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BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m406 (Published 31 January 2020) Cite this as: BMJ 2020;368:m406

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Re: Possible use of ARBs to mitigate lung damage caused by coronavirus

Dear Editor
Regarding the possible use of angiotensin II receptor antagonists (ARBs) to mitigate the lung damage caused by corona virus, some clarifications are necessary.
1- ACE1 is the enzyme that causes the formation of the vasoconstrictor hormone angiotensin II (Ang II)
2- Ang II shows a powerful pro-inflammatory action in lung tissue
3- ACE2 is the enzyme that deactivates Ang II by forming the angiotensin vasodilator hormone (1-7) (rebalancing the effects of Ang II)
4- ACE2 is also the receptor for the spike protein (protein present outside the coronavirus: MERS, SARS1 and SARS2)
5- The binding of viruses attenuates or cancels the activity of ACE2, causing the circulation of an excess of Ang II with consequent inflammatory damage
6- Ang II acts through AT1R receptors; this activity can be inhibited / attenuated by some well-known drugs (sartans or ARBs) widely used in antihypertensive therapy

I believe these premises may suggest the possibility of the use of ARBs to ameliorate pulmonary injury caused by coronavirus infections.
Various scientific articles, and also a patent application, can be found in support of this hypothesis.

References:

- A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus induced lung injury (NATURE MEDICINE VOL
11 | Nr 8 | pag 875 | 2005)
- US20060135422A1 USE OF ANGOTENSIN RECEPTOR BLOCKERS (ARBS) TO TREAT DISEASES ASSOCATED WITH EXCESS
ACE
- Reducing mortality from 2019-nCoV: host-directed therapies should be an option
(the lancet Vol 395 | e35 | 2020)

Competing interests: No competing interests

29 February 2020
Massimo Pinori
Head of Medicinal chemistry department (retired)
Italfarmaco SpA (retired)
Paderno d'Adda (LC) - Italy