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Open Access

Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19

Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan and Swapnil Hiremath
CJASN May 2020, 15 (5) 714-716; DOI: https://doi.org/10.2215/CJN.03530320
Matthew A. Sparks
1Division of Nephrology, Department of Medicine, Duke University School of Medicine and Durham VA Health System, Durham, North Carolina
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Andrew South
2Section of Nephrology, Department of Pediatrics, Department of Epidemiology & Prevention, Division of Public Health Sciences, Department of Surgery-Hypertension & Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Paul Welling
3Joseph S and Esther Handler Professor, Departments of Medicine (Nephrology) and Physiology, Johns Hopkins School of Medicine, Baltimore, Maryland
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J. Matt Luther
4Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Hypertension Center, Nashville, Tennessee
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Jordana Cohen
5Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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James Brian Byrd
6Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Louise M. Burrell
7Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
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Daniel Batlle
8Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Nephrology, Chicago, Illinois
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Laurie Tomlinson
9London School of Hygiene and Tropical Medicine, London, United Kingdom
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Vivek Bhalla
10Stanford Hypertension Center, Stanford University School of Medicine, Stanford, California
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Michelle N. Rheault
11Division of Pediatric Nephrology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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María José Soler
12Division of Nephrology, Hospital Universitari Vall d’Hebron, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Sundar Swaminathan
13Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
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Swapnil Hiremath
14Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
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    Figure 1.

    Potential effect of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–induced alterations to renin-angiotensin system pathways. SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) via its spike protein and induces internalization and shedding of ACE2, leading to increased angiotensin II (Ang II) and decreased angiotensin (1–7) [Ang-(1–7)] with net increase in inflammation and fibrosis (red) relative to anti-inflammatory and antifibrotic actions (blue). In the left panel, there is no ACEi or ARB; in the right panel, ACEi and/or ARB treatment could diminish effects of Ang II and increase Ang-(1–7) effects, leading to attenuated inflammation and fibrosis. The dashed inset in the right panel represents a theoretical increase in cell membrane expression of ACE2 with ACEi and/or ARB use. AT1R, type 1 angiotensin receptor; AT2R, type 2 angiotensin receptor; MasR, Mas receptor.

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Clinical Journal of the American Society of Nephrology: 15 (5)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 5
May 07, 2020
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Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19
Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan, Swapnil Hiremath
CJASN May 2020, 15 (5) 714-716; DOI: 10.2215/CJN.03530320

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Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19
Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan, Swapnil Hiremath
CJASN May 2020, 15 (5) 714-716; DOI: 10.2215/CJN.03530320
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Keywords

  • angiotensin
  • renin angiotensin system
  • virology
  • hypertension
  • ACE inhibitors
  • COVID-19
  • severe acute respiratory syndrome coronavirus 2
  • Renin-Angiotensin System
  • angiotensin-converting enzyme inhibitors

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