Correlation between renin-angiotensin-aldosterone system in patients with cancer and COVID-19 infection
Correlation between renin-angiotensin-aldosterone system in patients with cancer and COVID-19 infection
Javad Yaghmoorian Khojini,1Ali Osmay Gure,2Kamran Ghaedi,3,*
1. Department of Medical Biotechnology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2. Department of Medical Biology, Acibadem University, Istanbul, Turkey 3. Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. It emerged as pneumonia cases in Wuhan, China for the first time and rapidly spread across the world. The entry receptor of SARS-CoV2 known as ACE2 constitutes the Renin Angiotensin System (RAS) which performs different functions in different cases such as cancer, vascular homeostasis and many other body processes. It is expressed in many organs such as liver and brain too. The aim of this study was to investigate the relationship between RAS and COVID-19.
Methods: This systematic review study was done using various update articles, books and authoritative scientific sites.
Results: Coronavirus disease 2019 (COVID-19), a rapidly evolving pandemic infecting more than 150 million people worldwide with more than 4 million deaths according to the World Health Organization (WHO) to date. One of the concerns for patients suffering with the cancer with COVID-19 is the function of the renin angiotensin aldosterone (RAS) system. This system is a hormonal system that regulates blood pressure and body fluid balance and plays an important role in cancer regeneration of the tumor microenvironment, as well as tumor growth and metastasis of cancer cells throughout the body. However, COVID-19 disease modifies the normal function of this system using the angiotensin-converting enzyme (ACE2) receptor. This condition disrupts the function of the intravascular layer in many tissues and organs of the body. The RAS is composed of two pathways and both pathways begin with renin and these include the ACE-mediated vaso-constrictive side and the ACE2-mediated vaso-dilative side. ACE2 is the entry receptor for SARS-CoV-2. Once COVID-19 infection has taken place, virus binding is likely to prevent ACE2 mediating its usual pneumoprotective effects. The virus transmembrane spike glycoprotein (S protein) is essential for binding to the cellular membrane ACE2 and for the attachment of the virus to the target cells. ACE2 is localized in lung alveolar epithelial cells, small intestine, enterocytes arterial endothelial cells and other parts of the body. Therefore the lungs, and small intestine are the likely sites of SARS-CoV-2. The expression of ACE2 in the lining of blood vessels it could contribute to the risk of thrombotic events in patients with COVID-19. Another discovery is that the ACE2 gene is carried on the X chromosome which may possibly account for the apparent increased susceptibility of men to COVID-19. Further studies on this topic are undergone.
Conclusion: Because some types of cancer can be treated with ACE, the process of further disruption of the RAS system caused by COVID-19 can lead to much more serious complications in this type of cancer treatment process. So because of the interaction between ACE2 and the coronavirus virion could act as a target for vaccines. RAS inhibitor drugs targeting the ACE side of the system, and hence increasing activity of the ACE2 pathway, have the potential to reduce COVID-19. It is hoped that by conducting more studies, researchers around the world will be able to gain more knowledge about the processes and factors that contribute to the increased pathogenicity of COVID-19.