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Putative mechanisms of a decrease in angiotensin-converting enzyme 2 (ACE2) expression on endothelial cells. ACE2 expression on endothelial cells may be downregulated through ACE2 endocytosis along with SARS-CoV-2 particles and ectodomain shedding of ACE2 by a disintegrin and metalloprotease 17 (ADAM17). AT1R, angiotensin II type 1 receptor; ACE, angiotensin-converting enzyme; MasR, Mas receptor; TNF, tumor necrosis factor; TNFR, TNF receptor.
