i have been seeing and compiling mounting evidence re: topics in the title. id like to post my findings here in order to promote discussion and hopefully elucidate some of the dogma
aceis/arbs x covid19 – protective or harmful?
it was found by hoffman et al (
https://www.cell.com/cell/pdf/S0092-8674(20)30229-4.pdf) that sars cov 2 (covid) depends on ACE2 (and TMPRSS2) for cell entry
since, there have been 2 opposing schools of thought:
- ACEIs/ARBs decrease ACE2 activity, thereby being protective against covid
this idea is supported by the recent hfsa position statement, esc position statement (
https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang), and various other lit
The ACE inhibitor perindopril reduced the expression and activity of ACE in both plasma and in the kidney by 50–60% (Fig. 5). The magnitude of this effect was similar in both control and diabetic animals and in c57bl6 mice and ACE2 KO mice. Although the ACE2 enzyme is not inhibited by ACE inhibitors in vitro, perindopril also significantly modified the expression and activity of ACE2 in our models. Treatment of c57Bl6 mice with perindopril reduced plasma ACE2 activity and cortical ACE2 activity in both control and diabetic animals (Fig. 3C). This was also associated with a significant reduction in cortical levels of Ang 1–7 when compared with those of untreated wild-type animals (Fig. 4).
- ACEIs/ARBs increase ACE2 activity, thereby being a risk factor for covid
supported by various lit, but summarized by rami sommerstein in a letter to the editor of bmj
he cites multiple studies showing that ACEIs/ARBs increase ACE2 activity, ie providing more entry sites for covid
which is it?
hydroxychloroquine vs covid
there is a growing body of evidence (in no small part thanks to /u/aedes' research – check his/her post history for some more insight on this) that chloroquine (and thus, hydroxychloroquine/plaquenil) may be active against covid. here are a few pieces of lit supporting this:
nsaids vs covid
recent advice from european councils have recommended against the use of nsaids/steroids in covid19, suggesting that it may increase ACE2 activity
however, i read on here somewhere (and seem to remember being taught in school) that nsaids may have antiviral activity
so, my friends – what are your thoughts/experiences/anecdotes?
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