Metabolic and Inflammatory Dysregulation in Autism Spectrum Disorder and COVID-19: A Hypothesis-Generating Review

This narrative review conceptually integrates neurodevelopmental and infectious disease research to examine whether shared metabolic and immune dysregulation provides a biologically plausible framework for understanding COVID-19 risk and recovery in individuals with Autism Spectrum Disorder (ASD). Rather than inferring causality, the aim is to critically evaluate existing evidence, identify gaps in current knowledge, and propose testable hypotheses to guide future longitudinal, mechanistic, and biomarker-driven investigations. By situating ASD within a systems-level metabolic–immune framework, this work seeks to inform more precise strategies for risk stratification and clinical monitoring in vulnerable populations.A structured literature search was conducted using PubMed, PsycINFO, ScienceDirect, and Scopus, covering publications from 2007 to 2025. Search terms included ASD, COVID-19, cholesterol, glucose, ferritin, and white blood cells. Priority was given to peer-reviewed original research, reviews, and meta-analyses with mechanistic or biomarker relevance. Preclinical studies were included to support pathway-level discussion, while case reports and non-peer-reviewed sources were excluded.Evidence suggests overlapping biomarker patterns in ASD and COVID-19, including reduced HDL, elevated glucose, and increased neutrophil-to-lymphocyte ratios. Ferritin, often reduced in ASD, may rise during acute infection. These shared alterations underscore the importance of early biomarker monitoring and targeted intervention strategies.