arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2020-26-3-240-247arthyper-1954Research ArticleРЕДАКЦИОННАЯ СТАТЬЯEDITORIALРенин-ангиотензиновая система при новой коронавирусной инфекции COVID-2019Renin-angiotensin-aldosterone system in new coronavirus infection 2019https://orcid.org/0000-0003-2386-6707ЗагидуллинН. Ш.ZagidullinN. Sh.

Загидуллин Науфаль Шамилевич — доктор медицинских наук, профессор, директор научно-исследовательского института «Кардиология»

ул. Ленина, д. 3, Уфа, 450008

Naufal Sh. Zagidullin, MD, PhD, DSc, Professor, Director, Research Institute of Cardiology, Head, Department of Propaedeutics of Internal Diseases

3 Lenin street, Ufa, 450008

znaufal@mail.ruhttps://orcid.org/0000-0002-1874-8661ГарееваД. Ф.GareevaD. F.

Гареева Диана Фирдависовна — кандидат медицинских наук, ассистент кафедры пропедевтики внутренних болезней, врач-кардиолог

Уфа

Diana F. Gareeva, MD, PhD, Assistant, Department of Propaedeutics of Internal Diseases, Cardiologist

Ufa

danika09@mail.ruhttps://orcid.org/0000-0002-5527-4477ИшметовВ. Ш.IshmetovV. Sh.

Ишметов Владимир Шамилевич — доктор медицинских наук, заведующий отделением сердечно-сосудистой и рентгенохирургии Клиники

Уфа

Vladimir Sh. Ishmetov, MD, PhD, DSc, Head, Department of Cardiovascular and X-ray Surgery, Clinic

Ufa

ishv75@mail.ruhttps://orcid.org/0000-0002-9455-1801ПавловА. В.PavlovA. V.

Павлов Алексей Валерьевич — кандидат медицинских наук, заведующий отделением кардиохирургии Клиники

Уфа

Aleksey V. Pavlov, MD, PhD, Head, Department of Cardiac Surgery

Ufa

docpavlov1976@gmail.comhttps://orcid.org/0000-0001-9627-5508ПлотниковaМ. Р.PlotnikovaM. R.

Плотникова Марина Раилевна — кандидат медицинских наук, заведующая отделением кардиологии Клиники

Уфа

Marina R. Plotnikova, MD, PhD, Head, Cardiology Department

Ufa

plotnikovam.r@yandex.ruhttps://orcid.org/0000-0002-4637-4724ПушкареваА. Э.PushkarevaA. E.

Пушкарева Альфия Эдуардовна — кандидат медицинских наук, доцент кафедры госпитальной терапии

Уфа

Al’fiya E. Pushkareva, MD, PhD, Associate Professor, Department of Hospital Therapy

Ufa

alfia.cardio@yandex.ruПавловВ. Н.PavlovV. N.

Павлов Валентин Николаевич — доктор медицинских наук, профессор, заведующий кафедрой урологии

Уфа

Valentin N. Pavlov, MD, PhD, DSc, Professor, Head, Urology Department

Ufa

pavlov@bashgmu.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияBashkir State Medical UniversityRussian Federation202011052020263240247Copyright © Загидуллин Н.Ш., Гареева Д.Ф., Ишметов В.Ш., Павлов А.В., Плотниковa М.Р., Пушкарева А.Э., Павлов В.Н., 20202020Загидуллин Н.Ш., Гареева Д.Ф., Ишметов В.Ш., Павлов А.В., Плотниковa М.Р., Пушкарева А.Э., Павлов В.Н.Zagidullin N.S., Gareeva D.F., Ishmetov V.S., Pavlov A.V., Plotnikova M.R., Pushkareva A.E., Pavlov V.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1954

Новая коронавирусная инфекция (КВИ) 2019 года представляет собой серьезную угрозу человечеству. Хотя ее патогенез полностью не изучен, недавно стало известно, что ангиотензинпревращающий фермент 2 (АПФ2), будучи фиксированным на поверхности клеток, служит рецептором для входа в них коронавируса SARS-CoV-2, тем самым способствуя распространению инфекции в организме. Целью обзора явилось исследование значения ренин-ангиотензин-альдостероновой системы (РААС) в патогенезе действия вируса, функции и регуляции АПФ2 и влияния ингибиторов РААС на сердечно-сосудистую систему при КВИ. АПФ2 в крови способствует трансформации ангиотензина (АТ) I в АТ 1–7, которые оказывают ряд благоприятных эффектов на эндотелий сосудов и кардиомиоциты (вазодилатация, ингибирование клеточного роста, подавление пролиферации клеток и торможение гипертрофии кардиомиоцитов). Вирус SARS-CoV-2, помимо взаимодействия с АПФ2 на поверхности клеток в легких и сосудистой стенке, приводит к дисрегуляции АПФ2, что, в свою очередь, приводит к смещению баланса РААС в сторону АПФ1-рецепторов, которые обладают обратными эффектами. Ингибиторы АПФ (ИАПФ) и блокаторы рецепторов к ангиотензину (БРА) играют ключевую роль в лечении основных сердечно-сосудистых заболеваний, таких как артериальная гипертензия и хроническая сердечная недостаточность, и на сегодняшний день нет данных, однозначно свидетельствующих о том, что ИАПФ или БРА ухудшают тяжесть течения КВИ. Поэтому не рекомендуется прекращение приема или замена этих препаратов у пациентов со стабильным течением сердечно-сосудистых заболеваний. Человеческий рекомбинантный белок hrACE 2 может быть потенциальной терапией для КВИ, блокируя проникновение вируса и устраняя дисбаланс в РААС.

The new coronavirus infection (COVID-19) is a serious threat to humanity. Although its pathogenesis has not been fully studied, angiotensin-converting enzyme 2 (ACE 2) has recently been identified as a receptor for entry into the cell of the coronavirus SARS-CoV-2, thereby contributing to the spread of infection in the body. The goal of the review was to study the significance of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of the action of the coronavirus SARS-CoV-2, the function and regulation of ACE 2, and the effects of RAAS inhibitors in cardiovascular diseases. ACE 2 promotes the transformation of angiotensin (AT) I into AT 1–7, which have a number of beneficial effects on the state of endothelium and cardiomyocytes (vasodilation, inhibition of cell growth, inhibition of cell proliferation and inhibition of cardiomyocyte hypertrophy). SARS-CoV-2 virus, in addition to interaction with ACE 2 on the surface cells in the lungs and vascular wall, leads to dysregulation of ACE 2, which in turn leads to a shift in the balance of RAAS towards activation of ACE 1 receptors, which have the opposite effects. ACE inhibitors and angiotensin receptor blockers (ARBs) play a key role in the treatment of major cardiovascular diseases such as hypertension and chronic heart failure, and today there is no evidence that ACE inhibitors or ARBs worsen severity of cardiovascular diseases. Therefore, it is not recommended to discontinue these drugs in patients with stable cardiovascular diseases and afflicted by COVID-19. The human recombinant hrACE 2 protein may be a potential therapy for CVI by blocking virus entry and eliminating the imbalance in RAAS.

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The authors declare that there are no conflicts of interest present.