Potential use of renin-angiotensin-aldosterone system inhibitors to reduce COVID-19 severity

• Type: Another Publication in an International Scientific Journal
• Date: 2023

Authors

Goncalves, J (Author) Other; Santos, CD (Author) Other; Fresco, P (Author) FFUP; Fernandez-Llimos, F (Author) FFUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: Revista Portuguesa de Cardiologia (English Edition)

Vol. 42

Pages: 373-383

ISSN: 2174-2049

Publisher: Sociedade Portuguesa De Cardiologia

Indexing

ISI Web of Knowledge - 7 Citations

Scopus - 6 Citations

Other information

Authenticus ID: P-00Y-1MF

DOI: 10.1016/j.repc.2022.02.014

Abstract (EN): SARS-CoV-2 infection and its clinical manifestations (COVID-19) quickly evolved to a pandemic and a global public health emergency. The limited effectivity of available treatments aimed at reducing virus replication and the lessons learned from other coronavirus infections (SARS-CoV-1 or NL63) that share the internalization process of SARS-CoV-2, led us to revisit the COVID-19 pathogenesis and potential treatments.Virus protein S binds to the angiotensin-converting enzyme 2 (ACE2) initiating the internal-ization process. Endosome formation removes ACE2 from the cellular membrane preventing its counter-regulative effect mediated by the metabolism of angiotensin II to angiotensin (1-7). Internalized virus-ACE2 complexes have been identified for these coronaviruses. SARS-CoV-2 presents the highest affinity for ACE2 and produces the most severe symptoms. Assuming ACE2 internalization is the trigger for COVID-19 pathogenesis, accumulation of angiotensin II can be viewed as the potential cause of symptoms. Angiotensin II is a strong vasoconstrictor, but has also important roles in hypertrophy, inflammation, remodeling, and apoptosis. Higher levels of ACE2 in the lungs explain the acute respiratory distress syndrome as primary symptoms. Most of the described findings and clinical manifestations of COVID-19, including increased interleukin levels, endothelial inflammation, hypercoagulability, myocarditis, dysgeusia, inflammatory neu-ropathies, epileptic seizures and memory disorders can be explained by excessive angiotensin II levels.Several meta-analyses have demonstrated that previous use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were associated with better prognosis for COVID-19. Therefore, pragmatic trials to assess the potential therapeutic benefits of renin-angiotensin-aldosterone system inhibitors should be urgently promoted by health authorities to widen the therapeutic options for COVID-19.(c) 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 11