ORIGINAL RESEARCH article
Front. Immunol.
Sec. Inflammation
This article is part of the Research TopicUnderstanding Chronic Inflammation: Mechanisms Behind its PersistenceView all 12 articles
THE METABOLIC-IMMUNE INTERFACE OF OBESITY IN COVID-19: A ROLE FOR ANGIOTENSIN II AND INFLAMMATORY CYTOKINES
Provisionally accepted
Cintia M Rodrigues1
Juliane D Santos1
Bruna C. Chaves Garcia1
Marcelo H Ottoni1
Karine Beatriz Costa1Marina L Costa1
Vivian G Figueiredo1Daniel Macedo1
Danilo Bretas De Oliveira1
Etel Rocha-Vieira1
EVELIN CAPELLARI CARNIO2*- 1Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
- 2Universidade de Sao Paulo, São Paulo, Brazil
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Background: Obesity is a major risk factor for severe COVID-19, partly explained by chronic systemic low-grade inflammation and renin-angiotensin-aldosterone system (RAAS) dysregulation. Objectives: To investigate the relationship between obesity and COVID-19 severity by measuring plasma angiotensin II (Ang II) and pro and anti-inflammatory cytokines across BMI categories. Methods: In a cross-sectional cohort of 142 adults (Lean and Obese), including mild and severe COVID-19 cases and matched uninfected controls. Plasma Ang II, IL-1β, IL-6, IL-10, and TNF were quantified by ELISA. Associations with BMI and clinical severity were assessed using ANOVA and correlation analyses. Results: Obese patients showed elevated Ang II, IL-1β, IL-6, and TNF, alongside reduced IL-10, compared to lean individuals and controls. Ang II positively correlated with BMI. Severe cases showed elevated neutrophil-to-lymphocyte ratios and greater need for ventilatory support requirements. Notably, mortality occurred exclusively among obese patients. Conclusion: Obesity exacerbates COVID-19 severity through RAAS imbalance and, amplified inflammatory responses. Ang II and pro-inflammatory cytokines may serve as early predictive biomarkers of disease progression in obese individuals, highlighting the metabolic-immune interface as a critical determinant of COVID-19 outcomes.
Keywords: Angiotensin II, Cytokines, Interleukins, Obesity, RAAS, Sars - cov - 2
Received: 21 Oct 2025; Accepted: 05 Dec 2025.
Copyright: © 2025 Rodrigues, Santos, Garcia, Ottoni, Costa, Costa, Figueiredo, Macedo, Bretas De Oliveira, Rocha-Vieira and CARNIO. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: EVELIN CAPELLARI CARNIO
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