Abstract
COVID-19 symptoms, including hypokalemia, hypoalbuminemia, ageusia, neurological dysfunctions, D-dimer production, and multi-organ microthrombosis reach beyond effects attributed to impaired angiotensin-converting enzyme 2 (ACE2) signaling and elevated concentrations of angiotensin II (Ang II). Although both SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and SARS-CoV-2 utilize ACE2 for host entry, distinct COVID-19 pathogenesis coincides with the acquisition of a new sequence, which is homologous to the furin cleavage site of the human epithelial Na+ channel (ENaC). This review provides a comprehensive summary of the role of ACE2 in the assembly of Na+-dependent transporters of glucose, imino and neutral amino acids, as well as the functions of ENaC. Data support an osmotic adaptation mechanism in which osmotic and hemostatic instability induced by Ang II-activated ENaC is counterbalanced by an influx of organic osmolytes and Na+ through the ACE2 complex. We propose a paradigm for the two-site attack of SARS-CoV-2 leading to ENaC hyperactivation and inactivation of the ACE2 complex, which collapses cell osmolality and leads to rupture and/or necrotic death of swollen pulmonary, endothelial, and cardiac cells, thrombosis in infected and non-infected tissues, and aberrant sensory and neurological perception in COVID-19 patients. This dual mechanism employed by SARS-CoV-2 calls for combinatorial treatment strategies to address and prevent severe complications of COVID-19.
Highlights
Viruses have evolved to hijack specific multifunctional proteins that assist in viral entrance and subsequent viral proliferation, while simultaneously disabling the host’s metabolic responses and defense mechanisms
Findings regarding an angiotensin-converting enzyme 2 (ACE2)-centered supramolecular complex and propose the critical roleand of ACE2 in we summarize recent findings regarding an ACE2-centered supramolecular complex propose the regulation of cell volume in the context of coagulation, which becomes apparent after the disrupting the critical role of ACE2 in the regulation of cell volume in the context of coagulation, which becomes impact of SARS-CoV-2 infection. impact
On a low-protein diet, the water content was decreased in WT (89%); it continued to increase in Ace2−/− mice (213%), suggesting that the levels of organic osmolytes were dependent on ACE2 and likely on its interaction with B0 AT1 and SIT1
Summary
Viruses have evolved to hijack specific multifunctional proteins that assist in viral entrance and subsequent viral proliferation, while simultaneously disabling the host’s metabolic responses and defense mechanisms. This strategy is employed through Severe Acute Respiratory Syndrome. Mediates vasodilatory and anti-inflammatory effects through the MAS receptor (alias Mas, MasR; reviewed in [5,6]) (Figure 2B), which counteracts the damaging effects of Ang II/AT1R (reviewed in [7]). MasR; reviewed in [5,6]) (Figure 2B), which counteracts the damaging effects of Ang II/AT1R.
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