Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19
Wentao Ni,
Xiuwen Yang,
Deqing Yang,
Jing Bao,
Ran Li,
Yongjiu Xiao,
Chang Hou,
Haibin Wang,
Jie Liu,
Donghong Yang,
Yu Xu,
Zhaolong Cao,
Zhancheng Gao
Affiliations
Wentao Ni
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Xiuwen Yang
Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology
Deqing Yang
Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University
Jing Bao
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Ran Li
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Yongjiu Xiao
Department of Emergency, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army
Chang Hou
Department of Cardiology, Peking University People’s Hospital
Haibin Wang
Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University
Jie Liu
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital
Donghong Yang
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Yu Xu
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Zhaolong Cao
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Zhancheng Gao
Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital
Abstract An outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in Wuhan, China, at the end of 2019 has become a global pandemic. Both SARS-CoV-2 and SARS-CoV enter host cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in various human organs. We have reviewed previously published studies on SARS and recent studies on SARS-CoV-2 infection, named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), confirming that many other organs besides the lungs are vulnerable to the virus. ACE2 catalyzes angiotensin II conversion to angiotensin-(1–7), and the ACE2/angiotensin-(1–7)/MAS axis counteracts the negative effects of the renin-angiotensin system (RAS), which plays important roles in maintaining the physiological and pathophysiological balance of the body. In addition to the direct viral effects and inflammatory and immune factors associated with COVID-19 pathogenesis, ACE2 downregulation and the imbalance between the RAS and ACE2/angiotensin-(1–7)/MAS after infection may also contribute to multiple organ injury in COVID-19. The SARS-CoV-2 spike glycoprotein, which binds to ACE2, is a potential target for developing specific drugs, antibodies, and vaccines. Restoring the balance between the RAS and ACE2/angiotensin-(1–7)/MAS may help attenuate organ injuries. Graphical abstract SARS-CoV-2 enters lung cells via the ACE2 receptor. The cell-free and macrophage-phagocytosed virus can spread to other organs and infect ACE2-expressing cells at local sites, causing multi-organ injury.
