The Renin-Angiotensin System (RAS) in COVID-19 Disease: Where We Are 3 Years after the Beginning of the Pandemic

Area of Science:

• Cardiovascular Physiology
• Infectious Diseases
• Endocrinology

Background:

• The renin-angiotensin system (RAS) regulates blood pressure and electrolyte balance, and its dysregulation is linked to pathologies like acute respiratory distress syndrome (ARDS).
• COVID-19, a viral illness, has prompted research into the involvement of the RAS in its pathogenesis and clinical course.

Purpose of the Study:

• To review existing evidence on the role of RAS enzymes (ACE, ACE2) and products (AngII, Ang1-7) in SARS-CoV-2 infection.
• To present new experimental data on systemic RAS activity in hospitalized COVID-19 patients.
• To evaluate the potential of the RAS as a clinical marker for COVID-19 severity, progression, and outcome.

Main Methods:

• Literature review of studies on RAS components in COVID-19.
• Analysis of systemic ACE and ACE2 activity and AngII/Ang1-7 concentrations in 47 hospitalized COVID-19 patients.
• Correlation of RAS parameters with disease severity and outcomes.

Main Results:

• Evidence suggests a complex interplay between RAS components and SARS-CoV-2 infection.
• New data reveals specific systemic activity levels of ACE, ACE2, AngII, and Ang1-7 in COVID-19 patients.
• Preliminary findings indicate potential associations between RAS markers and clinical parameters.

Conclusions:

• The RAS, particularly ACE, ACE2, AngII, and Ang1-7, may play a significant role in COVID-19 pathophysiology.
• Systemic RAS activity in COVID-19 patients warrants further investigation as a potential clinical biomarker.
• Understanding RAS modulation could inform therapeutic strategies for severe COVID-19.