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Focus on clinical practice: angiotensin-converting enzyme 2 and corona virus disease 2019: pathophysiology and clinical implications.
J Cardiovasc Med (Hagerstown). 2020 Sep; 21(9):630-633.JC

Abstract

: ACE2 receptor has a broad expression pattern in the cellular membrane and provides a protective action against the development of cardiovascular diseases. Recently, this enzyme has become of extreme interest during the pandemic infection of COVID-19 (coronavirus disease 2019). This virus invades alveolar epithelium and cardiomyocytes using ACE2 as a transmembrane receptor. ACE2 is a counter-regulatory peptide that degrades Ang II into Ang 1-7, thereby attenuating the biological effects of the AT1 receptor. The binding between the spike protein of COVID-19 and the enzyme is crucial for the virus to enter the target cells, but whether an increase in ACE2 activity could facilitate the infection is not yet demonstrated. However, this aspect has raised many concerns about the use of ACE inhibitors or ARBs in infected patients or patients at risk of infection. It appears that cellular infection leads to a reduction in ACE2 expression and an increase in the activity of the Ang II--AT1 axis, which leads to the release of pro-inflammatory cytokines, ARDS, myocarditis, and hypercoagulability with the possibility of exacerbation of acute coronary syndrome, induction of pulmonary embolism, or appearance of disseminated intravascular coagulation. Therefore, ACE inhibitors or angiotensin receptor blocker drugs should be continued in infected patients, as their discontinuation can increase Ang II activity and induce injury to the lungs or cardiovascular system.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Barillà F
Department of Clinical, Internal, Anesthesiological, and Cardiovascular Sciences, University of Rome 'Sapienza', Italy.
Bassareo PP
University College of Dublin, Mater Misericordiae University Hospital, Dublin, Republic of Ireland.
Calcaterra G
Post Graduate Medical School, University of Palermo.
Romeo F
University of Rome Department of Cardiology, University of Rome 'Tor Vergata', Italy.
Mehta JL
University of Arkansas for Medical Sciences and the VA Medical Center, Little Rock, Arkansas, USA.

MeSH

Angiotensin Receptor AntagonistsAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsBetacoronavirusCOVID-19Cardiovascular DiseasesCoronavirus InfectionsHumansPandemicsPeptidyl-Dipeptidase APneumonia, ViralRenin-Angiotensin SystemSARS-CoV-2Spike Glycoprotein, CoronavirusVirus Internalization

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32740495

Citation

Barillà, Francesco, et al. "Focus On Clinical Practice: Angiotensin-converting Enzyme 2 and Corona Virus Disease 2019: Pathophysiology and Clinical Implications." Journal of Cardiovascular Medicine (Hagerstown, Md.), vol. 21, no. 9, 2020, pp. 630-633.
Barillà F, Bassareo PP, Calcaterra G, et al. Focus on clinical practice: angiotensin-converting enzyme 2 and corona virus disease 2019: pathophysiology and clinical implications. J Cardiovasc Med (Hagerstown). 2020;21(9):630-633.
Barillà, F., Bassareo, P. P., Calcaterra, G., Romeo, F., & Mehta, J. L. (2020). Focus on clinical practice: angiotensin-converting enzyme 2 and corona virus disease 2019: pathophysiology and clinical implications. Journal of Cardiovascular Medicine (Hagerstown, Md.), 21(9), 630-633. https://doi.org/10.2459/JCM.0000000000001071
Barillà F, et al. Focus On Clinical Practice: Angiotensin-converting Enzyme 2 and Corona Virus Disease 2019: Pathophysiology and Clinical Implications. J Cardiovasc Med (Hagerstown). 2020;21(9):630-633. PubMed PMID: 32740495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Focus on clinical practice: angiotensin-converting enzyme 2 and corona virus disease 2019: pathophysiology and clinical implications. AU - Barillà,Francesco, AU - Bassareo,Pier Paolo, AU - Calcaterra,Giuseppe, AU - Romeo,Francesco, AU - Mehta,Jawahar L, PY - 2020/8/3/entrez PY - 2020/8/3/pubmed PY - 2020/8/13/medline SP - 630 EP - 633 JF - Journal of cardiovascular medicine (Hagerstown, Md.) JO - J Cardiovasc Med (Hagerstown) VL - 21 IS - 9 N2 - : ACE2 receptor has a broad expression pattern in the cellular membrane and provides a protective action against the development of cardiovascular diseases. Recently, this enzyme has become of extreme interest during the pandemic infection of COVID-19 (coronavirus disease 2019). This virus invades alveolar epithelium and cardiomyocytes using ACE2 as a transmembrane receptor. ACE2 is a counter-regulatory peptide that degrades Ang II into Ang 1-7, thereby attenuating the biological effects of the AT1 receptor. The binding between the spike protein of COVID-19 and the enzyme is crucial for the virus to enter the target cells, but whether an increase in ACE2 activity could facilitate the infection is not yet demonstrated. However, this aspect has raised many concerns about the use of ACE inhibitors or ARBs in infected patients or patients at risk of infection. It appears that cellular infection leads to a reduction in ACE2 expression and an increase in the activity of the Ang II--AT1 axis, which leads to the release of pro-inflammatory cytokines, ARDS, myocarditis, and hypercoagulability with the possibility of exacerbation of acute coronary syndrome, induction of pulmonary embolism, or appearance of disseminated intravascular coagulation. Therefore, ACE inhibitors or angiotensin receptor blocker drugs should be continued in infected patients, as their discontinuation can increase Ang II activity and induce injury to the lungs or cardiovascular system. SN - 1558-2035 UR - https://www.unboundmedicine.com/medline/citation/32740495/Focus_on_clinical_practice:_angiotensin_converting_enzyme_2_and_corona_virus_disease_2019:_pathophysiology_and_clinical_implications_ DB - PRIME DP - Unbound Medicine ER -