Affiliation:
1. Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
Abstract
Background::
The Coronavirus Disease 2019 (COVID-19) is becoming the major health
issue in recent human history with thousands of deaths and millions of cases worldwide. Newer research
and old experience with other coronaviruses highlighted a probable underlying mechanism
of disturbance of the renin-angiotensin system (RAS) that is associated with the intrinsic effects of
SARS-CoV-2 infection.
Objective::
In this review, we aimed to describe the intimate connections between the RAS components,
the immune system and COVID-19 pathophysiology.
Methods::
This non-systematic review article summarizes recent evidence on the relationship between
COVID-19 and the RAS.
Results::
Several studies have indicated that the downregulation of membrane-bound ACE2 may exert
a key role for the impairment of immune functions and for COVID-19 patients’ outcomes. The
downregulation may occur by distinct mechanisms, particularly: (1) the shedding process induced
by the SARS-CoV-2 fusion pathway, which reduces the amount of membrane-bound ACE2, stimulating
more shedding by the high levels of Angiotensin II; (2) the endocytosis of ACE2 receptor
with the virus itself and (3) by the interferon inhibition caused by SARS-CoV-2 effects on the immune
system, which leads to a reduction of ACE2 receptor expression.
Conclusion::
Recent research provides evidence of a reduction of the components of the alternative
RAS axis, including ACE2 and Angiotensin-(1-7). In contrast, increased levels of Angiotensin II
can activate the AT1 receptor in several organs. Consequently, increased inflammation, thrombosis
and angiogenesis occur in patients infected with SARS-COV-2. Attention should be paid to the interactions
of the RAS and COVID-19, mainly in the context of novel vaccines and proposed medications.
Funder
Foundation of Research of Minas Gerais (FAPEMIG
Coordination of High Education Level Personnel (CAPES
Brazilian National Council of Research Development (CNPq
Publisher
Bentham Science Publishers Ltd.
Subject
Clinical Biochemistry,Drug Discovery,Pharmacology,Molecular Medicine
Cited by
36 articles.
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