Evidence is emerging that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect various organs of the body, including cardiomyocytes and cardiac endothelial cells in the heart. This review focuses on the effects of SARS-CoV-2 in the heart after direct infection that can lead to myocarditis and an outline of potential treatment options. The main points are: (1) Viral entry: SARS-CoV-2 uses specific receptors and proteases for docking and priming in cardiac cells. Thus, different receptors or protease inhibitors might be effective in SARS-CoV-2-infected cardiac cells. (2) Viral replication: SARS-CoV-2 uses RNA-dependent RNA polymerase for replication. Drugs acting against ssRNA(+) viral replication for cardiac cells can be effective. (3) Autophagy and double-membrane vesicles: SARS-CoV-2 manipulates autophagy to inhibit viral clearance and promote SARS-CoV-2 replication by creating double-membrane vesicles as replication sites. (4) Immune response: Host immune response is manipulated to evade host cell attacks against SARS-CoV-2 and increased inflammation by dysregulating immune cells. Efficiency of immunosuppressive therapy must be elucidated. (5) Programmed cell death: SARS-CoV-2 inhibits programmed cell death in early stages and induces apoptosis, necroptosis, and pyroptosis in later stages. (6) Energy metabolism: SARS-CoV-2 infection leads to disturbed energy metabolism that in turn leads to a decrease in ATP production and ROS production. (7) Viroporins: SARS-CoV-2 creates viroporins that lead to an imbalance of ion homeostasis. This causes apoptosis, altered action potential, and arrhythmia.
【저자키워드】 SARS-CoV-2, Apoptosis, immune response, viroporin, myocarditis, treatment of viral infection, myocardial damage, viral replication, viral docking, energy metabolism, 【초록키워드】 Apoptosis, Inflammation, coronavirus, immune response, therapy, SARS-COV-2 infection, drug, docking, protease, severe acute respiratory syndrome Coronavirus, autophagy, viral entry, protease inhibitors, viral clearance, metabolism, arrhythmia, Replication, Protease inhibitor, Viral, Host immune response, cells, myocarditis, viral replication, energy metabolism, heart, endothelial cells, pyroptosis, RNA-dependent RNA polymerase, immune cells, Proteases, receptor, ATP, respiratory, early stage, SARS-CoV-2 replication, immunosuppressive therapy, Endothelial cell, Potential treatment, immunosuppressive, necroptosis, leads, lead, host cell, energy, Imbalance, programmed cell death, acute respiratory syndrome, action potential, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, stages, early stages, priming, ssRNA, organ, direct infection, ion homeostasis, ROS production, attack, infect, Effect, Vesicle, effective, Cell, decrease, inhibit, promote, induce, cause, evade, turn, acting, creating, 【제목키워드】 myocardial damage, damage,