AbdelMassih Antoine Fakhry, Fouda Raghda, Kamel Aya, Mishriky Fady, Ismail Habiba-Allah, El Qadi Layla, Malak Lauris, Mohamed Maram, Arsanyous Mariem, Hazem Maysa, El-Husseiny Miral, Ashraf Mirette, Hafez Nada, AlShehry Nada, El-Husseiny Nadine, AbdelRaouf Nora, Shebl Noura, Hafez Nouran, Youssef Nourhan, Afdal Peter, Hozaien Rafeef, Menshawey Rahma, Saeed Rana, Yasser Reem, Hesham Shereen, Zakarriah Wesam, Khattab Shahenda, Elammary Yasmine, Ye Jianping
Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Egypt.
Pediatric Cardio-Oncology Department, Children Cancer Hospital of Egypt, 57357, Egypt.
Obes Med. 2020 Dec;20:100303. doi: 10.1016/j.obmed.2020.100303. Epub 2020 Sep 24.
COVID-19 has shown a substantial variation in the rate and severity by which it impacts different demographic groups. Specifically, it has shown a predilection towards obese patients as well as well as other vulnerable groups including predilection of males over females, old age over young age and black races over Caucasian ones. Single cell sequencing studies have highlighted the role of cell polarity and the co-expression of proteases, such as Furin, along with ACE2 in the genesis of coronavirus disease rather than exclusively link tissue involvement with ACE2 levels thought previously. It has also forged a connection between the genetic and immune cellular mechanisms underlying COVID infection and the inflammatory state of obese patients, offering a more accurate explanation as to why obese patients are at increased risk of poor COVID outcomes. These commonalities encompass macrophage phenotype switching, genetic expression switching, and overexpression of the pro-inflammatory cytokines, depletion of the regulatory cytokines, in situ T cell proliferation, and T cell exhaustion. These findings demonstrate the necessity of single cell sequencing as a rapid means to identify and treat those who are most likely to need hospital admission and intensive care, in the hopes of precision medicine. Furthermore, this study underlines the use of immune modulators such as Leptin sensitizers, rather than immune suppressors as anti-inflammation therapies to switch the inflammatory response from a drastic immunological type 1 response to a beneficial type 2 effective one.
新冠病毒（COVID-19）对不同人群的影响在发病率和严重程度上存在显著差异。具体而言，它对肥胖患者以及其他弱势群体表现出偏好，包括男性多于女性、老年人多于年轻人、黑人种族多于白种人。单细胞测序研究强调了细胞极性以及蛋白酶（如弗林蛋白酶）与血管紧张素转换酶2（ACE2）的共表达在冠状病毒病发病过程中的作用，而不是像之前认为的那样仅将组织受累与ACE2水平联系起来。它还在新冠病毒感染背后的遗传和免疫细胞机制与肥胖患者的炎症状态之间建立了联系，为肥胖患者新冠预后不良风险增加提供了更准确的解释。这些共性包括巨噬细胞表型转换、基因表达转换、促炎细胞因子的过度表达、调节性细胞因子的耗竭、原位T细胞增殖以及T细胞耗竭。这些发现表明单细胞测序作为一种快速手段来识别和治疗那些最有可能需要住院和重症监护的患者的必要性，以期实现精准医学。此外，本研究强调使用诸如瘦素敏化剂等免疫调节剂，而不是免疫抑制剂作为抗炎疗法，将炎症反应从剧烈的1型免疫反应转变为有益的2型有效反应。
