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Treatment with angiotensin-converting enzyme (ACE) inhibitors results in an upregulation of ACE2 in some organs.<ref name="pmid28619367">{{cite journal | vauthors = Li XC, Zhang J, Zhuo JL | title = The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases | journal = Pharmacological Research | volume = 125 | issue = Pt A | pages = 21–38 | date = November 2017 | pmid = 28619367 | pmc = 5607101 | doi = 10.1016/j.phrs.2017.06.005 }}</ref>{{quotation needed|date=March 2020}} ACE2 is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. This increased expression of ACE2 may facilitate infection with SARS-CoV or SARS-CoV-2. Hence, patients with diabetes or hypertension being treated with ACE inhibitors may be at increased risk of COVID-19 infection.<ref name="pmid32171062" />{{secondary source needed|date=March 2020}} However, multiple regulatory bodies have recommended continuing ACE inhibitor therapy as there is not definitive evidence of greater transmission or more severe illness from SARS-CoV-2 in patients taking ACE inhibitors.<ref name="Medscape">{{cite web | title=ESC Says Continue Hypertension Meds Despite COVID-19 Concern | website=Medscape | url=http://www.medscape.com/viewarticle/926838 | access-date=2020-03-20}}</ref><ref name="Caldeira Alarcao Vaz-Carneiro Costa pp. e4260–e4260">{{cite journal | vauthors = Caldeira D, Alarcão J, Vaz-Carneiro A, Costa J | title = Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis | journal = Bmj | volume = 345 | issue = jul11 1 | pages = e4260 | date = July 2012 | pmid = 22786934 | pmc = 3394697 | doi = 10.1136/bmj.e4260 | publisher = BMJ | quote = Our results suggest an important role of ACE inhibitors, but not ARBs, in reducing the risk of pneumonia. These data may discourage the withdrawal of ACE inhibitors in some patients with tolerable adverse events (namely, cough) who are at particularly high risk of pneumonia. ACE inhibitors also lowered the risk of pneumonia related mortality, mainly in patients with established disease, but the robustness of the evidence was weaker. }}</ref>
Treatment with angiotensin-converting enzyme (ACE) inhibitors results in an upregulation of ACE2 in some organs.<ref name="pmid28619367">{{cite journal | vauthors = Li XC, Zhang J, Zhuo JL | title = The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases | journal = Pharmacological Research | volume = 125 | issue = Pt A | pages = 21–38 | date = November 2017 | pmid = 28619367 | pmc = 5607101 | doi = 10.1016/j.phrs.2017.06.005 }}</ref>{{quotation needed|date=March 2020}} ACE2 is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. This increased expression of ACE2 may facilitate infection with SARS-CoV or SARS-CoV-2. Hence, patients with diabetes or hypertension being treated with ACE inhibitors may be at increased risk of COVID-19 infection.<ref name="pmid32171062" />{{secondary source needed|date=March 2020}} However, multiple regulatory bodies have recommended continuing ACE inhibitor therapy as there is not definitive evidence of greater transmission or more severe illness from SARS-CoV-2 in patients taking ACE inhibitors.<ref name="Medscape">{{cite web | title=ESC Says Continue Hypertension Meds Despite COVID-19 Concern | website=Medscape | url=http://www.medscape.com/viewarticle/926838 | access-date=2020-03-20}}</ref><ref name="Caldeira Alarcao Vaz-Carneiro Costa pp. e4260–e4260">{{cite journal | vauthors = Caldeira D, Alarcão J, Vaz-Carneiro A, Costa J | title = Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis | journal = Bmj | volume = 345 | issue = jul11 1 | pages = e4260 | date = July 2012 | pmid = 22786934 | pmc = 3394697 | doi = 10.1136/bmj.e4260 | publisher = BMJ | quote = Our results suggest an important role of ACE inhibitors, but not ARBs, in reducing the risk of pneumonia. These data may discourage the withdrawal of ACE inhibitors in some patients with tolerable adverse events (namely, cough) who are at particularly high risk of pneumonia. ACE inhibitors also lowered the risk of pneumonia related mortality, mainly in patients with established disease, but the robustness of the evidence was weaker. }}</ref>


The angiotensin II receptor antagonists telmisartan and olmesartan increased ACE2 expression in aorta of spontaneously hypertensive rats.<ref>{{cite journal |last1=Igase |first1=Michiya |last2=Strawn |first2=William B. |last3=Gallagher |first3=Patricia E. |last4=Geary |first4=Randolph L. |last5=Ferrario |first5=Carlos M. |title=Angiotensin II AT receptors regulate ACE2 and angiotensin-(1–7) expression in the aorta of spontaneously hypertensive rats |journal=American Journal of Physiology-Heart and Circulatory Physiology |date=September 2005 |volume=289 |issue=3 |pages=H1013–H1019 |doi=10.1152/ajpheart.00068.2005}}</ref><ref>{{cite journal |last1=Zhong |first1=Jiu-Chang |last2=Ye |first2=Jia-ying |last3=Jin |first3=Hai-yan |last4=Yu |first4=Xi |last5=Yu |first5=Hui-min |last6=Zhu |first6=Ding-liang |last7=Gao |first7=Ping-jin |last8=Huang |first8=Dong-yang |last9=Shuster |first9=Manfred |last10=Loibner |first10=Hans |last11=Guo |first11=Jun-min |last12=Yu |first12=Xi-yong |last13=Xiao |first13=Bing-xiu |last14=Gong |first14=Zhao-hui |last15=Penninger |first15=Josef M. |last16=Oudit |first16=Gavin Y. |title=Telmisartan attenuates aortic hypertrophy in hypertensive rats by the modulation of ACE2 and profilin-1 expression |journal=Regulatory Peptides |date=January 2011 |volume=166 |issue=1-3 |pages=90–97 |doi=10.1016/j.regpep.2010.09.005}}</ref>
The [[angiotensin II receptor antagonists]] telmisartan and olmesartan increased ACE2 expression in aorta of spontaneously hypertensive rats.<ref>{{cite journal |last1=Igase |first1=Michiya |last2=Strawn |first2=William B. |last3=Gallagher |first3=Patricia E. |last4=Geary |first4=Randolph L. |last5=Ferrario |first5=Carlos M. |title=Angiotensin II AT receptors regulate ACE2 and angiotensin-(1–7) expression in the aorta of spontaneously hypertensive rats |journal=American Journal of Physiology-Heart and Circulatory Physiology |date=September 2005 |volume=289 |issue=3 |pages=H1013–H1019 |doi=10.1152/ajpheart.00068.2005}}</ref><ref>{{cite journal |last1=Zhong |first1=Jiu-Chang |last2=Ye |first2=Jia-ying |last3=Jin |first3=Hai-yan |last4=Yu |first4=Xi |last5=Yu |first5=Hui-min |last6=Zhu |first6=Ding-liang |last7=Gao |first7=Ping-jin |last8=Huang |first8=Dong-yang |last9=Shuster |first9=Manfred |last10=Loibner |first10=Hans |last11=Guo |first11=Jun-min |last12=Yu |first12=Xi-yong |last13=Xiao |first13=Bing-xiu |last14=Gong |first14=Zhao-hui |last15=Penninger |first15=Josef M. |last16=Oudit |first16=Gavin Y. |title=Telmisartan attenuates aortic hypertrophy in hypertensive rats by the modulation of ACE2 and profilin-1 expression |journal=Regulatory Peptides |date=January 2011 |volume=166 |issue=1-3 |pages=90–97 |doi=10.1016/j.regpep.2010.09.005}}</ref>


== See also ==
== See also ==

Revision as of 20:02, 20 March 2020

ACE2
Available structures
PDBOrtholog search: PDBe RCSB
Identifiers
AliasesACE2, ACEH, angiotensin I converting enzyme 2, ACE 2
External IDsOMIM: 300335; MGI: 1917258; HomoloGene: 41448; GeneCards: ACE2; OMA:ACE2 - orthologs
Orthologs
SpeciesHumanMouse
Entrez

59272

70008

Ensembl

ENSG00000130234

ENSMUSG00000015405

UniProt

Q9BYF1

Q8R0I0

RefSeq (mRNA)

NM_021804
NM_001371415

NM_001130513
NM_027286

RefSeq (protein)

NP_068576
NP_001358344

NP_001123985
NP_081562

Location (UCSC)Chr X: 15.56 – 15.6 MbChr X: 162.92 – 162.97 Mb
PubMed search[3][4]
Wikidata
View/Edit HumanView/Edit Mouse

Angiotensin converting enzyme 2 (ACE2) is an exopeptidase that catalyses the conversion of angiotensin II to vasodilator angiotensin 1–7[5][6], and also conversion of angiotensin I to nanopeptide angiotensin[1–9][7] It is a single-pass type I membrane protein expressed on the surface of epithelial cells of the pulmonary alveolus, and on small intestine enterocytes and other cell types.[8] It serves as the entry point into human cells for most coronaviruses.

Coronavirus entry point

ACE2 has been shown to be the entry point into human cells for some coronaviruses, including SARS-CoV, the virus that causes SARS.[9] [10] A number of studies have identified that the entry point is the same for SARS-CoV-2,[11] the virus that causes COVID-19.[12][13][14][15]

This might lead some to believe that decreasing the levels of ACE2, in cells, might help in fighting the infection. On the other hand, ACE2 has been shown to have a protective effect against virus-induced lung injury by increasing the production of the vasodilator angiotensin 1–7.[16]Template:Secondary source required In fact, the interaction of the spike protein of the virus with the ACE2 induces a drop in the levels of ACE2 in cells,[10] possibly inducing lung damage. Claims that the available (AT1R) blockers (Angiotensin II receptor blocker) such as losartan, can help in curing COVID-19 need to be tested by data-mining of clinical patient records.[17]Template:Secondary source required A possible way of combating the infection could be the injection of soluble ACE2 into the blood stream which will have the twofold effect of competing with cellular ACE2, preventing the attachment of the virus to non-infected cells and replenishing ACE2 in infected cells.[18]Template:Secondary source required

Alternative studies have suggested a close co-morbidity link between hypertension and heart disease and COVID-19 which may be related to these patients normally being prescribed ACE inhibitors.[19]Template:Secondary source required

Treatment with angiotensin-converting enzyme (ACE) inhibitors results in an upregulation of ACE2 in some organs.[20][need quotation to verify] ACE2 is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. This increased expression of ACE2 may facilitate infection with SARS-CoV or SARS-CoV-2. Hence, patients with diabetes or hypertension being treated with ACE inhibitors may be at increased risk of COVID-19 infection.[19][non-primary source needed] However, multiple regulatory bodies have recommended continuing ACE inhibitor therapy as there is not definitive evidence of greater transmission or more severe illness from SARS-CoV-2 in patients taking ACE inhibitors.[21][22]

The angiotensin II receptor antagonists telmisartan and olmesartan increased ACE2 expression in aorta of spontaneously hypertensive rats.[23][24]

See also

References

  1. ^ a b c GRCh38: Ensembl release 89: ENSG00000130234 – Ensembl, May 2017
  2. ^ a b c GRCm38: Ensembl release 89: ENSMUSG00000015405 – Ensembl, May 2017
  3. ^ "Human PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
  4. ^ "Mouse PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
  5. ^ Keidar S, Kaplan M, Gamliel-Lazarovich A (February 2007). "ACE2 of the heart: From angiotensin I to angiotensin (1-7)". Cardiovascular Research. 73 (3): 463–9. doi:10.1016/j.cardiores.2006.09.006. PMID 17049503.
  6. ^ Wang W, McKinnie SM, Farhan M, Paul M, McDonald T, McLean B, et al. (August 2016). "Angiotensin-Converting Enzyme 2 Metabolizes and Partially Inactivates Pyr-Apelin-13 and Apelin-17: Physiological Effects in the Cardiovascular System". Hypertension. 68 (2): 365–77. doi:10.1161/HYPERTENSIONAHA.115.06892. PMID 27217402.
  7. ^ Donoghue M, Hsieh F, Baronas E, Godbout K, Gosselin M, Stagliano N, et al. (September 2000). "A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1–9". Circulation Research. 87 (5): E1-9. doi:10.1161/01.res.87.5.e1. PMID 10969042.
  8. ^ Hamming, I; Timens, W; Bulthuis, MLC; Lely, AT; Navis, GJ; van Goor, H (June 2004). "Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis". The Journal of Pathology. 203 (2): 631–637. doi:10.1002/path.1570. PMID 15141377.
  9. ^ Li, Fang (2013). "Receptor recognition and cross-species infections of SARS coronavirus". Antiviral Research. 100 (1): 246–54. doi:10.1016/j.antiviral.2013.08.014. PMC 3840050. PMID 23994189.
  10. ^ a b Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. (August 2005). "A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury". Nature Medicine. 11 (8): 875–9. doi:10.1038/nm1267. PMID 16007097.
  11. ^ "What are the official names of the disease and the virus that causes it?". Q&A on coronaviruses. World Health Organization. Retrieved 22 February 2020.
  12. ^ Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. (March 2020). "A pneumonia outbreak associated with a new coronavirus of probable bat origin". Nature. 579 (7798): 270–273. doi:10.1038/s41586-020-2012-7. PMID 32015507.
  13. ^ Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al. (March 2020). "Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission". Science China. Life Sciences. 63 (3): 457–460. doi:10.1007/s11427-020-1637-5. PMID 32009228.
  14. ^ Lewis, Ricki (2020-02-20). "COVID-19 Vaccine Will Close in on the Spikes". DNA Science Blog. Public Library of Science. {{cite web}}: Unknown parameter |name-list-format= ignored (|name-list-style= suggested) (help)
  15. ^ Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D (2020). "Structure, function and antigenicity of the SARS-CoV-2 spike glycoprotein". bioRxiv: 2020.02.19.956581. doi:10.1101/2020.02.19.956581.
  16. ^ Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, et al. (July 2005). "Angiotensin-converting enzyme 2 protects from severe acute lung failure". Nature. 436 (7047): 112–6. Bibcode:2005Natur.436..112I. doi:10.1038/nature03712. PMID 16001071.
  17. ^ Gurwitz D (March 2020). "Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics". Drug Development Research. doi:10.1002/ddr.21656. PMID 32129518.
  18. ^ Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS (March 2020). "Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target". Intensive Care Medicine. Springer Science and Business Media LLC. doi:10.1007/s00134-020-05985-9. PMID 32125455.
  19. ^ a b Fang L, Karakiulakis G, Roth M (March 2020). "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?". The Lancet. Respiratory Medicine. doi:10.1016/S2213-2600(20)30116-8. PMID 32171062.
  20. ^ Li XC, Zhang J, Zhuo JL (November 2017). "The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases". Pharmacological Research. 125 (Pt A): 21–38. doi:10.1016/j.phrs.2017.06.005. PMC 5607101. PMID 28619367.
  21. ^ "ESC Says Continue Hypertension Meds Despite COVID-19 Concern". Medscape. Retrieved 2020-03-20.
  22. ^ Caldeira D, Alarcão J, Vaz-Carneiro A, Costa J (July 2012). "Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis". Bmj. 345 (jul11 1). BMJ: e4260. doi:10.1136/bmj.e4260. PMC 3394697. PMID 22786934. Our results suggest an important role of ACE inhibitors, but not ARBs, in reducing the risk of pneumonia. These data may discourage the withdrawal of ACE inhibitors in some patients with tolerable adverse events (namely, cough) who are at particularly high risk of pneumonia. ACE inhibitors also lowered the risk of pneumonia related mortality, mainly in patients with established disease, but the robustness of the evidence was weaker.
  23. ^ Igase, Michiya; Strawn, William B.; Gallagher, Patricia E.; Geary, Randolph L.; Ferrario, Carlos M. (September 2005). "Angiotensin II AT receptors regulate ACE2 and angiotensin-(1–7) expression in the aorta of spontaneously hypertensive rats". American Journal of Physiology-Heart and Circulatory Physiology. 289 (3): H1013–H1019. doi:10.1152/ajpheart.00068.2005.
  24. ^ Zhong, Jiu-Chang; Ye, Jia-ying; Jin, Hai-yan; Yu, Xi; Yu, Hui-min; Zhu, Ding-liang; Gao, Ping-jin; Huang, Dong-yang; Shuster, Manfred; Loibner, Hans; Guo, Jun-min; Yu, Xi-yong; Xiao, Bing-xiu; Gong, Zhao-hui; Penninger, Josef M.; Oudit, Gavin Y. (January 2011). "Telmisartan attenuates aortic hypertrophy in hypertensive rats by the modulation of ACE2 and profilin-1 expression". Regulatory Peptides. 166 (1–3): 90–97. doi:10.1016/j.regpep.2010.09.005.

Further reading


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