Article ; Online: Overexpression of angiotensin-converting enzyme 2 by renin-angiotensin system inhibitors. Truth or myth? A systematic review of animal studies.
Hypertension research : official journal of the Japanese Society of Hypertension
2021 Volume 44, Issue 8, Page(s) 955–968
Abstract: Angiotensin-converting enzyme 2 (ACE2) protects against organ damage in hypertension and ... cardiovascular diseases by counter regulating the renin-angiotensin system (RAS). ACE2 is also the receptor ... overexpression in some animal experiments, concerns have arisen that RASIs may aggravate SARS-CoV-2 infection and ...
| Abstract | Angiotensin-converting enzyme 2 (ACE2) protects against organ damage in hypertension and cardiovascular diseases by counter regulating the renin-angiotensin system (RAS). ACE2 is also the receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on the claim that RAS inhibitors (RASIs) cause ACE2 overexpression in some animal experiments, concerns have arisen that RASIs may aggravate SARS-CoV-2 infection and coronavirus disease-2019 severity in RASI-treated patients. To achieve a comprehensive review, a systematic search of MEDLINE/PubMed was conducted regarding the effects of RASIs on tissue ACE2 mRNA/protein expression in healthy animals and animal models of human diseases. We identified 88 eligible articles involving 168 experiments in the heart, kidneys, lungs, and other organs. Three of 38 experiments involving healthy animals showed ACE2 expression greater than twice that of the control (overexpression). Among 102 disease models (130 experiments), baseline ACE2 was overexpressed in 16 models (18 experiments) and less than half the control level (repression) in 28 models (40 experiments). In 72 experiments, RASIs did not change ACE2 levels from the baseline levels of disease models. RASIs caused ACE2 overexpression compared to control levels in seven experiments, some of which were unsupported by other experiments under similar conditions. In 36 experiments, RASIs reversed or prevented disease-induced ACE2 repression, yielding no or marginal changes. Therefore, ACE2 overexpression appears to be a rare rather than common consequence of RASI treatment in healthy animals and disease models. Future studies should clarify the pathophysiological significance of RASI-induced reversal or prevention of ACE2 repression in disease models. |
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| MeSH term(s) | Angiotensin-Converting Enzyme 2/metabolism ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Animals ; Antihypertensive Agents/adverse effects ; Antihypertensive Agents/pharmacology ; COVID-19 ; Disease Models, Animal ; Gene Expression/drug effects ; MEDLINE ; Renin-Angiotensin System/drug effects | |||||
| Chemical Substances | Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) | |||||
| Language | English | |||||
| Publishing date | 2021-03-10 | |||||
| Publishing country | England | |||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review | |||||
| ZDB-ID | 1175297-x | |||||
| ISSN | 1348-4214 ; 0916-9636 | |||||
| ISSN (online) | 1348-4214 | |||||
| ISSN | 0916-9636 | |||||
| DOI | 10.1038/s41440-021-00641-1 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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