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• The relationship between coronavirus and the renin-angiotensin system in the light of the development of drugs to treat COVID-19

  58-67

  Rudolf Gesztelyi

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  SARS-Co-V of the Coronaviridae family emerged in 2019 in China and soon generated a pandemic.
  Albeit COVID-19 did not have as high death toll as some earlier pandemics, the severity and course of
  disease proved to be unpredictable if factors related to general health and case history of patients were
  considered. Thus COVID-19 due to its potentially fatal outcome and unpredictability demanded protective measures to be taken that were not sustainable in the long run (e.g. quarantining masses of people) during the early course of the pandemic (prior to the availability of vaccination and medications).
  Nonetheless, the vaccine for COVID-19, albeit showed efficacy, failed to reach the level of protection the
  former vaccines for other communicable diseases did. Additionally, available pharmaceutical treatmentregimens were not efficacious enough in preventing fatal outcome or long-term complications. These
  facts underscore the necessity of initiatives that seek future avenues for drug development, with special emphasis being placed on repositioning of medications with well-established use. Upon reviewing
  available scientific evidence four potential approaches may be identified that if repositioned could be
  evaluated as anti-COVID-19 agents: 1.) manipulating the a renin-angiotensin system by the use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs); 2.) inhibiting the
  binding between human ACE2 enzyme and SARS-CoV-2 spike protein by N-acetylcysteine, or possibly
  quercetin; 3.) increasing the activity of ACE2 using ibuprofen; 4.) administration of prebiotics, probiotics
  or tryptophan to normalize SARS-CoV-2 induced dysbiotic changes of the microbiome.