REVIEW  OBESITY: A SPOTLIGHT ON THERAPEUTIC APPROACHES Free access

Minerva Endocrinology 2021 June;46(2):193-201

DOI: 10.23736/S2724-6507.20.03402-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Obesity and COVID-19: 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 for Health, University of Milan, Milan, Italy

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 SARS-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-CoV-2 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-CoV-2-cell entrance. At present, no data support the necessity of modifying ACEi or ARBs treatment in hypertensive patients.

KEY WORDS: Obesity; COVID-19; Angiotensin-converting enzyme inhibitors; Renin-angiotensin system; Kallikrein-Kinin-system