Key result
ACE2-stimulating drugs like ACE inhibitors may increase severe COVID-19 risk via higher viral binding affinity.
Why the study?
Because SARS-CoV-2 enters cells via the ACE2 receptor and ACE inhibitors may upregulate ACE2 expression, concerns arose that treating hypertension, diabetes, and CVD with ACE2-stimulating drugs could increase the risk of severe and fatal COVID-19.
Does treatment with ACE2-stimulating drugs such as ACE inhibitors increase the risk of developing severe and fatal COVID-19 in patients with hypertension, diabetes, or cardiovascular disease?
Does treatment with ACE2-stimulating drugs such as ACE inhibitors increase the risk of developing severe and fatal COVID-19 in patients with hypertension, diabetes, or cardiovascular disease?
Answers are grounded in this paper and cite their sources.
This paper outlines the early theoretical hypothesis that ACE inhibitors and other ACE2-upregulating medications might increase susceptibility to severe and fatal COVID-19.
The SARS-CoV-2, the causative agent of COVID-19, has been established to gain access to the human cell via the ACE2 receptor similar to its familial coronavirus SARS-CoV which led to the outbreak in 2003. A concern with the newer 2019 coronavirus is its 10-20-fold higher affinity to the ACE2 receptor that of SARS-CoV, aiding its effective human-to-human transmission which has led to this pandemic. ACE2 receptor expression is thought to be upregulated in use with ACE inhibitors. As ACE inhibitors are known to be a used extensively in the treatment of hypertension it was a concern regarding the risk of using these medications alongside a SARS-COV-2 infection. ACE inhibitors are also used in the treatment regime of other common conditions including diabetes and Cardiovascular disease (CVD). It is worth noting that ACE2 expression has found to be upregulated by the use of thiazolidinediones and ibuprofen too. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. Therefore, it would hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs would increase the risk of developing severe and fatal COVID-19.
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Khashkhusha et al. (2020) conducted a review in COVID-19 in patients with hypertension, diabetes, and cardiovascular disease. ACE inhibitors, thiazolidinediones, and ibuprofen was evaluated on Risk of developing severe and fatal COVID-19. ACE2-stimulating drugs such as ACE inhibitors are hypothesized to increase severe COVID-19 risk, as SARS-CoV-2 has a 10-20-fold higher affinity to ACE2 than SARS-CoV.
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