The role of GLP-1 receptor agonists during COVID-19 pandemia: a hypothetical molecular mechanism

ABSTRACT

Introduction

A number of anti-diabetic treatments have been favored during the continuing spread of the current SARS-CoV-2 pandemic. Glucagon like peptide-1 receptor agonists (GLP1-RAs) are a group of antidiabetic drugs, the glucose reducing effect of which is founded on augmenting glucose-dependent insulin secretion with concomitant reduction of glucagon secretion and delayed gastric emptying. Apart from their glucose lowering effects, GLP1-RAs also exert a plethora of pleiotropic activities in the form of anti-inflammatory, anti-thrombotic and anti-obesogenic properties, with beneficial cardiovascular and renal impact. All these make this class of drugs a preferred option for managing patients with type 2 diabetes (T2D), and potentially helpful in those with SARS-CoV2 infection.

Areas covered

In the present article we propose a hypothetical molecular mechanism by which GLP1-RAs may interact with SARS–CoV-2 activity.

Expert Opinion

The beneficial properties of GLP1-RAs may be of specific importance during COVID-19 infection for the most fragile patients with chronic comorbid conditions such as T2D, and those at higher cardiovascular and renal disease risk. Yet, further studies are needed to confirm our hypothesis and preliminary findings available in the literature.

KEYWORDS:

• SARS-COV-2
• COVID-19
• GLP-1RA
• coronavirus
• pandemic
• diabetes
• therapy

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received speaking fees, consulting fees and research grants from Eli Lilly and Novo Nordisk; and research grants from AstraZeneca. A separate reviewer has disclosed that they have served as a consultant for Applied Therapeutics, Novo Nordisk, Pfizer and Sanofi; employee for Merck Research Laboratories (spouse) 2017-2020 and Janssen (spouse) May 2020 – present; research support (institutional contracts) for Applied Therapeutics/Medpace, Eli Lilly, Premier/Fractyl, Novo Nordisk, and Sanofi/Medpace. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

This article has been written independently, without any financial or professional help, and reflects only the authors’ opinion, without any role of the industry. The authors have given lectures, received honoraria and research support, and participated in conferences, advisory boards and clinical trials sponsored by several pharmaceutical companies, but they did not receive any financial or professional help with the preparation of the manuscript. A Sonmez is currently Secretary of the Turkish Society for Endocrinology and Metabolism. M Rizzo is full-time Professor of Internal Medicine at University of Palermo, Italy and currently Medical Director, Novo Nordisk Eastern Europe. AP Stoian is currently Vice President of Romanian National Diabetes Committee. The authors have no other 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.

Article highlights

• Diabetes represents a comorbidity very closely associated with COVID-19,

• Hyperglycemia is associated with the severity of prognosis in patients with COVID-19.

• Novel anti-diabetic drugs seem to have a greater role in the management of patients with T2D during COVID–19 era, due to their glyco-cardio-metabolic benefit.

We hypothesize that GLP1-RAs may modulate SARS–CoV-2 activity.

Additional information

Funding

This paper was not funded.