Therapeutic approaches targeting renin-angiotensin system in sepsis and its complications

Pharmacol Res. 2021 May:167:105409. doi: 10.1016/j.phrs.2020.105409. Epub 2021 Jan 16.

Abstract

Sepsis, caused by the inappropriate host response to infection, is characterized by excessive inflammatory response and organ dysfunction, thus becomes a critical clinical problem. Commonly, sepsis may progress to septic shock and severe complications, including acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), sepsis-induced myocardial dysfunction (SIMD), liver dysfunction, cerebral dysfunction, and skeletal muscle atrophy, which predominantly contribute to high mortality. Additionally, the global pandemic of coronavirus disease 2019 (COVID-19) raised the concern of development of effectve therapeutic strategies for viral sepsis. Renin-angiotensin system (RAS) may represent as a potent therapeutic target for sepsis therapy. The emerging role of RAS in the pathogenesis of sepsis has been investigated and several preclinical and clinical trials targeting RAS for sepsis treatment revealed promising outcomes. Herein, we attempt to review the effects and mechanisms of RAS manipulation on sepsis and its complications and provide new insights into optimizing RAS interventions for sepsis treatment.

Keywords: Coronavirus disease 2019; Inflammatory response; Organ dysfunction; Renin-angiotensin system; Sepsis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiotensin Receptor Antagonists / adverse effects
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Animals
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • COVID-19 / metabolism
  • COVID-19 / physiopathology
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Host-Pathogen Interactions
  • Humans
  • Renin-Angiotensin System / drug effects*
  • SARS-CoV-2 / drug effects*
  • SARS-CoV-2 / pathogenicity
  • Sepsis / drug therapy*
  • Sepsis / metabolism
  • Sepsis / physiopathology
  • Sepsis / virology
  • Treatment Outcome

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antiviral Agents