Following viral transmission, SARS-CoV-2 attaches to the surface of the epithelial membrane of the oral cavity, the mucosal membranes of the conjunctiva or the otic canal. ACE 2 protein, which is highly expressed on multiple human cells including type II alveolar cells (AT2), oral, esophageal, ileal epithelial cells, myocardial cells, proximal tubule cells of the kidneys as well as urothelial cells of the bladder is believed to mediate the internalization of SARS-CoV2.
The spike (S) protein of SARS-CoV2 is cleaved by a cellular enzyme named furin at the S1/S2 site. This cleavage is essential for viral entry to the lung cells. The activated S protein is primed by the TMPRSS2 and finally attaches ACE 2 receptors to enter the host cells. The genetic sequence of SARS-CoV-2 is homologous with the SARS-CoV, and the structure of (S) protein of these viruses is highly similar. They both use the same receptor to enter the host cell; however, SARS-CoV-2 binds ACE 2 receptors with tenfold higher affinity.