Patients with severe COVID‐19 have reduced circulating levels of angiotensin‐(1–7): A cohort study

Abstract

Background and Aims Angiotensin‐converting enzyme 2 (ACE2) acts as a functional receptor for the entry of severe acute respiratory syndrome coronavirus 2 into host cells. Angiotensin (1–7) (Ang (1–7)) obtained from the function of ACE2 improves heart and lung function. We investigated the relationship between Ang (1–7) level and disease severity in patients with coronavirus disease 2019 (COVID‐19). Methods This cohort study was carried out at Masih Daneshvari Hospital in Tehran, Iran from September 2020 to October 2020. To do so, the Ang (1–7) levels of 331 hospitalized COVID‐19 patients with and without underlying disease were measured by ELISA kit. The need for oxygen, intubation, and mechanical ventilation were recorded for all the patients. Results Results showed a significant inverse relationship between the levels of Ang 1–7 and the severity of the disease (needed oxygen, intubation, and mechanical ventilation). According to the results, median (interquartile range) of Ang (1–7) levels was significantly lower in patients who needed oxygen versus those who needed no oxygen (44.50 (91) vs. 82.25 (68), p = 0.002), patients who needed intubation and mechanical ventilation versus those who did not (9.80 (62) vs. 68.70 (102), p < 0.000) and patients hospitalized in an intensive care unit (ICU) than people hospitalized in other wards. We also found that the older patients were more in need of ICU and mechanical ventilation than younger patients. Conclusions Higher levels of Ang (1–7) have been associated with decreased disease severity. Besides this, we perceived that synthetic Ang 1–7 peptides may be useful to treat and reduce the complications of COVID‐19.

Extracellular vesicles and angiotensin-converting enzyme 2 in COVID-19 disease

“…Furthermore, angiotensin 1-7 also has a critical role in protecting against lung inflammation and fibrosis [79,80]. Recent studies have reported a potential link between angiotensin 1-7 and COVID-19 disease severity [82][83][84][85][86]. Decreased levels of blood angiotensin 1-7 have been reported in COVID-19 patients who were either severely ill or have died [83,84,86].…”

“…Recent studies have reported a potential link between angiotensin 1-7 and COVID-19 disease severity [82][83][84][85][86]. Decreased levels of blood angiotensin 1-7 have been reported in COVID-19 patients who were either severely ill or have died [83,84,86]. In contrast, higher levels of angiotensin 1-7 have been associated with reduced COVID-19 disease severity [83,84,86].…”

“…Decreased levels of blood angiotensin 1-7 have been reported in COVID-19 patients who were either severely ill or have died [83,84,86]. In contrast, higher levels of angiotensin 1-7 have been associated with reduced COVID-19 disease severity [83,84,86]. Furthermore, dysregulation of ACE2, angiotensin I/II, and angiotensin 1-7 are associated with mortality and end-organ damage in COVID-19 patients [87,88].…”