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The Yin and Yang of ACE/ACE2 Pathways: The Rationale for the Use of Renin-Angiotensin System Inhibitors in COVID-19 Patients

by Loris Zamai 1,2
1
Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61032 Urbino, Italy
2
INFN-Gran Sasso National Laboratory, Assergi, 67100 L’Aquila, Italy
Cells 2020, 9(7), 1704; https://doi.org/10.3390/cells9071704
Received: 20 March 2020 / Revised: 10 June 2020 / Accepted: 25 June 2020 / Published: 16 July 2020
The article describes the rationale for inhibition of the renin-angiotensin system (RAS) pathways as specific targets in patients infected by SARS-CoV-2 in order to prevent positive feedback-loop mechanisms. Based purely on experimental studies in which RAS pathway inhibitors were administered in vivo to humans/rodents, a reasonable hypothesis of using inhibitors that block both ACE and ACE2 zinc metalloproteases and their downstream pathways in COVID-19 patients will be proposed. In particular, metal (zinc) chelators and renin inhibitors may work alone or in combination to inhibit the positive feedback loops (initially triggered by SARS-CoV-2 and subsequently sustained by hypoxia independently on viral trigger) as both arms of renin-angiotensin system are upregulated, leading to critical, advanced and untreatable stages of the disease. View Full-Text
Keywords: severe acute respiratory syndrome coronavirus-2; eosinophil; asthma; IL-10; lung fibrosis; hypoxia; hypertension; cardiac dysfunction; renin-angiotensin system; Mas receptor severe acute respiratory syndrome coronavirus-2; eosinophil; asthma; IL-10; lung fibrosis; hypoxia; hypertension; cardiac dysfunction; renin-angiotensin system; Mas receptor
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Zamai, L. The Yin and Yang of ACE/ACE2 Pathways: The Rationale for the Use of Renin-Angiotensin System Inhibitors in COVID-19 Patients. Cells 2020, 9, 1704.

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