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Review

SARS-CoV-2, Endothelial Dysfunction, and the Renin-Angiotensin System (RAS): A Potentially Dangerous Triad for the Development of Pre-Eclampsia

1
Institute of Molecular Biology and Pathology, National Research Council (IBPM-CNR), 00186 Rome, Italy
2
Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Tor Vergata University Rome, 00169 Rome, Italy
3
Department of Surgery, Tor Vergata University, 00133 Rome, Italy
4
Futura Stem Cells, S.r.l., 00131 Rome, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Berthold Huppertz
Reprod. Med. 2021, 2(2), 95-106; https://doi.org/10.3390/reprodmed2020010
Received: 8 April 2021 / Revised: 12 May 2021 / Accepted: 14 May 2021 / Published: 18 May 2021
SARS-CoV-2 represents the greatest epidemiological, clinical, and social challenge the human being has had to face in this century. SARS-CoV-2 is not merely a respiratory virus, as its target cells range from upper airway respiratory cells to pulmonary cells but also and above all to the cardiovascular cells, such as pericytes and endothelial cells. Indeed, the pathology related to SARS-CoV-2, COVID-19, may be defined as a thromboinflammatory syndrome in its most severe form, characterized by sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulopathy (DIC), which is prevalent in individuals already presenting a chronic level of inflammation (e.g., obese individuals, elderly) and hypertension. Pregnancy is not only an inflammatory-prone condition but is characterized by a consistent rearrangement of the blood circulation and coagulation profile. Cardiac output increases while arterial systolic and diastolic pressure decrease, regardless of the activation of the RAS system. ACE2, the SARS-CoV-2 entry receptor into the host cells, which transforms Ang II in Ang 1–7, is highly expressed in endothelial, smooth muscle cells and pericytes of placental villi, regulating blood pressure and fetal development. Pre-eclampsia is a pregnancy disorder characterized by hypertension and low levels of ACE2, endothelial dysfunction, and a high production of pro-inflammatory cytokines, resembling COVID-19 manifestations. Whereas pre-eclampsia and COVID-19 have overlapping clinical features, a role for SARS-CoV-2 as a leading cause of pre-eclampsia in COVID-19 positive pregnant women has not been clarified yet. In this mini-review, we will explore the possibility of the existence of such a link, focusing on the role of endothelial dysfunction and RAS in both pre-eclampsia and SARS-CoV-2-induced COVID-19 pathogenesis. View Full-Text
Keywords: pre-eclampsia; SARS-CoV2; hypertension RAS system pre-eclampsia; SARS-CoV2; hypertension RAS system
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MDPI and ACS Style

Illi, B.; Vasapollo, B.; Valensise, H.; Totta, P. SARS-CoV-2, Endothelial Dysfunction, and the Renin-Angiotensin System (RAS): A Potentially Dangerous Triad for the Development of Pre-Eclampsia. Reprod. Med. 2021, 2, 95-106. https://doi.org/10.3390/reprodmed2020010

AMA Style

Illi B, Vasapollo B, Valensise H, Totta P. SARS-CoV-2, Endothelial Dysfunction, and the Renin-Angiotensin System (RAS): A Potentially Dangerous Triad for the Development of Pre-Eclampsia. Reproductive Medicine. 2021; 2(2):95-106. https://doi.org/10.3390/reprodmed2020010

Chicago/Turabian Style

Illi, Barbara, Barbara Vasapollo, Herbert Valensise, and Pierangela Totta. 2021. "SARS-CoV-2, Endothelial Dysfunction, and the Renin-Angiotensin System (RAS): A Potentially Dangerous Triad for the Development of Pre-Eclampsia" Reproductive Medicine 2, no. 2: 95-106. https://doi.org/10.3390/reprodmed2020010

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