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ACE inhibitors

Jerome Marot

Well-known member
This is a repost, but it may be important.

The majority of people infected with COVID-19 only have mild symptoms. Unfortunately, a minority evolves towards severe lung problems after about 10 days. The question thus arises why some people react differently. You may have read it is only old age. That is not quite true. While the elderly are indeed at a higher risk, some quite young people also develop respiratory failure.

Suspected are of course anything that acts detrimentally to the lungs: air pollution, smoking and even vaping.

More puzzling is a comorbidity with diabetes and high blood pressure. What does this have to do with the lungs? The explanation may be related to that study: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

In short: there is a whole class of medicines called ACE inhibitors. They are used to mitigate diabetes and high blood pressure. They work by acting on an enzyme called ACE, they lower it. Your body then upregulates a second enzyme, called ACE2 (I am sorry, I am not making these names). Unfortunately, COVID-19 binds to their target human cells with ACE2. It follows that the medicine agains high blood pressure and diabetes is making it easier for the virus to kill its host.

Common ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril. Furthermore, ACE2 can also be increased by thiazolidinediones and ibuprofen. People taking any of these drugs should ask their doctor for an alternative treatment. It is not worth taking a risk, there are several alternatives available.

Generally speaking, people taking medications on a regular basis should check what the active ingredients are and inquire whether there is a comorbidity with coronaviruses. It may not be only that class of product that is concerned.
 

Robert Watcher

Well-known member
I have used this resource to educate myself a little over the last couple of months. Very technical because it is an educational tool for those in the medical field, so I don’t understand everything - but nonetheless fascinating, balanced and often enlightening.

His post I watched yesterday, was along the same lines - Blood Clots and Strokes in COVID-19; ACE-2 Receptor; Oxidative Stress:


 
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James Lemon

Well-known member
I have had some mild symptoms persist for a few days on a couple of occasions in the span of a month. Similar to the description in the article. The most severe symptom was a swollen lymph node in my throat, the mild symptoms of sinus/throat irritation and nasal drip into back of throat. I know of handful of associates who have suffered from more severe symptoms and were bed-ridden. There illness was much shorter than my symptoms to the best of my knowledge. Recently my Granddaughter was very ill for 3 weeks she was tested but proved to be negative of Covid 19. As for the clinical significance of any of this I cannot comment without any tests. I don't know of anyone admitted to a hospital.
 
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This is a repost, but it may be important.

The majority of people infected with COVID-19 only have mild symptoms. Unfortunately, a minority evolves towards severe lung problems after about 10 days. The question thus arises why some people react differently. You may have read it is only old age. That is not quite true. While the elderly are indeed at a higher risk, some quite young people also develop respiratory failure.

Suspected are of course anything that acts detrimentally to the lungs: air pollution, smoking and even vaping.

More puzzling is a comorbidity with diabetes and high blood pressure. What does this have to do with the lungs? The explanation may be related to that study: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

In short: there is a whole class of medicines called ACE inhibitors. They are used to mitigate diabetes and high blood pressure. They work by acting on an enzyme called ACE, they lower it. Your body then upregulates a second enzyme, called ACE2 (I am sorry, I am not making these names). Unfortunately, COVID-19 binds to their target human cells with ACE2. It follows that the medicine agains high blood pressure and diabetes is making it easier for the virus to kill its host.

Common ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril. Furthermore, ACE2 can also be increased by thiazolidinediones and ibuprofen. People taking any of these drugs should ask their doctor for an alternative treatment. It is not worth taking a risk, there are several alternatives available.

Generally speaking, people taking medications on a regular basis should check what the active ingredients are and inquire whether there is a comorbidity with coronaviruses. It may not be only that class of product that is concerned.

Jerome, thanks for this entry. It could be important to me because my wife is on a low dosage of one of the ACE inhibitors you mention. So I read the Lancet article (published in early March). Essentially the article noted an association between COVID-19 severity with diabetes and hypertension, both of which are often treated by ACE inhibitors. The authors then hypothesize a route whereby ACE inhibitors might exacerbate the effects of COVID-19 on the respiratory system and hypothesize an effect of the drug to exacerbate COVID-19 severity.

The article dismayed me for methodological reasons. Put simply, none of the three studies that the authors cited reported whether or not severely affected patients received ACE inhibitor treatment. It saddens me that conscientious scientists, article reviewers and the journal editors agreed to the publication of an article hypothesizing that X causes Y (i.e., the treatment causes higher symptom severity) without reliable measurement of X? Sure, it's essential for scientists to hypothesize, I do it it all the time in my research. But for heavens sake don't publish prematurely without evidence based on reasonably sound methodology. It reeks of celebrity seeking. It's like COVID-19 modelling without good data that diminishes the reputation and perceived credibility of more careful science.

Since the publication of the preceding article, JAMA Cardiology published a study on April 23 of nearly 1200 hospitalized patients with COVID-19 in China. That study found no association between the presence or absence of ACE inhibitor treatment with respect to either mortality or severity See JAMA Cardiology here. Moreover Medscape reports on three further studies that found ACE/ARB had beneficial effects on mortality and/or severity See Medscape
 
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Jerome Marot

Well-known member
Thank you for the two articles, Michael. Indeed in present times, scientists publish prematurely and it is important to have the other sides of the hypothesis.
 
Thank you again for your post, Jerome. I haven't kept up with research on COVID-19 treatments, presuming that nothing conclusive will emerge this calendar year. But because you mentioned a drug my wife takes to keep hypertension at bay, ACE inhibitors suddenly became personally significant. Fortunately, recent findings suggest that category of drugs provide no major threat to the severity of COVID-19 effects.

Forgive me for my mild rant about premature publishing. Science to me is an improvement on religion. Like the latter, it requires hard work, patience, fortitude, carefulness, originality and an appreciation of elegance to achieve lasting gains in practical or moral knowledge. I find it annoying when scientists take shortcuts, fake research findings, or try to hide methodological shortcomings in order to further their own careers and/or gain influence and power. I know that scientists have foibles like everyone else, but find it irritating when they openly exhibit such shortcomings under a misleading guise incorrectly referred to as 'expertise'.
 

James Lemon

Well-known member
Thank you again for your post, Jerome. I haven't kept up with research on COVID-19 treatments, presuming that nothing conclusive will emerge this calendar year. But because you mentioned a drug my wife takes to keep hypertension at bay, ACE inhibitors suddenly became personally significant. Fortunately, recent findings suggest that category of drugs provide no major threat to the severity of COVID-19 effects.

Forgive me for my mild rant about premature publishing. Science to me is an improvement on religion. Like the latter, it requires hard work, patience, fortitude, carefulness, originality and an appreciation of elegance to achieve lasting gains in practical or moral knowledge. I find it annoying when scientists take shortcuts, fake research findings, or try to hide methodological shortcomings in order to further their own careers and/or gain influence and power. I know that scientists have foibles like everyone else, but find it irritating when they openly exhibit such shortcomings under a misleading guise incorrectly referred to as 'expertise'.

Apparently researchers spend a huge amounts of resources apply for grants! They should maybe start looking at adopting different funding strategies?

The Howard Hughes Medical Institute was recently rated as the second best research organisation worldwide by the Excellence Report, which is based on the SCImago Institutions Ranking World Report 2011 but puts more emphasis on the quality of the research output. The HHMI was only excelled by the Whitehead Institute for Biomedical Research and left behind many other highly acknowledged institutions. But what are the secrets behind the success? A team from the National Bureau of Economic Research and MIT Sloan School of Management in Cambridge addressed this question and published its results in the RAND Journal of Economics last September.

 
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