Equils Ozlem, Lekaj Klaudi, Wu Arthur, Fattani Sahar, Liu Gene, Rink Lothar
MiOra, Public Health Education Foundation California Los Angeles USA.
Cedars-Sinai Medical Center Division of Otolaryngology California Los Angeles USA.
Laryngoscope Investig Otolaryngol. 2020 Dec 25;6(1):21-24. doi: 10.1002/lio2.513. eCollection 2021 Feb.
Anosmia is common among COVID-19 patients and anosmia assessment is proposed to be useful in the early diagnosis and prognosis of patients. Data on the pathogenesis of anosmia during COVID-19 suggest potential olfactory nerve involvement. Zinc is an essential micronutrient that regulates the immune responses, and zinc deficiency is known to induce anosmia and ageusia. We previously proposed that a drop in nasal zinc level is a normal nasal immune response to acute viral infections, including SARS-CoV-2 infection, and play a role in the pathogenesis of anosmia. The drop in the local zinc level in response to SARS-CoV-2 may lead to lower type 1 interferons and shift toward Th2 immune responses; if prolonged, it may lead to increased viral replication and more severe disease. In people who are at risk for baseline systemic zinc deficiency, such as the elderly and those with chronic diseases such as, chronic lung disease, diabetes, cardiovascular disease, and cancer, SARS-CoV-2 infection-induced drop in nasal zinc level may be more severe and prolonged and lead to an insufficient anti-viral nasal immune response and control the spread of the virus systemically and to the lungs. A better understanding of the clinical implications of baseline systemic zinc deficiency on anosmia and nasal immune responses may allow the development of new treatment strategies to slow down or stop the systemic invasion of SARS-CoV-2.
嗅觉丧失在新冠病毒感染患者中很常见，嗅觉丧失评估被认为对患者的早期诊断和预后有用。新冠病毒感染期间嗅觉丧失的发病机制数据表明可能存在嗅神经受累。锌是一种调节免疫反应的必需微量营养素，已知锌缺乏会导致嗅觉丧失和味觉丧失。我们之前提出，鼻腔锌水平下降是对包括新冠病毒感染在内的急性病毒感染的正常鼻腔免疫反应，并在嗅觉丧失的发病机制中起作用。对新冠病毒的反应导致局部锌水平下降可能会导致I型干扰素减少，并向Th2免疫反应转变；如果持续时间延长，可能会导致病毒复制增加和病情加重。在基线存在全身性锌缺乏风险的人群中，如老年人以及患有慢性疾病（如慢性肺病、糖尿病、心血管疾病和癌症）的人，新冠病毒感染引起的鼻腔锌水平下降可能更严重且持续时间更长，导致鼻腔抗病毒免疫反应不足，并无法控制病毒在全身和肺部的传播。更好地了解基线全身性锌缺乏对嗅觉丧失和鼻腔免疫反应的临床影响，可能有助于开发新的治疗策略，以减缓或阻止新冠病毒的全身侵袭。
