Antidiabetes Agents against Sars-Cov-2 Infection
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COVID-19
Antidiabetes Agents against Sars-Cov-2 Infection Antonio Vitiello 1 & Francesco Ferrara 1 Accepted: 20 October 2020 # Springer Nature Switzerland AG 2020
Abstract People with chronic diseases represent a population at major risk of infection and complications from Sars-Cov-2 (COVID-19). Diabetes represents one of the most important comorbidities related to the severity of viral infection caused by the new Sars-Cov2. Diabetes patients have a higher risk of serious complications caused by Sars-Cov-2 infection, such as severe acute respiratory syndrome, a hyperinflammatory state associated with multi-organ dysfunction. Given the importance of the link between COVID-19 and diabetes, it is essential to better manage glycemic normalization and infection in this category of patients to avoid serious complications. However, for some antidiabetes agents, there is evidence of efficacy against Sars-Cov-2 extra glycemic normalization. The objective of this article is to provide an overview of the potential therapeutic benefits to fight Sars-Cov-2 infection with antidiabetic agents. Keywords Diabetes . COVID-19 . SARS-CoV-2 . Infection . Antidiabetes agents
Introduction
COVID-19 and Diabetes Mellitus
COVID-19 Infection
Diabetes is an important risk factor for viral, bacterial, and fungal infections. During the current global COVID-19 pandemic, diabetes has been identified as a primary risk factor for the development of severe Sars-Cov-2 viral infection pneumonia. Epidemiological data show that the risk of a fatal outcome of COVID-19 is up to 50% higher in patients with diabetes than in those without diabetes. There are many factors that may increase the risk for diabetes patients with COVID-19; among them, the presence of a deficient immune system, a dysfunctional coagulation cascade, a hyperactive inflammatory state, in the elderly patient with diabetes, there is also almost always a cardiovascular disease that could explain the more severe outcome of COVID-19 infection. In addition, the Sars-Cov-2 virus uses the angiotensin-converting enzyme 2 (ACE2) protein to enter the lung epithelial cells [4–6]. ACE2 has protective effects especially with regard to inflammation of the respiratory tract. COVID-19 infection in the most severe phases (two and three) reduces the expression of ACE2; this is one of the causes of hyperinflammation and respiratory failure. In the diabetic patient, ACE2 expression is altered, and this may cause an even more complicated clinical situation in the COVID-19 patient; moreover, the viral infection itself may cause a worsening of the diabetic disease with a glycemia that is difficult to control. [7–9] Another fundamental aspect to consider is that the DPP-4 protein (therapeutic target of gliptins) has been identified as a functional
The global pandemic caused by the new Sars-Cov-2 (COVID19), recorded its first cases in China in November 2019, and within a few months, became a worldwide problem, representing a health emergency with few precedents in human history. As of now, 5.8 million po
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