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Utilizing RNA sequencing and expression assessments, the authors of this study demonstrated that SARS-CoV-2 can infect and replicate within the glands and mucosa of the human oral cavity. Additionally, the authors found that saliva can serve as a vector for transmission of the virus in asymptomatic patients, and salivary viral load correlated with the degree of symptoms, namely loss of taste.
Prior to this study, it was unknown if SARS-CoV-2 could infect and replicate in the oral cavity. In addition to implicating the oral cavity as a potential source for transmission, this study indicates the need for additional evaluation of the interplay between the nasal and oral cavities in SARS-CoV-2 pathogenesis.
Despite signs of infection-including taste loss, dry mouth and mucosal lesions such as ulcerations, enanthema and macules-the involvement of the oral cavity in coronavirus disease 2019 (COVID-19) is poorly understood. To address this, we generated and analyzed two single-cell RNA sequencing datasets of the human minor salivary glands and gingiva (9 samples, 13,824 cells), identifying 50 cell clusters. Using integrated cell normalization and annotation, we classified 34 unique cell subpopulations between glands and gingiva. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral entry factors such as ACE2 and TMPRSS members were broadly enriched in epithelial cells of the glands and oral mucosae. Using orthogonal RNA and protein expression assessments, we confirmed SARS-CoV-2 infection in the glands and mucosae. Saliva from SARS-CoV-2-infected individuals harbored epithelial cells exhibiting ACE2 and TMPRSS expression and sustained SARS-CoV-2 infection. Acellular and cellular salivary fractions from asymptomatic individuals were found to transmit SARS-CoV-2 ex vivo. Matched nasopharyngeal and saliva samples displayed distinct viral shedding dynamics, and salivary viral burden correlated with COVID-19 symptoms, including taste loss. Upon recovery, this asymptomatic cohort exhibited sustained salivary IgG antibodies against SARS-CoV-2. Collectively, these data show that the oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a potential route of SARS-CoV-2 transmission.
SARS-CoV-2 Infection of the Oral Cavity and Saliva
Nat. Med. 2021 Mar 25;[EPub Ahead of Print], N Huang, P Pérez, T Kato, Y Mikami, K Okuda, RC Gilmore, CD Conde, B Gasmi, S Stein, M Beach, E Pelayo, JO Maldonado, BA Lafont, SI Jang, N Nasir, RJ Padilla, VA Murrah, R Maile, W Lovell, SM Wallet, NM Bowman, SL Meinig, MC Wolfgang, SN Choudhury, M Novotny, BD Aevermann, RH Scheuermann, G Cannon, CW Anderson, RE Lee, JT Marchesan, M Bush, M Freire, AJ Kimple, DL Herr, J Rabin, A Grazioli, S Das, BN French, T Pranzatelli, JA Chiorini, DE Kleiner, S Pittaluga, SM Hewitt, PD Burbelo, D Chertow, , , K Frank, J Lee, RC Boucher, SA Teichmann, BM Warner, KM Byrd