ANGIOTENSIN-II SERUM LEVELS IN PATIENTS WITH COVID-19 OF DIFFERENT SEVERITIES

• Grant number: 24/03240-7
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): July 01, 2024
• Effective date (End): June 30, 2025
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Marcelo Bezerra de Menezes
• Grantee: Marcello Fialho Guimarães
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Introduction: The disease caused by SARS-CoV-2 (COVID-19) was responsible for more than 7 million deaths worldwide since the first case was diagnosed in 2019. COVID-19 spreads through person-to-person contact, and some of its pathophysiologic processes are known; others are assumed by extrapolation of knowledge of diseases caused by other coronaviruses. The disease has a broad spectrum of severity, and critical cases usually progress to respiratory failure. SARS-Cov-2 binds to the angiotensin-converting enzyme 2 (ACE-2) on the surface of cells it infects. The role of ACE-2 in the pathophysiology of acute respiratory distress syndrome (ARDS) in cases triggered by viral or non-viral infections is known, with probable involvement of the renin-angiotensin-aldosterone system (RAAS), resulting in a reduction in pulmonary ACE-2 and increased levels of angiotensin II (Ang-II). It is likely that when a viral infection is the cause of ARDS, a reduction in ACE-2 levels and changes in the RAAS worsen lung injury. In the case of coronaviruses, although ACE-2 functions as a receptor for the virus, there appears to be a reduction in its levels after entry into the cell, resulting in more severe injury, which corroborates different animal models that also point to the role of Ang-II in pulmonary inflammation and fibrosis. Hydroelectrolyte disorders also seem to result from RAAS axis interactions in this context. A better understanding of the pathophysiological role of the RAAS (especially ACE-2 and Ang-II) has the potential to support new therapies, prognostic assessment and development of immunization agents. Objectives: To evaluate whether Ang-II levels correlate with clinical severity in patients with COVID-19 by measuring angiotensin-II in the serum of patients with COVID-19 infection. Methods: Observational cross-sectional study of patients with different severities of COVID-19 treated at the Hospital das Clínicas complex of the Faculty of Medicine of Ribeirão Preto of the University of São Paulo (HCFMRP-USP). We will include individuals with COVID-19 treated at the HCFMRP-USP complex divided into four groups according to severity level (mild, moderate, severe and critical). We will measure Ang-II levels in every patient's serum and compare levels between groups. We will use serum samples from patients already included in another research protocol at the institution. We will draw clinical and laboratory information from medical records. We will then assess whether there are significant differences in Ang-II levels between the groups and whether the levels are associated with the disease severity.