COVID-19, ACE2, and the cardiovascular consequences
COVID-19, ACE2, and the cardiovascular consequences
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DOI：
10.1152/ajpheart.00217.2020
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发表时间：
2020-05-01
影响因子：
4.8
通讯作者：
Chappell, Mark C.
中科院分区：
文献类型：
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作者：
South, Andrew M.;Diz, Debra, I;Chappell, Mark C.
新的SARS冠状病毒SARS-CoV-2大流行可能对患有潜在心血管疾病(CVD)的患者特别有害。SARS-CoV-2感染的机制是病毒与膜结合形式的血管紧张素转换酶2(ACE2)的必要结合和宿主细胞对复合体的内化。认识到ACE2是冠状病毒的辅助受体，已促使新的治疗方法阻止该酶或减少其表达，以防止细胞进入和SARS-CoV-2在包括肺在内的表达ACE2的组织中的感染。心脏、肾脏、大脑和肠道。然而，ACE2。是肾素-血管紧张素-醛固酮系统(RAAS)的关键酶组分：ACE2降解Ang II，Ang II是一种具有多种作用的促进心血管疾病的多肽，并产生Ang-(1-7)。此外，实验证据表明，血管紧张素转换酶抑制剂、血管紧张素II 1型受体拮抗剂、盐皮质激素拮抗剂以及他汀类药物阻断RAAS可增强ACE2，这在一定程度上有助于这些方案的益处。许多患有高血压或其他心血管疾病的老年患者常规使用RAAS阻滞剂和他汀类药物治疗，取而代之的是，这些患者是否有更大的感染SARS-CoV-2的风险，RAAS和他汀类药物是否应该停止治疗，以及RAAS阻滞剂对新冠肺炎相关病理(如急性和慢性呼吸道疾病)的潜在后果，取代了这一事实。目前的观点是认真研究RAAS阻滞剂和他汀类药物调节血管紧张素转换酶2的证据，血管紧张素转换酶2的心血管益处，以及血管紧张素转换酶2阻断是否是减弱冠状病毒感染-19的可行方法。请收听本文的相应播客：https://ajpheart.podbean.com/e/covid-19-ace2-and-the-cardiovascular-consequences/.
The novel SARS coronavirus SARS-CoV-2 pandemic may be particularly deleterious to patients with underlying cardiovascular disease (CVD). The mechanism for SARS-CoV-2 infection is the requisite binding of the virus to the membrane-bound form of angiotensin-converting enzyme 2 (ACE2) and internalization of the complex by the host cell. Recognition that ACE2 is the coreceptor for the coronavirus has prompted new therapeutic approaches to block the enzyme or reduce its expression to prevent the cellular entry and SARS-CoV-2 infection in tissues that express ACE2 including lung. heart, kidney, brain, and gut. ACE2, however. is a key enzymatic component of the renin-angiotensin-aldosterone system (RAAS): ACE2 degrades ANG II, a peptide with multiple actions that promote CVD, and generates Ang-(1-7). which antagonizes the effects of ANG II. Moreover, experimental evidence suggests that RAAS blockade by ACE inhibitors, ANG II type 1 receptor antagonists, and mineralocorticoid antagonists, as well as statins, enhance ACE2 which, in part, contributes to the benefit of these regimens. In lieu of the fact that many older patients with hypertension or other CVDs are routinely treated with RAAS blockers and statins, new clinical concerns have developed regarding whether these patients are at greater risk for SARS-CoV-2 infection, whether RAAS and statin therapy should be discontinued, and the potential consequences of RAAS blockade to COVID-19-related pathologies such as acute and chronic respiratory disease. The current perspective critically examines the evidence for ACE2 regulation by RAAS blockade and statins, the cardiovascular benefits of ACE2, and whether ACE2 blockade is a viable approach to attenuate COVID-19.Listen to this article's corresponding podcast at: https://ajpheart.podbean.com/e/covid-19-ace2-and-the-cardiovascular-consequences/.