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. 2022 Dec 24;245:103071. doi: 10.1016/j.autneu.2022.103071

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Fig. 4 — An imbalance in the renin-angiotensin system can be responsible for autonomic dysfunction following SARS-CoV-2 infection. The downregulation of ACE-2 upon SARS-CoV-2 cell entry in addition to the formation of autoantibodies against ACE-2 and AT1R are important contributors to such imbalance. Consequently, levels of angiotensin I and angiotensin II increase while levels of angiotensin 1–9 and angiotensin 1–7 drop. This results in the hyperactivation of AT1R responsible for mediating the pro-inflammatory pathway and sympathetic effects. Abbreviations: ACE: angiotensin-converting enzyme.