The use of α1-adrenergic receptor antagonists in the prevention of adverse outcomes of COVID-19 infection in obese patients

Abstract

Obesity is widely reported to be associated with a higher risk of the severity and worse clinical outcome of COVID-19. With the global prevalence of obesity, exploring the relationship between obesity and the severity of COVID-19 disease is of major clinical importance, thus requiring increased attention to preventive measures in susceptible individuals. Studies have shown that obesity is associated with increased risk of hospitalisation, intensive care unit admission, integrated motivational–volitional requirement and mortality among patients with COVID-19. The pathophysiological mechanisms which cause disease severity and adverse outcomes among obese subjects remain unclear. Recently, it was shown that elevated leptin levels correlate positively with the severity and progression of disease in COVID-19 patients. Leptin modulates both the innate and adaptive immune responses in cells. Elevated leptin levels in obese individuals may contribute to worse symptoms and outcomes in COVID-19 disease. Emerging evidence suggests that alpha-1 (α1)-adrenergic receptor stimulation increases leptin secretion, while the administration of α1-adrenergic receptor antagonists is reported to reduce plasma leptin levels in human subjects. Therefore, α1-adrenergic receptor antagonists may improve clinical outcomes in obesity patients with COVID-19 infection through modulation of hyperinflammation and reduction of plasma leptin levels. The aim of this minireview is to delineate the potential beneficial therapeutic effects of α1-adrenergic receptor antagonists in preventing adverse outcomes of coronavirus infection in obese patients. Large, randomised trials are needed to confirm the beneficial effects and safety profile of the use of α1-adrenergic receptor antagonists in obese patients with COVID-19.