The role of ACE2 in cardiovascular physiology

Trends Cardiovasc Med. 2003 Apr;13(3):93-101. doi: 10.1016/s1050-1738(02)00233-5.


The renin-angiotensin system (RAS) is critically involved in cardiovascular and renal function and in disease conditions, and has been shown to be a far more complex system than initially thought. A recently discovered homologue of angiotensin-converting enzyme (ACE)--ACE2--appears to negatively regulate the RAS. ACE2 cleaves Ang I and Ang II into the inactive Ang 1-9 and Ang 1-7, respectively. ACE2 is highly expressed in kidney and heart and is especially confined to the endothelium. With quantitative trait locus (QTL) mapping, ACE2 was defined as a QTL on the X chromosome in rat models of hypertension. In these animal models, kidney ACE2 messenger RNA and protein expression were markedly reduced, making ACE2 a candidate gene for this QTL. Targeted disruption of ACE2 in mice failed to elicit hypertension, but resulted in severe impairment in myocardial contractility with increased angiotensin II levels. Genetic ablation of ACE in the ACE2 null mice rescued the cardiac phenotype. These genetic data show that ACE2 is an essential regulator of heart function in vivo. Basal renal morphology and function were not altered by the inactivation of ACE2. The novel role of ACE2 in hydrolyzing several other peptides-such as the apelin peptides, opioids, and kinin metabolites-raises the possibility that peptide systems other than angiotensin and its derivatives also may have an important role in regulating cardiovascular and renal function.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiotensin II / physiology
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Animals
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / enzymology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Physiological Phenomena*
  • Endothelium, Vascular / enzymology
  • Humans
  • Mice
  • Mice, Knockout
  • Muscle, Smooth, Vascular / enzymology
  • Peptidyl-Dipeptidase A / physiology*
  • Renin-Angiotensin System / physiology


  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin II
  • Peptidyl-Dipeptidase A