期刊
KOREAN JOURNAL OF INTERNAL MEDICINE
卷 36, 期 2, 页码 247-262出版社
KOREAN ASSOC INTERNAL MEDICINE
DOI: 10.3904/kjim.2020.355
关键词
Angiotensin converting enzyme 2; Cardiovascular diseases; COVID-19; Kidney diseases; Severe acute respiratory syndrome coronavirus 2
资金
- National Research Foundation of Korea (NRF) - Korean government (MIST) [2020R1A2C2005620, NRF-2019R1A2C1003971, NRF-2017M3A9E8023001, NRF-2020R1F1A1074001]
- Chonnam National University Hospital Biomedical Research Institute Grant [BCRI 20025, 20076]
- National Research Foundation of Korea [2020R1A2C2005620] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
This review examines the role of ACE2 in kidney, cardiovascular, and pulmonary diseases, highlighting the re-evaluation of its functions and the potential risk of upregulating ACE2 receptor expression level in COVID-19 patients. The study explores the relationship between ACE2 and ACEi/ARBs and discusses whether ACEi/ARBs therapies should be stopped in COVID-19-infected patients.
In the decades since the discovery of angiotensin-converting enzyme 2 (ACE2), its protective role in terms of antagonizing activation of the classical renin-angiotensin system (RAS) axis has been recognized in clinical and experimental studies on kidney and cardiovascular diseases. The effects of ACE inhibitor/angiotensin type 1 receptor blockers (ACEi/ARBs) on ACE2-angiotensin-(1-7) (Ang(1-7))-Mas receptor (MasR) axis activation has encouraged the use of such blockers in patients with kidney and cardiovascular diseases, until the emergence of coronavirus disease 2019 (COVID-19). The previously unchallenged functions of the ACE2-Ang-(1-7)-MasR axis and ACEi/ARBs are being re-evaluated in the era of COVID-19; the hypothesis is that ACEi/ARBs may increase the risk of severe acute respiratory syndrome coronavirus 2 infection by upregulating the human ACE2 receptor expression level. In this review, we examine ACE2 molecular structure, function (as an enzyme of the RAS), and distribution. We explore the roles played by ACE2 in kidney, cardiovascular, and pulmonary diseases, highlighting studies that defined the benefits imparted when ACEi/ARBs activated the local ACE2Ang-(1-7)-MasR axis. Finally, the question of whether ACEi/ARBs therapies should be stopped in COVID-19-infected patients will be reviewed by reference to the available evidence.
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