Role of Angiotensin Converting Enzyme-2 and its modulation in disease: exploring new frontiers

Angiotensin Converting Enzyme-2 (ACE2), an important enzyme in the Renin Angiotensin Aldosterone System, degrades Angiotensin II (Ang II) into Angiotensin-(1-7) (Ang-(1-7)), whose actions are opposite to that of Ang II. Interestingly, SARS CoV-2 virus entry into human cells is mediated by ACE2. ACE2 receptors that are widely expressed in lungs and various other organs. Ang-(1-7) seems to have favorable effects on lungs, by preventing fibrosis in lung inflammation models, and exerts a similar action in cardiac and renal pathologies as well. Thus, modulation of Ang-(1-7) can be of potential benefit in chronic as well as acute inflammatory diseases affecting lungs and other organs. Upregulation of ACE2 by statins in different organs, and its consequent beneficial effects, have been demonstrated in many experimental studies, and also in a few clinical ones. This review aims at probing the role of ACE2 and its therapeutic modulation in pulmonary and extra pulmonary diseases, including COVID-19.