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. 2020 Mar 25;75(6):1382–1385. doi: 10.1161/HYPERTENSIONAHA.120.15082

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© 2020 American Heart Association, Inc.

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Figure. — Overview of the connections between renin-angiotensin system blockers, ACE2 (angiotensin-converting enzyme 2) and the coronavirus. The carboxypeptidase ACE2 converts Ang II (angiotensin II) to Ang-(1–7) and Ang I to Ang-(1–9) (A), yet is not blocked by ACE (angiotensin-converting enzyme) inhibitors, which prevent the conversion of Ang I to Ang II. ACE2 also binds and internalizes SARS-Cov-2 (severe acute respiratory syndrome coronavirus-2; B), after priming by the serine protease TMPRSS2 (transmembrane protease, serine 2). Shedding of membrane-bound ACE2 by a disintegrin and metalloprotease 17 (ADAM17) results in the occurrence of soluble (s) ACE2, which can no longer mediate SARS-Cov-2 entry and which might even prevent such entry by keeping the virus in solution. AT₁R (Ang II, via its type 1 receptor) upregulates ADAM17, and AT₁R blockers (ARBs) would prevent this.