Next Article in Journal
Elastography and Metalloproteinases in Patients at High Risk of Preterm Labor
Next Article in Special Issue
Check the Need–Prevalence and Outcome after Transvenous Cardiac Implantable Electric Device Extraction without Reimplantation
Previous Article in Journal
Pattern of Prostate Cancer Recurrence Assessed by 68Ga-PSMA-11 PET/CT in Men Treated with Primary Local Therapy
Previous Article in Special Issue
Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy
Review

ACE2, the Counter-Regulatory Renin–Angiotensin System Axis and COVID-19 Severity

1
Department of Cardiology, Larissa University General Hospital, 41110 Larissa, Greece
2
Department of Medicine/Cardiovascular Medicine, The Ohio State University, Columbus, OH 43210, USA
3
Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
4
Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
*
Author to whom correspondence should be addressed.
Academic Editor: Toshihiro Tsuruda
J. Clin. Med. 2021, 10(17), 3885; https://doi.org/10.3390/jcm10173885
Received: 5 July 2021 / Revised: 25 August 2021 / Accepted: 25 August 2021 / Published: 29 August 2021
(This article belongs to the Special Issue JCM-Advances in Cardiology)
Angiotensin (ANG)-converting enzyme (ACE2) is an entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). ACE2 also contributes to a deviation of the lung renin–angiotensin system (RAS) towards its counter-regulatory axis, thus transforming harmful ANG II to protective ANG (1–7). Based on this purported ACE2 double function, it has been put forward that the benefit from ACE2 upregulation with renin–angiotensin–aldosterone system inhibitors (RAASi) counterbalances COVID-19 risks due to counter-regulatory RAS axis amplification. In this manuscript we discuss the relationship between ACE2 expression and function in the lungs and other organs and COVID-19 severity. Recent data suggested that the involvement of ACE2 in the lung counter-regulatory RAS axis is limited. In this setting, an augmentation of ACE2 expression and/or a dissociation of ACE2 from the ANG (1–7)/Mas pathways that leaves unopposed the ACE2 function, the SARS-CoV-2 entry receptor, predisposes to more severe disease and it appears to often occur in the relevant risk factors. Further, the effect of RAASi on ACE2 expression and on COVID-19 severity and the overall clinical implications are discussed. View Full-Text
Keywords: COVID-19; ACE2; renin–angiotensin system COVID-19; ACE2; renin–angiotensin system
Show Figures

Figure 1

MDPI and ACS Style

Triposkiadis, F.; Xanthopoulos, A.; Giamouzis, G.; Boudoulas, K.D.; Starling, R.C.; Skoularigis, J.; Boudoulas, H.; Iliodromitis, E. ACE2, the Counter-Regulatory Renin–Angiotensin System Axis and COVID-19 Severity. J. Clin. Med. 2021, 10, 3885. https://doi.org/10.3390/jcm10173885

AMA Style

Triposkiadis F, Xanthopoulos A, Giamouzis G, Boudoulas KD, Starling RC, Skoularigis J, Boudoulas H, Iliodromitis E. ACE2, the Counter-Regulatory Renin–Angiotensin System Axis and COVID-19 Severity. Journal of Clinical Medicine. 2021; 10(17):3885. https://doi.org/10.3390/jcm10173885

Chicago/Turabian Style

Triposkiadis, Filippos, Andrew Xanthopoulos, Grigorios Giamouzis, Konstantinos D. Boudoulas, Randall C. Starling, John Skoularigis, Harisios Boudoulas, and Efstathios Iliodromitis. 2021. "ACE2, the Counter-Regulatory Renin–Angiotensin System Axis and COVID-19 Severity" Journal of Clinical Medicine 10, no. 17: 3885. https://doi.org/10.3390/jcm10173885

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop