Angiotensin converting enzyme 2 at the interface between renin‐angiotensin system inhibition and coronavirus disease 2019

• Published in: The Journal of physiology Vol. 598; no. 19; pp. 4181 - 4195
• Main Authors: Siri‐Angkul, Natthaphat, Chattipakorn, Siriporn C., Chattipakorn, Nipon
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2020
• Subjects: ACE2; ACEI; Angiotensin; Angiotensin Receptor Antagonists - pharmacology; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-converting enzyme 2; Angiotensin-Converting Enzyme 2 - metabolism; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Animals; ARB; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - drug therapy; COVID-19 - metabolism; Decision making; Diuretics; Enzymes; Humans; Infectivity; Peptidyl-dipeptidase A; Renin; Renin-Angiotensin System - drug effects; SARS‐CoV‐2; Severe acute respiratory syndrome coronavirus 2; COVID-19; ACEI; ACE2; ARB; SARS-CoV-2
• ISSN: 0022-3751; 1469-7793
• DOI: 10.1113/JP280138

The coronavirus disease 2019 (COVID‐19) is the third major coronavirus outbreak of this century. Its aetiological agent, the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), requires angiotensin converting enzyme 2 (ACE2) for cellular entry. The commonly used angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could affect SARS‐CoV‐2 infectivity and may alter COVID‐19 disease progression by altering ACE2 expression. Current evidence of ACEI/ARB‐ACE2 interaction as well as the effects of ACEIs/ARBs on viral‐associated acute lung injury is summarized and discussed in this review. This review assesses the evidence gathered so far and highlights the research that needs to be done to help inform clinical decision making. figure legend The ubiquitous use of ACEIs/ARBs has raised major concerns regarding their effects on COVID‐19 disease severity and progression. These drugs may affect the levels of membrane‐bound ACE2 and/or soluble ACE2, which serve as a SARS‐CoV‐2 co‐receptor and an anti‐inflammatory enzyme, respectively. Unfortunately, existing in vivo and clinical studies yield discrepant findings, and confounding factors in those clinical reports could contribute to the inconclusive results. ACE, angiotensin converting enzyme; ACE2, angiotensin converting enzyme 2; ACEI, angiotensin converting enzyme inhibitor; COVID‐19, coronavirus disease 2019; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2.