RE:Reduction of visceral fat by TesamorelinHaving read the full paper, it strikes me as majorly important. Those are groundbreaking findings! Management should be all over it. Did you forward it to IR?
This is both immediately usable to promote tesamorelin prescription in PLWH with a very strong scientific rationale and opens huge Covid-19 prophylactic perspectives for the general population (even though TH might not directly benefit from those I guess).
Only the evidence for the mechanistic aspect - the overexpression of ACE 2 in VF of the Covid-19 pts themselves isn't established by the study beyond any doubt, but the rest of it looks rock solid.
"The relationship between high VF amount and the severity of COVID-19 was stronger than the relationship between the severity of COVID-19 and BMI (p=0.022) or sex (p=0.010) ".
"Severe COVID-19 was defined as requirement for mechanical ventilation or death."
Wow.
scarlet1967 wrote: Apart from the indirect transcriptomic effect of Tesamorelin by inhibiting actions on inflammatory proteins resulting in reduction of fibrosis and inflammation, Tesammorelin also directly reduces the visceral fat within the abdominal cavities near vital organs.
As mentioned earlier these inflammatory enzymes interact with ACE 2 (receptor for Covid19) resulting in inflammation/fibrosis in vital organs.
Recently it has been many discussion re ACE 2 receptors and as per the article below the receptor is expressed more in visceral fat than subcutaneous fat.
“Abstract
Background
Excess visceral fat (VF) or high body mass index (BMI) is risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients.
Aim
To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI.
Methods
We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR.
Results
Among 165 patients with a mean BMI of 26.1±5.4kg/m2, VF was associated with severe COVID-19 (p=0.022) and SCF was not (p=0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p=0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5cm2 (ROC curve), which was independently associated with COVID-19 severity (p<0.001). in="" an="" exploratory="" analysis,="" ace="" 2="" mrna="" positively="" correlated="" with="" bmi="" in="" vf="" but="" not="" in="" scf="" of="" non-covid-19="" patients="" (r2="0.27" vs="">
Conclusion
Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.”
https://www.metabolismjournal.com/article/S0026-0495(20)30304-8/fulltext