Horm Metab Res 2020; 52(05): 257-263
DOI: 10.1055/a-1155-0501
Immediate Interest
© Georg Thieme Verlag KG Stuttgart · New York

The ACE-2 in COVID-19: Foe or Friend?

Rinkoo Dalan
1  Tan Tock Seng Hospital, Singapore
2  Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
,
Stefan R. Bornstein
2  Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
3  Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
4  Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
5  Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland
,
Ali El-Armouche
6  Department of Pharmacology and Toxicology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Roman N Rodionov
7  Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Alexander Markov
8  Department of General Physiology, Saint-Petersburg State University, Saint-Petersburg, Russia
,
Ben Wielockx
9  Institute of Clinical Chemistry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Felix Beuschlein
5  Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland
10  Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
,
Bernhard O. Boehm
1  Tan Tock Seng Hospital, Singapore
2  Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
› Author Affiliations
Funding: RD is supported by Ministry of Health, Clinician Scientist Award [MOH-CSAINV17nov-0006]; and National Medical Research Council Centre Grant [NMRC/CG/017/2013]. BOB is supported by Ong Tiong Tat Professorship.
Further Information

Publication History

received 06 April 2020

accepted 07 April 2020

Publication Date:
27 April 2020 (online)

Abstract

COVID-19 is a rapidly spreading outbreak globally. Emerging evidence demonstrates that older individuals and people with underlying metabolic conditions of diabetes mellitus, hypertension, and hyperlipidemia are at higher risk of morbidity and mortality. The SARS-CoV-2 infects humans through the angiotensin converting enzyme (ACE-2) receptor. The ACE-2 receptor is a part of the dual system renin-angiotensin-system (RAS) consisting of ACE-Ang-II-AT1R axis and ACE-2-Ang-(1–7)-Mas axis. In metabolic disorders and with increased age, it is known that there is an upregulation of ACE-Ang-II-AT1R axis with a downregulation of ACE-2-Ang-(1–7)-Mas axis. The activated ACE-Ang-II-AT1R axis leads to pro-inflammatory and pro-fibrotic effects in respiratory system, vascular dysfunction, myocardial fibrosis, nephropathy, and insulin secretory defects with increased insulin resistance. On the other hand, the ACE-2-Ang-(1–7)-Mas axis has anti-inflammatory and antifibrotic effects on the respiratory system and anti-inflammatory, antioxidative stress, and protective effects on vascular function, protects against myocardial fibrosis, nephropathy, pancreatitis, and insulin resistance. In effect, the balance between these two axes may determine the prognosis. The already strained ACE-2-Ang-(1–7)-Mas in metabolic disorders is further stressed due to the use of the ACE-2 by the virus for entry, which affects the prognosis in terms of respiratory compromise. Further evidence needs to be gathered on whether modulation of the renin angiotensin system would be advantageous due to upregulation of Mas activation or harmful due to the concomitant ACE-2 receptor upregulation in the acute management of COVID-19.