COVID-19: Infection of bat and human intestinal organoids by SARS-CoV-2.

COVID-19: Infection of bat and human intestinal organoids by SARS-CoV-2. Spencer EA, Heneghan C.

Published on July 9, 2020

Reference Zhou J, Li C, Liu X, et al. Infection of bat and human intestinal organoids by SARS-CoV-2 [published online ahead of print, 2020 May 13]. Nat Med. 2020;10.1038/s41591-020-0912-6. 2020
Study type
Country N/A
Setting Laboratory
Funding Details Health and Medical Research Fund of the Food and Health Bureau of the Hong Kong Special Administrative Region; the High-Level Hospital-Summit Program in Guangdong; and donations from the Shaw Foundation Hong Kong
Transmission mode Orofecal
Exposures N/A

Bottom Line

SARS-CoV-2 can infect bat intestinal cells, and demonstrated SARS-CoV-2 replication in human intestinal organoids, suggesting that the human intestinal tract might be a transmission route of SARS-CoV-2.

Evidence Summary

Extracted bat enteroids were fully susceptible to SARS-CoV-2 infection and sustained robust viral replication.

Active replication of SARS-CoV-2 in human intestinal organoids was demonstrated 

Isolation of infectious virus from the stool specimen of a patient with diarrheal COVID-19.

What did they do?

This was an experimental study in which the researchers established horseshoe bat intestinal organoid culture; assessed whether these bat enteroids were susceptible to SARS-CoV-2 and could be used for virus isolation.

In addition, the authors experimentally investigated the possibility of enteric infection by SARS-CoV-2 in human intestinal organoids. They also isolated infectious virus from the feces of a patient with diarrheal COVID-19.

Study reliability

This was an experimental study and as such provides evidence complementary to that from observational human studies.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes N/A N/A N/A

What else should I consider?

Previously, isolation of respiratory syndrome-related coronaviruses using a bat cell line had not been documented. The authors proposed that bat organoids could be instrumental for experimentally probing the potential origin of SARS-CoV-2.

Based on full-genome sequence analysis, SARS-CoV-2 shows high similarity due to shared ancestry to SARS-related coronaviruses in horseshoe bats. [Zhou P]

Enteric involvement has been reported in patients with SARS. [Zhu N]

MERS-CoV replication has been shown in human intestinal organoids, and the human intestinal tract serves as an alternative route of infection. [Leung W, and Zhou J]


Zhou, P. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579, 270–273 (2020).

Zhu, N. et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 382, 727–733 (2020).

Leung, W. K. et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology 125, 1011–1017 (2003).

Zhou, J. et al. Human intestinal tract serves as an alternative infection route for middle east respiratory syndrome coronavirus. Sci. Adv. 3, eaao4966 (2017).

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Elizabeth Spencer

Dr Elizabeth Spencer; MMedSci, PhD. Epidemiologist, Nuffield Department for Primary Care Health Sciences, University of Oxford.