Relationship Between ACE2 and Other Components of the Renin-Angiotensin System
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Relationship Between ACE2 and Other Components of the Renin-Angiotensin System Jordana B. Cohen 1,2 & Thomas C. Hanff 2,3 & Adam P. Bress 4 & Andrew M. South 5,6,7
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review Angiotensin-converting enzyme 2 (ACE2) is a key counter-regulatory component of the reninangiotensin system. Here, we briefly review the mechanistic and target organ effects related to ACE2 activity, and the importance of ACE2 in SARS-CoV-2 infection. Recent Findings ACE2 converts angiotensin (Ang) II to Ang-(1–7), which directly opposes the vasoconstrictive, proinflammatory, and prothrombotic effects of Ang II. ACE2 also facilitates SARS-CoV-2 viral entry into host cells. Drugs that interact with the renin-angiotensin system may impact ACE2 expression and COVID-19 pathogenesis; however, the magnitude and direction of these effects are unknown at this time. Summary High quality research is needed to improve our understanding of how agents that act on the renin-angiotensin system impact ACE2 and COVID-19-related disease outcomes. Keywords COVID-19 . Angiotensin-converting enzyme . Renin-angiotensin system . Angiotensin receptor blockers . Angiotensin-converting enzyme inhibitors . Hypertension . Coronavirus infections . Chronic kidney disease . Cardiovascular disease
Introduction The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, is associated with a high risk of acute respiratory distress syndrome and mortality [1–4]. Angiotensin-converting enzyme 2 (ACE2) facilitates SARSCoV-2 entry into host cells in the respiratory tract, and altered
ACE2 regulation is speculated to play a role in the pathogenesis of COVID-19 [5]. In the setting of the COVID-19 pandemic, there has been increasing interest in the physiologic and pathophysiologic function of ACE2 [6•]. Here, we briefly review the role of ACE2 in the renin-angiotensin system, the therapeutic potential of ACE2, and potential interactions of ACE2 with SARS-CoV-2 and its role in COVID-19 pathophysiology.
* Jordana B. Cohen [email protected]
4
Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
1
Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
5
Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine and Brenner Children’s Hospital, Winston Salem, USA
2
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
6
Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, USA
3
Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
7
Department of Surgery-Hypertens
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