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Review
. 2022 May 2;27(9):2903.
doi: 10.3390/molecules27092903.

The Pathophysiology of Long COVID throughout the Renin-Angiotensin System

Shaymaa Khazaal  1 , Julien Harb  2 , Mohamad Rima  3 , Cédric Annweiler  4 , Yingliang Wu  5 , Zhijian Cao  5 , Ziad Abi Khattar  6 , Christian Legros  7 , Hervé Kovacic  8 , Ziad Fajloun  1   3 , Jean-Marc Sabatier  8
Affiliations
Review

The Pathophysiology of Long COVID throughout the Renin-Angiotensin System

Shaymaa Khazaal et al. Molecules. .

Abstract

COVID-19 has expanded across the world since its discovery in Wuhan (China) and has had a significant impact on people's lives and health. Long COVID is a term coined by the World Health Organization (WHO) to describe a variety of persistent symptoms after acute SARS-CoV-2 infection. Long COVID has been demonstrated to affect various SARS-CoV-2-infected persons, independently of the acute disease severity. The symptoms of long COVID, like acute COVID-19, consist in the set of damage to various organs and systems such as the respiratory, cardiovascular, neurological, endocrine, urinary, and immune systems. Fatigue, dyspnea, cardiac abnormalities, cognitive and attention impairments, sleep disturbances, post-traumatic stress disorder, muscle pain, concentration problems, and headache were all reported as symptoms of long COVID. At the molecular level, the renin-angiotensin system (RAS) is heavily involved in the pathogenesis of this illness, much as it is in the acute phase of the viral infection. In this review, we summarize the impact of long COVID on several organs and tissues, with a special focus on the significance of the RAS in the disease pathogenesis. Long COVID risk factors and potential therapy approaches are also explored.

Keywords: Angiotensin II receptor type 1; Angiotensin II receptor type 2; COVID-19; Long COVID; SARS-CoV-2; angiotensin-converting enzyme 2; immunity disorders; infectious disease; renin-angiotensin system.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Schematic ofRAS homeostasis (A) and impairment duringSARS-CoV-2 infection (B). ACE: Angiotensin-converting enzyme; Ang: Angiotensin; AT1R: Angiotensin II receptor type-1; AT2R: Angiotensin II receptor type-2; MAS: Mas-related G protein-coupled receptors.
Figure 2
Figure 2
Schematic ofRAS impairment in the brain duringSARS-CoV-2 infection. ACE: Angiotensin-converting enzyme; Ang: Angiotensin; AT1R: Angiotensin II receptor type 1; AT2R: Angiotensin II receptor type 2; MAS: Mas-related G protein-coupled receptors, PRR: Prorenin receptor.
Figure 3
Figure 3
Schematic of different systems and organs affected by long COVID. The infection can impact the nervous, cardiovascular, urinary, immune, and respiratory systems and the pancreas in diabetes conditions.
See this image and copyright information in PMC

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