Preexisting and inducible endotoxemia as crucial contributors to the severity of COVID-19 outcomes

[...]the age-adjusted levels of LPS significantly vary in different ethnic groups, being the highest in South Asians. [...]a “leaky gut” condition can be induced by SARS-CoV-2 infection in seemingly non-compromised individuals as well. [...]we have to differentiate between the “preexisting” and “induced” endotoxemia in COVID-19 patients. Amino acids are strongly involved in the regulation of the intestinal epithelial barrier function [19]; hence, a reduction of ACE2 content induced by interactions of these receptors with SARS-CoV-2 will significantly impair the integrity of the intestinal barrier. [...]it was reported that ACE2 exhibits a protective effect against LPS-induced acute lung injury in mice [21]; hence, viral suppression of ACE2 can lead to a stronger inflammatory responses in lungs.