Author: Chung, Mina K.; Karnik, Sadashiva; Saef, Joshua; Bergmann, Cornelia; Barnard, John; Lederman, Michael M.; Tilton, John; Cheng, Feixiong; Harding, Clifford V.; Young, James B.; Mehta, Neil; Cameron, Scott J.; McCrae, Keith R.; Schmaier, Alvin H.; Smith, Jonathan D.; Kalra, Ankur; Gebreselassie, Surafel K.; Thomas, George; Hawkins, Edward S.; Svensson, Lars G.
Title: SARS-CoV-2 and ACE2: The biology and clinical data settling the ARB and ACEI controversy Cord-id: zg9f19p8 Document date: 2020_8_6
ID: zg9f19p8
Snippet: BACKGROUND: SARS-CoV-2 enters cells by binding of its spike protein to angiotensin-converting enzyme 2 (ACE2). Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have been reported to increase ACE2 expression in animal models, and worse outcomes are reported in patients with co-morbidities commonly treated with these agents, leading to controversy during the COVID-19 pandemic over whether these drugs might be helpful or harmful. METHODS: : Animal, in vitr
Document: BACKGROUND: SARS-CoV-2 enters cells by binding of its spike protein to angiotensin-converting enzyme 2 (ACE2). Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have been reported to increase ACE2 expression in animal models, and worse outcomes are reported in patients with co-morbidities commonly treated with these agents, leading to controversy during the COVID-19 pandemic over whether these drugs might be helpful or harmful. METHODS: : Animal, in vitro and clinical data relevant to the biology of the renin-angiotensin system (RAS), its interaction with the kallikrein-kinin system (KKS) and SARS-CoV-2, and clinical studies were reviewed. FINDINGS AND INTERPRETATION: SARS-CoV-2 hijacks ACE2to invade and damage cells, downregulating ACE2, reducing its protective effects and exacerbating injurious Ang II effects. However, retrospective observational studies do not show higher risk of infection with ACEI or ARB use. Nevertheless, study of the RAS and KKS in the setting of coronaviral infection may yield therapeutic targets.
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