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The pivotal link between ACE2 deficiency and SARS-CoV-2 infection
Open accessAbstract
Angiotensin converting enzyme-2 (ACE2) receptors mediate the entry into the cell of three strains of coronavirus: SARS-CoV, NL63 and SARS-CoV-2. ACE2 receptors are ubiquitous and widely expressed in the heart, vessels, gut, lung (particularly in type 2 pneumocytes and macrophages), kidney, testis and brain. ACE2 is mostly bound to cell membranes and only scarcely present in the circulation in a soluble form. An important salutary function of membrane-bound and soluble ACE2 is the degradation of angiotensin II to angiotensin 1-7. Consequently, ACE2 receptors limit several detrimental effects resulting from binding of angiotensin II to AT1 receptors, which include vasoconstriction, enhanced inflammation and thrombosis. The increased generation of angiotensin 1-7 also triggers counter-regulatory protective effects through binding to G-protein coupled Mas receptors. Unfortunately, the entry of SARS-CoV2 into the cells through membrane fusion markedly down-regulates ACE2 receptors, with loss of the catalytic effect of these receptors at the external site of the membrane. Increased pulmonary inflammation and coagulation have been reported as unwanted effects of enhanced and unopposed angiotensin II effects via the ACE→Angiotensin II→AT1 receptor axis. Clinical reports of patients infected with SARS-CoV-2 show that several features associated with infection and severity of the disease (i.e., older age, hypertension, diabetes, cardiovascular disease) share a variable degree of ACE2 deficiency. We suggest that ACE2 down-regulation induced by viral invasion may be especially detrimental in people with baseline ACE2 deficiency associated with the above conditions. The additional ACE2 deficiency after viral invasion might amplify the dysregulation between the 'adverse' ACE→Angiotensin II→AT1 receptor axis and the 'protective' ACE2→Angiotensin 1-7→Mas receptor axis. In the lungs, such dysregulation would favor the progression of inflammatory and thrombotic processes triggered by local angiotensin II hyperactivity unopposed by angiotensin 1-7. In this setting, recombinant ACE2, angiotensin 1-7 and angiotensin II type 1 receptor blockers could be promising therapeutic approaches in patients with SARS-CoV-2 infection.
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“Of note, SARS-CoV and SARS-CoV-2 cell entry results in downregulation of ACE2 (Verdecchia et al., 2020)”
From Viral Infections, the Microbiome, and Probiotics (2021) · cites this paper as Verdecchia et al., 2020
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“The present review discusses the role of angiotensin converting enzyme 2 (ACE2) receptors which are not only the door through which the virus enters into cells, [2,3] but also the conductor of several pathophysiological reactions associated with the clinical features of the disease, with potential therapeutic implicat…”
InfluentialCOVID-19: consider cytokine storm syndromes and immunosuppression
Mehta, P., McAuley, D. F., Brown, M., Sanchez, E., Tattersall, R. S., & Manson, J. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30628-0 · Cited by 9,664 · cited 1×
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“Given its key role in lung injury and SARS-CoV-2 infection, there is great interest in developing ACE2 as a therapeutic for prevention or treatment of COVID-19 (Fig. 3; Verdecchia et al. 2020; Daniell et al. 2021).”
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Semen parameters and sex hormones as affected by SARS-CoV-2 infection: A systematic review
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Hassler, L., Wysocki, J. A., Gelarden, I. A., Τοματσίδου, Α., Gula, H., Nicoleascu, V., Randall, G. C., Henkin, J., Yeldandi, A. V., & BATLLE, D. C. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.03.12.435191 · Cited by 15
“In the process the ability to metabolize substrates of ACE2 such as Angiotensin II and des-Arg bradykinin are compromised and these peptides can promote lung injury (42, 44, 46).”
BackgroundEmerging importance of ACE2 in external stratified epithelial tissues
Kaplan, N., González, E., Peng, H., BATLLE, D. C., & Lavker, R. M. (2021) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2021.111260 · Cited by 14
“Upon engagement with the virus, ACE2 becomes down-regulated (Zhou et al., 2020; Xu et al., 2020; Verdecchia et al., 2020; Zhang et al., 2020).”
Cirrhosis-Associated RAS-Inflammation-Coagulation Axis Anomalies: Parallels to Severe COVID-19
Hartl, L., Jachs, M., Simbrunner, B., Bauer, D. J. M., Semmler, G., Gompelmann, D., Szekeres, T., Quehenberger, P., Trauner, M. A., Mandorfer, M., et al. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11121264 · Cited by 14
“Again, RAS activation and ACE2 downregulation contribute by promotion of proinflammatory mediators [43].”
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“Available evidence suggests that SARS-CoV-2 infection of host cells involves redox imbalance and subsequent oxidative stress [34–37].”
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“Downregulation of ACE-2 secondary to COVID-19 infection leads to suppression of the non-canonical pathway- ACE-2/AT-(1–7)/MasR axis [14].”
BackgroundInfluentialCOVID‐19 and male reproduction: Current research and unknown factors
Yao, Y., Yuan, X.-Q., Wu, L., Guo, N., Li, Y., & Li, Y. (2021) · Andrology · doi:10.1111/andr.12970 · Cited by 14
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“Ironically, ACE-2 receptors at lung cell surfaces may have a protective role, especially at severe stages of the infection with overt inflammation.(57,58) Therefore, the benefits of ACE-2 blocking are still debated.”
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Possible Benefits of Zinc supplement in CVD and COVID-19 Comorbidity
Karim, M. M., Sultana, S., Sultana, R., & Rahman, M. T. (2021) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2021.09.022 · Cited by 14
Diverse Techniques Applied for Effective Diagnosis of COVID-19
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Targeting Specific Checkpoints in the Management of SARS-CoV-2 Induced Cytokine Storm
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“ACE-2 converts angiotensin-I (ang-I) to angiotensin-II (ang-II) which in turn can interact with the Angiotensin Type-1 Receptor to induce pro-inflammatory and fibrotic response in the host body [14,15].”
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“For example, interaction of S protein on EVs with the host ACE2 receptor may potentially drive the downregulation of host ACE2, resulting in prolonged activation of angiotensin II triggering pulmonary inflammation and thrombosis (Shirbhate et al., 2021; Verdecchia et al., 2020).”
BackgroundLung Inflammasome Activation in SARS-CoV-2 Post-Mortem Biopsies
Carstens, L. B., D’Amico, R. C., de Moura, K. F., de Castro, E. M., de Oliveira, F. C., Barbosa, G. S., da Silva, G. V. C., Brenny, I. D., D’Agostini, J. C. H., Hlatchuk, E. C., et al. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232113033 · Cited by 14
“The NLRP-3 (or NALP) inflammasome complex is a multiprotein complex mediated and activated by both ACE2 and TMPRSS2 [8], and it may have a central role in the disproportionate cytokine release and immunothrombotic COVID-19 repercussions [9].”
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White, A., & Kirby, M. (2020) · Trends in Urology & Men s Health · doi:10.1002/tre.757 · Cited by 14
Usage of peptidases by SARS‐CoV‐2 and several human coronaviruses as receptors: A mysterious story
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“Upon vascular endothelium damage, the subendothelial collagen is exposed to blood, thereby activating the coagulation system [57], resulting in a large amount of thrombin generation and fibrin deposition, which is the key factor of hypercoagulability.”
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“[121] Pre-existing comorbidities characterized by chronic inflammation, including diabetes, hypertension, cancer, and obesity, upregulate the RAS pathway.”
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“Moreover, the virus’s interaction with ACE2 receptors can also disrupt the Renin-Angiotensin System, promoting hypertension and kidney damage [105].”
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“It has been noted that hypertension may be associated with a variable degree of ACE2 deficiency [6,7].”
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“Although it is not yet evident why this correlation occurs, many interpretations have been suggested by investigators, such as greater contact with and more evolved immune responses to other viruses,(28,29) greater incidence of comorbidities,(30) and reduced angiotensin-converting enzyme 2 (ACE2) protein expression am…”
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A review of the mechanisms of blood–brain barrier disruption during COVID ‐19 infection
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“Different studies have demonstrated the pivotal role of ACE2 receptors in SARS-CoV-2 infection and subsequent sequela [1,2].”
InfluentialCOVID-19 and the cardiovascular system: a study of pathophysiology and interpopulation variability
Zhao, Y., Han, X., Li, C., Liu, Y., Cheng, J., Adhikari, B. K., & Wang, Y. (2023) · Frontiers in Microbiology · doi:10.3389/fmicb.2023.1213111 · Cited by 13
“In an ACE2-deficient environment, SARS-CoV-2 entry into cells induces further downregulation of ACE2, amplifying the adverse effects of the ACE/ AngII/AT1 axis and attenuating the beneficial effects of the ACE2/ Ang1-7 (Angiotensin1-7) /mas axis, leading to cardiomyocyte fibrosis, endothelial damage, mediating inflamm…”
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“their spike glycoprotein on the viral envelope with ACE2 receptors on the membrane of several organisms, such as heart, vessels, gut, lung, kidney, testis, and brain (Ni et al., 2020; Verdecchia et al., 2020).”
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Highly expressed ACE-2 receptors during pregnancy: A protective factor for SARS-COV-2 infection?
Figueiró-Filho, E. A., Hobson, S. R., Farine, D., & Yudin, M. H. (2021) · Medical Hypotheses · doi:10.1016/j.mehy.2021.110641 · Cited by 13
“Both the immune system and the renin-angiotensin system (RAS) play particularly important roles in mediating SARS-CoV-2 virus entry into human cells [13].”
InfluentialImmune response variables and viral mutations impact on COVID-19 reinfection and relapse
Sanaie, S., Golipour, E., Shamekh, A., Sadaie, M. R., Mahmoodpoor, A., & Yousefi, M. (2021) · International Immunopharmacology · doi:10.1016/j.intimp.2021.108108 · Cited by 12
“In this regard, it is assumed that a renin-angiotensin system (RAS) is engaged in ARDS development following SARS-CoV-2 infection [15,16].”
State of the Art on the SARS-CoV-2 Toolkit for Antigen Detection: One Year Later
Fabiani, L., Caratelli, V., Fiore, L. D., Scognamiglio, V., Antonacci, A., Fillo, S., Santis, R. D., Monte, A., Bortone, M., Moscone, D., et al. (2021) · Biosensors · doi:10.3390/bios11090310 · Cited by 12
“N protein Molecularly imprinted polymer-based electrochemical sensor Differential Pulse Voltammetry Nasopharyngeal swab LOD: 27 fM in clinical samples 15 min [27]”
BackgroundMethodMolecular mechanisms of vasculopathy and coagulopathy in COVID-19
Al-Gburi, S., Beissert, S., & Günther, C. (2021) · Biological Chemistry · doi:10.1515/hsz-2021-0245 · Cited by 12
Sano, H., Kase, M., Aoyama, Y., & Sano, S. (2023) · The Journal of Dermatology · doi:10.1111/1346-8138.16816 · Cited by 12
Rocha, V. N. (2020) · Medical Hypotheses · doi:10.1016/j.mehy.2020.110330 · Cited by 12
Hoevenaar, M., Goossens, D., & Roorda, J. (2020) · Journal of the Renin-Angiotensin-Aldosterone System · doi:10.1177/1470320320979097 · Cited by 12
“ACE2-angiotensin-(1-7)-Mas receptor axis.”
BackgroundInfluentialPhysiology of Midkine and Its Potential Pathophysiological Role in COVID-19
Sanino, G., Bosco, M., & Terrazzano, G. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.616552 · Cited by 12
“Midkine promotes several actions ad is involved in various diseases. system (Vallamkondu et al., 2020; Verdecchia et al., 2020).”
BackgroundSalgo, M. (2021) · Infectious Diseases and Therapy · doi:10.1007/s40121-021-00478-8 · Cited by 12
A rapid bead-based assay for screening of SARS-CoV-2 neutralizing antibodies
Lupitha, S. S., Darvin, P., Chandrasekharan, A., Varadarajan, S. N., Divakaran, S. J., Sreekumar, E., Sathi, S. N., Umasankar, P. K., Jones, S., Joseph, I., et al. (2022) · Antibody Therapeutics · doi:10.1093/abt/tbac007 · Cited by 11
“ACE2 lacking the transmembrane domain is sufficient to render it a soluble form capable of binding to the S1 and neutralization [16].”
BackgroundChen, Y., Jiang, W., Deng, J., Chou, Y.-N., Wu, Y.-B., Liang, H.-J., Lin, J., & Huang, G. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242015062 · Cited by 11
Lesgards, J., Cerdan, D., & Perronne, C. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26167879 · Cited by 13
“This axis suppresses inflammatory mediators such as NF-κ B, IL-6, TNF-α , and IL-8 [198,224,225].”
Off‐target ACE2 ligands: Possible therapeutic option for CoVid‐19?
Brogi, S., & Calderone, V. (2020) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14343 · Cited by 11
“Moreover, this binding has been proposed to cause ACE2 downregulation; the consequent ACE2 deficiency and dysregulation seems to play a pathogenetic role in the progression of the overwhelming lung inflammation, observed in the most serious cases of CoVid-19.(6) ACE2 is located on the surface membrane of host cells in…”
BackgroundInfluentialMartin, J. H., & Head, R. J. (2020) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14551 · Cited by 10
“aspiration (summarized in Verdecchiaa et al.(18)).”
BackgroundInfluentialWong, M., Previde, P., Cole, J., Thomas, B., Laxmeshwar, N., Mallory, E. K., Lever, J., Petković, D., Altman, R. B., & Kulkarni, A. (2021) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2021.103732 · Cited by 11
Clinical characteristics of COVID-19 in family clusters: a systematic review
Song, W., Zou, N., Guan, W., Pan, J., & Xu, W. (2021) · World Journal of Pediatrics · doi:10.1007/s12519-021-00434-z · Cited by 11
Computational insights into the membrane fusion mechanism of SARS-CoV-2 at the cellular level
Wang, J., Maschietto, F., Guberman‐Pfeffer, M. J., Reiss, K. M., Allen, B., Xiong, Y., Lolis, E., & Batista, V. S. (2021) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2021.08.053 · Cited by 11
“…of super-complexes between dimeric ACE2 with trimeric spike protein should provide valuable insights into the observed correlation of SARS-CoV-2 infection and organ failure by disabling the normal function of the ACE2 that produces the vasodilator 7-residue peptide hormone of angiotensin [60].”
Lami, F., Elfadul, M., Rashak, H. A., Nsour, M. A., Akhtar, H., Khader, Y. S., Hussein, A. M., Naciri, M., Samy, S., Ghaleb, Y. A., et al. (2021) · JMIR Public Health and Surveillance · doi:10.2196/32831 · Cited by 11
“RAS has been linked to lung injury [36,37], which has led to concluding that ACE2 has a protective effect on the lungs [38,39] and that its pre-existing deficiency might lead to a more severe or even fatal COVID-19 [40].”
BackgroundMarazzato, J., Ponti, R. D., Verdecchia, P., Masnaghetti, S., Visca, D., Spanevello, A., Trapasso, M., Zappa, M., Mancinelli, A., & Angeli, F. (2021) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd8100133 · Cited by 11
“19 ST, A-STT, LVs Persistence 17 26 25 Mild 17 N/A Yes [5] Yes”
BackgroundInfluentialBakhtiari, M., & Asadipooya, K. (2022) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530322666220104103325 · Cited by 11
Fidler, G., Racz, A., Dávid, P., Szilágyi-Tolnai, E., Rejtő, L., Szász, R., Póliska, S., Bíró, S., & Paholcsek, M. (2022) · Scientific Reports · doi:10.1038/s41598-022-11239-z · Cited by 12
Johnson, S. (2022) · PubMed Central · Cited by 11
Zhang, H., & Feng, T. (2022) · Biochemical Genetics · doi:10.1007/s10528-022-10280-x · Cited by 11
Acute kidney injury and electrolyte disorders in COVID-19
Nogueira, G., Silva, N. L. O. R., Moura, A. F., Silveira, M. A. D., & Moura-Neto, J. A. (2022) · World Journal of Virology · doi:10.5501/wjv.v11.i5.283 · Cited by 11
Hani, A. B., Tarboush, N. A., Ali, M. B., Alabhoul, F., Alansari, F., Abuhani, A. A., Al-Kawak, M., Shamoun, B., Albdour, S., Abeeleh, M. A. A., et al. (2022) · Biomarker Insights · doi:10.1177/11772719221125123 · Cited by 11
Gut–Lung Microbiota Interaction in COPD Patients: A Literature Review
Krūmiņa, A., Bogdanova, M., Gintere, S., & Vīksna, L. (2022) · Medicina · doi:10.3390/medicina58121760 · Cited by 12
Mahajan, S., Sen, D., Sunil, A., Srikanth, P., Marathe, S. D., Shaw, K., Sahare, M., Galande, S., & Abraham, N. M. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1180868 · Cited by 11
“As SARS-CoV2 entry into the cells through membrane fusion is thought to down-regulate the ACE2 receptors with a loss of these receptors’ catalytic effect (Verdecchia et al., 2020), we created the ACE2 KO mouse model to mimic the effects of COVID-19 and studied its long-term effects.”
MethodBrain Pathology in COVID-19: Clinical Manifestations and Potential Mechanisms
Xu, Z., Wang, H., Jiang, S., Teng, J., Zhou, D., Chen, Z., Wen, C., & Xu, Z. (2023) · Neuroscience Bulletin · doi:10.1007/s12264-023-01110-0 · Cited by 10
“As SARS-CoV-2 interacts with ACE2 and influences its catalytic activity, it can further regulate the RAS and contribute to the cytokine storm [143].”
Angiotensin-converting enzyme 2: from a vasoactive peptide to the gatekeeper of a global pandemic
Perico, L., Benigni, A., & Remuzzi, G. (2020) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000692 · Cited by 10
Hallow, K. M., & Dave, I. (2021) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.2177 · Cited by 11
Cardiovascular Impacts on COVID-19 Infected Patients
Raghavan, S., Gayathri, R., Kancharla, S., Kolli, P., Ranjitha, J., & Vijayalakshmi, S. P. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.670659 · Cited by 11
“This intracellular viral replication suppresses and reduces the catalytic sensitivity of ACE2 surface molecules at its extracellular domain (34, 35).”
BackgroundClinical guidelines “Chronic diarrhea in adults”
Lazebnik, L. B., Sarsenbaeva, A. S., Avalueva, E. B., Oreshko, L. S., Sitkin, S. I., Голованова, Е. В., Туркина, С. В., Khlynova, O. V., Sagalova, O., & Мирончев, О. В. (2021) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-188-4-7-67 · Cited by 12
The Renin-Angiotensin System as a Component of Biotrauma in Acute Respiratory Distress Syndrome
Krenn, K., Tretter, V. E., Kraft, F., & Ullrich, R. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.806062 · Cited by 11
Dysbiosis in SARS-CoV-2–Infected Patients
Marazzato, M., Ceccarelli, G., & d’Ettorre, G. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.12.056 · Cited by 11
Suspected Cardiovascular Side Effects of two Covid-19 VaccinesPreprint
Lehmann, K. J. (2021) · doi:10.31219/osf.io/gh9u2 · Cited by 11
“ACE2 is expressed in the endothelium of coronary arteries, myocytes, fibroblasts, epicardial adipocytes, vascular endothelial and smooth cells, the gut, tracheal and bronchial epithelial cells, type 2 pneumocytes, macrophages, the kidney, testis and brain [5,13].”
ApoE4 causes severe COVID-19 outcomes via downregulation of ACE2Preprint
Chen, F., Chen, Y., Ke, Q., Wang, Y., Chen, X., Peng, X., Cai, Y., Li, S., Sun, Y., Ji, Y., et al. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.09.04.506474 · Cited by 11
“Therefore, reduced ACE2 protein expression is associated with a poor prognosis in patients with SARS-CoV-2(32, 45).”
BackgroundLuo, D., Bai, M., Zhang, W. Y., & Wang, J. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1409723 · Cited by 10
“Virus invasion induced down-regulation of ACE2 may be particularly harmful to individuals with baseline ACE2 de fi ciency, for example, due to older age, diabetes, hypertension and previous heart disease, including heart failure (86).”
Li, X., Liu, Y., Song, J., & Zhong, J. (2020) · Acta Pharmaceutica Sinica B · doi:10.1016/j.apsb.2020.09.003 · Cited by 10
Angiotensin Converting Enzyme-2 (ACE2) receptors, asthma and severe COVID-19 infection risk
Öztürk, A. B., & Caglayan, B. N. (2020) · European Annals of Allergy and Clinical Immunology · doi:10.23822/eurannaci.1764-1489.169 · Cited by 10
Clinical aspects of SARS-CoV-2 infection and vitamin D
Bandeira, L., Lazaretti‐Castro, M., & Binkley, N. (2021) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-021-09683-9 · Cited by 10
Skalska-Świstek, M., Huras, H. K., Jaworowski, A. P., Świstek, R., & Kolak, M. L. (2022) · Diagnostics · doi:10.3390/diagnostics12030655 · Cited by 10
“In addition, binding the virus with ACE2 inhibits the expression of ACE2, which may weaken the anti-inflammatory and anticoagulant ACE2-angiotensin-MAS receptor axis and enhance the pro-inflammatory and prothrombotic effects of angiotensin II [10].”
BackgroundHu, S., Yin, F., Nie, L., Wang, Y., Qin, J., & Chen, J. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.829879 · Cited by 10
“Therefore, the imbalance RAS leads to the systemic pathognomonic features of patients with COVID-19 (5).”
Background
Metadata
- Authors
- Verdecchia, P., Cavallini, C., Spanevello, A., & Angeli, F.
- Affiliations
- University of Insubria (IT)
- Corresponding author
- Verdecchia, Paolo
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2020-06
- Volume
- 76
- Pages
- 14-20
- ISSN
- 0953-6205 (ISSN-L)
- PMC
- PMC7167588
- OpenAlex
- W3017331996
- Cited by
- 1,237
- References
- 85
- Citations by year
- 2026: 22 · 2025: 50 · 2024: 84 · 2023: 156 · 2022: 245 · 2021: 384 · 2020: 295
- FWCI
- 45.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- ACE2 receptor, COVID-19 pandemic, angiotensin II, angiotensin-(1-7), Mas receptor, angiotensin II type 1 receptor, lung inflammation, thrombosis, hypertension, diabetes mellitus, cardiovascular disease, angiotensin receptor blockers, COVID-19 severity
- MeSH terms
- Betacoronavirus, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, Angiotensins, Diabetes Mellitus, Heart Failure, Humans, Hypertension, Peptidyl-Dipeptidase A, Pneumonia, Viral, Receptors, Virus, Recombinant Proteins, Risk Factors, Coronavirus Infections, Angiotensin II Type 1 Receptor Blockers, Drug Discovery, Pandemics
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