Obesity and COVID-19: ACE 2, the Missing Tile

Iannelli, Antonio; Favrè, Guillaume; Frey, Sébastien; Esnault, Vincent; Gugenheim, Jean; Bouam, Samir; Schiavo, Luigi; Tran, Albert; Alifano, Marco

doi:10.1007/s11695-020-04734-7

Cited by 58 publications

(64 citation statements)

References 16 publications

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“…In this review, children who were overweight or obese accounted for 50·8% ( n = 136 of 268) of children with co-morbidities. Proposed mechanisms explaining why obesity may be a risk factor for COVID-19/MIS-C include: an accumulation of inflammatory cells in adipose tissue, fat tissue-associated cytokines are proinflammatory, impaired respiratory function, and adipose cells have more SARS-CoV-2 binding receptors [39] , [40] , [41] , [42] .…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children: A systematic review

et al. 2020

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Background Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition. Methods We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515. Findings Our search yielded 39 observational studies ( n = 662 patients). While 71·0% of children ( n = 470) were admitted to the intensive care unit, only 11 deaths (1·7%) were reported. Average length of hospital stay was 7·9 ± 0·6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73·7%, n = 488), and vomiting (68·3%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22·2% ( n = 147) and 4·4% ( n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (54·0%) with depressed ejection fraction (45·1%, n = 262 of 581) comprising the most common aberrancy. Interpretation Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown. Funding Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study

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Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children: A systematic review

et al. 2020

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“…The impaired inflammatory response contributes to the severity of lung lesions found in patients with influenza ( 45 ), and may play a key role in COVID-19 progression. We put forward the hypothesis that white adipose tissue acts as a relevant player in the disease, since SARS-CoV-2 enters human cells via angiotensin-converting enzyme 2 (ACE2), which is expressed not only in the lung and heart, kidney, liver, and blood vessels, but also abundantly in the white adipose tissue ( 46 , 47 ), An additional interesting aspect is that there is adipose anatomical site–associated heterogeneity in the expression of ACE2, which is higher in the visceral depots ( 48 ). The enlarged visceral adipose pads in obese patients have been suggested to possibly act as reservoir for viruses, thereby increasing total virus load as a result of an “explosive systemic response of the angiotensin II and angiotensin II type 1 receptor axis” promoted by the tissue, and not perceived by the clinicians, who generally do not envisage white adipose tissue as a vital organ ( 47 ).…”

Section: Nutritional Status and Covid-19mentioning

confidence: 99%

Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?

Silvério

Gonçalves

Andrade

et al. 2021

Advances in Nutrition

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Coronavirus disease 2019 (COVID-19) is an emerging disease that has reached pandemic status by rapidly spreading worldwide. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension show a higher risk of hospitalization, severe disease, and mortality by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These patients frequently show exacerbated secretion of proinflammatory cytokines associated with an overreaction of the immune system, the so-called cytokine storm. Host nutritional status plays a pivotal role in the outcome of a variety of different infectious diseases. It is known that the immune system is highly affected by malnutrition, leading to decreased immune responses with consequent augmented risk of infection and disease severity. Body composition, especially low lean mass and high adiposity, has consistently been linked to worsened prognosis in many different diseases. In this review, evidence concerning the impact of nutritional status on viral infection outcomes is discussed.

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“…Obesity is one of the main risk factors for the severe form of COVID-19 [75]. There is evidence that the RAS system is closely related to obesity, energy metabolism, and food intake [76] due to an imbalance in the RAS system resulting in an overexpression of the ANGII and AT1R axis at the systemic levels [77].…”

Section: -Ace2 and Obesitymentioning

confidence: 99%

ACE2: THE DOORWAY TO SARS-CoV-2

Medina-Enríquez¹,

Carlos-Escalante²,

Aponte-Torres³

et al. 2020

Preprint

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The angiotensin-converting enzyme 2 (ACE2) is the host functional receptor for the new virus SARS-CoV-2 causing Coronavirus Disease 2019. ACE2 is expressed in 71 different cell types. Some factors that can affect the expression of the ACE2 are: sex, environment, lifestyles, comorbidities, medications (e.g. anti-hypertensives) and its interaction with other genes of the renin-angiotensin system and other pathways. All of these factors can affect the risk of infection of SARS-CoV-2 and determine the severity of the symptoms. The ACE2 enzyme is a negative regulator of RAS expressed in various organ systems. It has been seen to be associated with immunity, inflammation, increased coagulopathy, and cardiovascular disease. In this review, we describe the genetic and molecular functions of the ACE2 receptor and its relation with the physiological and pathological conditions to better understand how this receptor is involved in the pathogenesis of COVID-19.

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Obesity and COVID-19: ACE 2, the Missing Tile

Cited by 58 publications

References 16 publications

Multisystem inflammatory syndrome in children: A systematic review

Multisystem inflammatory syndrome in children: A systematic review

Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?

ACE2: THE DOORWAY TO SARS-CoV-2

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