key: cord-0782963-7t689x3w
authors: Bobkova, Irina; Kamyshova, Elena; Rudenko, Tatiana; Stavrovskaya, Ekaterina; Moiseev, Sergey
title: Is there enough evidence to discontinue the renin-angiotensin system inhibitors in patients with COVID-19?
date: 2020-05-27
journal: Med Hypotheses
DOI: 10.1016/j.mehy.2020.109888
sha: e5290aab8cce734c55e775e47e2f7d868e5ae550
doc_id: 782963
cord_uid: 7t689x3w

nan

Is there enough evidence to discontinue the renin-angiotensin system inhibitors in patients with COVID This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Is there enough evidence to discontinue the renin-angiotensin system inhibitors in Indeed, the ACE2-associated pathway of SARS-CoV-2 infectivity should not be neglected.

lacking. In animal model, SARS-CoV was absent in some ACE2 expressing cells, whereas virus was present in cells lacking ACE2. These findings suggest that additional co-factors are needed for virus entry into the cells [3] . Furthermore, it is unknown how ACEIs/ARBs influence on the membrane-bound АСЕ2 expression in lung and whether these changes (if any) affect Covid-19 outcomes.

We hypothesize that SARS-CoV2-АСЕ2 interaction and alteration of АСЕ2 expression in response to ACEIs/ARBs may be genetically determined. ACE2 gene variants may define the АСЕ2 tissue-specificity, serum level and ability to bind with SARS-CoV2, to exert local and system effects. The important role may be assigned to other renin-angiotensin system (RAS) genes variants, primarily ACE gene, associated with lung disease severity and ACEIs efficiency. Also the significance of АТ1-receptor and angiotensin genes polymorphisms, the combination of which may affect the RAS activity in tissues and circulation, are discussed.

Currently, there are several clinical trials investigating the ACEIs/ARBs effects and ACE2 regulation in COVID-19 [4] . These studies will allow to evaluate the effects of continuation/withdrawal ACEIs/ARBs on patients' outcomes.

Renin-angiotensin system: The unexpected flaw inside the human immune system revealed by SARS-CoV-2

Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target

Pathology and pathogenesis of severe acute respiratory syndrome

Response to recent commentaries regarding the involvement of angiotensin-converting enzyme 2 (ACE2) and renin-angiotensin system blockers in SARS-CoV-2 infections