The Lung, the Heart, the Novel Coronavirus, and the Renin-Angiotensin System; The Need for Clinical Trials

Eugenie R Lumbers; Sarah J Delforce; Kirsty G Pringle; Gary R Smith

doi:10.3389/fmed.2020.00248

The Lung, the Heart, the Novel Coronavirus, and the Renin-Angiotensin System; The Need for Clinical Trials

Front Med (Lausanne). 2020 May 22:7:248. doi: 10.3389/fmed.2020.00248. eCollection 2020.

Authors

Eugenie R Lumbers^{1

2

3}, Sarah J Delforce^{1

2

3}, Kirsty G Pringle^{1

2

3}, Gary R Smith⁴

Affiliations

¹ School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.
² Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia.
³ Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
⁴ VP System Practice, International Society for the System Sciences, Pontypool, United Kingdom.

Abstract

Angiotensin-converting enzyme 2 (ACE2) is the receptor for COVID-19 (SARs-CoV-2). ACE2 protects the lung and heart from acute respiratory distress syndrome (ARDS) and acute myocarditis and arrhythmias, because it breaks down Angiotensin II, which has inflammatory effects in the lung and heart as well as in the kidney. When SARS-CoV-2 binds to ACE2, it suppresses it, so this protective action of ACE2 is lost. Death from COVID-19 is due to ARDS and also heart failure and acute cardiac injury. Drugs that prevent the inflammatory actions of Angiotensin II (i.e., Angiotensin receptor blockers, ARBs) prevent acute lung injury caused by SARS-CoV. Clinical trials are underway to test the risks and benefits of ARBs and angiotensin-converting enzyme inhibitors (ACEIs) in COVID-19 patients requiring hospitalization. Other potential treatments are also discussed.

Keywords: ACE2; COVID-19; SARS- CoV-2; cardiovascular disease; lung injury; renin-angiotensin system (RAS).

Publication types

Review