Applied Medical Research. 2021;
8(1):(98-176)
Covid-19 and Angiotensin Converting Enzyme 2(ACE2)
Hayder M Al-kuraishy*, Nawar R Hussien, Marwa S Al-Niemi and Ali I Al-Gareeb
Abstract
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.
