Обзорная статья

Angiotensin‐converting enzyme 2 (<scp>ACE2</scp>), <scp>SARS‐CoV</scp>‐2 and the pathophysiology of coronavirus disease 2019 (<scp>COVID</scp>‐19)

Arno R. BourgonjeDepartment of Gastroenterology and Hepatology, University Medical Center Groningen University of Groningen Groningen The NetherlandsAmaal Eman AbdulleDepartment of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen University of Groningen Groningen The NetherlandsWim TimensDepartment of Pathology and Medical Biology, University of Groningen University Medical Center Groningen Groningen The NetherlandsJan‐Luuk HillebrandsDepartment of Pathology and Medical Biology, University of Groningen University Medical Center Groningen Groningen The NetherlandsGerjan NavisDepartment of Internal Medicine, Division of Nephrology, University Medical Center Groningen University of Groningen Groningen The NetherlandsSanne J. GordijnDepartment of Obstetrics and Gynecology, University Medical Center Groningen University of Groningen Groningen The NetherlandsMaria C. BollingDepartment of Dermatology, University Medical Center Groningen University of Groningen Groningen The NetherlandsGerard DijkstraDepartment of Gastroenterology and Hepatology, University Medical Center Groningen University of Groningen Groningen The NetherlandsAdriaan A. VoorsDepartment of Cardiology, University Medical Center Groningen University of Groningen Groningen The NetherlandsAlbert D. M. E. OsterhausResearch Center for Emerging Infections and Zoonoses University of Veterinary Medicine Hannover GermanyPeter H. J. van der VoortDepartment of Critical Care Medicine, University of Groningen University Medical Center Groningen Groningen The NetherlandsDouwe J. MulderDepartment of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen University of Groningen Groningen The NetherlandsHarry van GoorDepartment of Pathology and Medical Biology, University of Groningen University Medical Center Groningen Groningen The Netherlands

2020en

ABI

Аннотация

Angiotensin-converting enzyme 2 (ACE2) has been established as the functional host receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current devastating worldwide pandemic of coronavirus disease 2019 (COVID-19). ACE2 is abundantly expressed in a variety of cells residing in many different human organs. In human physiology, ACE2 is a pivotal counter-regulatory enzyme to ACE by the breakdown of angiotensin II, the central player in the renin-angiotensin-aldosterone system (RAAS) and the main substrate of ACE2. Many factors have been associated with both altered ACE2 expression and COVID-19 severity and progression, including age, sex, ethnicity, medication, and several co-morbidities, such as cardiovascular disease and metabolic syndrome. Although ACE2 is widely distributed in various human tissues and many of its determinants have been well recognised, ACE2-expressing organs do not equally participate in COVID-19 pathophysiology, implying that other mechanisms are involved in orchestrating cellular infection resulting in tissue damage. Reports of pathologic findings in tissue specimens of COVID-19 patients are rapidly emerging and confirm the established role of ACE2 expression and activity in disease pathogenesis. Identifying pathologic changes caused by SARS-CoV-2 infection is crucially important as it has major implications for understanding COVID-19 pathophysiology and the development of evidence-based treatment strategies. Currently, many interventional strategies are being explored in ongoing clinical trials, encompassing many drug classes and strategies, including antiviral drugs, biological response modifiers, and RAAS inhibitors. Ultimately, prevention is key to combat COVID-19 and appropriate measures are being taken accordingly, including development of effective vaccines. In this review, we describe the role of ACE2 in COVID-19 pathophysiology, including factors influencing ACE2 expression and activity in relation to COVID-19 severity. In addition, we discuss the relevant pathological changes resulting from SARS-CoV-2 infection. Finally, we highlight a selection of potential treatment modalities for COVID-19. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

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Идентификаторы

DOI: 10.1002/path.5471

Цитирования и источники

Цитирований: 2Использованных источников: 0

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