Obesity and COVID-19: ACE 2, the Missing Tile
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LETTER TO THE EDITOR
Obesity and COVID-19: ACE 2, the Missing Tile Antonio Iannelli 1,2,3,4 & Guillaume Favre 1,5,6 & Sébastien Frey 1,2 & Vincent Esnault 1,5 & Jean Gugenheim 1,2,3 & Samir Bouam 7 & Luigi Schiavo 8 & Albert Tran 1,3,9 & Marco Alifano 10,11
# Springer Science+Business Media, LLC, part of Springer Nature 2020
The COVID-19 pandemic is the major health crisis of our time. It bears the potential to create devastating social, economic, and political consequences in all the countries it touches. At the same time, it represents a great challenge for the entire scientific community. Indeed, the latter is currently making extraordinary efforts to increase knowledge on the severe acute respiratory syndrome coronavirus 2 (SARSCoV 2), and so helps in containing the pandemic and hopefully in eradicating it. The renin-angiotensin-aldosterone system (RAAS) has recently been put on the forefront as the angiotensin-converting enzyme (ACE) 2 is targeted by SARS-CoV 2. In parallel, obesity appears as the main risk factor for severe forms of COVID-19. The RAAS and obesity are closely related, leading to the aggravation of the disease. Here, we focus on the endogenous imbalance of RAAS in obesity.
In the beginning of the pandemic, the paradox of hypertension as most common risk factor for ICU admission, intubation, and COVID-19-related death has not driven major attention [1]. Then, it has become clear that type 2 diabetes (DT2) also withstands as a risk factor. Scientist further speculated that ACE inhibitors and angiotensin II type 1 receptor (ATR1) antagonists, which are widely used in DT2 patients, could upregulate ACE 2 and consequently might account for the high prevalence of hypertension and diabetes among patients with severe disease course. However, this causative effect has not been confirmed so far [2, 3]. Shreds of evidence show that RAAS is involved in energy metabolism, food intake, inflammatory process, oxidative stress, and blood pressure control. A classic view opposes the pro-inflammatory and hypertensive angiotensin (ANG) II and ATR1 axis to the anti-inflammatory and vasodilator
* Antonio Iannelli [email protected]
2
Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Archet 2 Hospital, Nice, France
3
Inserm, U1065, Team 8 “Hepatic complications of obesity and alcohol”, Nice, France
4
Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet, 151 Route Saint Antoine de Ginestière, BP 3079 Nice Cedex 3, France
Vincent Esnault [email protected]
5
Nephrology Department, University Hospital of Nice, Pasteur Hospital, Nice, France
Jean Gugenheim [email protected]
6
UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France
Samir Bouam [email protected]
7
Department of Medical Information, University Hospital of Paris, Cochin Hospital, APHP Centre, Paris, France
8
Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, Unive
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