Vias metabólicas e hiperinflamação na COVID 19 em obesos diabéticos renais crônicos e sua reabilitação física pós-infecção / Metabolic pathways and hyperinflammation in COVID 19 in obese and chronic renal diabetic patients and their post-infection physical rehabilitation

Lívia Maria Borges Amaral, Juliana Célia de Farias Santos, Antônio Filipe Pereira Caetano, Michelle Jacintha Cavalcante Oliveira

Abstract


A COVID-19 representa um grande risco para pessoas com obesidade e diabetes, que podem apresentar as formas graves da doença. O tecido adiposo de obesos é alvo e potencial reservatório para o coronavírus, uma vez que apresenta upregulation da expressão da enzima conversora de angiotensina 2 (ACE2), um receptor para a entrada do vírus na célula. Sujeitos obesos, subcronicamente inflamados, destacam-se por pior prognóstico. A dipeptidil peptidase 4 (DPP4) também funciona como ligante para o vírus e contribui com a clivagem do glucagon like peptide-1, reduzindo a sensibilidade à insulina. Assim, indivíduos obesos diabéticos apresentam um somatório de disfunções metabólicas e inflamatórias que são intensificadas e agravadas durante a infecção. Na presença de doença renal crônica, os tecidos renais que possuem receptores ACE2 sofrem ataque direto do vírus, além de servir de porta de entrada para espécies reativas e para produtos da hiperinflamação. Esse cenário, decorrente do ataque ao vírus, agrava-se com a hiperinflamação, a hipercoagulabilidade, o estresse oxidativo e a disfunção epitelial tecidual. Nesse contexto, um comprometimento corporal poderá ser observado especialmente em pacientes mais graves, com diminuição de força e de massa celular funcional.  O comportamento ativo e monitorado trará benefícios à saúde desta população, promovendo melhores condições motoras, função física e respostas metabólicas mais favoráveis, com recuperação acelerada.

 


Keywords


diabetes mellitus, doença renal crônica, COVID- 19, obesidade.

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DOI: https://doi.org/10.34117/bjdv7n7-167

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