Relación de la patogénesis de COVID-19 para la investigación en medicina periodontal. Parte I: Patogénesis de COVID-19
DOI:
https://doi.org/10.33448/rsd-v10i5.13729Palabras clave:
Infecciones por Coronavirus; Pathogenesis; Periodoncia.Resumen
La invasión celular mediada por la ectoenzima de la enzima convertidora de angiotensina 2 (ACE2) y las proteasas celulares, se dirige a diferentes tejidos y órganos. La pérdida de homeostasis del sistema renina-angiotensina desregula diferentes ejes, comprometiendo el control metabólico, cardiorrespiratorio, renal y hepático. La célula infectada con SARS-CoV-2 sufre piroptosis y libera patrones moleculares asociados con el daño: interleucina proinflamatoria (IL) -1b, IL-6, IL-8, IL-10, IL-17, proteína inducida-10, interferón gamma, proteína 10 inducida por interferón gamma, factor estimulante de colonias de granulocitos, factor estimulante de colonias de granulocitos-macrófagos, proteína inflamatoria de macrófagos 1α y 1β, proteína activante de quimioterapia de monocitos 1, proteína de macrófagos inflamatorios 1α, necrosis tumoral α y mediadores de enfermedades inflamatorias mediadas por el sistema inmunitario. La tormenta de citocinas y los anticuerpos no neutralizantes producidos por las células B circulantes agravan el daño a varios órganos. Durante la replicación viral y la baja saturación de oxígeno, la pérdida de homeostasis celular mediada por HIF puede provocar muerte/lisis celular y daño tisular, relacionado con la respuesta hiperinflamatoria. El SARS-CoV-2-ACE2 puede aumentar la permeabilidad, la inflamación y la transmisión microbiana debido a bacteriemia o endotoxemia, además de disbiosis. El potencial trombótico y el desequilibrio inmunoinflamatorio comprometen la función o conducen a lesiones e insuficiencia multiorgánica. La infección por SARS-CoV-2 tiene el potencial de modificar la historia natural de las enfermedades, las relaciones o interacciones entre diferentes sistemas y patologías y los efectos de sus tratamientos, como en el enfoque de la medicina periodontal.
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