COVID-19 and renin angiotensin aldosterone system: Pathogenesis and therapy

Fatemeh Babajani; Atefeh Kakavand; Hossien Mohammadi; Armin Sharifi; Saba Zakeri; Soheila Asadi; Zeinab Mohseni Afshar; Zohreh Rahimi; Babak Sayad

doi:10.1002/hsr2.440

COVID-19 and renin angiotensin aldosterone system: Pathogenesis and therapy

Health Sci Rep. 2021 Nov 17;4(4):e440. doi: 10.1002/hsr2.440. eCollection 2021 Dec.

Authors

Fatemeh Babajani¹, Atefeh Kakavand¹, Hossien Mohammadi¹, Armin Sharifi¹, Saba Zakeri¹, Soheila Asadi², Zeinab Mohseni Afshar³, Zohreh Rahimi^{2

4}, Babak Sayad³

Affiliations

¹ Students Research Committee Kermanshah University of Medical Sciences Kermanshah Iran.
² Department of Clinical Biochemistry Kermanshah University of Medical Sciences Kermanshah Iran.
³ Infectious Diseases Research Center Kermanshah University of Medical Sciences Kermanshah Iran.
⁴ Behavioral Research Center Kermanshah University of Medical Sciences Kermanshah Iran.

Abstract

Aims: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the ACE2 component of the renin-angiotensin aldosterone system (RAAS) and infects the human cells. The aims of the present review were to look at the role and alteration of the RAAS components in SARS-CoV-2 infection, therapeutic approaches, and clinical trials in this field.

Methods: We surveyed the literature (PubMed, Web of Science, and Scopus) till August 18, 2021, and 59 published papers regarding the components of the RAAS and their role and alterations in SARS-CoV-2 infection along with various COVID-19 therapies based on the RASS components were included in the study.

Results: ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor inhibitors are agents that significantly enhance the ACE2 and Ang-(1-7) levels, which can be suggestive for their role as therapeutics against SARS-CoV-2 infection. Beta-adrenergic blockers, which negatively regulate renin release from juxtaglomerular cells, and vitamin D, as a regulator of the RAAS and renin expression, are proposed therapeutics in the treatment of COVID-19. Some antihyperglycemic agents could be potentially protective against COVID-19-induced lung injury. Also, the inhibition of the Janus kinase/signal transducer and activator of the transcription pathway as a potential treatment for COVID-19 has been suggested. Finally, resveratrol, an antioxidant that can suppress Ang II, has been suggested as an adjunct to other therapies.

Conclusion: Regarding the suggested potential therapies for COVID-19, there are many clinical trials whose results might change the treatment strategies of SARS-CoV-2 infection. So, the results of well-organized clinical trials on the efficacy and safety of the mentioned agents in the treatment of COVID-19 will be useful in the management and therapy of the disease.

Keywords: ACE2; COVID‐19; Janus kinase inhibitors; RAAS inhibitors; SARS‐CoV‐2; antihyperglycemic drugs.

Publication types

Review