Cholesterol: A new game player accelerating vasculopathy caused by SARS-CoV-2?

Abstract

The pandemic of coronavirus disease 2019 (COVID-19) has become a global threat to public health. Functional impairments in multiple organs have been reported in COVID-19 including lungs, heart, kidney, liver, brain and vascular system. Patients with metabolic-associated preconditions such as hypertension, obesity and diabetes are susceptible to experience severe symptoms. The recent emerging evidence of coagulation disorders in COVID-19 suggests that vasculopathy appears to be an independent risk factor promoting disease severity and mortality of affected patients. We have recently found that the decreased levels of low-density lipoprotein cholesterols (LDL-c) correlate with disease severity in COVID-19 patients, indicating pathological interactions between dyslipidemia and vasculopothy in COVID-19 patients. However, this clinical manifestation has been unintentionally underestimated by physicians and scientific communities. As metabolic-associated morbidities are generally accompanied with endothelial cell (EC) dysfunctions, these pre-existing conditions may make ECs more vulnerable to SARS-CoV-2 attack. In this mini-review, we summarize the metabolic and vascular manifestations of COVID-19 with an emphasis on the association between changes in LDL-c levels and the development of severe symptoms as well as the pathophysiologic mechanisms underlying the synergistic effect of LDL-c and SARS-CoV-2 on EC injuries and vasculopathy.

Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: an observational study

“…Several studies showed infected patients, especially those with sepsis, always had a significant drop in HDL levels [ 17 , 19 , 22 , 27 – 29 ], but the reason for the decline in HDL level remained unanswered. However, several hypotheses are considered to be possible, including a decrease in HDL synthesis, overconsumption or redistribution of HDL particles from intravascular to the extravascular space [ 12 , 17 , 30 ].…”

“…SARS-CoV-2 was believed to affect lipid metabolism [10,11]. Low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels significantly decreased in COVID-19 patients, while the changes and effects of high-density lipoprotein cholesterol (HDL-C) in COVID-19 were still rarely reported [12][13][14]. High-density lipoproteins (HDLs) are a family of particles characterized by their ability to transport cholesterol from extrahepatic tissues to liver for metabolism.…”

COVID-19-activated SREBP2 disturbs cholesterol biosynthesis and leads to cytokine storm

“…SREBP-2-mediated biosynthesis of cholesterol is involved in the exocytosis process of SARS-CoV2, which explains its role in virus budding and envelop. 31 , 47 , 48 For the inhibition of this process, Statin-based drugs have been suggested as therapeutic agents. 31 These mechanisms collectively suggest that various responses caused by SARS-CoV-2 infection activates SREBP-2, as demonstrated in Fig.…”

The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak

“…It is important to note that other comorbidities commonly prevalent in individuals with diabetes (i.e. : hypertension, obesity, cardiovascular disease and dyslipidemia) are also associated with high risk of COVID-19 severity and/or mortality ( 2 , 15 , 16 ). For example, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates human cells through angiotensin-converting enzyme 2 (ACE2), which is more pronounced in adipose tissue and, consequently, in obese population ( 17 ).…”