Viral infiltration of pancreatic islets in patients with COVID-19

Nat Commun. 2021 Jun 10;12(1):3534. doi: 10.1038/s41467-021-23886-3.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angiotensin-Converting Enzyme 2 / metabolism*
  • Autopsy
  • COVID-19 / pathology*
  • Diabetes Complications / pathology
  • Diabetes Complications / virology
  • Diabetes Mellitus / pathology
  • Dipeptidyl Peptidase 4 / metabolism
  • Female
  • HMGN Proteins / metabolism
  • Humans
  • Insulin-Secreting Cells / metabolism
  • Insulin-Secreting Cells / virology*
  • Male
  • Middle Aged
  • Neuropilin-1 / metabolism
  • Organ Specificity / physiology
  • Receptors, Coronavirus / metabolism*
  • SARS-CoV-2 / isolation & purification*
  • Serine Endopeptidases / metabolism*


  • HMGN Proteins
  • NRP1 protein, human
  • Receptors, Coronavirus
  • Neuropilin-1
  • DPP4 protein, human
  • Dipeptidyl Peptidase 4
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • Serine Endopeptidases
  • HPN protein, human