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ACE2 Down-Regulation May Act as a Transient Molecular Disease Causing RAAS Dysregulation and Tissue Damage in the

Simone Gusmão Ramos1, Bruna Amanda da Cruz Rattis1, Giulia Ottaviani2

  • 1Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

The American Journal of Pathology
|May 8, 2021
PubMed

Insights

This review examines coronavirus disease 2019 (COVID-19) as a molecular disease affecting the angiotensin-converting enzyme 2 and renin-angiotensin-aldosterone system. These changes impact microcirculation, explaining multi-organ damage and informing new COVID-19 treatment strategies.

Area of Science:

  • Molecular biology
  • Pathophysiology
  • Virology

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, leading to widespread organ damage.
  • The disease affects multiple organ systems, including lungs, heart, brain, kidneys, and vasculature.

Purpose of the Study:

  • To reassess COVID-19 data, viewing it as a transient molecular disease.
  • To explore the negative regulation of angiotensin-converting enzyme 2 (ACE2) and its downstream effects.
  • To link microcirculatory changes to diverse organ injury mechanisms in COVID-19.

Main Methods:

  • Review and synthesis of existing COVID-19 research data.
  • Analysis of the molecular mechanisms involving ACE2 and the renin-angiotensin-aldosterone system (RAAS).
  • Exploration of the pathophysiological impact on the microcirculation.

Main Results:

  • COVID-19 deregulates the RAAS through ACE2, altering microcirculatory function.
  • Microcirculatory disturbances are implicated as a key factor in multi-organ damage.
  • A unifying pathophysiological model for COVID-19 is proposed.

Conclusions:

  • COVID-19 can be understood as a molecular disease impacting the ACE2-RAAS pathway.
  • Microcirculatory dysfunction is central to the systemic manifestations of COVID-19.
  • This perspective offers novel insights for developing targeted COVID-19 treatments.

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