Pro-fibrotic M2 macrophage markers may increase the risk for COVID19 in type 2 diabetes with obesity

Diabetes and obesity are associated with severe COVID-19-associated disease including acute respiratory distress syndrome (ARDS). Alveolar macrophage-derived cytokines contribute to the inflammation underlying ARDS, resulting in pulmonary fibrosis and edema, central facets of acute lung injury. Post-mortem histopathological features in the lung tissue of patients who died of severe COVID-19 disease demonstrate an extensive inflammatory infiltrate dominated by macrophages in the alveolar lumina. Thus, infected alveolar macrophages might drive the “cytokine storm” and lead to multiple organ failure in COVID-19 infected patients. Moreover, systemic cytokine profiles resemble cytokine release syndromes, such as macrophage activation syndrome, in patients with severe COVID-19 disease.