Covid-19 disease and, possibly, aggravates preexisting conditions.