Our Hearts are Yours to RECEIVE: SARS-CoV-2 and ACE-2 Receptors in Hypertensive COVID-19 Patients
This feature article was the winning abstract of the 2021 Cardiac Abstract Competition held by the McMaster Cardiac Care Club.
A well-described link between SARS-CoV-2 and cardiovascular health lies in the virus’s use of ACE-2 receptors to enter healthy cells. ACE-2 expression is elevated in individuals with hypertension 1,2 We propose that higher concentrations of SARS-CoV-2 would be found within arterial tissues among hypertensive individuals compared to non-hypertensive individuals infected with COVID-19, both aged 40-60. This demographic is both most impacted by and susceptible to hypertension and COVID-19. 3,4
Angiotensin II (A2) is an important compound in regulating blood pressure (BP), whose effect depends on the receptor to which it binds.
1
Generally, binding of the AT1 receptor increases BP, and binding of the AT 2 decreases BP.
1
The body naturally compensates for high BP by upregulating the expression of angiotensin-converting enzyme 2 (ACE-2) in cardiovascular epithelial tissue, which lowers BP by converting A2 into angiotensin 1-7, a vasodilator.
2
Since SARS-CoV-2 spike proteins must bind to the active site of membrane-bound ACE-2 in order to enter cells, greater local concentrations of ACE-2 might relate to similar increases in concentrations of SARS-CoV-2.
5
Mechanistically, more ACE-2 offers more binding sites for SARS-CoV-2, resulting in more virus in cardiovascular epithelial tissues. Corroborating our claim would require determining concentrations of SARS-CoV-2 within the arterial lining of the left radial artery (LRA) between two groups of patients diagnosed with Stage 1 of COVID-19: one group with preexisting hypertension and the second group without.
6,7
As the LRA is an accessible major artery, we can extrapolate its concentrations to be a relative indicator of overall cardiovascular health.
These findings can impact the administration of drugs that indirectly upregulate the production of ACE-2, such as Ramipril, among inpatients with hypertension during COVID-19. Patients who are admitted for solely hypertension could have an increased probability of contracting SARS-CoV-2 due to the increased production of ACE-2 associated with these drugs. 1
Isaac Glassman & Novera Shenin
Works Cited
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- Jiang F, Yang J, Zhang Y, Dong M, Wang S, Zhang Q, et al. Angiotensin-converting enzyme 2 and angiotensin 1–7: novel therapeutic targets. Nat Rev Cardiol. 2014;11(7):413–26.
- Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020 Mar 26;m1198.
- Wiener RS, Cao YX, Hinds A, Ramirez MI, Williams MC. Angiotensin converting enzyme 2 is primarily epithelial and is developmentally regulated in the mouse lung. J Cell Biochem. 2007 Aug 1;101(5):1278–91.
- Stasi C, Fallani S, Voller F, Silvestri C. Treatment for COVID-19: An overview. Eur J Pharmacol. 2020 Dec 15;889:173644.
- Mendoza EJ, Manguiat K, Wood H, Drebot M. Two Detailed Plaque Assay Protocols for the Quantification of Infectious SARS‐CoV‐2. Curr Protoc Microbiol [Internet]. 2020 Jun [cited 2021 Feb 27];57(1). Available from: htps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300432/
- Leung JM, Yang CX, Tam A, Shaipanich T, Hackett T-L, Singhera GK, et al. ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. Eur Respir J [Internet]. 2020 May 14 [cited 2021 Feb 27];55(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144263/
Cite This Article:
Glassman I., Shenin N,. Mughal, R. Our Hearts are Yours to RECEIVE: SARS-CoV-2 and ACE-2 Receptors in Hypertensive COVID-19 Patients. Rare Disease Review. April 2021.
DOI: 10.13140/RG.2.2.20023.04005
