Disease

Pathogenesis

Coronavirus disease 2019 (COVID-19)

Biology

Internal medicine

Immunology

Angiotensin-converting enzyme 2

Medicine

Angiotensin II receptor type 1

Receptor

Angiotensin II

Infectious disease (medical specialty)

Blood pressure

Renin–angiotensin system

Virology

Clinical Science

The emergency of SARS-CoV-2 in China started a novel challenge to the scientific community. As the virus turns pandemic, scientists try to map the cellular mechanisms and pathways of SARS-CoV-2 related to the pathogenesis of Coronavirus Disease 2019 (Covid-19). After transmembrane angiotensin-converting enzyme 2 (ACE2) has been found to be SARS-CoV-2 receptor, we hypothesized an immune-hematological mechanism for Covid-19 based on renin-angiotensin system (RAS) imbalance to explain clinical, laboratory and imaging findings on disease course. We believe that exaggerated activation of ACE/Angiotensin II (Ang II)/Angiotensin Type 1 (AT1) receptor RAS axis in line with reduction of ACE2/Angiotensin-(1-7)/Mas receptor may exert a pivotal role in the pathogenesis of Covid-19. In this perspective, we discuss potential mechanisms and evidence on this hypothesis.

Covid-19: the renin–angiotensin system imbalance hypothesis