Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

doi:10.1056/NEJMsr2005760

. 2020 Apr 23;382(17):1653-1659.

doi: 10.1056/NEJMsr2005760. Epub 2020 Mar 30.

Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

Muthiah Vaduganathan¹, Orly Vardeny¹, Thomas Michel¹, John J V McMurray¹, Marc A Pfeffer¹, Scott D Solomon¹

Affiliations

Affiliation

¹ From the Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston (M.V., T.M., M.A.P., S.D.S.); the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis (O.V.); and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.).

PMID: 32227760
PMCID: PMC7121452
DOI: 10.1056/NEJMsr2005760

Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

Muthiah Vaduganathan et al. N Engl J Med. 2020.

. 2020 Apr 23;382(17):1653-1659.

doi: 10.1056/NEJMsr2005760. Epub 2020 Mar 30.

Authors

Muthiah Vaduganathan¹, Orly Vardeny¹, Thomas Michel¹, John J V McMurray¹, Marc A Pfeffer¹, Scott D Solomon¹

Affiliation

¹ From the Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston (M.V., T.M., M.A.P., S.D.S.); the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis (O.V.); and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.).

PMID: 32227760
PMCID: PMC7121452
DOI: 10.1056/NEJMsr2005760

No abstract available

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Figures

**Figure 1. Interaction between SARS-CoV-2 and the Renin–Angiotensin–Aldosterone System.**
Shown is the initial entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into cells, primarily type II pneumocytes, after binding to its functional receptor, angiotensin-converting enzyme 2 (ACE2). After endocytosis of the viral complex, surface ACE2 is further down-regulated, resulting in unopposed angiotensin II accumulation. Local activation of the renin–angiotensin–aldosterone system may mediate lung injury responses to viral insults. ACE denotes angiotensin-converting enzyme, and ARB angiotensin-receptor blocker.

See this image and copyright information in PMC

Comment in

Covid-19 and the angiotensin-converting enzyme (ACE2): Areas for research.
Omar MB. Omar MB. Heart Lung. 2020 Jul-Aug;49(4):351. doi: 10.1016/j.hrtlng.2020.04.012. Epub 2020 Apr 20. Heart Lung. 2020. PMID: 32327200 Free PMC article. No abstract available.
Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19.
Lubel J, Garg M. Lubel J, et al. N Engl J Med. 2020 Jun 11;382(24):e92. doi: 10.1056/NEJMc2013707. Epub 2020 May 19. N Engl J Med. 2020. PMID: 32427428 No abstract available.
Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19.
Haug G, Eapen MS, Sohal SS. Haug G, et al. N Engl J Med. 2020 Jun 11;382(24):e92. doi: 10.1056/NEJMc2013707. Epub 2020 May 19. N Engl J Med. 2020. PMID: 32427429 No abstract available.
Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19.
Birnbaum RA. Birnbaum RA. N Engl J Med. 2020 Jun 11;382(24):e92. doi: 10.1056/NEJMc2013707. Epub 2020 May 19. N Engl J Med. 2020. PMID: 32427430 No abstract available.
Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19. Reply.
Vaduganathan M, Solomon SD. Vaduganathan M, et al. N Engl J Med. 2020 Jun 11;382(24):e92. doi: 10.1056/NEJMc2013707. Epub 2020 May 19. N Engl J Med. 2020. PMID: 32427431 No abstract available.
Curcumin as a potential treatment for COVID-19.
Rocha FAC, de Assis MR. Rocha FAC, et al. Phytother Res. 2020 Sep;34(9):2085-2087. doi: 10.1002/ptr.6745. Epub 2020 Jun 9. Phytother Res. 2020. PMID: 32442323 Free PMC article. No abstract available.
Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and COVID-19: Demonstrating the Actionability of Real-World Evidence.
Hennessy S, Cohen JB. Hennessy S, et al. Am J Hypertens. 2021 Apr 20;34(4):327-329. doi: 10.1093/ajh/hpaa177. Am J Hypertens. 2021. PMID: 33156920 Free PMC article. No abstract available.

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References

1. Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-454. - PMC - PubMed
1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020. March 4 (Epub ahead of print). - PMC - PubMed
1. Li W, Zhang C, Sui J, et al. Receptor and viral determinants of SARS-coronavirus adaptation to human ACE2. EMBO J 2005;24:1634-1643. - PMC - PubMed
1. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;367:1260-1263. - PMC - PubMed
1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020. March 11 (Epub ahead of print). - PMC - PubMed

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[1] Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-454. - PMC - PubMed

[2] Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-454. - PMC - PubMed

[3] Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020. March 4 (Epub ahead of print). - PMC - PubMed

[4] Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020. March 4 (Epub ahead of print). - PMC - PubMed

[5] Li W, Zhang C, Sui J, et al. Receptor and viral determinants of SARS-coronavirus adaptation to human ACE2. EMBO J 2005;24:1634-1643. - PMC - PubMed

[6] Li W, Zhang C, Sui J, et al. Receptor and viral determinants of SARS-coronavirus adaptation to human ACE2. EMBO J 2005;24:1634-1643. - PMC - PubMed

[7] Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;367:1260-1263. - PMC - PubMed

[8] Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;367:1260-1263. - PMC - PubMed

[9] Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020. March 11 (Epub ahead of print). - PMC - PubMed

[10] Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020. March 11 (Epub ahead of print). - PMC - PubMed

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Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

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