ABSTRACT
Bradykinin (BK) is a nonapeptide that belongs to the kinin family. It is an active inflammatory mediator that exerts multiple different effects via its B1 and B2 receptors (B1R and B2R);however, its role has not been fully elucidated so far. It is known that B1R and B2R interact with angiotensin-converting enzyme (ACE)-2 protein, which acts as a receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). By degrading BK to its desARG9-BK metabolite, ACE2 leads to B1R activation, which triggers a release of pro-and anti-inflammatory cytokines in an immune response to infectious pathogens. On the other hand, ACE2 stimulates the expression of B2R by activating the ANG(1-7)-MasR axis which is essential for proper endothelial function. A controlled increase in B1R-mediated cytokine release during SARS-CoV-2 cell entry may be considered a normal immune response aiming to prevent infection. However, if regulatory mechanisms fail, the increase in proinflammatory cytokine release may lead to progression of infection, endothelial activation, and onset of symptoms, including organ involvement. Available data strongly suggest that BK and its receptors are involved in the pathomechanism of COVID-19 and linked by various feedback mechanisms to ACE2, ACE1, as well as angiotensin II (ANGII) and its receptors. As expression of these pathways is likely to change dynamically throughout different stages of COVID-19, novel treatment options that target these pathways along with close monitoring of their activity should be developed.