Coronavirus infection (SARS-CoV-2) in obesity and diabetes comorbidities : is heat shock response determinant for the disease complications?

Abstract

Chronic infammation is involved in the pathogenesis of several metabolic diseases, such as obesity and type 2 diabetes mellitus (T2DM). With the recent worldwide outbreak of coronavirus disease (SARS-CoV-2), it has been observed that individuals with these metabolic diseases are more likely to develop complications, increasing the severity of the disease and a poorer outcome. Coronavirus infection leads to the activation of adaptive and innate immune responses, resulting in massive infammation (to so called cytokine storm), which in turn can lead to damage to various tissues, septic shock and multiple organ failure. Recent evidence suggests that the common link between metabolic diseases and SARS-CoV-2 is the infammatory response (chronic/low-grade for metabolic diseases and acute/intense in coronavirus infection). However, the ability of the infected individuals to resolve the infammation has not yet been explored. The heat shock response (HSR), an important anti-infammatory pathway, is reduced in patients with metabolic diseases and, consequently, may impair infammation resolution and control in patients with SARS-CoV-2, thus enabling its amplifcation and propagation through all tissues. Herein, we present a new hypothesis that aims to explain the increased severity of SARS-CoV-2 infection in people with metabolic diseases, and the possible benefts of HSR-inducing therapies to improve the infammatory profle in these patients.