TY - JOUR
T1 - Angiotensin II - A Brief Review and Role in Severe SARS-COV-2 Sepsis
AU - Carà, Gianmarco A.
AU - Pasin, Laura
AU - Alborino, Ettore
AU - Zarbock, Alexander
AU - Bellomo, Rinaldo
AU - Landoni, Giovanni
N1 - Funding Information:
Alexander Zarbock received honorariums and research grants from Fresenius, Baxter, Astellas, AM Pharma, Paion, Guard Therapeutics, Novartis, Bayer, BioMerieux, GIF, BMBF, and DFG. Giovanni Landoni received speaker fees from Paion.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water homeostasis and fluid and blood pressure homeostasis. RAAS plays a crucial role in cardiocirculatory shock because it counteracts hypotension and hypovolemia by activating different physiologic responses. Based on the encouraging results of the ATHOS-3 trial, the US Food and Drug Administration and the European Medicines Agency approved the use of ATII for catecholamine-resistant vasodilatory shock. More recently, ATII was used for the compassionate treatment of critically ill patients with COVID-19. Beyond its vasopressor properties, ATII was hypothesized to have antiviral activity because it induces internalization and degradation of angiotensin-converting enzyme 2 receptors used by SARS-Cov-2 to infect cells. Overall, the use of ATII in patients with COVID-19 showed promising results because its administration was associated with the achievement and maintenance of target mean arterial pressure, increased PaO2/FIO2 ratio, and decreased FIO2. The aim of this narrative review is to summarize the available knowledge on the use of ATII in patients with COVID-19.
AB - The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water homeostasis and fluid and blood pressure homeostasis. RAAS plays a crucial role in cardiocirculatory shock because it counteracts hypotension and hypovolemia by activating different physiologic responses. Based on the encouraging results of the ATHOS-3 trial, the US Food and Drug Administration and the European Medicines Agency approved the use of ATII for catecholamine-resistant vasodilatory shock. More recently, ATII was used for the compassionate treatment of critically ill patients with COVID-19. Beyond its vasopressor properties, ATII was hypothesized to have antiviral activity because it induces internalization and degradation of angiotensin-converting enzyme 2 receptors used by SARS-Cov-2 to infect cells. Overall, the use of ATII in patients with COVID-19 showed promising results because its administration was associated with the achievement and maintenance of target mean arterial pressure, increased PaO2/FIO2 ratio, and decreased FIO2. The aim of this narrative review is to summarize the available knowledge on the use of ATII in patients with COVID-19.
KW - angiotensin-II
KW - COVID-19
KW - shock
KW - vasopressor
UR - http://www.scopus.com/inward/record.url?scp=85136104621&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2022.07.022
DO - 10.1053/j.jvca.2022.07.022
M3 - Review Article
C2 - 35995637
AN - SCOPUS:85136104621
SN - 1053-0770
VL - 36
SP - 4496
EP - 4500
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 12
ER -