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The Renin-Angiotensin-Aldosterone System and Coronavirus Disease 2019

Eliecer Coto1,2,3,4, Pablo Avanzas5,2,3, Juan Gómez1,2

  • 1Genética Molecular, Hospital Universitario Central Asturias Oviedo, Spain.

European Cardiology
|March 19, 2021
PubMed

Insights

The renin-aldosterone-angiotensin system (RAAS) impacts COVID-19 severity, particularly in those with cardiovascular issues. Genetic variations in RAAS may influence individual responses to SARS-CoV-2 infection and disease outcomes.

Area of Science:

  • Cardiovascular Physiology
  • Infectious Disease Pathogenesis
  • Genetics

Background:

  • The renin-aldosterone-angiotensin system (RAAS) is crucial for cardiovascular regulation.
  • Angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for SARS-CoV-2, the virus causing COVID-19.
  • Imbalances in ACE/ACE2 levels, common in hypertension, may increase COVID-19 severity risk.

Purpose of the Study:

  • To explore the complex interplay between the RAAS and COVID-19 pathogenesis.
  • To investigate the potential role of RAAS genetic variations in COVID-19 susceptibility and severity.
  • To examine the relationship between cardiovascular disease and COVID-19 outcomes mediated by the RAAS.

Main Methods:

  • Literature review and synthesis of existing research on RAAS, ACE2, and COVID-19.
  • Analysis of studies investigating the effects of RAAS-targeting antihypertensive drugs on COVID-19 outcomes.
  • Exploration of genetic association studies linking RAAS gene variations to hypertension, cardiovascular disease, and COVID-19 risk.

Main Results:

  • RAAS plays a significant role in COVID-19 pathogenesis.
  • ACE2 expression levels may influence susceptibility and severity of SARS-CoV-2 infection.
  • RAAS-targeting antihypertensive medications do not appear to significantly alter infection risk or disease outcomes.
  • Genetic variations within the RAAS may contribute to the heterogeneous clinical responses observed in COVID-19 patients.

Conclusions:

  • The RAAS is a key mediator in the relationship between cardiovascular disease and COVID-19 severity.
  • Genetic factors influencing the RAAS could explain differential susceptibility and disease progression in SARS-CoV-2 infection.
  • Further research into RAAS genetics is warranted to understand COVID-19 heterogeneity.

Keywords:
COVID-19SARS-CoV-2angiotensin II receptor inhibitorsangiotensin-converting enzyme inhibitorsangiotensin-converting enzyme polymorphismscardiovascular comorbiditiescoronavirusrenin–angiotensin–aldosterone system

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