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

Endocr Rev. 2020 Jun 1;41(3):bnaa011. doi: 10.1210/endrev/bnaa011.

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.

Keywords: angiotensin converting enzyme 2; diabetes; dipeptidyl peptidase-4; obesity; receptor; virus.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Animals
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / metabolism
  • 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 Inhibitors / pharmacology
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Gastrointestinal Tract / metabolism
  • Humans
  • Insulin / therapeutic use
  • Lung / metabolism
  • Obesity / complications
  • Obesity / metabolism
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / metabolism
  • Receptors, Coronavirus
  • Receptors, Virus / metabolism
  • Risk Factors
  • SARS-CoV-2
  • Serine Endopeptidases / metabolism

Substances

  • Dipeptidyl-Peptidase IV Inhibitors
  • Insulin
  • Receptors, Coronavirus
  • Receptors, Virus
  • DPP4 protein, human
  • Dipeptidyl Peptidase 4
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • Serine Endopeptidases
  • TMPRSS2 protein, human