At the end of 2019, a novel human virus (SARS-CoV-2) causing severe acute respiratory syndrome (SARS) expanded globally from China. In February 2020, the World Health Organization (WHO) officially named this infectious disease coronavirus disease 2019 (COVID-19), and in March 2020, WHO announced COVID-19 a global pandemic. In June 2020, according to an interactive web-based dashboard to track COVID-19 in real time developed by the Johns Hopkins University Center for Systems Science and Engineering (https://www.eficiens. com/coronavirus-statistics/), more than 7 million people infected with the new coronavirus and more than 400,000 deaths were confirmed around the world. 1 China and European countries have found solutions to manage and reduce the number of daily infections. However, new COVID-19 cases have risen at alarming rates in many other countries, and today Brazil is the third country in number of cases. 2Recently, angiotensin-converting enzyme 2 (ACE2) was identified as an entry receptor for SARS-CoV-2. The binding of the novel coronavirus to ACE2 can reduce (downregulation) the number of ACE2 receptors, causing severe damage to alveolar cells that triggers a series of pulmonary and respiratory reactions that can lead to death. 3,4 ACE2 is part of a complex and integrated metabolic pathway known as the renin-angiotensin-aldosterone system (RAAS), which has been the target of several studies that describe physiological adaptations induced by physical exercise. Thus, given the potential role of ACE2 in the pathophysiology of coronavirus infection, this scientific letter sought to establish a probable relationship between physical exercise and COVID-19 through the RAAS and thereby add a contribution to studies on the management and prevention of COVID-19.
The Pathways of the RAASThe classical pathway of the RAAS is initiated by the release of angiotensinogen by the liver, which, combined with renin secreted by the kidneys, produces angiotensin I (Angio I). Angio I is converted to angiotensin II (Angio II) by the action of the angiotensin-converting enzyme (ACE) in the lungs. The physiological effects of Angio II are mediated primarily through membrane receptors, especially of the Angio II type 1 (AT1) receptor. These receptors, when stimulated, promote vasoconstriction, hypertrophy and hyperplasia of vascular cells, sodium retention, generation of reactive oxygen species (ROS), and inflammatory, thrombotic and fibrotic processes, which can cause tissue damage. 5 A counter-regulatory pathway of the RAAS involves the conversion of Angio II to angiotensin 1-7 (Angio-1-7) and membrane receptors (MAS) through the enzymatic activity of angiotensin-converting enzyme 2 (ACE2), which promotes a vasodilatory, anti-inflammatory, antifibrotic, and anti-proliferative effect on the tissues. 6 Under appropriate physiological conditions, there is a balance between these two RAAS pathways (Figure 1).