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Intoxication With Endogenous Angiotensin II: A COVID-19 Hypothesis.
Sfera, Adonis; Osorio, Carolina; Jafri, Nyla; Diaz, Eddie Lee; Campo Maldonado, Jose E.
  • Sfera A; Patton State Hospital, San Bernardino, CA, United States.
  • Osorio C; Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States.
  • Jafri N; Patton State Hospital, San Bernardino, CA, United States.
  • Diaz EL; Patton State Hospital, San Bernardino, CA, United States.
  • Campo Maldonado JE; Department of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States.
Front Immunol ; 11: 1472, 2020.
Article in English | MEDLINE | ID: covidwho-643141
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 has spread rapidly around the globe. However, despite its high pathogenicity and transmissibility, the severity of the associated disease, COVID-19, varies widely. While the prognosis is favorable in most patients, critical illness, manifested by respiratory distress, thromboembolism, shock, and multi-organ failure, has been reported in about 5% of cases. Several studies have associated poor COVID-19 outcomes with the exhaustion of natural killer cells and cytotoxic T cells, lymphopenia, and elevated serum levels of D-dimer. In this article, we propose a common pathophysiological denominator for these negative prognostic markers, endogenous, angiotensin II toxicity. We hypothesize that, like in avian influenza, the outlook of COVID-19 is negatively correlated with the intracellular accumulation of angiotensin II promoted by the viral blockade of its degrading enzyme receptors. In this model, upregulated angiotensin II causes premature vascular senescence, leading to dysfunctional coagulation, and immunity. We further hypothesize that angiotensin II blockers and immune checkpoint inhibitors may be salutary for COVID-19 patients with critical illness by reversing both the clotting and immune defects (Graphical Abstract).
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Angiotensin II / Up-Regulation / Coronavirus Infections / Betacoronavirus Type of study: Prognostic study Limits: Humans Language: English Journal: Front Immunol Year: 2020 Document Type: Article Affiliation country: Fimmu.2020.01472

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Angiotensin II / Up-Regulation / Coronavirus Infections / Betacoronavirus Type of study: Prognostic study Limits: Humans Language: English Journal: Front Immunol Year: 2020 Document Type: Article Affiliation country: Fimmu.2020.01472