Inhibitors of the Renin–Angiotensin–Aldosterone System and Covid-19

Abstract

SARS-CoV-2, the coronavirus that causes Covid-19, enters human cells by binding of its viral spike protein to the membrane-bound form of the monocarboxypeptidase angiotensin-converting enzyme 2 (ACE2).¹ From the viewpoint of human physiology, ACE2 plays an important regulatory role in the renin–angiotensin–aldosterone system (RAAS), metabolizing angiotensin II (a potent vasoconstrictor) to generate angiotensin-(1–7) (a vasodilator).² Studies in animals have suggested that angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) may up-regulate ACE2 expression,³ thus increasing the availability of target molecules for SARS-CoV-2.