Coronavirus Infections and Type 2 Diabetes—Shared Pathways with Therapeutic Implications

• Published in: Endocrine reviews Vol. 41; no. 3; pp. 457 - 470
• Main Author: Drucker, Daniel J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.06.2020; Copyright Oxford University Press
• Subjects: ACE inhibitors; ACE2; Angiotensin; Angiotensin converting enzyme; Angiotensin-Converting Enzyme 2; Animals; Betacoronavirus; Coronaviridae; Coronavirus Infections - complications; Coronavirus Infections - metabolism; Coronaviruses; COVID-19; Dextrose; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Dipeptidyl Peptidase 4 - metabolism; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors - pharmacology; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Gastrointestinal Tract - metabolism; Glucose; Health aspects; Health risks; Homeostasis; Humans; Immunomodulation; Immunomodulators; Infections; Inflammation; Insulin - therapeutic use; Lung - metabolism; Obesity; Obesity - complications; Obesity - metabolism; Pandemics; Pathophysiology; Peptidase; Peptidyl-dipeptidase A; Peptidyl-Dipeptidase A - metabolism; Physiological aspects; Pneumonia, Viral - complications; Pneumonia, Viral - metabolism; Receptors, Coronavirus; Receptors, Virus - metabolism; Review; Risk Factors; SARS-CoV-2; Serine Endopeptidases - metabolism; Severe acute respiratory syndrome; Substrates; Transducers; Type 2 diabetes; Viral diseases; Virus diseases; Middle East; China; receptor; diabetes; virus; angiotensin converting enzyme 2; obesity; dipeptidyl peptidase-4
• ISSN: 0163-769X; 1945-7189; 1945-7189
• DOI: 10.1210/endrev/bnaa011

Abstract Abstract Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection. Graphical Abstract Graphical Abstract