Basic mechanisms of SARS-CoV-2 infection. What endocrine systems could be implicated?

Abstract

Although SARS-CoV-2 viral attacks starts by the interaction of spike protein (S Protein) to ACE2 receptor located at the cell surface of respiratory tract and digestive system cells, different endocrine targets, endocrine organs and metabolic conditions are of fundamental relevance for understanding disease progression and special outcomes, in particular those of fatal consequences for the patient. During pandemic, moreover, a specific phenotype of COVID-19 metabolic patient has been described, characterized by being at particular risk of worse outcomes. In the present paper we describe the mechanism of viral interaction with endocrine organs, emphasizing the specific endocrine molecules of particular relevance explaining COVID-19 disease evolution and outcomes.

Keywords: COVID-19; Calcium; Diabetes mellitus; Endocrine systems; Hypoadrenalism; Mechanisms; Pituitary; SARS-CoV-2; Thyroid.

Fig. 1

Different pathogenic mechanisms including direct and indirect viral action could explain why different endocrine glands/organs that can be affected by COVID-19

Fig. 2

Possible endocrine and metabolic targets that have been considered for COVID-19 therapy. Different hormones and drugs have been included as possible targets for COVID-19 including melatonin, oxytocin, DPP-4 (human dipeptidyl peptidase 4) inhibitors, GLP-1 (glucagon-like peptide-1) agonists, ACE-2 (angiotensin converting enzyme-2) inhibitors, corticosteroids, estrogens, anti-androgens and statins