Sound Science Before Quick Judgement Regarding RAS Blockade in COVID-19

Clinical journal of the American Society of Nephrology: CJASN

Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan and Swapnil Hiremath 

Abstract

There has been much speculation in journals as well as social and traditional media about a link between popularly used classes of drugs that inhibit the renin-angiotensin system (RAS) and novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection or coronavirus disease 2019 (COVID-19) disease severity. After examining the available evidence, we advise that inhibitors of the RAS pathway should be continued in patients with COVID-19 who are taking these drugs for evidence-based indications. The putative link between SARS-CoV-2 angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) can be rationalized by the biology of virus entry. The spike protein of SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor to enter type II pneumocytes or enterocytes (and likely, other cells).

Keywords

angiotensinrenin angiotensin systemvirology, hypertension, ACE inhibitors, COVID-19, severe acute respiratory syndrome coronavirus 2, Renin-Angiotensin System, Angiotensin-Converting Enzyme Inhibitors

Molecular characterization of SARS-CoV-2 from the first case of COVID-19 in Italy

Clinical Microbiology and Infection

Capobianchi, Maria Rosaria; Rueca, Martina; Messina, Francesco; Giombini, Emanuela; Carletti, Fabrizio; Colavita, Francesca; Castilletti, Concetta; Lalle, Eleonora; Bordi, Licia; Vairo, Francesco; Nicastri, Emanuele; Ippolito, Giuseppe; Maria Gruber, Cesare Ernesto; Bartolini, Barbara

 

To the Editor,

On January 29, 2020, two Chinese spouses (patient 1, female; patient 2, male), coming to Italy as tourists from Hubei province, were hospitalized at the National Institute for Infectious Diseases “L. Spallanzani”, Rome, with fever and respiratory symptoms. SARSCoV-2 diagnosis was accomplished using real-time RT-PCR on a nasopharyngeal swab and sputum for patient 1 and on a nasopharyngeal swab for patient 2, collected 1 day after symptom onset. Partial sequencing confirmed both patients to be infected with SARS-CoV-2

Keywords

Clinical aspects, diagnosis, treatment