ACE2, Metformin, and COVID-19

Atul Malhotra; Mark Hepokoski; Karen C. McCowen; John Y-J Shyy

iScience (Sep 2020)

ACE2, Metformin, and COVID-19

Atul Malhotra,
Mark Hepokoski,
Karen C. McCowen,
John Y-J Shyy

Affiliations

Atul Malhotra: Department of Medicine, University of California, San Diego, La Jolla, CA 92023, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, CA 92023, USA; Corresponding author
Mark Hepokoski: Department of Medicine, University of California, San Diego, La Jolla, CA 92023, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, CA 92023, USA; VA San Diego Health System, 9500 Gilman Drive, La Jolla, CA 92023, USA
Karen C. McCowen: Department of Medicine, University of California, San Diego, La Jolla, CA 92023, USA; Division of Endocrinology, University of California, San Diego, La Jolla, CA 92023, USA
John Y-J Shyy: Department of Medicine, University of California, San Diego, La Jolla, CA 92023, USA; Division of Cardiology, University of California, San Diego, La Jolla, CA 92023, USA; Corresponding author

Journal volume & issue: Vol. 23, no. 9
p. 101425

Abstract

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Summary: COVID-19 is becoming a leading cause of mortality throughout the world, and few effective therapies are currently available. Angiotensin converting enzyme 2 (ACE2) is essential to COVID-19 pathogenesis, as the binding of SARS-CoV-2 spike protein (S protein) is required for viral entry and development of COVID-19. ACE2 regulates the protective arm of the renin-angiotensin-aldosterone system (RAAS) that endows anti-hypertensive and anti-inflammatory effects in the cardiovascular and pulmonary systems. Preclinical data suggest ACE2 might be downregulated after SARS-CoV-2 binding, and treatments that increase ACE2 may prevent cardiopulmonary injury. Development, testing, and mass production of novel ACE2 therapies may take years, whereas more effective treatments for COVID-19 are needed urgently. Metformin is a widely available anti-diabetic agent that has an excellent safety profile, and clinical and preclinical data suggest metformin may offer cardiopulmonary protection in COVID-19 via enhanced ACE2 expression.

Published in iScience

ISSN: 2589-0042 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Science
Website: http://www.cell.com/iscience/home

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Abstract

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