Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19
Open accessAbstract
An outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in Wuhan, China, at the end of 2019 has become a global pandemic. Both SARS-CoV-2 and SARS-CoV enter host cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in various human organs. We have reviewed previously published studies on SARS and recent studies on SARS-CoV-2 infection, named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), confirming that many other organs besides the lungs are vulnerable to the virus. ACE2 catalyzes angiotensin II conversion to angiotensin-(1-7), and the ACE2/angiotensin-(1-7)/MAS axis counteracts the negative effects of the renin-angiotensin system (RAS), which plays important roles in maintaining the physiological and pathophysiological balance of the body. In addition to the direct viral effects and inflammatory and immune factors associated with COVID-19 pathogenesis, ACE2 downregulation and the imbalance between the RAS and ACE2/angiotensin-(1-7)/MAS after infection may also contribute to multiple organ injury in COVID-19. The SARS-CoV-2 spike glycoprotein, which binds to ACE2, is a potential target for developing specific drugs, antibodies, and vaccines. Restoring the balance between the RAS and ACE2/angiotensin-(1-7)/MAS may help attenuate organ injuries. SARS-CoV-2 enters lung cells via the ACE2 receptor. The cell-free and macrophage-phagocytosed virus can spread to other organs and infect ACE2-expressing cells at local sites, causing multi-organ injury.
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SARS-CoV-2 uses ACE2 as its main receptor to infect lung epithelial and endothelial cells.
“SARS-CoV-2 spike protein uses ACE2 as its main receptor, suggesting that the Renin-Angiotensin System (RAS) could play a role in COVID-19 pathology.”
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- Authors
- Ni, W., Yang, X., Yang, D., Bao, J., Li, R., Xiao, Y., Hou, C., Wang, H., Liu, J., Yang, D., Xu, Y., Cao, Z., & Gao, Z.
- Affiliations
- Peking University People's Hospital (CN)
- Central Hospital of Wuhan (CN)
- Sichuan University (CN)
- Chinese People's Liberation Army (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
- Chinese PLA General Hospital (CN)
- Corresponding author
- Xu, Yu
- Cao, Zhaolong
- Gao, Zhancheng
- ORCID
- Venue
- Critical Care
- Published
- 2020-07-13
- Volume
- 24
- Issue
- 1
- Pages
- 422-422
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC7356137
- OpenAlex
- W3040907131
- Cited by
- 1,175
- References
- 111
- Citations by year
- 2026: 31 · 2025: 64 · 2024: 172 · 2023: 222 · 2022: 330 · 2021: 305 · 2020: 51
- FWCI
- 38.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81903672)
- Peking University People’s Hospital Research and Development Funds (RDY2018-14)
- Ministry of Science and Technology of China (2017ZX10103004006)
- 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
- angiotensin-converting enzyme 2, SARS-CoV-2, COVID-19 pandemic, angiotensin-(1-7), Mas receptor, renin-angiotensin system, multiple organ injury, SARS-CoV, viral entry, spike protein, viral dissemination, macrophages, immune response
- MeSH terms
- Angiotensin-Converting Enzyme 2, COVID-19, Humans, Peptidyl-Dipeptidase A, Pneumonia, Viral, Coronavirus Infections, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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