Physics

Internal medicine

Pathology

Virus

Pancreas

Disease

Coronavirus disease 2019 (COVID-19)

Infectious disease (medical specialty)

Diabetes mellitus

Biology

Endocrinology

Islet

Infiltration (HVAC)

Antibody

Virology

Immunohistochemistry

Immunology

Beta cell

Immunofluorescence

Pancreatic islets

Medicine

Immune system

Thermodynamics

Nature Communications

Metabolic diseases are associated with an increased risk of severe COVID-19 and conversely, new-onset hyperglycemia and complications of preexisting diabetes have been observed in COVID-19 patients. Here, we performed a comprehensive analysis of pancreatic autopsy tissue from COVID-19 patients using immunofluorescence, immunohistochemistry, RNA scope and electron microscopy and detected SARS-CoV-2 viral infiltration of beta-cells in all patients. Using SARS-CoV-2 pseudoviruses, we confirmed that isolated human islet cells are permissive to infection. In eleven COVID-19 patients, we examined the expression of ACE2, TMPRSS and other receptors and factors, such as DPP4, HMBG1 and NRP1, that might facilitate virus entry. Whereas 70% of the COVID-19 patients expressed ACE2 in the vasculature, only 30% displayed ACE2-expression in beta-cells. Even in the absence of manifest new-onset diabetes, necroptotic cell death, immune cell infiltration and SARS-CoV-2 viral infection of pancreatic beta-cells may contribute to varying degrees of metabolic dysregulation in patients with COVID-19.

Viral infiltration of pancreatic islets in patients with COVID-19