Title:Angiotensin-Converting Enzyme 2 Roles in the Pathogenesis of COVID-19
Volume: 17
Issue: 3
Author(s): Azra Kenarkoohi, Maryam Maleki, Tahereh Safari, Mohammad Reza Kaffashian, Fateme Saljoughi and Shahla Sohrabipour*
Affiliation:
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas,Iran
Keywords:
COVID-19, renin-angiotensin system, angiotensin-converting enzyme 2, coronavirus, SARS-CoV-2, angiotensinconverting
enzyme inhibitors.
Abstract: The new pandemic Coronavirus Disease 2019 (COVID-19) causes a wide range of clinical
consequences, from asymptomatic infection to acute respiratory failure, and it is very heterogeneous.
The renin-angiotensin system (RAS) is well recognized as a key regulating system in circulatory
homeostasis that plays prominent roles in pathophysiological processes in abnormal activation,
for instance, renal and cardiovascular diseases, obesity, and stroke. Angiotensin-converting enzyme
2(ACE2) is a component of the RAS system. However, unlike the ACE, its activity is not inhibited
by the ACE inhibitors. The major product of ACE2 is Ang1-7, known as a vasodilator peptide
and part of the depressant arm of the RAS. There are two forms of ACE2; Transmembrane
ACE2 and soluble ACE2. Coronavirus is covered with some proteins in order to help viral attachment
to the cell membrane ACE2 as a receptor and then fuse and enter the cells. ACE2 was expressed
in the oral cavity, salivary glands of the mouth, esophagus, myocardial cells, kidney, and
enterocytes, along with all the respiratory tract, intestine, and blood vessels. In this article, the renin-
angiotensin system and its components have been explained. Moreover, the organs involved in
COVID-19 disease, and the possible causes of damage to these organs have also been discussed.
The probable mechanism of using ACE2 in viral attachment and the probable treatment processes
will also be reviewed based on the surface proteins of the virus and ACE2. In addition, we briefly
discuss anti-angiotensin drugs and why patients with chronic diseases are more susceptible to
COVID-19 infection and show worse progression.
