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Review
. 2021 May;40(5):905-919.
doi: 10.1007/s10096-020-04138-6. Epub 2021 Jan 3.

COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection

Stephany Beyerstedt  1 , Expedito Barbosa Casaro  1 , Érika Bevilaqua Rangel  2   3
Affiliations
Review

COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection

Stephany Beyerstedt et al. Eur J Clin Microbiol Infect Dis. 2021 May.

Abstract

COVID-19 pandemic is caused by the novel coronavirus SARS-CoV-2. Angiotensin-converting enzyme 2 (ACE2) is not only an enzyme but also a functional receptor on cell surfaces through which SARS-CoV-2 enters the host cells and is highly expressed in the heart, kidneys, and lungs and shed into the plasma. ACE2 is a key regulator of the renin-angiotensin-aldosterone system (RAAS). SARS-CoV-2 causes ACE/ACE2 balance disruption and RAAS activation, which leads ultimately to COVID-19 progression, especially in patients with comorbidities, such as hypertension, diabetes mellitus, and cardiovascular disease. Therefore, ACE2 expression may have paradoxical effects, aiding SARS-CoV-2 pathogenicity, yet conversely limiting viral infection. This article reviews the existing literature and knowledge of ACE2 in COVID-19 setting and focuses on its pathophysiologic involvement in disease progression, clinical outcomes, and therapeutic potential.

Keywords: Angiotensin-converting enzyme; COVID-19; SARS-CoV-2; Tissue damage.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
SARS-CoV-2 life cycle: from binding to ACE2 receptor to shedding
Fig. 2
Fig. 2
Renin–angiotensin–aldosterone system (RAAS): ACE/ACE2 balance, pathophysiological mechanisms, and the impact of the RAAS blockers (ACEi and ARBs). ACEi, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers
See this image and copyright information in PMC

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