key: cord-0890129-o60ldhzc authors: Javanmard, Shaghayegh Haghjooy; Heshmat-Ghahdarijani, Kiyan; Vaseghi, Golnaz title: Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blocker (ARB) use in COVID-19 prevention or treatment: A paradox date: 2020-05-04 journal: Infection control and hospital epidemiology DOI: 10.1017/ice.2020.195 sha: 5689f47a48a39326607ba4694d1ab76a3f119f99 doc_id: 890129 cord_uid: o60ldhzc nan ACE-I and ARBs have been shown to upregulate the expression of ACE-2 or to prevent the loss of ACE2 in the heart; they may have a similar effect in lung tissue. 15, 16 Thus, an ACE-I and ARB blocker prescription in COVID-19 patient may make the patient vulnerable due to additional virus entrance and replication in type II alveolar cells. Hypertension, diabetes, and coronary heart disease were the most common comorbidities associated with death from COVID-19 in Wuhan patients, 17 which leads us to 2 paradoxical hypotheses: 1. The expression of ACE2 in hypertensive patients and patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors ARBs, is increased. 18 This upregulation may make these patients more vulnerable. 2. On the other hand, diabetes and hypertension are associated with decreased baseline levels of ACE2 expression. 18 Therefore, SARS-CoV-2 binding to ACE2 may decrease residual ACE2 activity and lead to a predominance of ANG II through AT1 receptor signaling. In this case, ANG II causes pulmonary vasoconstriction and inflammatory and oxidative organ damage, ultimately progressing toward ARDS. 19 Although some beneficial experimental evidence has emerged regarding ACEI or ARBs, and their use is well tolerated, inexpensive, and widespread; the potential therapeutic effects of these drugs in ARDS caused by SARS-CoV-2 is doubtful. However, multiple regulatory associations have recommended that hypertensive COVID-19 patients do not stop taking their previosuly prescribed ACE inhibitors or ARBs. 20 The evidence offered here precedes any clinical trials, and the paradoxical role of the aforementioned drugs should be solved in preclinical and epidemiological studies. A novel coronavirus from patients with pneumonia in China Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle COVID-19: a fast evolving pandemic COVID-19-new insights on a rapidly changing epidemic Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan COVID-19 Angiotensin-(1-7) improves oxygenation, while reducing cellular infiltrate and fibrosis in experimental acute respiratory distress syndrome A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9 Angiotensin-converting enzyme 2 (ACE2) is a key modulator of the renin angiotensin system in health and disease ACE2, angiotensin-(1-7) and Mas receptor axis in inflammation and fibrosis Angiotensin-converting enzyme 2 protects from severe acute lung failure A crucial role of angiotensinconverting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury Circulating angiotensin peptides levels in acute respiratory distress syndrome correlate with clinical outcomes: a pilot study Enalapril attenuates downregulation of Angiotensin-converting enzyme 2 in the late phase of ventricular dysfunction in myocardial infarcted rat Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2 Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases Recombinant human ACE2: acing out angiotensin II in ARDS therapy European Society of Cardiology website