The Role of High-Density Lipoprotein in COVID-19

Abstract

The current Coronavirus disease 2019 (COVID-19) pandemic has become a global challenge. Managing a large number of acutely ill patients in a short time, whilst reducing the fatality rate and dealing with complications, brings unique difficulties. The most striking pathophysiological features of patients with severe COVID-19 are dysregulated immune responses and abnormal coagulation function, which can result in multiple-organ failure and death. Normally metabolized high-density lipoprotein (HDL) performs several functions, including reverse cholesterol transport, direct binding to lipopolysaccharide (LPS) to neutralize LPS activity, regulation of inflammatory response, anti-thrombotic effects, antioxidant, and anti-apoptotic properties. Clinical data shows that significantly decreased HDL levels in patients with COVID-19 are correlated with both disease severity and mortality. However, the role of HDL in COVID-19 and its specific mechanism remain unclear. In this analysis, we review current evidence mainly in the following areas: firstly, the pathophysiological characteristics of COVID-19, secondly, the pleiotropic properties of HDL, thirdly, the changes and clinical significance of HDL in COVID-19, and fourthly the prospect of HDL-targeting therapy in COVID-19 to clarify the role of HDL in the pathogenesis of COVID-19 and discuss the potential of HDL therapy in COVID-19.

Triglyceride/High-Density Lipoprotein Cholesterol Ratio is Associated with the Mortality of COVID-19: A Retrospective Study in China

“… 48–52 Moreover, HDL-increasing drugs, such as cholesterol acyltransferase (LCAT) and Niacin, have also been studied as potential therapeutic strategies for COVID-19 treatment. 47 , 49 …”

COVID-19 and Lipid Disorders

“…Serum lipoprotein(a) [Lp(a)] did not significantly differ between COVID-19 patients and disease controls, although its concentration was found to be significantly positively associated with severity of COVID-19 illness, including acute kidney failure stage, admission disease severity, and peak severity [33]. Serum Lp(a) concentrations were higher in patients with recurrent cerebral venous sinus thrombosis (CVST) compared to patients without; that is, 28 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) mg/dl versus 14 (9-25) mg/dl [34]. The importance of elevated serum Lp(a) as a potential risk factor for CVST maybe even higher in patients with SARS-CoV-2 infection.…”

“…Under normal conditions, metabolized HDL mediates reverse cholesterol transport, direct binding to lipopolysaccharide (LPS) to neutralize LPS activity, regulation of inflammatory responses and antithrombotic, antioxidant and antiapoptotic effects [26]. COVID-19 patients with low HDL-C levels at admission to the hospital were at increased risk to develop a severe disease compared to patients with high HDL-C levels.…”

High-density lipoproteins and clinical outcomes of COVID-19 in hemodialysis patients: A multicenter, propensity-score matched case-control study

“…Продемонстровано, що рівень ЛПВЩ у сироватці крові SARS-CoV-2 інфікованих пацієнтів був статистично значущо нижчим ніж у здорових осіб [15]. Крім того, концентрація ЛПВЩ впливала на тривалість виділення вірусу, що передбачало ризик COVID-19асоційованої госпіталізації [16] та була значно нижчою у тяжкохворих і померлих пацієнтів порівняно з легкою формою COVID-19 [17,18] З метою визначення предикторів захворюваності на COVID-19, до багатофакторного логістичного регресійного аналізу були включені усі доступні демографічні та клініко-лабораторні показники пацієнтів. Аналіз продемонстрував, що цукровий діабет (OR 3,4; 95% CІ 1,3; 4,9, p = 0,001), тривалість лікування ГД (OR 1,2; 95% CІ 1,09; 2,7, p = 0,01), підвищення систолічного та діастолічного артеріального тиску (OR 1,17; 95% CІ 1,03; 3,3, p = 0,02), а також зниження ЛПВЩ (OR 2,8; 95% ДІ 1,2; 6,5, p = 0,003) є незалежними факторами ризику інфікування SARS-CoV-2 у ГД пацієнтів.…”