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The renin-angiotensin system - a therapeutic target in COVID-19?

Beattie Rh Sturrock1, Kate M Milne1, Timothy Jt Chevassut2

  • 1Brighton and Sussex Medical School, Brighton UK and Royal Sussex County Hospital, Brighton, UK.

Clinical Medicine (London, England)
|May 17, 2020
PubMed

Insights

COVID-19 infection involves SARS-CoV-2 entering cells via ACE2. Inhibiting the renin-angiotensin system (RAS) ACE-dependent pathway may treat lung injury and improve outcomes in COVID-19 patients.

Area of Science:

  • Cardiology
  • Pulmonology
  • Infectious Diseases

Background:

  • COVID-19, caused by SARS-CoV-2, presents with respiratory symptoms and can lead to severe lung injury.
  • The SARS-CoV-2 virus utilizes the ACE2 receptor for cellular entry.
  • The renin-angiotensin system (RAS) plays a critical role in cardiovascular and renal function, and its dysregulation is implicated in various diseases.

Purpose of the Study:

  • To explore the role of the renin-angiotensin system (RAS) in COVID-19 pathogenesis.
  • To investigate the potential therapeutic benefits of modulating the RAS pathway in COVID-19.
  • To address concerns regarding antihypertensive medications affecting ACE2 and COVID-19 severity.

Main Methods:

  • Overview of the renin-angiotensin system (RAS) pathway.
  • Discussion of the interaction between SARS-CoV-2, ACE2, and the RAS.
  • Review of existing literature on RAS components and their effects on lung injury.

Main Results:

  • ACE2 is protective against lung injury, while Angiotensin II (ANG II) is associated with lung injury.
  • Certain antihypertensives may increase ACE2, raising concerns about facilitating SARS-CoV-2 entry.
  • Inhibition of the ACE-dependent RAS pathway is proposed as a potential therapeutic strategy.

Conclusions:

  • Modulating the RAS pathway, specifically inhibiting the ACE-dependent arm, may offer a protective effect against COVID-19-induced lung injury.
  • Further research in animal models and clinical trials is warranted to evaluate RAS-targeted therapies for COVID-19.
  • Understanding the RAS in COVID-19 is crucial for optimizing patient outcomes and managing disease progression.
Keywords:
ACE2COVID-19RASRenin–angiotensin systemlung injury

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