Alcohol use disorder as a potential risk factor for COVID-19 severity: A narrative review |
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Authors: | Christopher B Forsyth Robin M Voigt Garth R Swanson Faraz Bishehsari Maliha Shaikh Lijuan Zhang Phillip Engen Ali Keshavarzian |
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Institution: | 1. Department of Internal Medicine, Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA;2. Department of Internal Medicine, Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, USA
Rush University Graduate College, Rush University Medical Center, Chicago, Illinois, USA;3. Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA |
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Abstract: | In Dec. 2019-January 2020, a pneumonia illness originating in Wuhan, China, designated as coronavirus disease 2019 (COVID-19) was shown to be caused by a novel RNA coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). People with advanced age, male sex, and/or underlying health conditions (obesity, type 2 diabetes, cardiovascular disease, hypertension, chronic kidney disease, and chronic lung disease) are especially vulnerable to severe COVID-19 symptoms and death. These risk factors impact the immune system and are also associated with poor health, chronic illness, and shortened longevity. However, a large percent of patients without these known risk factors also develops severe COVID-19 disease that can result in death. Thus, there must exist risk factors that promote exaggerated inflammatory and immune response to the SARS-CoV-2 virus leading to death. One such risk factor may be alcohol misuse and alcohol use disorder because these can exacerbate viral lung infections like SARS, influenza, and pneumonia. Thus, it is highly plausible that alcohol misuse is a risk factor for either increased infection rate when individuals are exposed to SARS-CoV-2 virus and/or more severe COVID-19 in infected patients. Alcohol use is a well-known risk factor for lung diseases and ARDS in SARS patients. We propose that alcohol has three key pathogenic elements in common with other COVID-19 severity risk factors: namely, inflammatory microbiota dysbiosis, leaky gut, and systemic activation of the NLRP3 inflammasome. We also propose that these three elements represent targets for therapy for severe COVID-19. |
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Keywords: | alcohol use disorder COVID-19 dysbiosis Leaky gut NLRP3 |
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