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COMMENTARY
Angiotensin receptor blockers as tentative SARS-CoV-2
therapeutics
David Gurwitz
Department of Human Molecular Genetics and
Biochemistry, Sackler Faculty of Medicine, Tel-
Aviv University, Tel-Aviv, Israel
Correspondence
David Gurwitz, Department of Human
Molecular Genetics and Biochemistry, Sackler
Faculty of Medicine, Tel-Aviv University, Tel-
Aviv 69978, Israel.
Email: gurwitz@post.tau.ac.il
Abstract
At the time of writing this commentary (February 2020), the coronavirus COVID-19
epidemic has already resulted in more fatalities compared with the SARS and MERS
coronavirus epidemics combined. Therapeutics that may assist to contain its rapid
spread and reduce its high mortality rates are urgently needed. Developing vaccines
against the SARS-CoV-2 virus may take many months. Moreover, vaccines based on
viral-encoded peptides may not be effective against future coronavirus epidemics, as
virus mutations could make them futile. Indeed, new Influenza virus strains emerge
every year, requiring new immunizations. A tentative suggestion based on existing
therapeutics, which would likely be resistant to new coronavirus mutations, is to use
available angiotensin receptor 1 (AT1R) blockers, such as losartan, as therapeutics for
reducing the aggressiveness and mortality from SARS-CoV-2 virus infections. This
idea is based on observations that the angiotensin-converting enzyme 2 (ACE2) very
likely serves as the binding site for SARS-CoV-2, the strain implicated in the current
COVID-19 epidemic, similarly to strain SARS-CoV implicated in the 2002–2003
SARS epidemic. This commentary elaborates on the idea of considering AT1R
blockers as tentative treatment for SARS-CoV-2 infections, and proposes a research
direction based on datamining of clinical patient records for assessing its feasibility.
KEYWORDS
angiotensin-converting enzyme 2 (ACE2), AT1R blockers, COVID-19 epidemic, losartan,
SARS-CoV-2
At the time of writing this commentary (February 2020), the death toll
from the COVID-19 epidemic caused by coronavirus SARS-CoV-2,
which emerged in late December 2019 in Wuhan, China (World Health
Organization, 2019), has surpassed the combined death toll of the
SARS (Severe Acute Respiratory Syndrome) epidemic of 2002–2003
and the MERS (Middle East Respiratory Syndrome) epidemic of 2013
combined (Mahase, 2020). This epidemic seems to be spreading at an
exponential rate, with a doubling period of 1.8 days, and there are
fears that it might progress to pandemic scales (Cheng & Shan, 2020).
Yet, no SARS-CoV-2 therapeutics are presently available, albeit some
treatment options which await validation have been published, includ-
ing several broad spectrum antivirals such as favipiravir and remdesivir
(Beigel et al., 2019, Li & De Clercq, 2020), the anti-malaria drug chloro-
quine (Gao, Tian, & Yang, 2020), and a traditional Chinese herbal
formula (Luo et al., 2020). The ultimate solution is, obviously, develop-
ing a SARS-CoV-2 vaccine (Patel et al., 2020; Zhang & Liu, 2020).
However, vaccines for the SARS-CoV developed since its outbreak
18 years ago have not materialized to an approved product. This topic
has been reviewed in detail (de Wit, van Doremalen, Falzarano, &
Munster, 2016) and is beyond the scope of this brief commentary. In
addition, there have been concerns about vaccine-mediated enhance-
ment of disease, for example, due to pulmonary immunopathology
upon challenge with SARS-CoV (Tseng et al., 2012). Moreover, even
once a vaccine is approved for human use, high virus mutation rates
mean that new vaccines may need to be developed for each outbreak,
similarly to the situation with new annual influenza vaccines (Belongia
et al., 2017). Below, I describe an alternative option which, if proven to
be effective, would allow a rapid application in the clinic.
Received: 25 February 2020 Accepted: 27 February 2020
DOI: 10.1002/ddr.21656
Drug Dev Res. 2020;81:537–540. wileyonlinelibrary.com/journal/ddr © 2020 Wiley Periodicals, Inc. 537