COVID-19 Clinical Trial
Official title:
Efficacy of Captopril Nebulization in Covid-19 Patients Suffering of SARS CoV-2 Pneumonia. A Randomized Phase II Study
Captopril being an effective drug available in liquid preparation, administration by nebulization could be of interest for maximizing lung action and minimizing systemic side effects. Such a treatment might be used for "Covid-19" patients with pneumonia in order to avoid ARDS.
Coronavirus Disease 2019 (COVID-19) is due to SARS-CoV-2 infection. The main cause of death
is refractory acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 pneumonia.
The SARS-CoV-2 may have specific virulence factors to achieve mortality rates around 3%. As
the SARS-CoV, virus responsible of the Severe Acute Respiratory Syndrome in 2003 (which
mortality was around 10%), the SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as the
receptor binding domain for its spike protein making ACE2 the gateway in the alveolar
epithelial cells1. Angiotensin-converting enzyme (ACE) and ACE2 are known to be present in
respiratory epithelium and to have antagonist physiological functions. ACE2 has an
anti-inflammatory, anti-fibrosing role, anti-oxydant and vasodilatator activity, while ACE
has the opposite characteristics. These two enzymes have a negative control on each other,
one inhibiting the other. Demonstrated that SARS-CoV is responsible of a downregulation of
ACE2 functions by using ACE2 as cell receptor2. While ACE2 is downregulated, ACE activity
increase leading to more alveolar damage and acute respiratory failure.
ACE inhibitors are common drugs used to treat hypertension worldwide. Using an ACE inhibitor
as treatment against SARS-CoV-2 could be counter-intuitive because increasing ACE2 expression
would open the cellular gate to the virus3,4. However, ACE2 was described as protecting lung
injury2, leading Recombinant Human ACE2 as a perspective for SARS-CoV-2 treatment.
A simple way to increase ACE2 in patients with SARS-CoV-2 pneumonia could be an inhalation of
ACE inhibitor.
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