Inhaled modified angiotensin converting enzyme 2 (ACE2) as a decoy to mitigate SARS-CoV-2 infection

N Z Med J. 2020 May 22;133(1515):112-118.


COVID-19 is a new zoonotic disease caused by the SARS-CoV-2 virus. Since its emergence in Wuhan City, China, the virus has rapidly spread across the globe causing calamitous health, economic and societal consequences. It causes disproportionately severe disease in the elderly and those with co-morbidities, such as hypertension and diabetes. There is currently no proven treatment for COVID-19 and a safe and effective vaccine is at least a year away. The virus gains access to the respiratory epithelium through cell surface angiotensin converting enzyme 2 (ACE2). The receptor binding domain (RBD) of the virus is unlikely to mutate without loss of pathogenicity and thus represents an attractive target for antiviral treatment. Inhaled modified recombinant human ACE2, may bind SARS-CoV-2 and mitigate lung damage. This decoy strategy is unlikely to provoke an adverse immune response and may reduce morbidity and mortality in high-risk groups.

MeSH terms

  • Administration, Inhalation*
  • Angiotensin-Converting Enzyme 2
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / drug therapy*
  • Humans
  • Lung / virology
  • Pandemics
  • Peptidyl-Dipeptidase A / administration & dosage
  • Peptidyl-Dipeptidase A / therapeutic use*
  • Pneumonia, Viral / drug therapy*
  • Protein Binding
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / therapeutic use
  • SARS-CoV-2
  • Spike Glycoprotein, Coronavirus


  • Recombinant Proteins
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2

Supplementary concepts

  • COVID-19 drug treatment