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Plasma ACE and ACE2 Levels Are Altered in Patients with COVID-19
Murat Oz1, Wassim Chehadeh2, Omamah Alfarisi1
1Department of Pharmacology and Therapeutics, College of Pharmacy, Kuwait University, Safat 13110, Kuwait.
Viruses
|April 27, 2026
Summary
COVID-19 severity correlates with renin-angiotensin system (RAS) imbalance. Lower ACE2 and higher ACE levels in severe cases suggest a shift toward inflammation, impacting COVID-19 (coronavirus disease 2019) pathophysiology.
Area of Science:
- Biochemistry
- Immunology
- Pathophysiology
Background:
- The COVID-19 pandemic caused by SARS-CoV-2 has led to significant global health challenges.
- The renin-angiotensin system (RAS) is implicated in COVID-19, with SARS-CoV-2 binding to ACE2.
- Understanding RAS component levels may offer insights into COVID-19 severity.
Purpose of the Study:
- To investigate the relationship between plasma concentrations of ACE and ACE2 and COVID-19 disease severity.
- To explore the potential role of RAS dysregulation in COVID-19 pathophysiology.
Main Methods:
- Retrospective cohort study of 224 PCR-confirmed COVID-19 adult patients.
- Patients stratified into five severity groups (asymptomatic to critical) based on WHO criteria.
- Plasma ACE and ACE2 levels measured by ELISA; clinical and laboratory data analyzed.
Main Results:
- Increasing COVID-19 severity correlated with higher mortality, BMI, and viral load.
- Severe illness showed leukocytosis, lymphopenia, anemia, elevated inflammatory markers, and renal dysfunction.
- Plasma ACE2 decreased significantly with severity, while plasma ACE increased, elevating the ACE/ACE2 ratio.
Conclusions:
- Progressive decline in ACE2 and rise in ACE with COVID-19 severity indicate a shift in RAS balance.
- The increased ACE/ACE2 ratio suggests a move towards the pro-inflammatory RAS pathway in severe COVID-19.
- This RAS dysregulation provides mechanistic insights into COVID-19 pathophysiology.
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