Cited by 86Renin-Angiotensin System StudiesCOVID-19 Clinical Research StudiesSARS-CoV-2 and COVID-19 Research

Disequilibrium between the classic renin-angiotensin system and its opposing arm in SARS-CoV-2-related lung injury

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Sarzani, Riccardo, Giulietti, Federico, Di Pentima, Chiara, Giordano, Piero, Spannella, Francesco·2020·American Journal of Physiology-Lung Cellular and Molecular Physiology

Abstract

A dysregulation of the renin-angiotensin system (RAS) has been involved in the genesis of lung injury and acute respiratory distress syndrome from different causes, including several viral infections. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of pneumocytes, the hallmark of the pandemic coronavirus disease 2019 (COVID-19) involving both alveolar interstitium and capillaries, is linked to angiotensin-converting enzyme 2 (ACE2) binding and its functional downregulation. ACE2 is a key enzyme for the balance between the two main arms of the RAS: the ACE/angiotensin (Ang) II/Ang II type 1 receptor axis ("classic RAS") and the ACE2/Ang(1-7)/Mas receptor (MasR) axis ("anti-RAS"). The ACE2 downregulation, as a result of SARS-coronaviruses binding, enhances the classic RAS, leading to lung damage and inflammation with leaky pulmonary blood vessels and fibrosis, when the attenuation mediated by the anti-RAS arm is reduced. ACE inhibitors (ACE-I) and Ang II type 1 receptor blockers (ARB), effective in cardiovascular diseases, were found to prevent and counteract acute lung injury in several experimental models by restoring the balance between these two opposing arms. The evidence of RAS arm disequilibrium in COVID-19 and the hypothesis of a beneficial role of RAS modulation supported by preclinical and clinical studies are the focus of the present review. Preclinical and clinical studies on drugs balancing RAS arms might be the right way to counter COVID-19.

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  1. Bastos AC, Magalhães GS, Gregório JF, Matos NA, Motta-Santos D, Bezerra FS, Santos RAS, Campagnole Santos MJ, Rodrigues- L332 DISEQUILIBRIUM OF RAS IN SARS-CoV-2-RELATED LUNG INJURY AJP-Lung Cell Mol Physiol • doi:10.1152/ajplung.00189.2020 • www.ajplung.org Downloaded from journals.physiology.org/journal/ajplung (151.019.095.153) on September 19, 2020. · DOI

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Authors
Sarzani, R., Giulietti, F., Di Pentima, C., Giordano, P., & Spannella, F.
Affiliations
  • Marche Polytechnic University (IT)
  • Internal Medicine and Geriatrics, “Hypertension Excellence Centre” of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy
  • European Society of Hypertension (IT)
Corresponding author
Sarzani, Riccardo
Venue
American Journal of Physiology-Lung Cellular and Molecular Physiology
Published
2020-08-01
Volume
319
Issue
2
Pages
L325-L336
ISSN
  • 1040-0605 (ISSN-L)
  • 1522-1504
OpenAlex
W3041583427
Cited by
86
References
114
Citations by year
2026: 1 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 19 · 2021: 26 · 2020: 18
FWCI
2.96
Type
journal article
Language
en
Open access
Locations
  • American Journal of Physiology-Lung Cellular and Molecular Physiology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
Keywords
renin-angiotensin system, SARS-CoV-2, COVID-19 pandemic, lung injury, acute respiratory distress syndrome, ACE2 downregulation, angiotensin II type 1 receptor, angiotensin-(1-7), Mas receptor, ACE inhibitors, angiotensin receptor blockers, pulmonary fibrosis, lung inflammation
MeSH terms
Betacoronavirus, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, Proto-Oncogene Mas, Angiotensin-Converting Enzyme Inhibitors, Humans, Peptidyl-Dipeptidase A, Pneumonia, Viral, Pulmonary Alveoli, Receptors, Angiotensin, Renin-Angiotensin System, Respiratory Distress Syndrome, Down-Regulation, Coronavirus Infections, Lung Injury, Alveolar Epithelial Cells, Angiotensin Receptor Antagonists, Pandemics

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