Leptin Reduction as a Potent Mitigative Strategy for the Treatment of PASC

摘要/摘要 虽然许多感染SARS-CoV2的人症状轻微，甚至可能没有症状，但有些人 患者会经历暴发性病理，可能会导致严重的后遗症，甚至死亡。对于其他人来说，其影响 对感染的急性反应持续数月(“长期冠状病毒病”)。这种感染有可能导致 使先前存在的疾病恶化，特别是那些与代谢性疾病有关的疾病。有几条证据 建议进行干预以限制长期的新冠肺炎严重程度：1)感染在以下方面最成问题 患有高危代谢综合征的个体；2)感染的严重程度与下列参数相关 与胰岛素抵抗有关，包括炎症、血糖水平升高和严重的胰岛素抵抗， 并增加肝脏损伤。高瘦素血症和糖尿病在肥胖人群中很常见，而且它 人们很早就知道瘦素在调节免疫系统和新陈代谢方面起着重要作用。 我们对肥胖/糖尿病和疾病加重之间的联系非常感兴趣。 过去两年的严重程度/结果。在这里，我们的目标是直接测试减少 血浆瘦素水平或增加水平对免疫系统和纤维化有积极影响。 我们将在细胞、组织和系统层面解决这些问题。具体地说，我们希望：1：确定 -MSH对瘦素-POMC信号转导免疫应答的作用 COVID集中。2：确定瘦素中和是否对肺纤维化有影响 博莱霉素肝纤维化模型。3：确定瘦素中和是否对炎症有影响 在外围。4：确定瘦素中和和降低瘦素的噻唑烷二酮类药物对 Long-Covid。综合起来，这些研究将测试瘦素中和、-MSH和PPAR的效果 长期COVID的激活对疾病结局的影响。Scherer和Elmquist在新陈代谢方面都有记录 并已与久负盛名的传染病专家Jyothi Nagajyothi合作，并进一步 在耶鲁大学的迪克西特和西里厄斯公司的曾傑瑞·科尔卡的支持下，作为三个核心实验室之间的团队， 我们相信，我们手中有独特的专业知识和工具来评估这些干预措施的有效性， 包括亚临床炎症增加，持续性纤维化和胰岛素敏感性恶化 在长冠状病毒感染期间持续存在。我们的初步数据有力地支持了瘦素参与 瘦素中和抗体降低新冠肺炎病毒载量的疾病进展 模型降低了85%，并有效地重建了至少部分肺脂联素水平。肺中的脂肪母细胞 表达脂联素，但在转化为纤维化生肌成纤维细胞时丢失。瘦素通过 使用中和抗瘦素抗体似乎可以保护脂肪母细胞的功能。 我们认为，这是在以下背景下最切实和最可立即翻译的干预措施之一 Long-COVID。

Summary/Abstract While many individuals infected with SARS-CoV2 have mild symptoms and may even be asymptomatic, some patients experience fulminant pathology that can cause severe sequelae or even death. For others, the effects of the acute response to the infection linger for many months (“Long-COVID”). The infection has the potential to exasperate pre-existing conditions, in particular those related to metabolic disease. Several lines of evidence suggest the potential for intervention to limit prolonged COVID-19 severity: 1) Infections are most problematic in individuals with high risk metabolic syndrome; 2) The severity of the infection is associated with parameters that are related to insulin resistance, including inflammation, elevated glucose levels with severe insulin resistance, and increased liver damage. Hyperleptinemia and diabetes are common among the obese population, and it has long been known that leptin plays an important role in regulating the immune system as well as metabolism. We have taken an intense interest in the connection of obesity/diabetes and enhanced disease severity/outcome over the past two years. Here, we aim to directly test the hypothesis that reducing plasma leptin levels or increasing MSH levels has a positive impact on the immune system and fibrosis. We will address these questions at the cellular, tissue and systemic level. Specifically, we want to: 1: Determine the role of -MSH towards leptin-POMC signaling in mediating immune responses in the context of Long- COVID centrally. 2: Determine whether leptin neutralization has an impact on lung fibrosis in the bleomycin fibrosis model. 3: Determine whether leptin neutralization has an impact on inflammation peripherally. 4: Determine the impact of leptin neutralization and leptin-lowering thiazolidinediones on Long-Covid. Combined, these studies will test the effect of leptin neutralization, -MSH and PPAR activation on disease outcome in long COVID. Both Scherer and Elmquist have track records in metabolism and have teamed up with Jyothi Nagajyothi, an established infectious disease specialist and are further supported by Deep Dixit at Yale and Jerry Colca from Cirius Inc. As a team between the three core laboratories, we believe we have unique expertise and tools in hand to assess the effectiveness of these interventions, including the increased subclinical inflammation, persistent fibrosis and deteriorated insulin sensitivity that persists during Long-COVID. Our preliminary data strongly support the premise of leptin involvement in the disease progression with leptin neutralizing antibodies reducing the viral load in a rodent COVID-19 model by 85% and effectively reconstituting at least partially adiponectin levels in the lung. Lipoblasts in the lung express adiponectin, but lose it as they convert to fibrosis generating myofibroblasts. Leptin reduction through the use of neutralizing anti-leptin antibodies seems to preserve lipoblast function. We believe this constitutes one of the most tangible and immediately translatable interventions in the context of Long-COVID.