The widespread occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a pandemic of coronavirus disease 2019 (COVID-19). The S spike protein of SARS-CoV-2 binds with angiotensin-converting enzyme 2 (ACE2) as a functional “receptor” and then enters into host cells to replicate and damage host cells and organs. ACE2 plays a pivotal role in the inflammation, and its downregulation may aggravate COVID-19 via the renin-angiotensin system, including by promoting pathological changes in lung injury and involving inflammatory responses. Severe patients of COVID-19 often develop acute respiratory distress syndrome and multiple organ dysfunction/failure with high mortality that may be closely related to the hyper-proinflammatory status called the “cytokine storm.” Massive cytokines including interleukin-6, nuclear factor kappa B (NFκB), and tumor necrosis factor alpha (TNFα) released from SARS-CoV-2-infected macrophages and monocytes lead inflammation-derived injurious cascades causing multi-organ injury/failure. This review summarizes the current evidence and understanding of the underlying mechanisms of SARS-CoV-2, ACE2 and inflammation co-mediated multi-organ injury or failure in COVID-19 patients.
【저자키워드】 COVID-19, SARS-CoV-2, Cytokine storm, angiotensin-converting enzyme 2, renin-angiotensin system, multiple organ failure, 【초록키워드】 coronavirus disease, Monocytes, Inflammation, Necrosis, Macrophage, Tumor, Respiratory distress syndrome, Coronavirus disease 2019, ACE2, Cytokine storm, coronavirus, pandemic, Cytokines, macrophages, acute respiratory distress syndrome, Inflammatory responses, interleukin-6, cytokine, Lung injury, severe acute respiratory syndrome Coronavirus, angiotensin-converting enzyme 2, Spike protein, monocyte, renin-angiotensin system, interleukin, tumor necrosis factor, organ dysfunction, Alpha, receptor, respiratory, mechanism, multiple organ dysfunction, COVID-19 patients, Angiotensin-converting enzyme, acute respiratory distress, Evidence, angiotensin, Injury, lead, host cells, respiratory distress, host cell, tumor necrosis, tumor necrosis factor alpha, acute respiratory syndrome, Renin, severe patients, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, failure, syndrome, high mortality, TNFα, downregulation, organs, cascade, pathological changes, nuclear, massive, multiple organ dysfunction/failure, NFκB, Severe patients of COVID-19, widespread, bind, Occurrence, develop, replicate, functional, pathological change, released, aggravate, patients of COVID-19, 【제목키워드】 ACE2, Multiple, drive,