Why Is COVID-19 More Severe in Patients With Diabetes? The Role of Angiotensin-Converting Enzyme 2, Endothelial Dysfunction and the Immunoinflammatory System

Frontiers in Cardiovascular Medicine

Adriano G. Rossi¹  Sandra M. MacRury²  Andrew T. Treweeke²  Jacob Roberts²  Nicole Brace²  Antonia L. Pritchard²  Jun Wei²  Ian L. Megson²  Paul Cahill³ 

[1] Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom;Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom;School of Biotechnology, Dublin City University, Dublin, Ireland;

关键词: COVID-19;    SARS– CoV– 2;    diabetes;    endothelium;    oxidative stress;    angiotensin converting enzyme-2;    inflammation;    immune response;   

DOI  :  10.3389/fcvm.2020.629933

来源: Frontiers

【 摘 要 】

Meta-analyses have indicated that individuals with type 1 or type 2 diabetes are at increased risk of suffering a severe form of COVID-19 and have a higher mortality rate than the non-diabetic population. Patients with diabetes have chronic, low-level systemic inflammation, which results in global cellular dysfunction underlying the wide variety of symptoms associated with the disease, including an increased risk of respiratory infection. While the increased severity of COVID-19 amongst patients with diabetes is not yet fully understood, the common features associated with both diseases are dysregulated immune and inflammatory responses. An additional key player in COVID-19 is the enzyme, angiotensin-converting enzyme 2 (ACE2), which is essential for adhesion and uptake of virus into cells prior to replication. Changes to the expression of ACE2 in diabetes have been documented, but they vary across different organs and the importance of such changes on COVID-19 severity are still under investigation. This review will examine and summarise existing data on how immune and inflammatory processes interplay with the pathogenesis of COVID-19, with a particular focus on the impacts that diabetes, endothelial dysfunction and the expression dynamics of ACE2 have on the disease severity.

【 授权许可】

CC BY