Study shows that reflux may increase the risk of death from Covid-19

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Since the world entered a crisis due to the pandemic, several researches have been carried out in Brazil. One of these was by the São Paulo State Research Support Foundation (Fapesp), which highlights: digestive disorders such as reflux and Barrett’s syndrome, a long-term reflux disease, may be associated with an increased risk of death from Covid-19.

According to the researchers, the attack on the esophagus by stomach acid would induce an increase in the expression of the ACE2 gene in the tissue, responsible for encoding the protein to which the new coronavirus binds to enter human cells.

The professor at the Faculty of Pharmaceutical Sciences at the University of São Paulo (FCF-USP) and research coordinator, Helder Nakaya, explains that esophageal cells have become more susceptible to infection by the coranavirus. “One of the most altered molecules was precisely the protein that the new coronavirus needs to enter cells, which is called ACE2”, he explained.

Nakaya says that the discovery occurred by a doctoral student Leandro Jimenez and other researchers who analyzed data from the transcriptome (set of RNA molecules expressed in a tissue) from patients with Barrett’s syndrome. “When we discovered that ACE2 was at high levels in people who had this disease, the possibility opened up that it could be an unknown comorbidity for Covid-19,” he said.

With the collaboration of Pedro Moraes-Vieira, professor at the Institute of Biology at the State University of Campinas (IB-Unicamp) and co-author of the article, in vitro experiments were conducted to test this hypothesis. “Reflux causes people to have greater acidity in the esophagus, this increase is related to greater expression of ACE2, which is the molecule that the virus enters our cells. It was what we saw in the laboratory ”, he reported.

The collaborator explained that cultures of human monocytes – defense cells present in the blood – were placed in media with different degrees of acidity and incubated with SARS-CoV-2. “We observed that in acid PH, the monocyte, expresses a greater amount of molecule, which is the gateway for the virus to enter our body. In addition to expressing more of this molecule that the virus uses to infect cells, when we play the coronavirus virus, we observe that it infects these monocytes more ”, he said.

Clinical evidence

Researcher Nakaya says that one of the steps to carry out the study was to analyze data from two groups of patients hospitalized for complications associated with Covid-19 – 551 in Manaus (AM) and 806 in São José do Rio Preto (SP) – and verify whether, in fact, there was an association between the severity of the disease and pre-existing gastric disorders.

According to Nakaya, among the people analyzed, it was observed that the fact that they have stomach problems increases the risk of death by Covid-19. For him, this work opens new perspectives in the understanding of the disease severity factors.

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