Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic

Abstract

SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed.

Keywords: hypoxia; inflammation; oxidative stress; sarcopenia; sarcopenic obesity.

Figure 1

Direct and indirect effects of Sars-CoV-2 on skeletal muscle mass and possible countermeasures. On the left side: Direct and indirect effects of Sars-CoV-2 on muscle mass potentially lead to muscle wasting and the so called “long-Covid Syndrome”; on the right-side: possible countermeasures to avoid or at least maintain muscle mass quality and quantity.