Renin-angiotensin system: Basic and clinical aspects-A general perspective

Area of Science:

• Endocrinology and Physiology
• Cardiovascular Research
• Infectious Diseases

Background:

• The renin-angiotensin system (RAS) is a complex hormonal network crucial for regulating cardiovascular function and related diseases.
• Recent discoveries reveal two antagonistic RAS subsystems: the classic and alternative, influencing inflammation, hypertrophy, and fibrosis.
• Local RAS in tissues and its role in COVID-19 pathogenesis, particularly ACE2 interaction, highlight its systemic importance.

Purpose of the Study:

• To provide a narrative review of the preclinical and clinical aspects of the renin-angiotensin system.
• To discuss the complexity of the RAS, including its classic and alternative subsystems.
• To identify areas for future research and clarify unresolved aspects of RAS function.

Main Methods:

• Narrative review of existing preclinical and clinical literature on the RAS.
• Synthesis of current understanding regarding RAS subsystems and their roles in disease.
• Identification of knowledge gaps and future research directions.

Main Results:

• The RAS is more complex than previously thought, featuring antagonistic classic and alternative pathways.
• The classic RAS is implicated in inflammatory and fibrotic pathologies contributing to chronic diseases.
• RAS plays a role in COVID-19 severity via angiotensin-converting enzyme 2 (ACE2) interactions in the respiratory system.

Conclusions:

• The dual nature of the RAS necessitates a deeper understanding of its regulatory balance.
• Further investigation into tissue-specific RAS and its interaction with viral infections like COVID-19 is crucial.
• Clarifying the multifaceted roles of the RAS is essential for developing novel therapeutic strategies.