Abstract
Seventeen years after the epidemic of SARS coronavirus, a novel coronavirus SARS-CoV-2-emerged resulting in an unprecedented pandemic. Angiotensin-converting enzyme 2 (ACE2) is an essential receptor for cell entry of SARS-CoV-2 as well as the SARS coronavirus. Despite many similarities to SARS coronavirus, SARS-CoV-2 exhibits a higher affinity to ACE2 and shows higher infectivity and transmissibility, resulting in explosive increase of infected people and COVID-19 patients. Emergence of the variants harboring mutations in the receptor-binding domain of the Spike protein has drawn critical attention to the interaction between ACE2 and Spike and the efficacies of vaccines and neutralizing antibodies. ACE2 is a carboxypeptidase which degrades angiotensin II, B1-bradykinin, or apelin, and thereby is a critical regulator of cardiovascular physiology and pathology. In addition, the enzymatic activity of ACE2 is protective against acute respiratory distress syndrome (ARDS) caused by viral and non-viral pneumonias, aspiration, or sepsis. Upon infection, both SARS-CoV-2 and SARS coronaviruses downregulates ACE2 expression, likely associated with the pathogenesis of ARDS. Thus, ACE2 is not only the SARS-CoV-2 receptor but might also play an important role in multiple aspects of COVID-19 pathogenesis and possibly post-COVID-19 syndromes. Soluble forms of recombinant ACE2 are currently utilized as a pan-variant decoy to neutralize SARS-CoV-2 and a supplementation of ACE2 carboxypeptidase activity. Here, we review the role of ACE2 in the pathology of ARDS in COVID-19 and the potential application of recombinant ACE2 protein for treating COVID-19.
Highlights
Angiotensin-converting enzyme 2 (ACE2) is a homologous molecule of angiotensin converting enzyme (ACE) and functions as an enzyme that degrades angiotensin II peptides on the cell membrane surface [1]
We found that ACE2 is highly expressed in the lung and that the expression of ACE2 is suppressed in the lungs of SARS infected mice [20]
Our study in the early 2000s, where we developed pulmonary intensive care units for mice, revealed that ACE2 has a lung protective effect in acute respiratory distress syndrome (ARDS) in the acute phase [26]
Summary
ACE2 is a homologous molecule of angiotensin converting enzyme (ACE) and functions as an enzyme (carboxypeptidase) that degrades angiotensin II peptides on the cell membrane surface [1]. It has been shown that structural changes in the Spike protein can be mediated by neutrophils proteases such as elastase, one mechanism by which inflammatory cells could affect SARS-CoV-2 infections [11, 12]. In the ARDS/acute lung injury model of mice, ACE2-deficient mice develop markedly worsened respiratory functions, increased vascular permeability, marked pulmonary edema, neutrophil infiltration, and destruction of alveolar structures as compared to wild-type mice [26].
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