Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2024; 30(11): 1480-1487
Published online Mar 21, 2024. doi: 10.3748/wjg.v30.i11.1480
Current remarks and future directions on the interactions between metabolic dysfunction-associated fatty liver disease and COVID-19
Leonidas Brilakis, Eirini Theofilogiannakou, Panagis M Lykoudis
Leonidas Brilakis, Eirini Theofilogiannakou, Panagis M Lykoudis, School of Medicine, National & Kapodistrian University of Athens, Athens 11527, Greece
Panagis M Lykoudis, Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom
Author contributions: Lykoudis PM designed the study and revised the draft; Brilakis L and Theofilogiannakou E performed the research and wrote the draft of the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: Leonidas Brilakis, Eirini Theofilogiannakou and Panagis M Lykoudis have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Panagis M Lykoudis, MD, MSc, PhD, Lecturer, Division of Surgery & Interventional Science, University College London, Gower Street, London WC1E 6BT, United Kingdom. p.lykoudis@ucl.ac.uk
Received: December 29, 2023
Peer-review started: December 29, 2023
First decision: January 19, 2024
Revised: January 30, 2024
Accepted: March 4, 2024
Article in press: March 4, 2024
Published online: March 21, 2024
Abstract

During the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, particular interest rose regarding the interaction between metabolic dysfunction-associated fatty liver disease (MAFLD) and the COVID-19 infection. Several studies highlighted the fact that individuals with MAFLD had higher probability of severe acute respiratory syndrome coronavirus 2 infection and more severe adverse clinical outcomes. One of the proposed mechanisms is the inflammatory response pathway, especially the one involving cytokines, such as interleukin 6, which appeared particularly elevated in those patients and was deemed responsible for additional insult to the already damaged liver. This should increase our vigilance in terms of early detection, close follow up and early treatment for individuals with MAFLD and COVID-19 infection. In the direction of early diagnosis, biomarkers such as cytokeratin-18 and scoring systems such as Fibrosis-4 index score are proposed. COVID-19 is a newly described entity, expected to be of concern for the years to come, and MAFLD is a condition with an ever-increasing impact. Delineating the interaction between these two entities should be brought into the focus of research. Reducing morbidity and mortality of patients with COVID-19 and MAFLD should be the ultimate objective, and the optimal way to achieve this is by designing evidence-based prevention and treatment policies.

Keywords: Metabolic dysfunction-associated fatty liver disease, COVID-19, Liver fibrosis, Cytokine storm, Drug induced liver injury

Core Tip: The intricate intertwining of metabolic dysfunction-associated fatty liver disease (MAFLD) and coronavirus disease 2019 (COVID-19) presents a critical nexus with severe clinical outcomes. The symbiotic impact of MAFLD increasing susceptibility to severe COVID-19, and the reciprocal exacerbation by the viral infection, mandate special attention. Early identification, vigilant monitoring and tailored evidence-based interventions, navigating both conditions, are pivotal in mitigating adverse effects. Investigating the molecular pathways underlying the synergistic effects of MAFLD and COVID-19, and the impact of specific COVID-19 treatment drugs on liver function and their potential exacerbation of MAFLD, stands as a promising research avenue that could unveil novel therapeutic targets.