TY - JOUR TI - Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients AU - Rossi, Gian Paolo AU - Sanga, Viola AU - Barton, Matthias A2 - Rosen, Clifford J A2 - Zaidi, Mone A2 - Salata, Robert VL - 9 PY - 2020 DA - 2020/04/06 SP - e57278 C1 - eLife 2020;9:e57278 DO - 10.7554/eLife.57278 UR - https://doi.org/10.7554/eLife.57278 AB - The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1–angiotensin II–angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2–angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2–angiotensin(1-7)–Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful. KW - SARS-CoV-2 KW - ACEIs KW - ARBs KW - ACE-2 KW - treatment KW - ARDS KW - angiotensin KW - angiotensin-converting enzyme-1 KW - angiotensin-converting enzyme-2 KW - ACE inhibitor KW - angiotensin receptor blocker KW - COVID-19 KW - coronavirus KW - arterial hypertension KW - infection KW - virus KW - SARS KW - renin-angiotensin-aldosterone system KW - cardiovascular KW - RAAS KW - Acute respiratory distress syndrome KW - ACE inhibitors KW - therapy KW - ACE KW - angiotensin receptor antagonists JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -