COVID-19 and fat embolism: a hypothesis to explain the severe clinical outcome in people with obesity

Cinti, Saverio; Graciotti, Laura; Giordano, Antonio; Valerio, Alessandra; Nisoli, Enzo

doi:10.1038/s41366-020-0624-5

Cited by 25 publications

(40 citation statements)

References 44 publications

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“…Moreover, the low-grade chronic inflammation is also known to activate prothrombotic signaling in the vascular endothelial cells in the obese. Apart from that, the adipocytes of the obese individuals may get infected with SARS-CoV-2 and undergo necrotic cell death liberating free fatty acids in the adipose interstitium which may further predispose the obese COVID-19 patients to fat embolism syndrome [ 82 ]. Hence, the direct recruitment of SARS-CoV-2 to endothelium or the adipocytes as well as preexisting systemic chronic inflammation in the obese may lead to severe form of the COVID-19.…”

Section: Obesity and Covid-19mentioning

confidence: 99%

COVID-19 severity in obese patients: Potential mechanisms and molecular targets for clinical intervention

Sharma

Yadav

2021

Obesity Research & Clinical Practice

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Section: Obesity and Covid-19mentioning

confidence: 99%

COVID-19 severity in obese patients: Potential mechanisms and molecular targets for clinical intervention

Sharma

Yadav

2021

Obesity Research & Clinical Practice

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“…Therefore, there are some abundantly infiltrated tissues, as they are particularly rich in ACE-2, which constitute the real "deposits of infection", from where the virus spreads. These tissues are the brain, central nervous system [8] and the adipose tissue [9]. Moreover, adipose cell embolism amplifies both the inflammatory phenomena and the pro-thrombotic status [9].…”

mentioning

confidence: 99%

“…These tissues are the brain, central nervous system [8] and the adipose tissue [9]. Moreover, adipose cell embolism amplifies both the inflammatory phenomena and the pro-thrombotic status [9]. The latter is a well-known prognostic factor and chronic oral anti-coagulation showed a reduction in mortality in patients with chronic cardiac disease [10].…”

mentioning

confidence: 99%

Protective role of statins in COVID 19 patients: importance of pharmacokinetic characteristics rather than intensity of action

et al. 2020

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Statins represent a family of drugs that are potentially able to defend COVID-19 patients against uncontrolled systemic inflammatory response produced by the virus Sars-Cov-2. Therefore, some physicians proposed and used anti-inflammatory agents in the treatment regimen of patients with COVID-19 [1]. Statins are well known for their anti-inflammatory effects [2], and some hospitals included them in the COVID-19 treatment protocol [3]. In addition, studies in vitro verified that "there is evidence suggesting that statins exert anti-viral activity and may block the infectivity of enveloped viruses" [4]. In other words, statins could be efficient SARS-CoV-2 inhibitors of the main protease, a key coronavirus enzyme, which is a potential drug target [4]. Considering the above premises, we hypothesized that patients taking statins were better protected against mortality risk than those who do not take statins. We verified this hypothesis in a population of 71 consecutive patients with a pre-existing chronic cardiovascular disease, who become ill from COVID-19 between February 29, 2020, and May 20, 2020. The follow-up ended on June 15, 2020. The only endpoint of the study was all-cause mortality. Continuous variables were expressed as mean ± one SD or median (range) values; and categorical data as percentages. All dichotomous variables were compared utilizing the χ2 test; and continuous parameters using analysis of variance (ANOVA) or Mann-Whitney U test, as appropriate. Survival probabilities were estimated with the Kaplan-Meier method and survival curves plotted and compared between groups using the log-rank test. P < 0.05 was considered statistically significant.

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“…For example: the epicardial adipose tissue (EAT) which is in close proximity with the myocardium could be a possible source for myocarditis and indeed myocarditis is reported in COVID-19 patients ( 114 ). Fat embolism in lungs through the action of the released lipid droplets from necrotic adipose tissue could be another way by which obesity affects lung function upon viral infection ( 115 ).…”

Section: Is Obesity a Risk Factor For Sars-cov-2?mentioning

confidence: 99%

From Influenza Virus to Novel Corona Virus (SARS-CoV-2)–The Contribution of Obesity

et al. 2020

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From the beginning of 2020, the governments and the health systems around the world are tackling infections and fatalities caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) resulting in the coronavirus disease 2019 (COVID-19). This virus pandemic has turned more complicated as individuals with co-morbidities like diabetes, cardiovascular conditions and obesity are at a high risk of acquiring infection and suffering from a more severe course of disease. Prolonged viral infection and obesity are independently known to lower the immune response and a combination can thus result in a “cytokine storm” and a substantial weakening of the immune system. With the rise in obesity cases globally, the chances that obese individuals will acquire infection and need hospitalization are heightened. In this review, we discuss why obesity, a low-grade chronic inflammation, contributes toward the increased severity in COVID-19 patients. We suggest that increased inflammation, activation of renin-angiotensin-aldosterone system, elevated adipokines and higher ectopic fat may be the factors contributing to the disease severity, in particular deteriorating the cardiovascular and lung function, in obese individuals. We look at the many lessons learnt from the 2009 H1N1 influenza A pandemic and relate it to the very little but fast incoming information that is available from the SARS-CoV-2 infected individuals with overweight and obesity.

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COVID-19 and fat embolism: a hypothesis to explain the severe clinical outcome in people with obesity

Cited by 25 publications

References 44 publications

COVID-19 severity in obese patients: Potential mechanisms and molecular targets for clinical intervention

COVID-19 severity in obese patients: Potential mechanisms and molecular targets for clinical intervention

Protective role of statins in COVID 19 patients: importance of pharmacokinetic characteristics rather than intensity of action

From Influenza Virus to Novel Corona Virus (SARS-CoV-2)–The Contribution of Obesity

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