Title:	Hypercoagulopathy and adipose tissue exacerbated inflammation may explain higher mortality in COVID-19 patients with obesity
Authors:	Nascimento, Gabriel Pasquarelli do Melo, Heloísa Antoniella Braz de Faria, Sara Socorro Santos, Igor de Oliveira Kobinger, Gary P. Magalhães, Kelly Grace
Assunto::	Tecido adiposo Covid-19 Obesidade SARS-CoV-2 Hipercoagulopatia ACE2
Issue Date:	28-Jul-2020
Publisher:	Frontiers
Citation:	NASCIMENTO, Gabriel Pasquarelli do et al. Hypercoagulopathy and adipose tissue exacerbated inflammation may explain higher mortality in COVID-19 patients with obesity. Frontiers in Endocrinology, v. 11, art. 530, 28 jul. 2020. DOI: https://doi.org/10.3389/fendo.2020.00530. Disponível em: https://www.frontiersin.org/articles/10.3389/fendo.2020.00530/full. Acesso em: 16 nov. 2020.
Abstract:	COVID-19, caused by SARS-CoV-2, is characterized by pneumonia, lymphopenia, exhausted lymphocytes and a cytokine storm. Several reports from around the world have identified obesity and severe obesity as one of the strongest risk factors for COVID-19 hospitalization and mechanical ventilation. Moreover, countries with greater obesity prevalence have a higher morbidity and mortality risk of developing serious outcomes from COVID-19. The understanding of how this increased susceptibility of the people with obesity to develop severe forms of the SARS-CoV-2 infection occurs is crucial for implementing appropriate public health and therapeutic strategies to avoid COVID-19 severe symptoms and complications in people living with obesity. We hypothesize here that increased ACE2 expression in adipose tissue displayed by people with obesity may increase SARS-CoV-2 infection and accessibility to this tissue. Individuals with obesity have increased white adipose tissue, which may act as a reservoir for a more extensive viral spread with increased shedding, immune activation and pro-inflammatory cytokine amplification. Here we discuss how obesity is related to a pro-inflammatory and metabolic dysregulation, increased SARS-CoV-2 host cell entry in adipose tissue and induction of hypercoagulopathy, leading people with obesity to develop severe forms of COVID-19 and also death. Taken together, it may be crucial to better explore the role of visceral adipose tissue in the inflammatory response to SARSCoV-2 infection and investigate the potential therapeutic effect of using specific target anti-inflammatories (canakinumab or anakinra for IL-1β inhibition; anti-IL-6 antibodies for IL-6 inhibition), anticoagulant or anti-diabetic drugs in COVID-19 treatment of people with obesity. Defining the immunopathological changes in COVID-19 patients with obesity can provide prominent targets for drug discovery and clinical management improvement.
Licença::	Copyright © 2020 Pasquarelli-do-Nascimento, Braz-de-Melo, Faria, Santos, Kobinger and Magalhães. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI:	https://doi.org/10.3389/fendo.2020.00530
Appears in Collections:	Artigos publicados em periódicos e afins UnB - Covid-19

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