New normal: two aspects of adipose tissue in COVID-19—treat and threat?

ABSTRACT

Introduction

Adipose-derived stromal cells (ADSCs) can be an important alternative in COVID-19 prevention, treatment, and subsequent sequelae repair. However, ACE-2 plays a common role in the pathogenesis of adipocyte hypertrophy and COVID 19.

Areas covered

In this ‘Perspective,’ the author would like to emphasize the use of adipose tissue-derived stromal cells in COVID 19 and the issues that clinicians should pay attention to in fat graft applications in terms of adipose tissue–RAS relationship. The new normal for adipose tissue in COVID 19 will be highlighted.

Expert Opinion

ADSCs may potentially be used in COVID-19. However, it has been speculated that ACE2 receptors are responsible for the pathogenesis of adipose tissue overgrowth and may be a potential danger in terms of the relationship between ACE2 receptors and COVID19. We speculate that reducing the size of overgrown fat tissue by ultra-sharp blades and using near-normal adipocytes will create a ‘new normal.’

KEYWORDS:

• Adipose tissue
• COVID19
• stromal cells
• MSC
• ADSC
• hypertrophied
• ACE2

Article highlights

• Adipose tissue is the body’s largest and most important source of regenerative cells. These regenerative cells are obtained enzymatically or mechanically. Mechanically obtained regenerative cells have more advantages.

• Regenerative cells originating from adipose tissue can be used both in the prevention of COVID 19, in the treatment of active disease, and in the repair of post-disease sequelae, due to their immunosuppressive, anti-inflammatory, and tolerogenic effects.

• RAS and ACE-2 receptors play an important role in both COVID-19 pathogenesis and adipose tissue hypertrophy.

• If adipose tissue-derived stromal cells will be used in the treatment, there is no such danger, but it is presented that there may be a potential danger in fat graft applications, one of the most common surgical procedures in the world, and a possible suggestion can be made based on a hypothesis.

• In today’s conditions, reducing the size of overgrown fat tissue and using near-normal adipocytes can only be achieved with ultra-sharp blade systems without killing the adipocytes.

• If the speculation we present related with COVID 19 – ACE 2 and adipocyte hypertrophy – ACE2 become reality, this will create a ‘new normal’ situation for physicians dealing with adipose tissue.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.