Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
J Endocrinol Invest. 2020 Aug;43(8):1053-1060. doi: 10.1007/s40618-020-01318-1. Epub 2020 Jun 3.
The Coronavirus disease 2019 (COVID-19) and type 2 diabetes (T2D) are two pandemics that share the dramatic impact on global mortality and economic resources. COVID-19 largely exhibits mild to moderate clinical manifestations. However, severe pneumonia with high fatality rate may occur, especially in the elderly and in patients with underlying conditions, such as diabetes and cardiovascular disease. SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) binds to the angiotensin-converting enzyme 2 (ACE2), a ubiquitous trans-membrane carboxypeptidase, to enter the cells.
This short review discusses some open questions about the link between COVID-19 and diabetes, principally focusing on the possible effects of commonly used drugs in patients with diabetes.
Preclinical studies have reported that angiotensin receptor blockers (ARBs) and ACE inhibitors might increase ACE2 expression in several cell types. Hence, it has been speculated that the treatment with these agents might influence the course of the infection, and both harmful and beneficial effects have been supposed. Other pharmacological agents are thought to increase ACE2 expression, including statins and proliferator-activated receptor gamma (PPAR-γ) agonists. All these drug classes are broadly adopted in T2D. Besides ACE2, other unknown co-factors might be involved in cell infection. It has been recently observed that dipeptidyl peptidase-4 (DPP4), the receptor for MERS-CoV (Middle East respiratory syndrome-related coronavirus) and ACE2 have similar expression profiles in the lung. DPP4 has important metabolic and immune functions and is a target for commonly used therapies in T2D.
Although clinical data supporting an influence of all these drugs on the course of the disease are limited, this is an interesting background for further research that might help unravel the complex mechanisms underlying the link between COVID-19 and diabetes.
2019 年冠状病毒病（COVID-19）和 2 型糖尿病（T2D）是两种对全球死亡率和经济资源产生巨大影响的大流行疾病。COVID-19 主要表现为轻度至中度临床表现。然而，特别是在老年人和患有糖尿病和心血管疾病等基础疾病的患者中，可能会发生严重肺炎和高死亡率。SARS-CoV-2（严重急性呼吸系统综合症冠状病毒 2）与血管紧张素转换酶 2（ACE2）结合，ACE2 是一种普遍存在的跨膜羧肽酶，进入细胞。
本综述简要讨论了 COVID-19 和糖尿病之间联系的一些悬而未决的问题，主要集中在糖尿病患者常用药物的可能影响上。
临床前研究报告称，血管紧张素受体阻滞剂（ARBs）和 ACE 抑制剂可能会增加几种细胞类型中的 ACE2 表达。因此，有人推测这些药物的治疗可能会影响感染过程，并且推测既有有害作用也有有益作用。其他被认为会增加 ACE2 表达的药物包括他汀类药物和过氧化物酶体增殖物激活受体 γ（PPAR-γ）激动剂。所有这些药物类别在 T2D 中广泛使用。除 ACE2 外，其他未知的共同因素可能参与细胞感染。最近观察到二肽基肽酶 4（DPP4），即中东呼吸综合征相关冠状病毒（MERS-CoV）和 ACE2 的受体，在肺中的表达谱相似。DPP4 具有重要的代谢和免疫功能，是 T2D 中常用治疗方法的靶点。
尽管支持所有这些药物对疾病过程的影响的临床数据有限，但这是进一步研究的有趣背景，这可能有助于揭示 COVID-19 和糖尿病之间联系的复杂机制。
