Abstract
The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1-angiotensin II-angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2-angiotensin(1-7)-Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.
TY - JOUR
T1 - Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients.
AU - Rossi,Gian Paolo,
AU - Sanga,Viola,
AU - Barton,Matthias,
Y1 - 2020/04/06/
PY - 2020/03/26/received
PY - 2020/04/03/accepted
PY - 2020/4/7/pubmed
PY - 2020/5/7/medline
PY - 2020/4/7/entrez
KW - ACE
KW - ACE inhibitor
KW - ACE inhibitors
KW - ACE-2
KW - ACEIs
KW - ARBs
KW - ARDS
KW - Acute respiratory distress syndrome
KW - COVID-19
KW - RAAS
KW - SARS
KW - SARS-CoV-2
KW - angiotensin
KW - angiotensin receptor antagonists
KW - angiotensin receptor blocker
KW - angiotensin-converting enzyme-1
KW - angiotensin-converting enzyme-2
KW - arterial hypertension
KW - cardiovascular
KW - coronavirus
KW - human biology
KW - infection
KW - medicine
KW - renin-angiotensin-aldosterone system
KW - therapy
KW - treatment
KW - virus
JF - eLife
JO - Elife
VL - 9
N2 - The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1-angiotensin II-angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2-angiotensin(1-7)-Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.
SN - 2050-084X
UR - https://www.unboundmedicine.com/medline/citation/32250244/Potential_harmful_effects_of_discontinuing_ACE_inhibitors_and_ARBs_in_COVID_19_patients_
DB - PRIME
DP - Unbound Medicine
ER -
