Effects of COVID-19 and Diabetes Mellitus on Apolipoprotein A1 Level in the Blood Plasma of Patients

Abstract

Background. Increased levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) in plasma is associated with a reduced risk of developing cardiovascular diseases (CVD). In addition to its potential cardioprotective function, HDL and ApoA1, the main HDL apolipoprotein, also have antidiabetic properties. Aim. The aim of the study was to determine the level of ApoA1 in the blood of patients (n = 81) with diabetes mellitus and COVID-19. Methods. ApoA1 was determined by enzyme-linked immunosorbent assay (ELISA) kits (Elabscience, USA). The measurements were performed at an optical wavelength of 450 nm. Results. ApoA1 level in the blood of patients with diabetes and especially with COVID-19 was significantly lower than in the blood of healthy people. The study of the dependence of the content of ApoA1 in blood plasma on the level of Hb1Ac, the gender of patients and the type of diabetes showed that in blood of patients with type 2 diabetes the amount of ApoA1 is lower than in patients with type 1 diabetes, and with an increase in the level of Hb1Ac the amount of ApoA1 decreases. There was also significant gender difference. With an increase in BMI, the content of ApoA1 in blood plasma decreases below normal - 0.9 g/L, and at BMI <25 kg/m2, the amount of ApoA1 is significantly higher than the average lipoprotein level in diabetic patients. In patients with newly diagnosed diabetes, the level of ApoA1 is significantly higher, and in patients with more than 10 years of illness, it is below average and below normal. Treatment with biguanides, either in combination with other drugs (mainly insulin) or as monotherapy, does not significantly affect the level of ApoA1 compared to the entire group average. In patients treated with sulfonylurea, the level of ApoA1 is significantly lower than the average level for the group and the norm. A significant positive effect on the amount of ApoA1 in plasma was observed in patients treated with a combination of drugs with iSGLT2, insulin and especially DPP-4 inhibitors. However, insulin monotherapy did not significantly affect the ApoA1 content. Possible mechanisms of apoA1 decrease in COVID-19 and diabetes are discussed. Conclusion. Thus, the level of ApoA1 may be one of the promising markers of severe COVID-19.