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Review
. 2020 Jul;92(7):726-730.
doi: 10.1002/jmv.25785. Epub 2020 Apr 5.

Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19

Hao Cheng  1 , Yan Wang  1 , Gui-Qiang Wang  1   2   3
Affiliations
Review

Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19

Hao Cheng et al. J Med Virol. 2020 Jul.

Abstract

This article reviews the correlation between angiotensin-converting enzyme 2 (ACE2) and severe risk factors for coronavirus disease 2019 (COVID-19) and the possible mechanisms. ACE2 is a crucial component of the renin-angiotensin system (RAS). The classical RAS ACE-Ang II-AT1R regulatory axis and the ACE2-Ang 1-7-MasR counter-regulatory axis play an essential role in maintaining homeostasis in humans. ACE2 is widely distributed in the heart, kidneys, lungs, and testes. ACE2 antagonizes the activation of the classical RAS system and protects against organ damage, protecting against hypertension, diabetes, and cardiovascular disease. Similar to SARS-CoV, SARS-CoV-2 also uses the ACE2 receptor to invade human alveolar epithelial cells. Acute respiratory distress syndrome (ARDS) is a clinical high-mortality disease, and ACE2 has a protective effect on this type of acute lung injury. Current research shows that the poor prognosis of patients with COVID-19 is related to factors such as sex (male), age (>60 years), underlying diseases (hypertension, diabetes, and cardiovascular disease), secondary ARDS, and other relevant factors. Because of these protective effects of ACE2 on chronic underlying diseases and ARDS, the development of spike protein-based vaccine and drugs enhancing ACE2 activity may become one of the most promising approaches for the treatment of COVID-19 in the future.

Keywords: acute respiratory distress syndrome (ARDS); angiotensin-converting enzyme 2 (ACE2); coronavirus disease 2019 (COVID-19); renin-angiotensin system (RAS); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Classical and counter‐regulatory RAS. ACE, angiotensin‐converting enzyme; ACE2, angiotensin‐converting enzyme 2; Ang 1‐7, angiotensin 1‐7; Ang I, angiotensin I; Ang II, angiotensin II; Ang III, angiotensin III; AT1R, type 1 angiotensin II receptor; MasR, MAS proto‐oncogene receptor; RAS, renin‐angiotensin system
Figure 2
Figure 2
The role of ACE2 in organ protection. ACEI, angiotensin‐converting enzyme inhibitors; ACE2, angiotensin‐converting enzyme 2; Ang II, angiotensin II; ARB, type 1 angiotensin II receptor; ARDS, acute respiratory distress syndrome; ROS, reactive oxygen species
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