Magnitskaya E.A., Speranskaya E.M., Golubtsova N.N.
Morphological features of the human liver when exposed to SARS-CoV-2 (literature review)
Keywords: liver, hepatocytes, Ito cells, Kupffer macrophages, pit cells, SARS-CoV-2
The review article presents the results of modern scientific research on morphological changes in the liver when exposed to the SARS-CoV-2 virus. The purpose of the review is to summarize scientific data on the effect of the new coronavirus infection on the cellular structures of the liver lobule. The liver is a parenchymal organ that is responsible for many functions, including metabolism, immunity, digestion, detoxification and vitamin accumulation. It makes up approximately 2% of an adult's body weight. The uniqueness of the liver lies in its ability to regenerate and the presence of a dual blood supply. The study of the morphological features of this parenchymal organ when SARS-CoV-2 penetrates it is of great importance for medicine. The data obtained will expand understanding of the pathogenesis of SARS-CoV-2 viral infection, identify and develop treatment methods and reduce the number of complications in this disease. The scientific publications dated 2020-2025 from the databases of the electronic scientific libraries "PubMed", "eLIBRARY.RU" were analyzed, they were selected by the following key words: hepatocytes, Ito cells, Kupffer macrophages, pit cells, SARS-CoV-2. The issue of pathological changes in parenchymal organs and their reparative regeneration during drug treatment after a new coronavirus infection remains relevant, which determines the scientific novelty of this review.
References
- Blinkova N.B., Sazonov S.V., Leont’ev S.L. Poliploidiya gepatotsitov v regeneratsii pecheni pri khronicheskom gepatite u patsientov iz raznykh vozrastnykh grupp [Polyploidy of hepatocytes in liver regeneration in chronic hepatitis in patients of different age groups]. Moscow, 2017, 104 p.
- Meshcheryakova I.E., Il’ina A.R., Lin’kova N.S. et al. Vozrastnaya patologiya pecheni: molekulyarnye markery i perspektivnye gepatoprotektory [Age-related liver pathology: molecular markers and promising hepatoprotectors]. Vrach, 2020, vol. 31, no. 6, pp. 16–23.
- El’chaninov A.V., Fatkhudinov T.Kh. Regeneratsiya pecheni mlekopitayushchikh: mezhkletochnye vzaimodeistviya [Mammalian liver regeneration: intercellular interactions]. Moscow, Nauka Publ., 2020, 125 p.
- Mnatsakanyan M.G., Pogromov A.P., Lishuta A.S. et al. Mekhanizmy povrezhdeniya pecheni pri COVID-19 [Mechanisms of liver damage in COVID-19]. Terapevticheskii arkhiv, 2021, vol. 93, no. 4, pp. 427–430.
- Pinchuk T.V., Orlova N.V., Suranova T.G., Bonkalo T.I. Mekhanizmy porazheniya pecheni pri COVID-19 [Mechanisms of liver damage in COVID-19]. Meditsinskii alfavit, 2020, no. 19, pp. 39–46.
- Mekhtiev S.N., Mekhtieva O.A., Berko O.M. Porazhenie pecheni pri COVID-19: epidemiologiya, patogenez, lechenie [Liver damage in COVID-19: epidemiology, pathogenesis, treatment]. Effektivnaya farmakoterapiya, 2022, no. 18, pp. 86–92.
- Aggarwal R., Goel A. Hepatitis A: epidemiology in resource-poor countries. Opin. Infect. Dis., 2015, vol. 28, no. 5, pp. 488–496. DOI: 10.1097/QCO.0000000000000188.
- Akbari H., Taghizadeh-Hesary F. COVID-19 induced liver injury from a new perspective: Mitochondria. Mitochondrion, 2023, vol. 70, pp. 103–110. DOI: 10.1016/j.mito.2023.04.001.
- Alexander E.C., Deep A. Characterization of a Hepatitis Outbreak in Children. JAMA Netw. Open, 2022, vol. 3, pp. 5–10. DOI: 10.1001/jamanetworkopen.2022.37091.
- Baroiu L., Dumitru C., Iancu A. et al. COVID-19 impact on the liver. World J. Clin. Cases, 2021, vol. 9, no. 16, pp. 3814–3825. DOI: 10.12998/wjcc.v9.i16.3814.
- Beigmohammadi M.T., Jahanbin B., Safaei M. et al. Pathological Findings of Postmortem Biopsies From Lung, Heart, and Liver of 7 Deceased COVID-19 Patients. J. Surg. Pathol., 2021, vol. 29, no. 2, pp. 135–145. DOI: 10.1177/1066896920935195.
- Biassoni R., Malnati M.S. Human Natural Killer Receptors, Co-Receptors, and Their Ligands. Protoc. Immunol., 2018, vol. 121, no. 1, e47. DOI: 10.1002/cpim.47.
- Borges V.F.A., Cotrim H.P., Andrade A. et al. COVID-19-Related Cholangiopathy: Histological Findings. Diagnostics, 2024, vol. 14, no. 16, 1804. DOI: 10.3390/diagnostics14161804.
- Braet F., Wisse E. Structural and functional aspects of liver sinusoidal endothelial cell fenestrae: a review. Hepatol., 2002, vol. 23, no. 1, 1. DOI: 10.1186/1476-5926-1-1.
- Cao J., Wang L., Yu C. et al. Development of an antibody-dependent cellular cytotoxicity reporter assay for measuring anti-Middle East Respiratory Syndrome antibody bioactivity. Rep., 2020, vol. 6, no. 1, 16615. DOI: 10.1038/s41598-020-73960-x.
- Deshmukh V., Motwani R., Kumar A. et al. Histopathological observations in COVID-19: a systematic review. Clin. Pathol., 2021, vol. 74, no. 2, pp. 76–83. DOI: 10.1136/jclinpath-2020-206995.
- Dixon L.J., Barnes M., Tang H. et al. Kupffer cells in the liver. Physiol., 2013, vol. 3, no. 2, pp. 785–797. DOI: 10.1002/cphy.c120026.
- Dominik F., Katarzyna Z., Konrad K. et al. Overreactive macrophages in SARS-CoV-2 infection: The effects of ACEI. Int. Immunopharmacol., 2023, vol. 123, pp. 110858. DOI: 10.1016/j.intimp.2023.110858.
- Dousari A.S., Hosseininasab S.S., Dousari F.S. et al. The impact of COVID-19 on liver injury in various age. World J. Virol., 2023, vol. 12, no. 2, pp. 91–99. DOI: 10.5501/wjv.v12.i2.91.
- Drescher H., Bartsch L., Weiskirchen S. et al. Intrahepatic TH17/TReg cells in homeostasis and disease-it’s all about the balance. Front. , 2020, vol. 11, 588436. DOI: 10.3389/fphar.2020.588436.
- Effenberger M., Grander C., Grabherr F. et al. Systemic inflammation as fuel for acute liver injury in COVID-19. Liver Dis., 2021, vol. 53, pp. 158–165.
- El-Ghiaty M.A., Shoieb S.M., El-Kadi A.O.S. Cytochrome P450-mediated drug interactions in COVID-19 patients: Current findings and possible mechanisms. Hypotheses, 2020, vol. 144, 110033. DOI: 10.1016/j.mehy.2020.110033.
- Gong J., Tu W., Liu J. et al. Hepatocytes: A key role in liver inflammation. Immunol., 2023, vol. 14, 1083780. DOI: 10.3389/fimmu.2022.1083780.
- Haruki S., Naosuke K., Mitsuru S. Vitamin A-Storing Cells (Stellate Cells). Horm., 2007, vol. 75, pp. 131–159. DOI: 10.1016/S0083-6729(06)75005-4.
- Hellerbrand C. Hepatic stellate cells–the pericytes in the liver. Pflugers Arch., 2013, vol. 465, no. 6, pp. 775–778. DOI: 10.1007/s00424-012-1209-5.
- Hojyo S., Uchida M., Tanaka K. et al. How COVID-19 induces cytokine storm with high mortality. Regen., 2020, vol. 40, no. 1, pp. 37–40. DOI: 10.1186/s41232-020-00146-3.
- Hora S., Wuestefeld T. Liver Injury and Regeneration: Current Understanding, New Approaches, and Future Perspectives. Cells, 2023, vol. 12, no. 17, 2129. DOI: 10.3390/cells12172129.
- Ippolito D., Maino C., Vernuccio F. et al. Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features. World J. Gastroenterol., 2023, vol. 29, no. 5, pp. 834–850. DOI: 10.3748/wjg.v29.i5.834.
- Jindal A., Jagdish R.K., Kumar A. Hepatic Regeneration in Cirrhosis. J. Clin. Hepatol., 2022, vol. 12, no. 2, pp. 603–616. DOI: 10.1016/j.jceh.2021.08.029.
- Karlafti E., Paramythiotis D., Pantazi K. et al. Drug-Induced Liver Injury in Hospitalized Patients during SARS-CoV-2 Infection. Medicina (Kaunas), 2022, vol. 58, no. 12, 1848. DOI: 10.3390/medicina58121848.
- Kleiner D.E. Liver Biopsy Shines a Light on COVID-19-Related Liver Injury. Mol. Gastroenterol. Hepatol., 2021, vol. 11, no. 3, pp. 881–882. DOI: 10.1016/j.jcmgh.2020.10.003.
- Kolesova O., Vanaga I., Laivacuma S. et al. Intriguing findings of liver fibrosis following COVID- BMC Gastroenterol., 2021, vol. 21, 370. DOI: 10.1186/s12876-021-01939-7.
- Kondo R., Kawaguchi N., McConnell M.J. et al. Pathological characteristics of liver sinusoidal thrombosis in COVID-19 patients. Res., 2021, vol. 51, no. 9, pp. 1000–1006. DOI: 10.1111/hepr.13696.
- Krishna M. Microscopic anatomy of the liver. Liver Dis. (Hoboken), 2013, vol. 29, no. 2, pp. S4–S7. DOI: 10.1002/cld.147.
- Lagana S.M., Kudose S., Iuga A.C. et al. Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data. Pathol., 2020, vol. 33, no. 11, pp. 2147–2155. DOI: 10.1038/s41379-020-00649-x.
- Li Y., Xiao S.Y. Hepatic involvement in COVID-19 patients: Pathology, pathogenesis, and clinical implications. Med. Virol., 2020, vol. 92, no. 9, pp. 1491–1494. DOI: 10.1002/jmv.25973.
- Lozano-Sepulveda S.A., Galan-Huerta K., Martínez-Acuña N. et al. SARS-CoV-2 another kind of liver aggressor, how does it do that? Hepatol., 2020, vol. 19, no. 6, pp. 592–596. DOI: 10.1016/j.aohep.2020.08.062.
- Luedde T., Kaplowitz N., Schwabe R. Cell death and cell death responses in liver disease: mechanisms and clinical relevance. Gastroenterology, 2014, vol. 147, no. 4, pp. 765–783. DOI: 10.1053/j.gastro.2014.07.018.
- Ma X., Huang T., Chen X. et al. Molecular mechanisms in liver repair and regeneration: from physiology to therapeutics. Signal Transduct. Target Ther., 2025, vol. 10, no. 1, pp. 63. DOI: 10.1038/s41392-024-02104-8.
- Market M., Angka L., Martel A.B. et al. Flattening the COVID-19 Curve With Natural Killer Cell Based Immunotherapies. Immunol., 2020, vol. 11, 1512. DOI: 10.3389/fimmu.2020.01512.
- Mehta P., McAuley D.F., Brown M. et al. UK COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet, 2020, vol. 395, pp. 1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.
- Metawea M.I., Yousif W.I., Moheb I. COVID 19 and liver: An A-Z literature review. Liver Dis., 2021, vol. 53, pp. 146–152. DOI: 10.1016/j.dld.2020.09.011.
- Michael L., Diana N., Catia T. et al. The immune niche of the liver. Sci. (Lond)., 2021, vol. 135, no. 20, pp. 2445–2466. DOI: 10.1042/CS20190654.
- Moretta L., Montaldo E., Vacca P. et al. Human natural killer cells: origin, receptors, function, and clinical applications. Arch. Allergy Immunol., 2014, vol. 164, no. 4, pp. 53–64. DOI: 10.1159/000365632.
- Nasir N., Khanum I., Habib K. et al. Insight into COVID-19 associated liver injury: Mechanisms, evaluation, and clinical implications. Forum, 2024, vol. 5, no. 3, pp. 139–149. DOI: 10.14744/hf.2023.2023.0025.
- Nguyen-Lefebvre A.T., Horuzsko A. Kupffer Cell Metabolism and Function. Enzymol. Metab., 2015, vol. 1, no. 1, 101. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4771376.
- Ozaki M. Cellular and molecular mechanisms of liver regeneration. Cell Dev. Biol., 2020, vol. 100, pp. 62–73. DOI: 10.1016/j.semcdb.2019.10.007.
- Petrov S., Taskov H., Murdjeva M. Guardians of immunity: NK cell-mediated defense in COVID-19 and post-COVID scenarios. Folia Med., 2024, vol. 66, no. 1, pp. 12–18. DOI: 10.3897/folmed.66.e113356.
- Rahman A., Niloofa R., Jayarajah U. et al. Hematological Abnormalities in COVID-19: A Narrative Review. J. Trop. Med. Hyg., 2021, vol. 104, no. 4, pp. 1188–1201. DOI: 10.4269/ajtmh.20-1536.
- Ridruejo E., Soza A. The liver in times of COVID-19: What hepatologists should know. Hepatol., 2020, vol. 19, no. 4, pp. 353–358. DOI: 10.1016/j.aohep.2020.05.001.
- Rinella M.E. Nonalcoholic fatty liver disease: a systematic review. JAMA, 2015, vol. 313, no. 22, pp. 2263–2273. DOI: 10.1001/jama.2015.5370.
- Sakellariou S., Michaelides C., Voulgaris T. et al. Keratin 7 expression in hepatic cholestatic diseases. Virchows Arch., 2021, vol. 479, no. 4, pp. 815–824. DOI: 10.1007/s00428-021-03152-z.
- Sodeifian F., Seyedalhosseini Z.S., Kian N. et al. Drug-Induced Liver Injury in COVID-19 Patients: A Systematic Review. Med. (Lausanne), 2021, vol. 8, Art. 731436. DOI: 10.3389/fmed.2021.731436.
- Stapelbroek J.M., van Erpecum K.J., Klomp L.W. et al. Liver disease associated with canalicular transport defects: current and future therapies. Hepatol., 2010, vol. 52, no. 2, pp. 258–271. DOI: 10.1016/j.jhep.2009.11.012.
- Trefts E., Gannon M., Wasserman D.H. The liver. Biol., 2017, vol. 27, no. 21, pp. 1147–1151. DOI: 10.1016/j.cub.2017.09.019.
- Tu T., Calabro S.R., Lee A. et al. Hepatocytes in liver injury: Victim, bystander, or accomplice in progressive fibrosis? Gastroenterol. Hepatol., 2015, vol. 30, no. 12, pp. 1696–1704. DOI: 10.1111/jgh.13065.
- Veerankutty F.H., Sengupta K., Vij M. et al. Post-COVID-19 cholangiopathy: Current understanding and management options. World J. Gastrointest. Surg., 2023, vol. 15, no. 5, pp. 788–798. DOI: 10.4240/wjgs.v15.i5.788.
- Vekemans K., Braet F. Structural and functional aspects of the liver and liver sinusoidal cells in relation to colon carcinoma metastasis. World J. Gastroenterol., 2005, vol. 11, no. 33, pp. 95–102. DOI: 10.3748/wjg.v11.i33.5095.
- Wang M., Feng Z. Mechanisms of Hepatocellular Injury in Hepatitis A. Viruses, 2021, vol. 13, no. 5, 861. DOI: 10.3390/v13050861.
- Wang N., Guo M., Zhang C. et al. Liver regeneration: unraveling the molecular mechanisms and clinical application. Transl. Med., 2025, vol. 23, no. 1, 1409. DOI: 10.1186/s12967-025-07412-3.
- Wang Y., Liu S., Liu H. et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19. Hepatol., 2020, vol. 73, no. 4, pp. 807–816. DOI: 10.1016/j.jhep.2020.05.002.
- Xu Z., Shi L., Wang Y. et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med., 2020, vol. 8(4), pp. 420–422. DOI: 10.1016/S2213-2600(20)30076-X.
- Yadlapati S., Jarrett S.A., Baik D. et al. COVID-19 related biliary injury: A review of recent literature. World J. Gastroenterol., 2023, vol. 29(14), pp. 2127–2133. DOI: 10.3748/wjg.v29.i14.2127.
- Zafarani A., Razizadeh M.H., Pashangzadeh S. et al. Natural killer cells in COVID-19: from infection, to vaccination and therapy. Future Virol., 2023, vol. 18, pp. 22–40. DOI: 10.2217/fvl-2022-0040.
- Zghal M., Bouhamed M., Mellouli M. et al. Liver injury in COVID-19: pathological findings. Pan Afr. Med. J., 2022, vol. 41, 56. DOI: 10.11604/pamj.2022.41.56.31114.
- Zhang C., Shi L., Wang F.S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol. Hepatol., 2020, vol. 5(5), pp. 428–430. DOI: 10.1016/S2468-1253(20)30057-1.
- Zhou Z., Xu M.J., Gao B. Hepatocytes: a key cell type for innate immunity. Mol. Immunol., 2016, vol. 13(3), pp. 301–315. DOI: 10.1038/cmi.2015.97.
- Zuniga-Aguilar E., Ramirez-Fernandez O. Fibrosis and hepatic regeneration mechanism. Gastroenterol. Hepatol., 2022, vol. 7, 9. DOI: 10.21037/tgh.2020.02.21.
About authors
- Magnitskaya Ekaterina A.
- Senior Lecturer, Department of Propaedeutics of Internal Medicine with a Course in Radiology, Chuvash State University, Russia, Cheboksary (razbirinae@mail.ru; ORCID: https://orcid.org/0000-0003-3189-0360)
- Speranskaya Ekaterina M.
- Candidate of Medical Sciences, Associate Professor, Department of General and Clinical Morphology and Forensic Medicine, Chuvash State University, Russia, Cheboksary (ne28@bk.ru; ORCID: https://orcid.org/0000-0003-0946-3434)
- Golubtsova Natalya N.
- Doctor of Biological Sciences, Associate Professor, Head of the Department of General and Clinical Morphology and Forensic Medicine, Chuvash State University, Russia, Cheboksary (golubnata@list.ru; ORCID: https://orcid.org/0000-0002-5436-1333)
Article link
Magnitskaya E.A., Speranskaya E.M., Golubtsova N.N. Morphological features of the human liver when exposed to SARS-CoV-2 (literature review) [Electronic resource] // Acta medica Eurasica. – 2026. – №3. P. 87-100. – URL: https://acta-medica-eurasica.ru/en/single/2026/3/10/. DOI: 10.47026/2413-4864-2026-3-87-100.
Copyright holder: authors. License: Attribution 4.0 International (CC BY 4.0)