Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic
Identifieur interne : 000760 ( 2020/Analysis ); précédent : 000759; suivant : 000761Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic
Auteurs : Erkan Cure [Turquie] ; Medine Cumhur Cure [Turquie]Source :
- Diabetes & Metabolic Syndrome [ 1871-4021 ] ; 2020.
Abstract
The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient’s blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.
Url:
DOI: 10.1016/j.dsx.2020.04.019
PubMed: 32311651
PubMed Central: 7159862
Affiliations:
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Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient’s blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ribeiro Oliveira, A" uniqKey="Ribeiro Oliveira A">A. Ribeiro-Oliveira</name></author><author><name sortKey="Nogueira, A I" uniqKey="Nogueira A">A.I. Nogueira</name></author><author><name sortKey="Pereira, R M" uniqKey="Pereira R">R.M. Pereira</name></author><author><name sortKey="Boas, W W" uniqKey="Boas W">W.W. Boas</name></author><author><name sortKey="Dos Santos, R A" uniqKey="Dos Santos R">R.A. Dos Santos</name></author><author><name sortKey="Sim Es E Silva, A C" uniqKey="Sim Es E Silva A">A.C. Simões e Silva</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nehme, A" uniqKey="Nehme A">A. Nehme</name></author><author><name sortKey="Zouein, F A" uniqKey="Zouein F">F.A. Zouein</name></author><author><name sortKey="Zayeri, Z D" uniqKey="Zayeri Z">Z.D. Zayeri</name></author><author><name sortKey="Zibara, K" uniqKey="Zibara K">K. Zibara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lelis, D F" uniqKey="Lelis D">D.F. Lelis</name></author><author><name sortKey="Freitas, D F" uniqKey="Freitas D">D.F. Freitas</name></author><author><name sortKey="Machado, A S" uniqKey="Machado A">A.S. Machado</name></author><author><name sortKey="Crespo, T S" uniqKey="Crespo T">T.S. Crespo</name></author><author><name sortKey="Santos, S H S" uniqKey="Santos S">S.H.S. Santos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cure, E" uniqKey="Cure E">E. Cure</name></author><author><name sortKey="Cumhur Cure, M" uniqKey="Cumhur Cure M">M. Cumhur Cure</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cure, E" uniqKey="Cure E">E. Cure</name></author><author><name sortKey="Cumhur Cure, M" uniqKey="Cumhur Cure M">M. Cumhur Cure</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Resnick, L M" uniqKey="Resnick L">L.M. Resnick</name></author><author><name sortKey="Gupta, R K" uniqKey="Gupta R">R.K. Gupta</name></author><author><name sortKey="Sosa, R E" uniqKey="Sosa R">R.E. Sosa</name></author><author><name sortKey="Corbett, M L" uniqKey="Corbett M">M.L. Corbett</name></author><author><name sortKey="Laragh, J H" uniqKey="Laragh J">J.H. Laragh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Costa Pessoa, J M" uniqKey="Costa Pessoa J">J.M. Costa-Pessoa</name></author><author><name sortKey="Figueiredo, C F" uniqKey="Figueiredo C">C.F. Figueiredo</name></author><author><name sortKey="Thieme, K" uniqKey="Thieme K">K. Thieme</name></author><author><name sortKey="Oliveira Souza, M" uniqKey="Oliveira Souza M">M. Oliveira-Souza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cure, E" uniqKey="Cure E">E. Cure</name></author><author><name sortKey="Cumhur Cure, M" uniqKey="Cumhur Cure M">M. Cumhur Cure</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Komukai, K" uniqKey="Komukai K">K. Komukai</name></author><author><name sortKey="Mochizuki, S" uniqKey="Mochizuki S">S. Mochizuki</name></author><author><name sortKey="Yoshimura, M" uniqKey="Yoshimura M">M. Yoshimura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bilodeau, M S" uniqKey="Bilodeau M">M.S. Bilodeau</name></author><author><name sortKey="Leiter, J C" uniqKey="Leiter J">J.C. Leiter</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Turquie</li></country></list><tree><country name="Turquie"><noRegion><name sortKey="Cure, Erkan" sort="Cure, Erkan" uniqKey="Cure E" first="Erkan" last="Cure">Erkan Cure</name></noRegion><name sortKey="Cumhur Cure, Medine" sort="Cumhur Cure, Medine" uniqKey="Cumhur Cure M" first="Medine" last="Cumhur Cure">Medine Cumhur Cure</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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