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Review
. 2020 Sep;287(17):3651-3655.
doi: 10.1111/febs.15303. Epub 2020 Mar 28.

Is nicotine exposure linked to cardiopulmonary vulnerability to COVID-19 in the general population?

James L Olds  1 , Nadine Kabbani  2
Affiliations
Review

Is nicotine exposure linked to cardiopulmonary vulnerability to COVID-19 in the general population?

James L Olds et al. FEBS J. 2020 Sep.

Abstract

The recent emergence of COVID-19 has resulted in a worldwide crisis, with large populations locked down and transportation links severed. While approximately 80% of infected individuals have minimal symptoms, around 15-20% need to be hospitalized, greatly stressing global healthcare systems. As of March 10, the death rate appears to be about 3.4%, although this number is highly stratified among different populations. Here, we focus on those individuals who have been exposed to nicotine prior to their exposure to the virus. We predict that these individuals are 'primed' to be at higher risk because nicotine can directly impact the putative receptor for the virus (ACE2) and lead to deleterious signaling in lung epithelial cells.

Keywords: addiction; infectious Disease; pandemic; public Health; tobacco.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A schematic model for how nicotine exposure augments risk of COVID‐19 entry into the human host lung. (A) Pulmonary and immune responses to COVID‐19 infection in epithelial cells of smokers (right) and nonsmokers (left). (B) Cellular mechanisms of nicotinic receptor activity that promotes COVID‐19 entry and proliferation in epithelial cells through co‐expression of ACE2. Nicotine activation of nicotinic receptors can lead to enhanced protease activation, cell death (apoptosis), and inflammatory signaling through mechanisms that converge on ACE2 regulation and signaling.
Fig. 2
Fig. 2
World Health Organization data on global smoking prevalence (percentage of smokers of overall population) segmented by country. Note how China, South Korea, and Italy represent local ‘hot spots’ for smoking of nicotine cigarettes. These nations were also early epicenters for COVID‐19. If our hypothesis is correct, nicotine consumption heterogeneities in Latin America and Africa predict future health challenges for at‐risk populations as the epidemic proceeds.
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