Figure 2. Spike-mediated ACE2 downregulation and cell signaling might promote cancer progression in COVID-19 patients and vaccinees.

ACE2 downregulation and its subsequent AT1R-mediated response have the potential to encourage cancer progression and metastasis through its growth-promoting and proangiogenic activities.

SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, COVID-19: coronavirus 2019, ACE2 R: angiotensin-converting enzyme 2 acting as an entry receptor for SARS-CoV-2, ACE2: angiotensin-converting enzyme 2, AT II: angiotensin II, AT1R: angiotensin II type 1 receptor, PI3K: phosphatidylinositol 3-kinase, MAPK: mitogen-activated protein kinase, ERK: extracellular signal-regulated kinase, NF-κB: nuclear factor-κB, IL-6: interleukin 6, AP-1: activating protein 1