Why Angiotensin II is a Poor Choice for Circulatory Support of Ventilated COVID-19 Patients Compared to Vasopressin.
Why Angiotensin II is a Poor Choice for Circulatory Support of Ventilated COVID-19 Patients Compared to Vasopressin.
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发表时间：
2022-09
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通讯作者：
Bader M
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作者：
Speth RC;Bader M
在COVID-19大流行的早期，当首次报道SARS-CoV-2使用膜结合血管紧张素转换酶-2（ACE 2）作为其进入细胞的受体时，人们警告不要使用血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB），因为它们可能增加ACE 2的表达。这些报道忽略了肾素-血管紧张素系统（RAS）通过其主要激素血管紧张素（Ang）II作用于AT 1受体对心血管系统和肾脏产生的不良影响，这可能加剧SARS-CoV-2诱导的细胞因子风暴。有一次，甚至建议患有心血管衰竭的COVID-19患者服用Ang II来恢复血压，而不是去甲肾上腺素或加压素。治疗COVID-19的另一种策略是给予可溶性ACE 2（sACE 2）作为病毒的诱饵受体，将其误导远离表达膜结合ACE 2的脆弱细胞。然而，2021年初发表的一篇论文描述了一种情况，即sACE 2和加压素在SARS-CoV-2感染易受病毒感染的细胞中发挥了重要作用。这篇评论质疑了基于误解和技术错误的报告，这些误解和技术错误对严重受影响的COVID-19患者的救生治疗构成了威胁。
Early in the COVID-19 pandemic when it was first reported that SARS-CoV-2 used membrane-bound angiotensin-converting enzyme-2 (ACE2) as its receptor for entry into cells, warnings were raised against the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) because of their potential to increase ACE2 expression. These reports ignored the adverse effects that the renin-angiotensin system (RAS) exerts on the cardiovascular system and kidneys via its primary hormone angiotensin (Ang) II acting upon AT1 receptors that could exacerbate the cytokine storm induced by SARS-CoV-2 . At one point it was even recommended that COVID-19 patients suffering from cardiovascular collapse be administered Ang II to restore blood pressure rather than norepinephrine or vasopressin . An alternative strategy for treating COVID-19 was the administration of soluble ACE2 (sACE2) to act as a decoy receptor for the virus, misdirecting it away from vulnerable cells expressing membrane bound ACE2 . However, a paper published in early 2021 described a scenario in which sACE2 and vasopressin played essential roles in SARS-CoV-2 infection of cells vulnerable to the virus. This commentary challenges both the and reports based upon their misconceptions and technical errors that pose a threat to the administration of life-saving therapies for severely affected COVID-19 patients.