Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA.
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Int J Obes (Lond). 2021 Jun;45(6):1163-1169. doi: 10.1038/s41366-021-00804-7. Epub 2021 Mar 16.
The COVID-19 pandemic has emerged as a public health crisis and has placed a significant burden on healthcare systems. Patients with underlying metabolic dysfunction, such as type 2 diabetes mellitus and obesity, are at a higher risk for COVID-19 complications, including multi-organ dysfunction, secondary to a deranged immune response, and cellular energy deprivation. These patients are at a baseline state of chronic inflammation associated with increased susceptibility to the severe immune manifestations of COVID-19, which are triggered by the cellular hypoxic environment and cytokine storm. The altered metabolic profile and energy generation of immune cells affect their activation, exacerbating the imbalanced immune response. Key immunometabolic interactions may inform the development of an efficacious treatment for COVID-19. Novel therapeutic approaches with repurposed drugs, such as PPAR agonists, or newly developed molecules such as the antagomirs, which block microRNA function, have shown promising results. Those treatments, alone or in combination, target both immune and metabolic pathways and are ideal for septic COVID-19 patients with an underlying metabolic condition.
新型冠状病毒肺炎疫情已成为公共卫生危机，给医疗系统带来了巨大负担。患有 2 型糖尿病和肥胖等潜在代谢功能障碍的患者，发生 COVID-19 并发症（继发于免疫反应紊乱和细胞能量耗竭的多器官功能障碍）的风险更高。这些患者处于慢性炎症的基线状态，由于细胞缺氧环境和细胞因子风暴，导致对 COVID-19 严重免疫表现的易感性增加。免疫细胞的代谢特征和能量产生改变会影响其激活，从而加剧免疫反应失衡。关键的免疫代谢相互作用可能为 COVID-19 的有效治疗提供信息。具有重新定位药物（如过氧化物酶体增殖物激活受体激动剂）或新开发分子（如拮抗 miR 功能的抗 miR）的新型治疗方法已显示出良好的效果。这些治疗方法单独或联合应用，靶向免疫和代谢途径，是治疗有潜在代谢疾病的脓毒症 COVID-19 患者的理想方法。
