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Serum Angiotensin II as a Biomarker in COVID-19

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Biomarkers in Trauma, Injury and Critical Care

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Abstract

Angiotensin II, synthesized by the cleavage of angiotensinogen to angiotensin I by renin and then conversion to angiotensin II by the angiotensin-converting enzyme, is the main effector peptide of the renin-angiotensin system. Transmembrane angiotensin-converting enzyme 2 (ACE2), the enzyme that metabolizes angiotensin II, is the host receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2, which binds to transmembrane angiotensin-converting enzyme 2, affects angiotensin II levels by causing an imbalance in the renin-angiotensin system.

Angiotensin II triggers inflammation, coagulopathy, vasculopathy, fibrosis, oxidative stress, and thrombosis through the angiotensin II type 1 receptor (AT1R). Angiotensin II is thought to contribute to pneumonia, sepsis, acute respiratory distress syndrome, diffuse thrombosis, and multi-organ damage in coronavirus disease 2019 (COVID-19).

Studies conducted in the preclinical and early period of the SARS-CoV-2 pandemic on severe acute respiratory syndrome coronavirus (SARS-CoV) shared findings that serum angiotensin II levels increased. However, recent studies have shown an increase in circulating soluble ACE2 levels and a decrease in serum angiotensin II levels in COVID-19.

Despite conflicting results, the majority of studies have shown that decreased serum angiotensin II levels are associated with the severity, prognosis, and mortality of COVID-19.

In this chapter, the relationship between COVID-19 and angiotensin II and the renin-angiotensin system was discussed in light of scientific studies conducted during the SARS-CoV-2 pandemic.

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Abbreviations

ACE:

Angiotensin-converting enzyme

ACE2:

Angiotensin-converting enzyme 2

ADAM17:

A disintegrin and metalloproteinase 17 domain

ADH:

Antidiuretic hormone

ALI:

Acute lung injury

Ang:

Angiotensin

AP:

Aminopeptidase

ARDS:

Acute respiratory distress syndrome

AT1R:

Angiotensin II type 1 receptor

AT2R:

Angiotensin II type 2 receptor

AT4R:

Angiotensin II type 4 receptor

COVID-19:

Coronavirus disease 2019

CP:

Carboxypeptidase

MasR:

Mas receptor

MrgD:

Mas-related G protein-coupled receptor member

NEP:

Neprilysin

POP:

Prolyloligopeptidase

RAS:

Renin-angiotensin system

sACE2:

Soluble angiotensin-converting enzyme 2

SARS-CoV:

Severe acute respiratory syndrome coronavirus

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

TF:

Tissue factor

TMPRSS2:

Human androgen-sensitive transmembrane serine protease type 2

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  1. İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Emergency Medicine, İstanbul, Turkey

    Seda Ozkan & Afsin Ipekci

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  1. Seda Ozkan
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  2. Afsin Ipekci
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Correspondence to Seda Ozkan .

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  1. Department of Medicine, King Abdulaziz Med City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  2. Franklin-Wilkins Bldg, Rm 4.101, 4th Fl, Kings Coll London, Sch Biomed Health Sci, London, UK

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, UK

    Vinood B. Patel

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Ozkan, S., Ipekci, A. (2022). Serum Angiotensin II as a Biomarker in COVID-19. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Biomarkers in Trauma, Injury and Critical Care. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Cham. https://doi.org/10.1007/978-3-030-87302-8_69-1

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