Home > Journals > Minerva Endocrinologica > Past Issues > Articles online first > Minerva Endocrinologica 2021 Jan 12

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as

 

 

Minerva Endocrinologica 2021 Jan 12

DOI: 10.23736/S0391-1977.20.03402-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Obesity and COVID-19: 2 The ominous duet affecting the renin-angiotensin system

Livio LUZI 1, 2 , Loredana BUCCIARELLI 1, Anna FERRULLI 1, 2, Ileana TERRUZZI 1, 2, Stefano MASSARINI 1

1 Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy; 2 Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy


PDF


The World population is facing a health challenge never seen since the Spanish influenza of one hundred years ago. During the last months, the scientific community has been debating on the potential harmful effect of Angiotensin-converting-enzyme inhibitors (ACEi) or Angiotensin II receptor Type 1 receptor blockers (AT1-Receptor blockers, ARBs) during the COVID-19 pandemic. That is because the S spike protein of SARS8 CoV viruses utilizes the angiotensin-converting enzyme 2 (ACE2) as a receptor to enter alveolar epithelial cells. Obesity, often associated to type 2 Diabetes, was shown to worsen the prognosis of SARS-CoV2 infection. Herein we discuss the complex interaction between the Renin-Angiotensin-Aldosterone System (RAAS), its receptors, and the interaction with the Kallikrein-Kinin-System (KKS) and the potential activation of the coagulation cascade. Alteration of the equilibrium between the RAAS system and the KKS cascade may explain the frequent thromboembolic complications of COVID-19 mainly seen in obese and diabetic-obese patients. In contrast, angiotensin (1-7) contributes to maintaining a correct balance between RAAS and KKS system. Our conclusion is that the higher mortality rate in patients with obesity is linked to the alteration of RAS and RAS-KKS interaction consequent to SARS-CoV2-cell entrance. At present, no data support the necessity of modifying ACEi or ARBs treatment in hypertensive patients.


KEY WORDS: Obesity; COVID-19; ACE inhibitors; Renin-Angiotensin-Aldosterone-System; Kallikrein-Kinin-System

top of page