Cited by 1,882Renin-Angiotensin System StudiesSARS-CoV-2 and COVID-19 ResearchCoagulation, Bradykinin, Polyphosphates, and Angioedema

Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2

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Gheblawi, Mahmoud, Wang, Kaiming, Viveiros, Anissa, Nguyen, Quynh, Zhong, Jiu-Chang, Turner, Anthony J., Raizada, Mohan K., Grant, Maria B. +1 more·2020·Circulation Research

Abstract

ACE2 (angiotensin-converting enzyme 2) has a multiplicity of physiological roles that revolve around its trivalent function: a negative regulator of the renin-angiotensin system, facilitator of amino acid transport, and the severe acute respiratory syndrome-coronavirus (SARS-CoV) and SARS-CoV-2 receptor. ACE2 is widely expressed, including, in the lungs, cardiovascular system, gut, kidneys, central nervous system, and adipose tissue. ACE2 has recently been identified as the SARS-CoV-2 receptor, the infective agent responsible for coronavirus disease 2019, providing a critical link between immunity, inflammation, ACE2, and cardiovascular disease. Although sharing a close evolutionary relationship with SARS-CoV, the receptor-binding domain of SARS-CoV-2 differs in several key amino acid residues, allowing for stronger binding affinity with the human ACE2 receptor, which may account for the greater pathogenicity of SARS-CoV-2. The loss of ACE2 function following binding by SARS-CoV-2 is driven by endocytosis and activation of proteolytic cleavage and processing. The ACE2 system is a critical protective pathway against heart failure with reduced and preserved ejection fraction including, myocardial infarction and hypertension, and against lung disease and diabetes mellitus. The control of gut dysbiosis and vascular permeability by ACE2 has emerged as an essential mechanism of pulmonary hypertension and diabetic cardiovascular complications. Recombinant ACE2, gene-delivery of Ace2 , Ang 1–7 analogs, and Mas receptor agonists enhance ACE2 action and serve as potential therapies for disease conditions associated with an activated renin-angiotensin system. rhACE2 (recombinant human ACE2) has completed clinical trials and efficiently lowered or increased plasma angiotensin II and angiotensin 1-7 levels, respectively. Our review summarizes the progress over the past 20 years, highlighting the critical role of ACE2 as the novel SARS-CoV-2 receptor and as the negative regulator of the renin-angiotensin system, together with implications for the coronavirus disease 2019 pandemic and associated cardiovascular diseases.

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  • ACE2 serves as a SARS-CoV-2 entry route in human cells, but as this enzyme is internalized following virus binding, its enzyme function is lost.

    “ACE2, independent from its enzymatic activity, serves as SARS-CoV-2 entry route in human cells, but as this enzyme is internalized following virus binding, its enzyme function is lost [6, 116].”

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Authors
Gheblawi, M., Wang, K., Viveiros, A., Nguyen, Q., Zhong, J.-C., Turner, A. J., Raizada, M. K., Grant, M. B., & Oudit, G. Y.
Affiliations
  • University of Alberta (CA)
  • Capital Medical University (CN)
  • University of Leeds (GB)
  • University of Florida (US)
  • University of Alabama at Birmingham (US)
Corresponding author
  • Gheblawi, Mahmoud
  • Wang, Kaiming
Venue
Circulation Research
Published
2020-05-08
Volume
126
Issue
10
Pages
1456-1474
ISSN
  • 0009-7330 (ISSN-L)
  • 1524-4571
OpenAlex
W3014571869
Cited by
1,882
References
201
Citations by year
2026: 51 · 2025: 90 · 2024: 136 · 2023: 221 · 2022: 329 · 2021: 602 · 2020: 449 · 2019: 1
FWCI
67.93
Type
journal article
Language
en
Open access
Locations
  • Circulation Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL110170, R01HL102033)
  • National Eye Institute (R01EY028037, R01EY028858, P30EY003039)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
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 › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
Keywords
angiotensin-converting enzyme 2, SARS-CoV-2 receptor, renin-angiotensin system, COVID-19 pandemic, angiotensin II, angiotensin-(1-7), receptor internalization, proteolytic cleavage, amino acid transport, gut dysbiosis, vascular permeability, pulmonary hypertension, cardiovascular complications of diabetes, heart failure, hypertension, myocardial infarction
MeSH terms
ADAM17 Protein, Betacoronavirus, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Animals, Cardiovascular Diseases, Humans, Peptidyl-Dipeptidase A, Pneumonia, Viral, Receptors, Virus, Renin-Angiotensin System, Coronavirus Infections, Diabetes Complications, Virus Attachment, Pandemics, Molecular Targeted Therapy

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