Background: COVID-19 has continued to generate concerns from across the globe with symptoms ranging from mild to acute ones. The disease has been linked to angiotensin-converting enzyme (ACE) 1 and 2, but ACE1 has been lowly researched.
Aim: To conduct a systematic review that explores the role of Angiotensin-Converting Enzymes ACE1 and ACE 2 in COVID-19 Infection and the clinical conditions of the patients with the disease.
Materials and Methods: the guidelines of PRISMA were used to select 40 journal articles across various databases namely PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase for researches between 2019 and 2021. Various key terms were employed in the search process, such as "Covid-19," "Covid," "Corona Virus," "ACE," "Angiotensin-Converting Enzyme," “SARS-CoV-2,” “ACE1,” “ACE2,” and “angiotensin receptors.” The search terms were combined using Boolean operators “and/or” incomplete sentences affiliated with the topic in order to generate substantial results.
Results: COVID-19 pathologies/severity are affiliated with inverse proportionality of ACE1/ACE2 ratio. High ACE2 levels in adults act as the targets for COVID-19 while in children the high level of ACE2 is not associated with the disease’s severity. ACE1 contributes to cytokine production, which contributes to ARDS.
Discussion: Imbalanced ratio of ACE1/ACE2 increase COVID-19 severity. However, the findings apply to patients with hypertension, and therefore, more research would be needed for other pathologies of COVID-19.
Conclusion: Both the ACE1 and ACE2 are affiliated with COVID-19 severity. Therefore, ACE1/ACE2 activities can be used as markers to reflect the clinical conditions of COVID-19, thereby helping to manage the disease efficiently.
Table of Contents
1. Introduction
2. Materials and Methods
3. Results
3.1 Role of ACE1 and ACE2 in COVID-19 Infection and Patients’ Conditions
4. Discussion
5. Conclusion
Research Objectives and Key Topics
The primary objective of this systematic review is to investigate the role of Angiotensin-Converting Enzymes (ACE1 and ACE2) in the context of COVID-19 infections and to analyze how these enzymes correlate with the clinical status of infected patients.
- The regulatory relationship and inverse proportionality between ACE1 and ACE2 levels.
- The impact of ACE1/ACE2 imbalance on disease severity and ARDS development.
- Mechanisms of SARS-CoV-2 entry into the host via the ACE2 receptor.
- The clinical potential of using ACE1 and ACE2 levels as biomarkers for COVID-19 management.
Excerpt from the Book
Role of ACE1 and ACE2 in COVID-19 Infection and Patients’ Conditions
The final number of studies used in the systematic review was 40. Various studies that were reviewed revealed that all the pathologies of COVID-19 patients, such as death, heart failure, chronic renal failure, pulmonary diseases, etc. are associated with inverse proportionality of ACE1 and ACE2 [20–24]. Other studies also report that SARS-CoV-2 has a high affinity for ACE2 [25]. As a result, organs that exhibit high ACE2 levels become the targets for COVID-19 infection. To support this finding, Zhang et al. found that the virus enters the host’s body following the respiratory channel [11]. This finding implies that the lungs are the main target organs for COVID-19 infection. Nonetheless, other researchers have had a different outcome indicating that a high concentration of ACE2 receptors in the lungs has a protective impact on the severity of COVID-19 after the invasion, particularly in children [26]. This finding portrays a negative correlation between the COVID-19 severity and the expression of ACE2, thereby indicating that therapies aimed at improving ACE1/ACE2 ratio may be one of the ways to help patients [27–29].
Summary of Chapters
1. Introduction: This chapter outlines the global health impact of COVID-19 and establishes the foundational relationship between the Renin-Angiotensin System (RAS), specifically ACE1 and ACE2, and the pathogenesis of the disease.
2. Materials and Methods: This section details the systematic review process, adhering to PRISMA guidelines, to select and analyze 40 relevant journal articles from databases such as PubMed and Embase.
3. Results: This chapter presents data regarding the correlation between ACE1/ACE2 ratios, organ-specific viral targeting, and the clinical outcomes of patients, including the development of cytokine storms and ARDS.
4. Discussion: This section evaluates the clinical implications of the findings, suggesting that the ACE1/ACE2 balance is a critical factor in disease severity and discussing the potential for future therapeutic interventions.
5. Conclusion: The final chapter summarizes that ACE1/ACE2 activities serve as meaningful markers for reflecting the clinical conditions of COVID-19 patients and assisting in efficient disease management.
Keywords
COVID-19, SARS-CoV-2, ACE1, ACE2, Renin-Angiotensin System, RAS, ARDS, Cytokine Storm, Pathogenesis, Biomarker, Hypertension, Inflammation, Hypoxia, Systematic Review, Clinical Management
Frequently Asked Questions
What is the core subject of this systematic review?
The paper examines the specific roles of Angiotensin-Converting Enzymes (ACE1 and ACE2) in COVID-19 infections and how these enzymes relate to patient clinical outcomes.
What are the primary thematic areas covered?
The research focuses on the Renin-Angiotensin System (RAS), the mechanism of viral entry, the inverse proportionality of ACE receptors, and their impact on respiratory and cardiovascular health.
What is the primary goal of the research?
The goal is to determine if ACE1 and ACE2 activities can be effectively utilized as biomarkers to monitor the clinical severity of COVID-19 and improve patient management strategies.
Which scientific methodology was applied?
The authors conducted a systematic review following PRISMA guidelines, analyzing 40 peer-reviewed articles sourced from major medical databases published between 2019 and 2021.
What key topics are addressed in the main section?
The main text covers the pathophysiology of COVID-19, the role of ACE2 as a receptor for SARS-CoV-2, the pro-inflammatory effects of ACE1, and the resulting clinical conditions like ARDS and hypertension.
Which keywords characterize this work?
Key terms include COVID-19, SARS-CoV-2, ACE1, ACE2, RAS, ARDS, cytokine storm, and clinical biomarkers.
How does the ACE1/ACE2 ratio affect disease severity?
An imbalance in this ratio, specifically a higher ACE1/ACE2 ratio, is associated with increased disease severity, contributing to inflammation and oxidative stress.
Is the role of ACE2 the same in children as it is in adults?
No, the research highlights that while high ACE2 levels act as viral entry targets in adults, this high expression is not associated with increased disease severity in children.
Why is ACE1 considered a potential biomarker?
ACE1 has been historically linked to ARDS and endothelial cell damage, suggesting it can serve as an indicator for the severity of lung injury in COVID-19 patients.
What is the therapeutic implication discussed in the conclusion?
The authors conclude that maintaining or restoring a healthy balance between ACE1 and ACE2 activities could be a viable therapeutic target to mitigate the severity of COVID-19 comorbidities.
- Quote paper
- Jacques Meljen (Author), 2021, The Role of Angiotensin-Converting Enzymes ACE1 and ACE2 in COVID-19 Infection, Munich, GRIN Verlag, https://www.grin.com/document/1157201
