Impacto do alelo ε4 de apoe na progressão e gravidade da covid-19 e outras síndromes gripais respiratórias

Abstract

Apolipoprotein E (ApoE), especially the ApoE4 isoform, is suggested to influence the severity of respiratory viral infections; however, this association is still unclear. Hypothesis: The presence of allele ε4 impacts the development of Flu-like syndromes. Aim: This study aimed to evaluate the impact of the ε 4 allele on the severity and duration of Flu-like syndromes, including COVID-19. Methodology: This study comprised 280 individuals presenting flu-like symptoms, all genotyped for ApoE isoforms. Data were collected on clinical course, comorbidities, nutritional status, biochemical and inflammatory markers, SARS-CoV-2 RT-PCR results, and disease severity (mild, moderate/severe) according to the World Health Organization (WHO) criteria. The individuals were analyzed as a whole and within subgroups based on the SARS-CoV-2 positive (COVID-19 group) or negative (flu-like syndrome group) test. Results: The frequency of the ε4 allele was similar across the whole population and in both the COVID-19 and Flu-like syndrome subgroups (17 and 18%, respectively). No differences were seen in sex, age range, self-reported skin color, BMI, number of comorbidities, vaccination status, biochemical, cytokine, and lipid profiles (except for total cholesterol) in the flu-like group when ε4 allele carriers and non-carriers were compared. In the COVID-19 group, the ε4 allele did not correlate with disease severity or duration, number of comorbidities, or inflammatory biomarkers. While gender distribution was equal in the overall COVID-19 population, male gender strongly correlated with COVID-19 severity. Multivariate analysis showed that older individuals, male gender, higher BMI, and the presence of comorbidities were linked to increased chances of developing moderate and severe disease. IL-4 was the only factor found to reduce the risk of severe COVID-19. Conclusion: The presence of one ɛ4 allele showed no association with the duration and severity of Flu-like syndromes, including COVID-19. Nonetheless, SARS-CoV-2-positive individuals tend to be older men with a higher BMI and a tendency to be overweight and obese. Regarding COVID-19 severity, BMI, male sex, and the number of associated comorbidities were the factors that increased the chance of developing a more severe form of COVID-19, while Il-4 decreased the chance.