The Global Impact of SARS-CoV-2
Introduction to the Pandemic
Since the emergence of SARS-CoV-2 in December 2019, the virus has rapidly spread from Wuhan, China to countries worldwide. Currently classified as a global pandemic, each nation is grappling with the challenges of “flattening the curve” of new cases while striving to identify effective treatments.
Epidemiological Insights
Extensive epidemiological data has been collected in the quest to understand more about SARS-CoV-2, commonly known as COVID-19. The virus has the potential to affect individuals of all ages and genders. However, those at heightened risk include individuals aged 70 and older, those with pre-existing conditions, and individuals with co-morbidities. Notably, data indicates that older men with chronic illnesses exhibit a higher susceptibility to COVID-19. This finding is consistent with prior epidemiological research from the 2003 SARS outbreak, which showed that men had a higher mortality rate compared to women.
Research Focus: ACE2 and COVID-19 Susceptibility
Investigating Higher Susceptibility in Men
To explore the reasons behind the increased susceptibility of men with chronic illnesses to COVID-19, a research team led by Dr. Adriaan Voors examined angiotensin-converting enzyme 2 (ACE2). This enzyme serves as a functional receptor for both COVID-19 and SARS, allowing the virus to enter and infect healthy cells. Patients with cardiovascular diseases who are treated with medications that inhibit the renin-angiotensin-aldosterone system (RAAS) are reported to have elevated levels of plasma ACE2.
Study Design and Methodology
Dr. Voors conducted a study focusing on the impact of RAAS inhibitors on plasma ACE2 concentration. The study utilized three different types of RAAS inhibitors: angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs). Two large cohorts were formed from 11 European countries, consisting of both men and women with heart failure. The primary cohort aimed to test the hypothesis that higher ACE2 concentrations correlate with increased COVID-19 susceptibility, while the validation cohort sought to confirm these findings. Blood samples were collected from both groups to measure plasma ACE2 levels.
Findings from the Cohorts
Data analysis revealed that men had higher concentrations of ACE2 in both cohorts. This finding may be linked to the greater number of ACE2 receptors present in male testes and other organs. Interestingly, individuals taking ACE inhibitors or ARBs did not exhibit elevated ACE2 concentrations, a trend consistent in both cohorts. The validation cohort even indicated a decrease in ACE2 levels among those on these medications. Conversely, individuals taking MRAs in the validation cohort showed a slight increase in ACE2 concentrations, although this was not observed in the index cohort.
Conclusions and Future Research Directions
Study Conclusions
As the first significant study to examine the relationship between plasma ACE2 concentrations and RAAS inhibitors in cardiovascular disease patients, Dr. Voors concluded that there is no evidence supporting that RAAS inhibitors directly increase plasma ACE2 levels or influence COVID-19 susceptibility. He emphasized that heart failure patients should not discontinue RAAS inhibitor medications due to concerns regarding COVID-19.
Need for Further Research
The study acknowledged several limitations, including its focus solely on heart failure patients. More comprehensive research is necessary to establish a definitive link between COVID-19 and ACE2 concentrations. As highlighted in the press release, “this field is moving so rapidly that we now have two observational studies of ARB/ACE inhibitor use in hospitalized COVID-19 patients showing no augmented risk to COVID-19 patients and even suggesting possible benefit.”
Additional Resources
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References
Mason, Emma. “Men’s Blood Contains Greater Concentrations of Enzyme That Helps COVID-19 Infect Cells.” EurekAlert!, 10 May 2020, www.eurekalert.org/pub_releases/2020-05/esoc-mbc050720.php.
Sama, et al. “Circulating Plasma Concentrations of Angiotensin-Converting Enzyme 2 in Men and Women with Heart Failure and Effects of Renin–Angiotensin–Aldosterone Inhibitors.” Oxford Academic, European Heart Journal, 10 May 2020, academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa373/5834647.
Image by PIRO4D from Pixabay.