Roux-en-Y Gastric Bypass Downregulates Angiotensin-Converting Enzyme 2 (ACE2) Gene Expression in Subcutaneous White Adipose Tissue: A Putative Protective Mechanism Against Severe COVID-19

Kristem, Leonardo; Recamonde‐Mendoza, Mariana; Cigerza, Giuliano C.; Khoraki, Jad; Campos, Guilherme M.; Mazzini, Guilherme S.

doi:10.1007/s11695-021-05271-7

Cited by 6 publications

(11 citation statements)

References 11 publications

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“…Weight loss achieved by bariatric surgery determines a significant reduction in adipose tissue volume, and also downregulates ACE 2 gene expression in the subcutaneous adipose tissue, which might also constitute a putative protective mechanism against severe COVID-19. Roux-en-Y gastric bypass was demonstrated to positively impact numerous comorbidities obesity-related (often linked to poorer COVID-19 outcomes), resulting independently associated with a reduced risk of mechanical ventilation and death in obese patients with COVID-19 (43).…”

Section: Obesity and Covid-19 Pathogenesismentioning

confidence: 99%

Review: Obesity and COVID-19: A Detrimental Intersection

Gammone

D’Orazio

2021

Front. Endocrinol.

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Obesity has been recognized as an independent risk factor for critical illness and major severity in subjects with coronavirus disease 2019 (COVID-19). The role of fat distribution, particularly visceral fat (often linked to metabolic abnormalities), is still unclear. The adipose tissue represents a direct source of cytokines responsible for the pathological modifications occurring within adipose tissue in obese subjects. Adipokines are a crucial connection between metabolism and immune system: their dysregulation in obesity contributes to chronic low-grade systemic inflammation and metabolic comorbidities. Therefore the increased amount of visceral fat can lead to a proinflammatory phenotypic shift. This review analyzes the interrelation between obesity and COVID-19 severity, as well as the cellular key players and molecular mechanisms implicated in adipose inflammation, investigating if adipose tissue can constitute a reservoir for viral spread, and contribute to immune activation and cytokines storm. Targeting the underlying molecular mechanisms might have therapeutic potential in the management of obesity-related complications in COVID-19 patients.

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Section: Obesity and Covid-19 Pathogenesismentioning

confidence: 99%

Review: Obesity and COVID-19: A Detrimental Intersection

Gammone

D’Orazio

2021

Front. Endocrinol.

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“…Besides dietary interventions, bariatric surgery, such as Roux-en-Y gastric bypass (RYGB), represents an additional effective intervention tool to reduce adipose tissue volume. Therefore, RYGB is currently considered as a potential strategy to reduce COVID-19 risk of infection, especially in patients suffering from severe obesity [ 45 ]. Indeed, analysis on publicly available transcriptomic datasets (GSE59034) of subcutaneous white adipose tissue (sWAT) biopsies from 16 women before and 2 years after RYGB revealed that ACE2 gene expression is down-regulated by RYGB in this tissue.…”

Section: Influence Of Obesity and Diet In Adipose Tissue Ace2 Levels Evidence From Studies Conducted In Humansmentioning

confidence: 99%

“…Indeed, analysis on publicly available transcriptomic datasets (GSE59034) of subcutaneous white adipose tissue (sWAT) biopsies from 16 women before and 2 years after RYGB revealed that ACE2 gene expression is down-regulated by RYGB in this tissue. It is worth noting that the Ace2 gene expression in these patients resulted even lower than that found in subcutaneous adipose tissue of subjects that had never been obese [ 45 ].…”

Section: Influence Of Obesity and Diet In Adipose Tissue Ace2 Levels Evidence From Studies Conducted In Humansmentioning

confidence: 99%

An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity

Gómez‐Zorita

Milton-Laskíbar

García-Arellano

et al. 2021

IJMS

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The present review is aimed at analysing the current evidence concerning the potential modulation of obesity and/or diet in adipose tissue ACE2. Additionally, the potential implications of these effects on COVID-19 are also addressed. The results published show that diet and obesity are two factors that effectively influence the expression of Ace2 gene in adipose tissue. However, the shifts in this gene do not always occur in the same direction, nor with the same intensity. Additionally, there is no consensus regarding the implications of increased adipose tissue ACE2 expression in health. Thus, while in some studies a protective role is attributed to ACE2 overexpression, other studies suggest otherwise. Similarly, there is much debate regarding the role played by ACE2 in COVID-19 in terms of degree of infection and disease outcomes. The greater risk of infection that may hypothetically derive from enhanced ACE2 expression is not clear since the functionality of the enzyme seems to be as important as the abundance. Thus, the greater abundance of ACE2 in adipose tissue of obese subjects may be counterbalanced by its lower activation. In addition, a protective role of ACE2 overexpression has also been suggested, associated with the increase in anti-inflammatory factors that it may produce.

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“…In another U.S. study that conducted a multivariate analysis, a prior history of metabolic surgery was associated with a lower hospital admission rate compared with control patients with obesity. Intriguingly, it is noted that Roux-en-Y gastric bypass downregulates ACE2 gene expression in subcutaneous adipose tissue [ 40 ], which might act as a protective mechanism against COVID-19 infection.…”

Section: The Role Of Bariatric and Metabolic Surgeries During The Cov...mentioning

confidence: 99%

“…In this analysis, the mean presurgical BMI was 44.5±6.8 kg/m In another U.S. study that conducted a multivariate analysis, a prior history of metabolic surgery was associated with a lower hospital admission rate compared with control patients with obesity. Intriguingly, it is noted that Roux-en-Y gastric bypass downregulates ACE2 gene expression in subcutaneous adipose tissue[40], which might act as a protective mechanism against COVID-19 infection.Although bariatric surgery is being postponed due to COVID-19, the American Society for Metabolic and Bariatric Surgery (ASMBS) recently released a statement regarding metabolic and bariatric surgery during the COVID-19 pandemic. The society claims that metabolic and bariatric surgeries should be resumed when it is safe, and it disagrees with the concept that the surgery should be postponed until the pandemic is over.…”

mentioning

confidence: 99%

Obesity and Coronavirus Disease 2019

Kim

Jeon

2021

J Metab Bariatr Surg

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Obesity, which is one of the most important noncommunicable diseases, has become an epidemic. With the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the collision of these two health risks has increased the threat of adverse events and serious threats to public health. In this review, the impact of obesity on COVID-19 severity and mortality is presented. The mechanism by which obesity increases susceptibility and severity is discussed. As a low-grade inflammatory disease, obesity provides a pro-inflammatory milieu by which adipose tissue expressing angiotensin converting enzyme 2, which is known as a receptor for severe acute respiratory syndrome coronavirus 2, works as a viral reservoir. Finally, the role of metabolic and bariatric surgeries during the COVID-19 era will be discussed.

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Roux-en-Y Gastric Bypass Downregulates Angiotensin-Converting Enzyme 2 (ACE2) Gene Expression in Subcutaneous White Adipose Tissue: A Putative Protective Mechanism Against Severe COVID-19

Cited by 6 publications

References 11 publications

Review: Obesity and COVID-19: A Detrimental Intersection

Review: Obesity and COVID-19: A Detrimental Intersection

An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity

Obesity and Coronavirus Disease 2019

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