Clinical Interventions in Aging (Jul 2020)
COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients
Abstract
Jerzy Sieńko,1 Maciej Kotowski,1 Anna Bogacz,2 Kacper Lechowicz,3 Sylwester Drożdżal,4 Jakub Rosik,5 Marek Sietnicki,6 Magdalena Sieńko,7 Katarzyna Kotfis3 1Department of General Surgery and Transplantology, Pomeranian Medical University in Szczecin, Szczecin, Poland; 2Department of Pharmacology and Phytochemistry, Institute of Natural Fibers and Medicinal Plants, Poznan, Poland; 3Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland; 4Department of Pharmacokinetics and Monitored Therapy, Pomeranian Medical University in Szczecin, Szczecin, Poland; 5Department of Physiology, Pomeranian Medical University in Szczecin, Szczecin, Poland; 6Department of Civil Engineering and Architecture, West Pomeranian University of Technology in Szczecin, Szczecin, Poland; 7Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University in Szczecin, Szczecin, PolandCorrespondence: Katarzyna KotfisDepartment of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, Szczecin 70-111, PolandTel/ Fax +48 91 466 11 44Email [email protected]: Since the beginning of 2020, the whole world has been struggling with the pandemic of Coronavirus Disease 2019 (COVID-19) caused by a novel coronavirus SARS-CoV-2. The SARS-CoV-2 infection depends on ACE2, TMPRSS2, and CD147, which are expressed on host cells. Several studies suggest that some single nucleotide polymorphisms (SNPs) of ACE2 might be a risk factor of COVID-19 infection. Genotypes affect ACE2 structure, its serum concentration, and levels of circulating angiotensin (1-7). Moreover, there is evidence that ACE genotype affects the outcomes of acute respiratory distress syndrome (ARDS) treatment, the most severe consequence of SARS-CoV-2 infection. COVID-19 morbidity, infection course, and mortality might depend on ACE D allele frequency. The aim of this narrative review was to analyze and identify the mechanisms of ACE-I and ARBs with particular emphasis on angiotensin receptors and their polymorphism in the light of COVID-19 pandemic as these medications are commonly prescribed to elderly patients. There is no direct evidence yet for ACE-I or ARBs in the treatment of COVID-19. However, for those already taking these medications, both the European Society of Cardiology and the American College of Cardiology recommend continuing the treatment, because at present, there is no clear clinical or scientific evidence to justify the discontinuation of ACE-I or ARBs. Individualized treatment decisions should be based on the clinical condition and co-morbidities of each patient.Keywords: SARI, hypertension, coronavirus, age, ACEI, ARB
