SARS-CoV-2, the virus that causes COVID-19, elicits both acute and chronic damage to the lungs and heart. Other parts of the body may be affected, too, including the kidneys, brain, skin, and olfactory tissues. Evidence from a recent study indicates that SARS-CoV-2 infects pancreatic beta cells, increasing the risk of developing diabetes.
Pancreatic beta cells are endocrine cells that produce, store, and release insulin. Beta cell failure and death are hallmarks of type 1 and type 2 diabetes. Multiple factors can promote beta cell death, including viral infection and hyperglycemia (high blood glucose), among others. Cases of new-onset diabetes, hyperglycemia, and diabetic ketoacidosis (a life-threatening condition that can accompany hyperglycemia) in people who have had COVID-19 are on the rise.
The SARS-CoV-2 virus exploits the ACE2 receptor to gain entry into cells and replicate. The ACE2 receptor is widely distributed in the body’s tissues, including pancreatic tissues. Other cellular factors involved in SARS-CoV-2 entry include transmembrane serine protease 2, transferrin receptor, and neuropilin 1. Neuropilin 1 participates in pain sensing and angiogenesis (the development of new blood vessels) and is a receptor for vascular endothelial growth factor-A.
The authors of the study collected pancreatic islet cells from healthy organ donors and from patients who had died from COVID-19 (collected during autopsy). They infected the cells with SARS-CoV-2 and performed various assays to determine the presence of cellular factors that contribute to infection. They measured insulin levels and glucose-stimulated insulin secretion, a measure of beta cell insulin release, in the infected cells.
They determined that SARS-CoV-2 infects beta cells, and this infection promotes beta cell death and decreases insulin release. They also found that beta cells express ACE2, transmembrane serine protease 2, transferrin receptor, and neuropilin 1. They posited that neuropilin 1, and possibly transferrin receptor, provide the stimulus for SARS-CoV-2 entry into beta cells.
These findings demonstrate that SARS-CoV-2 promotes beta cell death and may increase the risk of developing diabetes associated with COVID-19 illness. Learn about some of the other complications associated with COVID-19 in this episode featuring Dr. Roger Seheult.
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