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. 2020 Apr 28;12(5):491.
doi: 10.3390/v12050491.

ACE2: The key Molecule for Understanding the Pathophysiology of Severe and Critical Conditions of COVID-19: Demon or Angel?

Li Xiao  1 , Hiroshi Sakagami  2 , Nobuhiko Miwa  3
Affiliations

ACE2: The key Molecule for Understanding the Pathophysiology of Severe and Critical Conditions of COVID-19: Demon or Angel?

Li Xiao et al. Viruses. .

Abstract

Recently, the SARS-CoV-2 induced disease COVID-19 has spread all over the world. Nearly 20% of the patients have severe or critical conditions. SARS-CoV-2 exploits ACE2 for host cell entry. ACE2 plays an essential role in the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure and fluid balance. ACE2 also protects organs from inflammatory injuries and regulates intestinal functions. ACE2 can be shed by two proteases, ADAM17 and TMPRSS2. TMPRSS2-cleaved ACE2 allows SARS-CoV-2 cell entry, whereas ADAM17-cleaved ACE2 offers protection to organs. SARS-CoV-2 infection-caused ACE2 dysfunction worsens COVID-19 and could initiate multi-organ failure. Here, we will explain the role of ACE2 in the pathogenesis of severe and critical conditions of COVID-19 and discuss auspicious strategies for controlling the disease.

Keywords: ACE2; ADAM17; Ang-(1-7); B0AT1; COVID-19; RAAS; SARS-CoV-2; TMPRSS2.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hypothesis of ACE2 shedding and SARS-CoV-2 entry.
Figure 2
Figure 2
Role of ACE2 in the renin–angiotensin–aldosterone system (RAAS).
Figure 3
Figure 3
Hypothesis of ACE2 and the pathogenesis of severe and critical COVID-19.
See this image and copyright information in PMC

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