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ACE2: a key modulator of the renin-angiotensin system and pregnancy.
- Source :
-
American journal of physiology. Regulatory, integrative and comparative physiology [Am J Physiol Regul Integr Comp Physiol] 2021 Dec 01; Vol. 321 (6), pp. R833-R843. Date of Electronic Publication: 2021 Oct 20. - Publication Year :
- 2021
-
Abstract
- Angiotensin-converting enzyme 2 (ACE2) is a membrane-bound protein containing 805 amino acids. ACE2 shows approximately 42% sequence similarity to somatic ACE but has different biochemical activities. The key role of ACE2 is to catalyze the vasoconstrictor peptide angiotensin (ANG) II to Ang-(1-7), thus regulating the two major counterbalancing pathways of the renin-angiotensin system (RAS). In this way, ACE2 plays a protective role in end-organ damage by protecting tissues from the proinflammatory actions of ANG II. The circulating RAS is activated in normal pregnancy and is essential for maintaining fluid and electrolyte homeostasis and blood pressure. Renin-angiotensin systems are also found in the conceptus. In this review, we summarize the current knowledge on the regulation and function of circulating and uteroplacental ACE2 in uncomplicated and complicated pregnancies, including those affected by preeclampsia and fetal growth restriction. Since ACE2 is the receptor for SARS-CoV-2, and COVID-19 in pregnancy is associated with more severe disease and increased risk of abnormal pregnancy outcomes, we also discuss the role of ACE2 in mediating some of these adverse consequences. We propose that dysregulation of ACE2 plays a critical role in the development of preeclampsia, fetal growth restriction, and COVID-19-associated pregnancy pathologies and suggest that human recombinant soluble ACE2 could be a novel therapeutic to treat and/or prevent these pregnancy complications.
- Subjects :
- Angiotensin-Converting Enzyme 2 therapeutic use
Animals
Blood Pressure
COVID-19 enzymology
COVID-19 physiopathology
COVID-19 virology
Female
Fetal Growth Retardation enzymology
Fetal Growth Retardation physiopathology
Humans
Inflammation Mediators metabolism
Placenta physiopathology
Pre-Eclampsia enzymology
Pre-Eclampsia physiopathology
Pregnancy
Pregnancy Complications drug therapy
Pregnancy Complications physiopathology
Pregnancy Complications, Infectious enzymology
Pregnancy Complications, Infectious physiopathology
Pregnancy Complications, Infectious virology
SARS-CoV-2 pathogenicity
Uterus physiopathology
Water-Electrolyte Balance
Angiotensin-Converting Enzyme 2 metabolism
Placenta enzymology
Pregnancy Complications enzymology
Renin-Angiotensin System
Uterus enzymology
Subjects
Details
- Language :
- English
- ISSN :
- 1522-1490
- Volume :
- 321
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of physiology. Regulatory, integrative and comparative physiology
- Publication Type :
- Academic Journal
- Accession number :
- 34668428
- Full Text :
- https://doi.org/10.1152/ajpregu.00211.2021