Angiotensin-Converting Enzyme 2 and its Potential in the Respiratory and Cardiovascular Systems

Angiotensin-converting enzyme 2 (ACE2) is a zinc metallopeptidase that participates in the metabolism of renin-angiotensin system (RAS) hormones and serves as the entry point for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. This review explores the characteristics of ACE2 as a potential therapeutic target for various conditions, including acute respiratory distress syndrome, pulmonary fibrosis, pulmonary hypertension, atherosclerosis, myocardial infarction, arterial hypertension, and arrhythmias. The literature highlights that angiotensin II (Ang II), a very active hormone in the RAS, exacerbates these conditions through pro-inflammatory, pro-fibrotic, and oxidative stress-inducing effects. Oxidative stress and immune system overactivation are critical factors in the progression of cardiovascular and pulmonary diseases. Ang II is synthesized by ACE and is subsequently converted to angiotensin-(1-7) (Ang-(1-7)) by ACE2, which counter regulates the effects of Ang II. ACE2s importance is observed during SARS-CoV-2 infection, where its association with the spike protein leads to decreased ACE2 levels, increased inflammation and reactive oxygen species, thereby worsening the diseases selected for this review. In conclusion, ACE2 can be a potential therapeutic target due to its ability to mitigate the harmful effects of Ang II, offering potential benefits in the treatment and prevention of different diseases.