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Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week.
J Am Coll Cardiol. 2020 Jun 23; 75(24):3085-3095.JACC

Abstract

Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease. Based on the anti-inflammatory benefits of the upregulation of the ACE2/Ang1-7/Mas axis and previously demonstrated benefits of lung function improvement in SARS-CoV infections, it has been hypothesized that the benefits of treatment with renin-angiotensin system inhibitors in SARS-CoV-2 may outweigh the risks and at the very least should not be withheld.

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Authors+Show Affiliations

Brojakowska A
Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Narula J
Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Shimony R
Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Bander J
Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jeffrey.bander@mountsinai.org.

MeSH

Angiotensin Receptor AntagonistsAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsBetacoronavirusCOVID-19Cardiovascular DiseasesCoronavirus InfectionsHost Microbial InteractionsHumansMedication Therapy ManagementMineralocorticoid Receptor AntagonistsPandemicsPeptidyl-Dipeptidase APneumonia, ViralRenin-Angiotensin SystemSARS-CoV-2

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32305401

Citation

Brojakowska, Agnieszka, et al. "Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week." Journal of the American College of Cardiology, vol. 75, no. 24, 2020, pp. 3085-3095.
Brojakowska A, Narula J, Shimony R, et al. Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;75(24):3085-3095.
Brojakowska, A., Narula, J., Shimony, R., & Bander, J. (2020). Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week. Journal of the American College of Cardiology, 75(24), 3085-3095. https://doi.org/10.1016/j.jacc.2020.04.028
Brojakowska A, et al. Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Jun 23;75(24):3085-3095. PubMed PMID: 32305401.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week. AU - Brojakowska,Agnieszka, AU - Narula,Jagat, AU - Shimony,Rony, AU - Bander,Jeffrey, Y1 - 2020/04/16/ PY - 2020/4/2/received PY - 2020/4/9/revised PY - 2020/4/13/accepted PY - 2020/4/20/pubmed PY - 2020/7/1/medline PY - 2020/4/20/entrez KW - ACE inhibitor KW - COVID-19 KW - SARS-CoV-2 KW - angiotensin II receptor blockers KW - angiotensin-converting enzyme-2 KW - mineralocorticoid receptor antagonist SP - 3085 EP - 3095 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 75 IS - 24 N2 - Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease. Based on the anti-inflammatory benefits of the upregulation of the ACE2/Ang1-7/Mas axis and previously demonstrated benefits of lung function improvement in SARS-CoV infections, it has been hypothesized that the benefits of treatment with renin-angiotensin system inhibitors in SARS-CoV-2 may outweigh the risks and at the very least should not be withheld. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/32305401/Clinical_Implications_of_SARS_CoV_2 Interaction_With_Renin_Angiotensin_System:_JACC_Review_Topic_of_the_Week_ DB - PRIME DP - Unbound Medicine ER -