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. 2021 Jun;21(6):498-503.
doi: 10.1007/s12012-021-09649-y. Epub 2021 Apr 9.

Scientific Hypothesis for Treatment of COVID-19's Lung Lesions by Adjusting ACE/ACE2 Imbalance

F Ferrara  1 , A Vitiello  2
Affiliations

Scientific Hypothesis for Treatment of COVID-19's Lung Lesions by Adjusting ACE/ACE2 Imbalance

F Ferrara et al. Cardiovasc Toxicol. 2021 Jun.

Abstract

In March 2019 began the global pandemic COVID-19 caused by the new Coronavirus SARS-CoV-2. The first cases of SARS-CoV-2 infection occurred in November-19 in Wuhan, China. The preventive measures taken did not prevent the rapid spread of the virus to all countries around the world. To date, there are about 2.54 million deaths, effective vaccines are in clinical trials. SARS-CoV-2 uses the ACE-2 protein as an intracellular gateway. ACE-2 is a key component of the Renin Angiotensin (RAS) system, a key regulator of cardiovascular function. Considering the key role of ACE-2 in COVID-19 infection, both as an entry receptor and as a protective role, especially for the respiratory tract, and considering the variations of ACE-2 and ACE during the stages of viral infection, it is clear the important role that the pharmacological regulation of RAS and ACE-2 can assume. This biological knowledge suggests different pharmacological approaches to treat COVID-19 by modulating RAS, ACE-2 and the ACE/ACE2 balance that we describe in this article.

Keywords: ACE-2; COVID-19; RAS; SARS-CoV-2.

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Conflict of interest statement

All Authors declare that they have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Schematic representation of the renin-angiotensin system (RAS). Activation of AT2-r and MasR receptors induce vasodilatory, anti-inflammatory, and antifibrotic effects with potential clinical benefit in the most severe stages of SARS-CoV-2 infection, in contrast, vasoconstrictor, proinflammatory, and profibrotic effects mediated by AT1-r activation could increase lung and tissue damage
Fig. 2
Fig. 2
SARS-CoV-2 uses ACE-2 as a cellular input receptor, decreasing its expression and activity (Zhang et al. 2020), this may favor the ACE/Ang II/AT-1r axis. Therapeutic strategies can rebalance the ACE/ACE-2 balance in favor of the ACE-2/Ang(1–7)MASr axis with antifibrotic and antifibrotic effects in reducing COVID-19 lung lesions
See this image and copyright information in PMC

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