American researchers have reviewed a series of studies and think they may have identified why COVID-19 seems to severely impact people who have diabetes and are obese.

A team from Dallas say they believe coronavirus works with the body’s microbiota in the lungs which worsens outcomes for some and might explain why they are more likely to develop severe acute respiratory syndrome (SARS) after COVID-19.

Professor Philipp Scherer, from the Department of Internal Medicine, and Director of the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, said: “There is rapidly emerging evidence highlighting obesity and type 2 diabetes as key risk factors linked to severity of COVID-19 infections in all ethnic groups, but the detailed underlying connections with these risk factors remain largely unknown.

“There is a paradox that people with obesity and diabetes are generally known to recover better from lung conditions than others. So, what is it about COVID-19 that makes this group of people more susceptible?”

To carry out their work they looked at disease pathways closely associated with obesity and diabetes and the severity of COVID-19.

Their investigations brought them to look at the role microbiota plays as it is usually associated with the progression of lung diseases.

They also found evidence that lower levels of ACE2, which is involved in regulating fluid volumes, blood pressure and the function of blood vessels, can lead to impaired gut barrier function.

This can lead to more bacteria and toxins getting into the body’s circulation and once in the lungs, severe injury and tissue damage will be caused among anyone who has become infected with COVID-19.

Professor Scherer said: “While all of these potential mechanisms can contribute to the severity of COVID-19, we believe that one of them plays the predominant role, and that this must be present not only in obese and diabetic patients, but also in other groups of increased risk in COVID-19.

“Our theory is supported by experiments showing that the combination of bacterial and viral infection can lead to a ‘cytokine storm’ – an extreme inflammatory reaction – which is a hallmark of COVID-19.

“Moreover, the involvement of viral-bacterial interactions can also explain the increased risk of severe COVID-19 seen in older people, those with heart disease and in some ethnic groups.”

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