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急切需要评估血管紧张素-(1-7)/Mas 受体轴激动剂治疗 COVID-19 患者的效果。

Urgent need for evaluating agonists of angiotensin-(1-7)/Mas receptor axis for treating patients with COVID-19.

机构信息

ICMR-National AIDS Research Institute, 73, G-block, MIDC, Bhosari, Pune 411026, India.

出版信息

Int J Infect Dis. 2020 Jul;96:348-351. doi: 10.1016/j.ijid.2020.05.002. Epub 2020 May 7.

Abstract

ACE2 is a receptor of entry of SARS-CoV-2 into the host cells, and its upregulation has been implicated in increasing susceptibility of individuals to this infection. The clinical picture of COVID-19 suggests a role of ACE2 blockade, rather than its overexpression, in causing the pathogenesis. ACE2 blockade results in increased angiotensin II activity with simultaneous hampering of functions of angiotensin-(1-7)/MasR axis. Acute respiratory distress due to interstitial pulmonary fibrosis, cardiomyopathy and shock reported in COVID-19 patients can be explained by imbalanced angiotensin II and angiotensin-(1-7) activities. Failure of angiotensin II type 1 receptor blockers to control the severity of SARS-CoV-2 infections indicates the importance of simultaneous induction of angiotensin-(1-7)/MasR axis for correcting pathological conditions in COVID-19 through its anti-fibrotic, anti-inflammatory, vasodilatory, and cardioprotective roles. MasR agonists have also shown organ protective effects in a number of animal studies. Unfortunately, these agonists have not been tested in clinical studies. Their evaluation in seriously ill COVID-19 patients is urgently warranted to reduce mortality due to infection.

摘要

ACE2 是 SARS-CoV-2 进入宿主细胞的受体,其上调与个体对这种感染的易感性增加有关。COVID-19 的临床特征表明 ACE2 阻断而非其过表达在导致发病机制中起作用。ACE2 阻断导致血管紧张素 II 活性增加,同时阻碍血管紧张素-(1-7)/MasR 轴的功能。COVID-19 患者报告的间质性肺纤维化、心肌病和休克导致的急性呼吸窘迫,可以通过不平衡的血管紧张素 II 和血管紧张素-(1-7)活性来解释。血管紧张素 II 型 1 受体阻滞剂不能控制 SARS-CoV-2 感染的严重程度表明,通过其抗纤维化、抗炎、血管扩张和心脏保护作用,同时诱导血管紧张素-(1-7)/MasR 轴对于纠正 COVID-19 中的病理状况非常重要。MasR 激动剂在许多动物研究中也显示出对器官的保护作用。不幸的是,这些激动剂尚未在临床试验中进行测试。迫切需要在患有严重 COVID-19 的患者中评估它们,以降低因感染导致的死亡率。

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