Mechanisms and clinical relevance of the bidirectional relationship of viral infections with metabolic diseases.

Viruses have been present during all evolutionary steps on earth and have had a major effect on human history. Viral infections are still among the leading causes of death. Another public health concern is the increase of non-communicable metabolic diseases in the last four decades. In this Review, we revisit the scientific evidence supporting the presence of a strong bidirectional feedback loop between several viral infections and metabolic diseases. We discuss how viruses might lead to the development or progression of metabolic diseases and conversely, how metabolic diseases might increase the severity of a viral infection. Furthermore, we discuss the clinical relevance of the current evidence on the relationship between viral infections and metabolic disease and the present and future challenges that should be addressed by the scientific community and health authorities.

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Declaration of interests NP reports consulting fees from Bayer Vital GmbH, speaker honoraria and travel support from Novo Nordisk, and speaker honoraria from GWT outside the submitted work. BGH is a member of the Gene Therapy Working Group, a permanent working group of the Swiss Expert Committee for Biosafety. NT is a member of the steering committee of the German Society for Pediatric Infectious Diseases. IAA reports grants from the Promedica foundation, consulting fees from Sanofi, speaker honoraria from MSD, and travel support from Gilead. PAG reports consulting fees and travel support from Novo Nordisk, consulting fees from Amgen, speaker honoraria from Eli Lilly, and is the President of the Swiss Association for the Study of Metabolism and Obesity. GM reports consulting fees from Novo Nordisk and Fractyl Health; participates on a data safety monitoring board or advisory board at Novo Nordisk, Fractyl Health, Recor, Metadeq, Keyron, and GHP Scientific; reports grants from Boehringer Ingelheim, and receives advisory board and speaker honoraria from Novo Nordisk and Boehringer Ingelheim. TC received grants from the European Research Council, Deutsche Forschungsgemeinschaft, US National Institutes of Health, Else Kröner Fresenius Center for Digital Health Dresden, Bundesministerium für Bildung und Forschung, German Center for Diabetes Research, and Sächsisches Staatsministerium für Wissenschaft, Kultur und Tourismus. All other authors report no competing interests.