Editorial

. 2020 Apr 7;24(1):136.

doi: 10.1186/s13054-020-02862-1.

COVID-19 and the RAAS-a potential role for angiotensin II?

Laurence W Busse^{1

2

3}, Jonathan H Chow⁴, Michael T McCurdy⁵, Ashish K Khanna^{6

7}

Affiliations

¹ Department of Medicine, Emory University, Atlanta, GA, USA. lbusse@emory.edu.
² Emory Critical Care Center, Atlanta, GA, USA. lbusse@emory.edu.
³ Department of Critical Care Medicine, Emory Johns Creek Hospital, 6325 Hospital Parkway, Johns Creek, GA, 30097, USA. lbusse@emory.edu.
⁴ Department of Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Departments of Medicine and Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁶ Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁷ Outcomes Research Consortium, Cleveland, OH, USA.

PMID: 32264922
PMCID: PMC7137402
DOI: 10.1186/s13054-020-02862-1

Editorial

COVID-19 and the RAAS-a potential role for angiotensin II?

Laurence W Busse et al. Crit Care. 2020.

. 2020 Apr 7;24(1):136.

doi: 10.1186/s13054-020-02862-1.

Authors

Laurence W Busse^{1

2

3}, Jonathan H Chow⁴, Michael T McCurdy⁵, Ashish K Khanna^{6

7}

Affiliations

¹ Department of Medicine, Emory University, Atlanta, GA, USA. lbusse@emory.edu.
² Emory Critical Care Center, Atlanta, GA, USA. lbusse@emory.edu.
³ Department of Critical Care Medicine, Emory Johns Creek Hospital, 6325 Hospital Parkway, Johns Creek, GA, 30097, USA. lbusse@emory.edu.
⁴ Department of Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Departments of Medicine and Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁶ Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁷ Outcomes Research Consortium, Cleveland, OH, USA.

PMID: 32264922
PMCID: PMC7137402
DOI: 10.1186/s13054-020-02862-1

No abstract available

Keywords: ACE2; Angiotensin II; COVID-19; Coronavirus; RAAS.

PubMed Disclaimer

Conflict of interest statement

JHC serves on the Speaker’s Bureau for La Jolla Pharmaceutical Company.

All other authors report no competing interests.

Figures

**Fig. 1**
Effect of angiotensin II on the RAAS and SARS-CoV-2 binding. Angiotensin I is hydrolyzed by ACE1 to form angiotensin II, which binds to AT₁ receptors. This causes release of aldosterone from the adrenal gland, vasopressin secretion from the hypothalamus, and vasoconstriction. Vasopressin and aldosterone both lead to increased sodium and free water reabsorption in the kidney, leading to increased mean arterial pressure (MAP). Angiotensin II is then metabolized into Ang-(1–7) by ACE2. SARS-CoV-2 binds to ACE2 to gain entry into the host cell. Exogenous angiotensin II can also bind to ACE2, which can lead to competitive inhibition of the ACE2 receptor. In addition, binding of angiotensin II to AT₁ receptors leads to internalization, downregulation, and degradation of ACE2. These actions may potentially prevent SARS-CoV2 from entering the cell. Figure created with Motifolio Toolkit. Ang-2, angiotensin II; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ACE1, angiotensin-converting-enzyme 1; ACE2, angiotensin-converting-enzyme 2; H₂O, water; Na⁺, sodium

See this image and copyright information in PMC

Comment in

Why the Use of Angiotensin II May be a Fatal Mistake in COVID-19.
Ferreira JA, Mcmanus J, Jankowski CA, Searcy R. Ferreira JA, et al. Shock. 2020 Nov;54(5):697-699. doi: 10.1097/SHK.0000000000001577. Shock. 2020. PMID: 32453250 Free PMC article. No abstract available.
Potential benefit of angiotensin II in COVID-19 patients: beyond reasonable doubt?
Tralhão A, Moita LF, Póvoa P. Tralhão A, et al. Crit Care. 2020 Jun 9;24(1):324. doi: 10.1186/s13054-020-03027-w. Crit Care. 2020. PMID: 32517796 Free PMC article. No abstract available.

References

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1. Murthy S, Gomersall CD, Fowler RA. Care for critically ill patients with COVID-19. JAMA. 2020. [Epub ahead of print]. - PubMed
1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. [Epub ahead of print]. - PMC - PubMed

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COVID-19 and the RAAS-a potential role for angiotensin II?

Affiliations

COVID-19 and the RAAS-a potential role for angiotensin II?

Authors

Affiliations

Conflict of interest statement

Figures

Comment in

References

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