The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1–angiotensin II–angiotensin AT 1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2–angiotensin(1-7)-angiotensin AT 2 receptor and the ACE-2–angiotensin(1-7)–Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.
【저자키워드】 COVID-19, Treatment, SARS-CoV-2, ARDS, coronavirus, therapy, acute respiratory distress syndrome, SARS, Infection, virus, ACE inhibitors, cardiovascular, ACE-2, RAAS, ACE inhibitor, angiotensin-converting enzyme-2, angiotensin receptor blocker, renin-angiotensin-aldosterone system, angiotensin, ACE, ACEIs, ARBs, Arterial hypertension, angiotensin receptor antagonists, angiotensin-converting enzyme-1, 【초록키워드】 Respiratory failure, Angiotensin converting enzyme-2, ARB, Coronavirus disease-19, pathophysiology, therapeutic, SARS- CoV-2, Patient, pathway, plasma, receptor, respiratory, medication, Protective, ACEi, acute respiratory distress, COVID-19 patient, Activation, syndrome, renal, shown, contribute, implicated, Discontinuing, 【제목키워드】 ARB, COVID-19 patient, Effect, Potential,