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Applied Medical Research ISSN: 2149-2018
Applied Medical Research. 2021; 8(1):(98-120)

Covid-19 and Angiotensin Converting Enzyme 2(ACE2)

Hayder M Al-kuraishy1*, Nawar R Hussien2, Marwa S Al-Niemi3 and Ali I Al-Gareeb

Renin-angiotensin system (RAS) is a signaling pathway for regulation of blood pressure, blood volume, natriuresis, and other vascular functions. In coronavirus infection disease (Covid-19), SARS-CoV-2 binds ACE2 which is highly expressed by the epithelial cells of blood vessel, intestine and lung. The expression of ACE2 is augmented by angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), ibuprofen, statins, thiazolidinedione and by cigarette smoking. Pulmonary ACE2 is seems to be a protective defense pathway during acute respiratory distress syndrome (ARDS). Polymorphism of ACE2 has been associated with different cardio-metabolic disorders, thus implication of ACE2 and angiotensin receptor type 2 (ATR2) receptors in Covid-19-induced pneumonia should be considerably regarded with ACE2 polymorphisms. Covid-19 leads to significant lung injury through down-regulation of ACE2, which is attenuated by administration of angiotensin-receptor blockers (ARBs). Therefore, ACE2 receptors are protective against SARS-CoV-2 pathogenesis. Therefore, ACE2 is regarded as an important entry-point for SARS-CoV-2 and up-regulation of ACE2 by ACEIs, ARBs and during development of cytokine storm is regarded as a protective compensatory mechanism to overcome hyperinflammatory-induced ALI and ARDS.