Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes
Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes
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肥胖和COVID-19：免疫和代谢紊乱可能与不良临床结局有关
DOI：
10.1152/ajpendo.00198.2020
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发表时间：
2020-06-01
影响因子：
5.1
通讯作者：
Lambadiari, Vaia
中科院分区：
文献类型：
--
作者：
Korakas, Emmanouil;Ikonomidis, Ignatios;Lambadiari, Vaia
最近的报告显示，肥胖与COVID-19感染的严重程度之间存在很强的相关性，即使在没有其他合并症的情况下。感染宿主细胞后，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能会通过过度释放细胞因子引起炎症反应，这种情况被称为“细胞因子风暴”，同时诱导淋巴细胞减少和免疫反应中断。肥胖与慢性低度炎症和免疫失调有关，但它加剧COVID-19感染的确切机制尚未完全阐明。大量细胞因子如TNF α、IL-1、IL-6和单核细胞趋化蛋白（MCP-1）的产生导致氧化应激和先天性和适应性免疫功能的缺陷，而NOD样受体家族pyrin domain containing 3（NLRP 3）炎性体的激活似乎在感染的发病机制中起关键作用。内皮功能障碍和动脉硬化可能有利于最近发现的SARS-CoV-2感染内皮，而心脏结构和功能的改变以及肥胖患者的血栓前微环境可能与这些患者的心血管事件增加有关。抗炎剂如IL-1和IL-6阻滞剂在类似的炎症环境中的成功使用，如类风湿性关节炎，引发了关于此类药物是否可以在选定的COVID-19疾病患者中使用的讨论。
Recent reports have shown a strong association between obesity and the severity of COVID-19 infection, even in the absence of other comorbidities. After infecting the host cells, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause a hyperinflammatory reaction through the excessive release of cytokines, a condition known as "cytokine storm," while inducing lymphopenia and a disrupted immune response. Obesity is associated with chronic low-grade inflammation and immune dysregulation, but the exact mechanisms through which it exacerbates COVID-19 infection are not fully clarified. The production of increased amounts of cytokines such as TNF alpha, IL-1, IL-6, and monocyte chemoattractant protein (MCP-1) lead to oxidative stress and defective function of innate and adaptive immunity, whereas the activation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome seems to play a crucial role in the pathogenesis of the infection. Endothelial dysfunction and arterial stiffness could favor the recently discovered infection of the endothelium by SARS-CoV-2, whereas alterations in cardiac structure and function and the prothrombotic microenvironment in obesity could provide a link for the increased cardiovascular events in these patients. The successful use of anti-inflammatory agents such as IL-1 and IL-6 blockers in similar hyperinflammatory settings, like that of rheumatoid arthritis, has triggered the discussion of whether such agents could be administrated in selected patients with COVID-19 disease.