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Potential muscle wasting mechanisms of COVID-19. SARS-CoV-2 induces ACE2 downregulation and increases the viral effect on the body. Inflammation, physical inactivity, energy imbalance, and hypoxia may also downregulate muscle protein synthesis and cause muscle wasting. Figure created with BioRender.com. ACE2: angiotensin-converting enzyme 2; mTOR, mammalian/mechanistic target of rapamycin; P, phosphate; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
