Plasma Angiotensin Peptide Profiling and ACE (Angiotensin-Converting Enzyme)-2 Activity in COVID-19 Patients Treated With Pharmacological Blockers of the Renin-Angiotensin System

摘要

Pharmacological blockade of the renin-angiotensin system (RAS) with ACE (angiotensin-converting enzyme) inhibi- tors or angiotensin type 1 receptor blockers (ARB) reduces morbidity and mortality in various cardiovascular diseases. One of the key RAS-modulating enzymes, ACE2, has recently gained increasing attention because it converts not only angi- otensin (Ang) II to the alternative RAS metabolite Ang-(1–7) but also functions as the cellular entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. 1 At the beginning of the SARS-CoV-2 pandemic, some inves- tigators suggested that because ACE inhibitor or ARB may lead to upregulation of ACE2 expression/activity, use of these agents in coronavirus disease 2019 (COVID-19) patients might be associated with worsened outcomes. 1 Meanwhile, several observational studies have shown that neither the risk of COVID-19 nor its severity is negatively affected by ACE inhibitor or ARB. 2,3 However, it remains unclear how RAS ac- tivity, particularly ACE2, is regulated in COVID-19 and how this is altered by ACE inhibitor/ARB therapy. In this study, we analyzed distinct RAS components in plasma from patients with COVID-19 ±ACE inhibitor/ARB therapy using liquid chromatography-mass spectrometry/mass spectrometry.