tetano
Editor, Senior Moderator
Elife. 2020 Apr 6;9. pii: e57278. doi: 10.7554/eLife.57278. [Epub ahead of print]
Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients.
Rossi GP[SUP]1[/SUP], Sanga V[SUP]1[/SUP], Barton M[SUP]2[/SUP].
Author information
Abstract
The discovery that SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) RNA binds to the angiotensin converting enzyme (ACE)-2, which is highly expressed in the lower airways, explained why SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and respiratory failure. After this, news spread that ACEis and ARBs would be harmful in SARS-CoV-2-infected subjects. To the contrary, compelling evidence exists that the ACE-1/angiotensin(Ang)II/ATR-1 pathway is involved in SARS-CoV-2-induced ARDS, while the ACE-2/Ang(1-7)/ATR2/MasR pathway counteracts the harmful actions of AngII in the lung. A reduced ACE-1/ACE-2 ratio is, in fact, a feature of ARDS that can be rescued by human recombinant ACE-2 and Ang(1-7) administration, thus preventing SARS-CoV-2-induced damage to the lung. Based on the current clinical evidence treatment with ACE-inhibitors I (ACEis) or angiotensin receptor blockers (ARBs) continues to provide cardiovascular and renal protection in patients diagnosed with COVID-19. Discontinuing these medications may therefore be potentially harmful in this patient population.
? 2020, Rossi et al.
KEYWORDS:
epidemiology; global health; viruses
PMID:32250244DOI:10.7554/eLife.57278
Free full text
Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients.
Rossi GP[SUP]1[/SUP], Sanga V[SUP]1[/SUP], Barton M[SUP]2[/SUP].
Author information
Abstract
The discovery that SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) RNA binds to the angiotensin converting enzyme (ACE)-2, which is highly expressed in the lower airways, explained why SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and respiratory failure. After this, news spread that ACEis and ARBs would be harmful in SARS-CoV-2-infected subjects. To the contrary, compelling evidence exists that the ACE-1/angiotensin(Ang)II/ATR-1 pathway is involved in SARS-CoV-2-induced ARDS, while the ACE-2/Ang(1-7)/ATR2/MasR pathway counteracts the harmful actions of AngII in the lung. A reduced ACE-1/ACE-2 ratio is, in fact, a feature of ARDS that can be rescued by human recombinant ACE-2 and Ang(1-7) administration, thus preventing SARS-CoV-2-induced damage to the lung. Based on the current clinical evidence treatment with ACE-inhibitors I (ACEis) or angiotensin receptor blockers (ARBs) continues to provide cardiovascular and renal protection in patients diagnosed with COVID-19. Discontinuing these medications may therefore be potentially harmful in this patient population.
? 2020, Rossi et al.
KEYWORDS:
epidemiology; global health; viruses
PMID:32250244DOI:10.7554/eLife.57278
Free full text