Figure 2.

Scheme of the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in obese individuals. Increased production of angiotensinogen by adipose tissue leads to elevated angiotensin (Ang) II levels in obesity. SARS-CoV-2 attenuates Ang II metabolism by binding to angiotensin-converting enzyme 2 (ACE2), promoting a system imbalance. High Ang II levels lead to pulmonary vasoconstriction and inflammation that contributes to acute lung injury (left side of figure). ACE2 expression in adipose tissue is higher than that in the lung, a major target organ affected by coronavirus disease 2019 (COVID-19). Increased ACE2 expression in adipocytes may make them more vulnerable to SARS-CoV-2 infection and a potential viral reservoir leading to prolonged viral clearance (right side of the figure). AT₁R = angiotensin II type I receptor; MasR = G-protein coupled Mas receptor.