Association between COVID-19 and angiotensin-converting enzyme inhibitors with the spotlight on zinc: an opinion

Abstract

In the setting of the raging COVID-19 pandemic, the search for innovative therapeutics is desperately sought after. As we learn more about the characteristics and metabolic health of patients and as our understanding of COVID-19 pathophysiology and treatment progresses, so is our understanding of medication effects that might increase disease severity. As of late, ACE inhibitors have been under investigation for a potential increase in illness severity due to ACE2 upregulation. Given our knowledge of other nutrient-pharmaceutical interactions, could the ACE inhibitor impact on COVID be due to something else? In this paper, we discuss the possibility that ACE inhibitors might be affecting COVID-19 patients by causing zinc insufficiency. KEY MESSAGES Zinc deficiency caused by chronic ACE inhibitor usage may exacerbate the pathogenicity of COVID-19 in susceptible patients. A multi-center study is needed to assess the zinc levels of patients with COVID-19 who are taking ACE inhibitors and other medications that may result in low zinc levels.

Antioxidant, Anti-inflammatory, and Immunomodulatory Roles of Nonvitamin Antioxidants in Anti-SARS-CoV-2 Therapy

“…Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors increase zinc excretion, an aspect relevant for zinc inclusion in therapy. 218 …”

“… 218 A multicenter study is nevertheless required to thoroughly determine the real impact on zinc amounts in COVID-19 patients who are taking ACE inhibitors or other pharmaceuticals likely to result in low zinc amounts. 218 …”

“… 155 Moreover, zinc absorption is promoted by glutathione. 218 , 387 Excessive zinc amounts, exceeding the recommended daily allowances, can convert zinc into a pro-oxidant, with pro-inflammatory and pro-apoptotic effects. The copper deficiency induced by zinc excess may result in impaired expression of copper-dependent enzymes.…”

“…Zinc absorption is promoted by glutathione, citric acid, and in acidic medium and is lowered by folate, phytic acid, gallic acid, or tannins. Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors increase zinc excretion, an aspect relevant for zinc inclusion in therapy …”

“…Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors increase zinc excretion, an aspect relevant for zinc inclusion in therapy. 218 Copper exerts a significant role in the immune function, as it is involved in production and differentiation of immune cells. It promotes T-cell proliferation and natural killer cells' activation.…”