Interactions of renin-angiotensin system and COVID-19: the importance of daily rhythms in ACE2, ADAM17 and TMPRSS2 expression

Physiol Res. 2021 Dec 16;70(S2):S177-S194. doi: 10.33549/physiolres.934754.

Abstract

Angiotensin-converting enzyme 2 (ACE2) was identified as a molecule that mediates the cellular entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several membrane molecules of the host cell must cooperate in this process. While ACE2 serves in a membrane receptor-mediating interaction with the surface spike (S) glycoprotein of SARS-CoV-2 located on the virus envelope, enzyme A disintegrin and metalloproteinase 17 (ADAM17) regulates ACE2 availability on the membrane and transmembrane protease serine 2 (TMPRSS2) facilitates virus-cell membrane fusion. Interestingly, ACE2, ADAM17 and TMPRSS2 show a daily rhythm of expression in at least some mammalian tissue. The circadian system can also modulate COVID-19 progression via circadian control of the immune system (direct, as well as melatonin-mediated) and blood coagulation. Virus/ACE2 interaction causes ACE2 internalization into the cell, which is associated with suppressed activity of ACE2. As a major role of ACE2 is to form vasodilatory angiotensin 1-7 from angiotensin II (Ang II), suppressed ACE2 levels in the lung can contribute to secondary COVID-19 complications caused by up-regulated, pro-inflammatory vasoconstrictor Ang II. This is supported by the positive association of hypertension and negative COVID-19 prognosis although this relationship is dependent on numerous comorbidities. Hypertension treatment with inhibitors of renin-angiotensin system does not negatively influence prognosis of COVID-19 patients. It seems that tissue susceptibility to SARS-CoV-2 shows negative correlation to ACE2 expression. However, in lungs of infected patient, a high ACE2 expression is associated with better outcome, compared to low ACE2 expression. Manipulation of soluble ACE2 levels is a promising COVID-19 therapeutic strategy.

Publication types

  • Review

MeSH terms

  • ADAM17 Protein / metabolism*
  • Angiotensin-Converting Enzyme 2 / metabolism*
  • Animals
  • COVID-19 / metabolism*
  • COVID-19 / physiopathology
  • COVID-19 / therapy
  • COVID-19 / virology
  • Circadian Rhythm*
  • Host-Pathogen Interactions
  • Humans
  • Hypertension / metabolism
  • Hypertension / physiopathology
  • Periodicity
  • Prognosis
  • Renin-Angiotensin System*
  • SARS-CoV-2 / metabolism
  • SARS-CoV-2 / pathogenicity*
  • Serine Endopeptidases / metabolism*
  • Signal Transduction
  • Time Factors

Substances

  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • Serine Endopeptidases
  • TMPRSS2 protein, human
  • ADAM17 Protein
  • ADAM17 protein, human