Role of the renin-angiotensin-aldosterone system in sepsis and its therapeutic targets

An imbalance in the host's response to infection causes sepsis, a potentially fatal condition. Sepsis may advance to septic shock, organ dysfunction (including the brain, liver, lung, kidney, and heart), skeletal muscle atrophy, and an array of severe complications. The renin-angiotensin-aldosterone system (RAAS) undergoes significant alterations during sepsis, and the expression of its principal bioactive components is closely associated with the prognosis of patients with sepsis. Targeting RAAS may offer an effective approach to managing sepsis and its complications. Consequently, this review primarily summarizes the impact of sepsis on the activity and expression of key RAAS components in the circulation and tissues. We also discuss the effects and mechanisms of selectively modulating the RAAS in the context of sepsis and its associated complications. Furthermore, we introduce innovative perspectives on the precise regulation of the RAAS with the aim of optimizing treatment strategies tailored to different stages of sepsis and diverse complications.