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. 2021 Jun 7;18:120. doi: 10.1186/s12985-021-01578-0

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 3 — SARS-CoV causes damage to the gastrointestinal system through direct viremia (attachment to ACE2) receptors and inflammation. (1) In the gut, the virus binds to ACE2 receptors in the gut epithelium and enters the cells causing inflammation and damage to the epithelial cells. This can result in function of the epithelial cells and cause diarrhea [94]. Furthermore, it can disrupt the normal population of gut flora which has some important functions in the body including maintaining a balance between different organisms in the gut. SARS infection can disrupt this balance leading to diarrhea. Since the gut flora also has impact on respiratory flora and vice-versa, referred to as the gut lung axis, this also affects the flora of respiratory tract and hence lead to respiratory symptoms [95, 97]. (2) In the liver, viral attachment to ACE2 receptors cause upregulation of ACE2 receptors in hepatocytes leading to hepatocyte proliferation and resulting tissue injury [92]. (Image created with Biorender.com)