Role of Angiotensin receptor blockers towards COVID-19

Debraj Ghosh, Undergraduate student of Medicinal Institute, People’s Friendship Institute of Russia, Moscow, Russia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)⁽¹⁾ is the strain of coronavirus causes the respiratory illness responsible for the COVID-19 pandemic. It is a positive ssRNA⁽⁴⁾ virus that is contagious to humans and is a successor to SARS-CoV-1 according to the U.S. National Institute of Health.

The SARS-CoV-2 virion is 50-200 nanometres in diameter⁽⁵⁾. It has four structural proteins, known as the S (Spike), E (Envelop), M (Membrane), and N (Nucleocapsid) proteins; the N protein holds the RNA genome and S, M, E proteins together create the viral envelop⁽⁶⁾. The Spike protein (S) is responsible for the attaching with the receptors in host cells (Angiotensin Converting enzyme -2 (ACE2) in human cells) by imagining at the atomic level using cryogenic electron microscopy⁽⁷⁾.

Initial spike protein priming by transmembrane protease, serine 2 (TMPRSS2)⁽⁸⁾ is essential for SARS-CoV-2. After the attachment of the virus to a target cell, TMPRSS2, the cell’s protease cleave the spike protein of the virus, exposing a fusion peptide in the S2 subunit, and the host receptor ACE2. After it gets fused with the cell, there is a formation of endosomes around the virion After fusion, an endosome forms around the virion, separating it from the rest of the host cell. The virion escapes when the pH of the endosome drops or cathepsin cleaves it. The virion then releases RNA into the cell and forces the cell to produce and disseminate copies of the virus, which infect more cells⁽⁹⁾.

As we come to know that ACE2 is a potential pathway for the SARS-CoV-2 to infect host cells we can use Angiotensin Receptors Blockers (ARBs) and angiotensin receptor antagonists as a possible way to prevent infection using drugs like Losartan, Telmisartan, etc.

The rapid review identified 11 observational studies,^10-20 eight of which were conducted in China,^{12-14, 14-18} along with single studies from Italy,¹⁴ the United Kingdom,¹¹ and the United States.¹⁰  Nearly all studies included only patients with lab-confirmed COVID-19. No studies were found that were designed to directly assess whether ACE inhibitors or ARBs increase the risk of acquiring COVID-19.

There is low-certainty evidence that patients on long-term therapy with ACE inhibitors or ARBs are not at higher risk of poor outcomes from COVID-19.  

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