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

Area of Science:

• Endocrinology
• Cardiovascular Physiology
• Molecular Biology

Background:

• The renin-angiotensin system (RAS) is a complex hormonal network crucial for regulating cardiovascular function.
• Historically, RAS research focused on its role in cardiovascular diseases, leading to targeted pharmacological treatments.
• Recent discoveries reveal a more intricate RAS with two antagonistic subsystems and tissue-specific roles.

Purpose of the Study:

• To present a comprehensive narrative review of the preclinical and clinical aspects of the RAS.
• To highlight the expanded understanding of the RAS beyond cardiovascular regulation.
• To identify areas requiring further investigation within the RAS.

Main Methods:

• Narrative review of existing preclinical and clinical literature on the RAS.
• Synthesis of evidence regarding the dual subsystem model of the RAS.
• Exploration of the RAS's involvement in inflammation, hypertrophy, fibrosis, and chronic diseases.

Main Results:

• The RAS comprises classic and alternative subsystems with generally opposing effects, maintaining physiological balance.
• The classic RAS is implicated in pathologies characterized by inflammation, hypertrophy, and fibrosis, contributing to chronic diseases.
• Local RAS exist in various tissues, and the system plays a role in COVID-19 severity via angiotensin-converting enzyme 2 interactions.

Conclusions:

• The RAS is a highly complex system with significant implications for multiple body systems and chronic disease development.
• Understanding the interplay between RAS subsystems and local tissue RAS is critical for comprehending disease pathogenesis.
• Further research is essential to elucidate the full spectrum of RAS functions and develop novel therapeutic strategies.