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. 2024;6(6):255-265.
doi: 10.33696/immunology.6.213.

Evaluating the Role of the Renin-angiotensin System in COVID-19: Implications for ACE Inhibitor and ARB Use During SARS-CoV-2 Infection

Sarah R Tritsch  1 , Evelyn Mendoza-Torres  2 , Mónica Gómez-Pulido  2 , Jairo Castellar-López  2 , Rebecca Lynch  1 , Carlos Herrera Gomez  1 , Hana Akselrod  1 , Adrienne Poon  1 , Sam Simmens  1 , Christopher N Mores  1 , Gary Simon  1 , Lauren C Ray  3 , Sarah Conway  1 , Aileen Y Chang  1
Affiliations

Evaluating the Role of the Renin-angiotensin System in COVID-19: Implications for ACE Inhibitor and ARB Use During SARS-CoV-2 Infection

Sarah R Tritsch et al. J Cell Immunol. 2024.

Abstract

This study aimed to investigate the role of the renin-angiotensin system (RAS) in COVID-19, particularly focusing on key components such as ACE, ACE2, and their related peptides, angiotensin-(1-7) and angiotensin-(1-9). Using serum samples from healthy controls and both non-severe and severe COVID-19 patients, ELISA assays revealed no significant differences in these RAS components between the groups. In addition, in vitro studies showed no impact of ACE inhibitors or Angiotensin Receptor Blockers (ARB) on cell viability during SARS-CoV-2 infection. These clinical findings suggest that RAS alterations may not be a major factor in COVID-19 severity and the in vitro data support current guidelines, indicating the safety of continuing ACE inhibitors and ARBs in COVID-19 patients without evidence of increased SARS-CoV-2 infectivity in the presence of these compounds. This study highlights the lack of significant changes in key RAS components during COVID-19 in a clinical cohort and provides critical in vitro evidence supporting the continued use of ACE inhibitors and ARBs in treating patients.

Keywords: COVID-19; Cardiovascular disease; Coronavirus disease; Diabetes; Hypertension.

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Conflict of interest statement

Conflict of Interest The authors declare no conflict of interest. The sponsors had no role in the design, execution, interpretation, or writing of the study.

Figures

Figure 1.
Figure 1.
Comparison of the median concentrations of ACE, ACE2, Angiotensin-(1–9) and Angiotensin-(1–7) determined by ELISA in serum samples of healthy controls and non-severe and severe COVID-19 cases. Median and interquartile ranges are shown.
Figure 2.
Figure 2.
Average cell count via IFA for samples infected with SARS-COV-2 for 24 hours at 0.1 and 0.5 MOI, followed by drug treatment for 48 hours.
Figure 3.
Figure 3.
Average cell count via IFA for samples treated with drugs for 24 hours, followed by SARS-COV-2 infection for 48 hours at 0.1 and 0.5 MOI.
Figure 4.
Figure 4.
Average cell count via IFA for samples infected with SARS-COV-2 at 0.1 and 0.5 MOI and treated with drugs at the same time for 48 hours.
See this image and copyright information in PMC

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