Department of Cardiovascular Surgery, Inselspital - University Hospital of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia.
Int J Mol Sci. 2020 Oct 28;21(21):8038. doi: 10.3390/ijms21218038.
Acute respiratory distress syndrome (ARDS) is characterized by massive inflammation, increased vascular permeability and pulmonary edema. Mortality due to ARDS remains very high and even in the case of survival, acute lung injury can lead to pulmonary fibrosis. The renin-angiotensin system (RAS) plays a significant role in these processes. The activities of RAS molecules are subject to dynamic changes in response to an injury. Initially, increased levels of angiotensin (Ang) II and des-Arg-bradykinin (DABK), are necessary for an effective defense. Later, augmented angiotensin converting enzyme (ACE) 2 activity supposedly helps to attenuate inflammation. Appropriate ACE2 activity might be decisive in preventing immune-induced damage and ensuring tissue repair. ACE2 has been identified as a common target for different pathogens. Some Coronaviruses, including SARS-CoV-2, also use ACE2 to infiltrate the cells. A number of questions remain unresolved. The importance of ACE2 shedding, associated with the release of soluble ACE2 and ADAM17-mediated activation of tumor necrosis factor-α (TNF-α)-signaling is unclear. The roles of other non-classical RAS-associated molecules, e.g., alamandine, Ang A or Ang 1-9, also deserve attention. In addition, the impact of established RAS-inhibiting drugs on the pulmonary RAS is to be elucidated. The unfavorable prognosis of ARDS and the lack of effective treatment urge the search for novel therapeutic strategies. In the context of the ongoing SARS-CoV-2 pandemic and considering the involvement of humoral disbalance in the pathogenesis of ARDS, targeting the renin-angiotensin system and reducing the pathogen's cell entry could be a promising therapeutic strategy in the struggle against COVID-19.
急性呼吸窘迫综合征(ARDS)的特征是大量炎症、血管通透性增加和肺水肿。ARDS 导致的死亡率仍然非常高,即使存活下来,急性肺损伤也会导致肺纤维化。肾素-血管紧张素系统(RAS)在这些过程中起着重要作用。RAS 分子的活性会随着损伤而发生动态变化。最初,血管紧张素(Ang)II 和去精氨酸缓激肽(DABK)水平的增加对于有效的防御是必要的。后来,增强的血管紧张素转换酶(ACE)2 活性据称有助于减轻炎症。适当的 ACE2 活性可能对防止免疫诱导的损伤和确保组织修复至关重要。ACE2 已被确定为不同病原体的共同靶标。一些冠状病毒,包括 SARS-CoV-2,也利用 ACE2 进入细胞。还有许多问题尚未解决。ACE2 脱落的重要性,与可溶性 ACE2 的释放和 ADAM17 介导的肿瘤坏死因子-α(TNF-α)信号转导的激活有关,目前尚不清楚。其他非经典 RAS 相关分子的作用,如alamandine、Ang A 或 Ang 1-9,也值得关注。此外,还需要阐明已确立的 RAS 抑制药物对肺 RAS 的影响。ARDS 的预后不佳和缺乏有效治疗方法促使人们寻求新的治疗策略。在当前 SARS-CoV-2 大流行的背景下,考虑到体液失衡在 ARDS 发病机制中的作用,针对肾素-血管紧张素系统和减少病原体的细胞进入可能是对抗 COVID-19 的一种有前途的治疗策略。