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2020 ; 26
(ä): 14
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The angiotensin-converting enzyme 2 (ACE2) receptor in the prevention and
treatment of COVID-19 are distinctly different paradigms
#MMPMID32685191
McLachlan CS
Clin Hypertens
2020[]; 26
(ä): 14
PMID32685191
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There is current debate concerning the use of angiotensin-converting enzyme (ACE)
inhibitors or angiotensin II type 1 receptor blockers (ARBs), for hypertension
management, during COVID-19 infection. Specifically, the suggestion has been made
that ACE inhibitors or ARBs could theoretically contribute to infection via
increasing ACE2 receptor expression and hence increase viral load. The ACE2
receptor is responsible for binding the SAR-CoV2 viral spike and causing COVID-19
infection. What makes the argument somewhat obtuse for ACE inhibitors or ARBs is
that ACE2 receptor expression can be increased by compounds that activate or
increase the expression of SIRT1. Henceforth common dietary interventions,
vitamins and nutrients may directly or indirectly influence the cellular
expression of the ACE2 receptor. There are many common compounds that can
increase the expression of the ACE2 receptor including Vitamin C, Metformin,
Resveratrol, Vitamin B3 and Vitamin D. It is important to acknowledge that
down-regulation or blocking the cellular ACE2 receptor will likely be
pro-inflammatory and may contribute to end organ pathology and mortality in
COVID-19. In conclusion from the perspective of the ACE2 receptor, COVID-19
prevention and treatment are distinctly different. This letter reflects on this
current debate and suggests angiotensin-converting enzyme inhibitors and ARBs are
likely beneficial during COVID-19 infection for hypertensive and normotensive
patients.