Correlation between renin-angiotensin system and Severe Acute Respiratory Syndrome Coronavirus 2 infection: What do we know?

Eur J Pharmacol. 2020 Sep 15;883:173373. doi: 10.1016/j.ejphar.2020.173373. Epub 2020 Jul 15.


The first cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19) infections were recorded in China in November 2019. Since its appearance in China at the end of last year, the virus has spread to all continents causing a "global pandemic". To date, some aspects remain to be investigate about the pathophysiology of this viral infection. One of the aspects to be still clarified is the correlation between the renin-angiotensin system (RAS) and SARS-CoV-2 infection. RAS is a physiological system playing a key role in different human body functions regulation. SARS-CoV-2 uses the angiotensin-converting enzyme 2 (ACE-2), a component of RAS, as a potential factor of cell penetration and infectivity; in addition, in the different infection stages, a functional variation of the RAS has been noted. In this article, we discuss the correlation between the role of RAS and system-modifying agents, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and direct renin inhibitors (DRIs), with SARS-CoV-2 infection.

Keywords: ACE-2; Coronavirus; Infection; Pharmacology; RAS; Renin; SARS-CoV-2.

MeSH terms

  • Angiotensin Receptor Antagonists / pharmacology*
  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology*
  • Betacoronavirus* / drug effects
  • Betacoronavirus* / physiology
  • COVID-19
  • Cardiovascular Diseases / drug therapy
  • Coronavirus Infections* / metabolism
  • Coronavirus Infections* / therapy
  • Coronavirus Infections* / virology
  • Humans
  • Pandemics*
  • Peptidyl-Dipeptidase A / metabolism*
  • Pneumonia, Viral* / metabolism
  • Pneumonia, Viral* / therapy
  • Pneumonia, Viral* / virology
  • Renin-Angiotensin System* / drug effects
  • Renin-Angiotensin System* / physiology
  • SARS-CoV-2


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2