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Comment
. 2020 Sep-Oct;14(5):723-724.
doi: 10.1016/j.dsx.2020.05.029. Epub 2020 May 23.

Letter in response to the article: Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et al.)

Kunal Mahajan  1 , Naresh Gaur  2
Affiliations
Comment

Letter in response to the article: Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et al.)

Kunal Mahajan et al. Diabetes Metab Syndr. 2020 Sep-Oct.
No abstract available

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Figures

Fig. 1
Fig. 1
A proposed mechanism of benefit with renin-angiotensin system blockers in SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) associated tissue injury. SARS-CoV-2 enters the host epithelial cells (1) through the interaction of its spike protein with the functional receptor “ACE-2” (angiotensin converting enzyme-2). After cell entry, viral replication takes place (2) which simultaneously downregulates the membrane bound ACE-2 receptors and causes their internalization (3). The reduced expression of ACE-2 leads to unopposed action of angiotensin II on its AT1 (angiotensin II type 1) receptor. This results in increased inflammation, fibrosis, vasoconstriction, oxidative stress, and aldosterone mediated sodium and water retention, subsequently resulting in acute lung injury. Diminished production of angiotensin II with an ACE-I or blockade of AT1 receptor with an ARB enhances the generation of angiotensin (1–7) by ACE-2 and activation of the MAS receptor, which attenuates harmful effects of angiotensin II and therefore attenuates lung injury.
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References

    1. Singh A.K., Gupta R., Misra A. Comorbidities in COVID-19: outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetes Metabol Syndrome Res Rev. 2020 Apr 9;14(4):283–287. doi: 10.1016/j.dsx.2020.03.016. Online ahead of print. - DOI - PMC - PubMed
    1. Bavishi C., Maddox T.M., Messerli F.H. Coronavirus disease 2019 (COVID-19) infection and renin angiotensin system blockers. JAMA Cardiol. 2020 doi: 10.1001/jamacardio.2020.1282. Published online April 03. - DOI - PubMed
    1. Vaduganathan M., Vardeny O., Michel T. Renin-AngiotensinAldosterone system inhibitors in patients with covid-19. N Engl J Med. 2020 doi: 10.1056/NEJMsr2005760. [published online ahead of print, 2020 Mar 30] NEJM sr2005760. - DOI - PMC - PubMed
    1. Komine N., Khang S., Wead L.M. Effect of combining an ACE inhibitor and an angiotensin II receptor blocker on plasma and kidney tissue angiotensin II levels. Am J Kidney Dis. 2002;39(1):159–164. doi: 10.1053/ajkd.2002.29909. - DOI - PubMed
    1. Dijkman R., Jebbink M.F., Deijs M. Replication-dependent downregulation of cellular angiotensin-converting enzyme 2 protein expression by human coronavirus NL63. J Gen Virol. 2012;93:1924–1929. - PubMed