Mechanical view of COVID 19 Infection in humans

• 2021-04-29

During this pandemic every human system got influenced by a Novel Corona Virus  SARS-CoV-2, according to a research  titled “Molecular interaction and inhibition of SARS-CoV-2 binding to ACE2 receptor” of Louvain Institute of Biomolecular Science and Technology ( funded by European Research Council under The European Union’s Horizon 2020 research and innovation program and FNRS-Welbio)  published in Nature Communication,  Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global pandemic that initially started in Wuhan, China, and spread extremely quickly, making its way to over 180 countries.

The Novel Corona Virus SARS-CoV-2 entry into host cells is mediated by its spike glycoprotein(S- glycoprotein) and the Angiotensin –converting enzyme2 (ACE2) has been identified as a cellular receptor. ACE2 is very crucial part of Renin-angiotensin-aldosterone system (RAAS), RAAS is a very complex system that is responsible for regulation of body’s blood pressure (Constriction of arteries and blood vessels) and Body’s Water level also regulates the extracellular volume in the blood plasma, lymph and interstitial fluid.

Renin also known as angiotensinogenase, an enzyme played an important role in Renin-angiotensin-aldosterone system (RAAS). Renin, a peptide hormone is secreted by the kidneys from specialized cells called Granular cells found in the juxtaglomerular apparatus. The secretion of Renin is stimulated by the three factors:

• When a fall in arterial blood pressure is detected by pressure sensitive receptors (baroreceptors) in the arterial vessels.
• A decrease in sodium chloride (NaCl, salt) is detected in kidney by the macula densa in the Juxtaglomerular apparatus.
• When sympathetic nervous system activity is detected through beta1 adrenergic receptors.

Let’s understand how this system works in our body Renin cleaves( Catalytically)  angiotensinogen and forms angiotensin 1 Angiotensin –converting enzymes then convert Angiotensin 1 to its physiologically active form , Angiotensin 2 that cause contraction of the muscles surrounding blood vessels, narrowing vessels and increase blood pressure. Simultaneously stimulates the release of aldosterone, which stimulates water and sodium reabsorption, thereby increasing blood volume and blood pressure.  Now  what is the role of ACE 2 that is receptor for Novel Corona Virus  SARS-CoV-2, Angiotensin –Converting –Enzyme 2 (ACE2) reduce the increased blood pressure, In fact, ACE2, involved in the RAS mediated homeostasis, plays at intestinal level regulating the microbiome, acting on amino acid uptakes, and expression of antimicrobial peptides .

Now  understand the COVID 19 infection in lungs , lungs(lower part) have high level density of ACE2, when someone get infected more of ACE2 receptors by Novel Corona Virus  SARS-CoV-2, damage to ACE2 receptor will lead to pathological blood circulation . According to recent studies related to ACE2 and COVID 19 virus lungs inflammation is one of the main symptom during SARS-CoV-2 infection, the lungs, among all organs, present a moderate expression of ACE2 and, SARS-CoV-2 may affect other organs, organs that have a high to moderate expression of ACE2. In this context a map of the physiological organ-specific distribution, expression, and activities of ACE2, organs often poorly considered (specific brain regions, oral cavity, thyroid, pancreas, duodenum, colon, rectum, gallbladder, male -testis and seminal vesicle- and female tissues -ovary, oocyte, uterus, vagina-, skin, and others). These organs and SARS-CoV-2 may contribute to understand the potential infection routes as well as the clinical symptoms and mechanisms of the virus susceptibility.  If we hypothesis it, this virus must be more deadly for patients of Hypertension who have dominance of sympathetic nervous system in contrast to ACE2 involved in the RAS mediated homeostasis, now this is true when we are looking at comorbidities, according to research titled “Comorbidity and its Impact on Patients with COVID-19” published in 2020 suggested that Hypertension and diabetes are the leading vulnerabilities leads to major health complication and deaths. Another study titled “Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India” indicated that Hypertension and diabetes have highest level of Prevalence of comorbidities in COVID-19.

According to current findings we can make some inferences, Novel Corona Virus SARS-CoV-2 is a biggest health challenge in coming years for the people who have Hypertension and other behavioral and lifestyle disorders.

Some suggestions for systems who are dealing with Novel Corona Virus SARS-CoV-2 need to understand the role of Psychology and Behavioral Health or Mental Health.

1. Increase the involvement of Behavioral medicine in regular health practice
2. Increase the participation of clients in crisis management
3. Fund the researches involved in behavioral health and Mental health
4. Increase the psychoeducation and mental health awareness.

For those who are suffering from Novel Corona Virus SARS-CoV-2

Especially for those who are suffering from hypertension and other related NDCs

1. Take proper sleep
2. Do not get panic
3. If have anxiety ask to your psychologist and Health counselor for better management
4. Take proper mental health support or counselling
5. Do meditation regularly
6. Healthy diets
7. Regular breathing exercise regularly
8. Regular physical exercise

Sources:

Daimon, M., Kamba, A., Murakami, H., Takahashi, K., Otaka, H., Makita, K., ... & Nakaji, S. (2016). Association between pituitary-adrenal axis dominance over the renin-angiotensin-aldosterone system and hypertension. The Journal of Clinical Endocrinology & Metabolism, 101(3), 889-897.

Sanyaolu, A., Okorie, C., Marinkovic, A., Patidar, R., Younis, K., Desai, P., ... & Altaf, M. (2020). Comorbidity and its Impact on Patients with COVID-19. SN comprehensive clinical medicine, 1-8.

Gold, M. S., Sehayek, D., Gabrielli, S., Zhang, X., McCusker, C., & Ben-Shoshan, M. (2020). COVID-19 and comorbidities: a systematic review and meta-analysis. Postgraduate medicine, 132(8), 749-755.

Lumbers, E. R., Delforce, S. J., Pringle, K. G., & Smith, G. R. (2020). The lung, the heart, the novel coronavirus, and the renin-angiotensin system; the need for clinical trials. Frontiers in medicine, 7, 248.

            ACE Inhibitors: Mechanism of Action, Side Effects and Precautions