Hypercoagulopathy and Adipose Tissue Exacerbated Inflammation May Explain Higher Mortality in COVID-19 Patients With Obesity

COVID-19, caused by SARS-CoV-2, is characterized by pneumonia, lymphopenia, exhausted lymphocytes and a cytokine storm. Several reports from around the world have identified obesity and severe obesity as one of the strongest risk factors for COVID-19 hospitalization and mechanical ventilation. Moreo...

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Published in:Frontiers in endocrinology (Lausanne) Vol. 11; p. 530
Main Authors: Pasquarelli-do-Nascimento, Gabriel, Braz-de-Melo, Heloísa Antoniella, Faria, Sara Socorro, Santos, Igor de Oliveira, Kobinger, Gary P., Magalhães, Kelly Grace
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 28.07.2020
Subjects:
ACE-2
adipose tissue
Adipose Tissue - physiopathology
Betacoronavirus - isolation & purification
Coronavirus Infections - complications
Coronavirus Infections - epidemiology
Coronavirus Infections - mortality
Coronavirus Infections - virology
COVID-19
Endocrinology
Humans
hypercoagulopathy
Inflammation - physiopathology
Obesity
Obesity - complications
Pandemics
Pneumonia, Viral - complications
Pneumonia, Viral - epidemiology
Pneumonia, Viral - mortality
Pneumonia, Viral - virology
Prognosis
SARS-CoV-2
Survival Rate
Thrombophilia - physiopathology
COVID-19
adipose tissue
Obesity
SARS-CoV-2
ACE-2
hypercoagulopathy
ISSN:1664-2392, 1664-2392
Online Access:Get full text
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Summary:COVID-19, caused by SARS-CoV-2, is characterized by pneumonia, lymphopenia, exhausted lymphocytes and a cytokine storm. Several reports from around the world have identified obesity and severe obesity as one of the strongest risk factors for COVID-19 hospitalization and mechanical ventilation. Moreover, countries with greater obesity prevalence have a higher morbidity and mortality risk of developing serious outcomes from COVID-19. The understanding of how this increased susceptibility of the people with obesity to develop severe forms of the SARS-CoV-2 infection occurs is crucial for implementing appropriate public health and therapeutic strategies to avoid COVID-19 severe symptoms and complications in people living with obesity. We hypothesize here that increased ACE2 expression in adipose tissue displayed by people with obesity may increase SARS-CoV-2 infection and accessibility to this tissue. Individuals with obesity have increased white adipose tissue, which may act as a reservoir for a more extensive viral spread with increased shedding, immune activation and pro-inflammatory cytokine amplification. Here we discuss how obesity is related to a pro-inflammatory and metabolic dysregulation, increased SARS-CoV-2 host cell entry in adipose tissue and induction of hypercoagulopathy, leading people with obesity to develop severe forms of COVID-19 and also death. Taken together, it may be crucial to better explore the role of visceral adipose tissue in the inflammatory response to SARS-CoV-2 infection and investigate the potential therapeutic effect of using specific target anti-inflammatories (canakinumab or anakinra for IL-1β inhibition; anti-IL-6 antibodies for IL-6 inhibition), anticoagulant or anti-diabetic drugs in COVID-19 treatment of people with obesity. Defining the immunopathological changes in COVID-19 patients with obesity can provide prominent targets for drug discovery and clinical management improvement.
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Reviewed by: Luca Spiezia, University of Padova, Italy; Erik Albert Karlsson, Institut Pasteur du Cambodge, Cambodia
Edited by: Jeff M. P. Holly, University of Bristol, United Kingdom
This article was submitted to Obesity, a section of the journal Frontiers in Endocrinology
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2020.00530