Angiotensin II receptor blocker as a novel therapy in acute lung injury induced by avian influenza A H5N1 virus infection in mouse

Yan, Yongnian; Liu, Qiang; Li, Ning; Du, Jun; Li, Xiao; Li, Chang; Jin, Ningyi; Jiang, Chengyu

doi:10.1007/s11427-015-4814-7

Cited by 44 publications

(47 citation statements)

References 12 publications

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“…[51,92] Such studies have raised concern that losartan treatment might decrease microbial clearance. In sharp contrast, study results actually demonstrate reduced viral loads [90] and increased bacterial clearance [51] in lung injury models treated with losartan.…”

Section: Chronic Lung Diseasementioning

confidence: 66%

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

et al. 2020

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ImportanceCoronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a global pandemic with significant morbidity and mortality since first appearing in Wuhan, China, in late 2019. As many countries are grappling with the onset of their epidemics, pharmacotherapeutics remain lacking. The window of opportunity to mitigate downstream morbidity and mortality is narrow but remains open. The renin–angiotensin–aldosterone system (RAAS) is crucial to the homeostasis of both the cardiovascular and respiratory systems. Importantly, SARS-CoV-2 utilises and interrupts this pathway directly, which could be described as the renin–angiotensin–aldosterone–SARS-CoV (RAAS–SCoV) axis. There exists significant controversy and confusion surrounding how anti-hypertensive agents might function along this pathway. This review explores the current state of knowledge regarding the RAAS–SCoV axis (informed by prior studies of SARS-CoV), how this relates to our currently evolving pandemic, and how these insights might guide our next steps in an evidence-based manner.ObservationsThis review discusses the role of the RAAS–SCoV axis in acute lung injury and the effects, risks and benefits of pharmacological modification of this axis. There may be an opportunity to leverage the different aspects of RAAS inhibitors to mitigate indirect viral-induced lung injury. Concerns have been raised that such modulation might exacerbate the disease. While relevant preclinical, experimental models to date favour a protective effect of RAAS–SCoV axis inhibition on both lung injury and survival, clinical data related to the role of RAAS modulation in the setting of SARS-CoV-2 remain limited.ConclusionProposed interventions for SARS-CoV-2 predominantly focus on viral microbiology and aim to inhibit viral cellular injury. While these therapies are promising, immediate use may not be feasible, and the time window of their efficacy remains a major unanswered question. An alternative approach is the modulation of the specific downstream pathophysiological effects caused by the virus that lead to morbidity and mortality. We propose a preponderance of evidence that supports clinical equipoise regarding the efficacy of RAAS-based interventions, and the imminent need for a multisite randomised controlled clinical trial to evaluate the inhibition of the RAAS–SCoV axis on acute lung injury in COVID-19.

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Section: Chronic Lung Diseasementioning

confidence: 66%

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

et al. 2020

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“…In addition, a retrospective cohort study in Texas, USA with hospitalized pneumonia patients reported that prior and inpatients use of ACE inhibitor and ARB were associated with the decreased mortality (Mortensen et al, 2012). Our previous studies demonstrated that ARB drugs, especially losartan, could effectively ameliorate mice acute lung injury induced by Yan et al, 2015). These data suggest that ARB drugs may be used as treatment for ICU patients infected with 2019-nCoV.…”

Section: Discussionmentioning

confidence: 88%

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Liu

Yang

Zhang

et al. 2020

Sci. China Life Sci.

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“…This was evident from a small study among 12 patients wherein it was seen that plasma levels of angiotensin II in COVID-19 patients was markedly elevated as compared to healthy controls and had a linear association with viral load and lung injury [66]. Studies previously done in mice showed that ARBs such as losartan can mitigate the effects of acute lung injury induced by SARS-CoV [67] and H5N1 influenza virus A [68]. With all these uncertainties and multiple theories regarding the role of RAAS inhibition in COVID-19 infection, withdrawal of ACE inhibitors/ARBs would lead to more harm than benefit in critically ill patients with multiple comorbidities.…”

Section: Ace Inhibitors/arbs Usage In Covid-19 Patientsmentioning

confidence: 99%

Cardiovascular system and COVID-19: perspectives from a developing country

Kunal

Gupta

Sharma

et al. 2020

Monaldi Arch Chest Dis

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A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the “heart and virus” link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients.

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Angiotensin II receptor blocker as a novel therapy in acute lung injury induced by avian influenza A H5N1 virus infection in mouse

Cited by 44 publications

References 12 publications

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Cardiovascular system and COVID-19: perspectives from a developing country

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