Commentary
Recent papers confirm that the relation between metabolic syndrome and mortality rate of COVID-19 is more and more evident. These diseases are often treated with ACE inhibitors, which might upregulate ACE2 expression.
ACE2 is normally expressed in low amounts in cholangiocytes and hepatocytes, but was shown to increase in chronic liver damage and in experimental set-ups of diet-induced NAFLD. While under normal conditions, ACE2 may exert anti-obesity and anti-inflammatory effects, it is also the way of entry for SARS- CoV-2.
Patients suffering from NAFLD might be especially vulnerable to SARS-CoV-2 infection and COVID-19 complications, where the latter may also increase NAFLD progression to NASH in the long-term.
Take home message: It is important to identify and monitor patients with pre-existing liver disease, especially those with metabolic disorder, during and after the COVID-19 crisis.
