Pharmacological agents modifying the renin angiotensin and natriuretic peptide systems in COVID-19 patients

Coronaviruses (CoV) are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. The new virus was subsequently named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease caused by the virus is coronavirus disease 2019 (COVID-19). The new coronavirus SARS-CoV‑2 (COVID-19) is responsible for the current global pandemic [1]. In December 2020, vaccinations began in Europe. To date, forms of treatment are experimental [2]. The COVID-19 infection has caused 2 million deaths [3]. The infection is described in three phases: the first asymptomatic or slightly symptomatic, the second moderately severe characterized by a pulmonary inflammatory state, the third very severe characterized by a generalized inflammatory state affecting all tissues causing multiorgan dysfunction. In the more severe stages of infection, COVID-19 lung lesions are characterized by diffuse alveolar damage with irregular inflammatory cellular infiltration [4, 5].The literature data not only identify COVID-19 viral infections as a respiratory disease, but in more severe cases there may be involvement of other organs, such as the heart and liver, contributing to the development of serious complications [6]. Pharmacological treatment of the infection involves the use of antivirals, anticoagulants and immunomodulants [7‐10]. In the most severe stages of infection, a generalized inflammatory state induced by a cytokine storm results in multiorgan dysfunction and tissue injury. The SARS-CoV‑2 penetrates cells using the S protein through the angiotensin-converting enzyme receptor 2 (ACE-2) widely present in respiratory mucosa epithelial cells and other tissues. ACE‑2 is also a conversion enzyme with a key role in the renin-angiotensin system (RAS) [11]. …