Nicotine and the renin-angiotensin system

Abstract

Cigarette smoking is the single most important risk factor for the development of cardiovascular and pulmonary diseases (CVPD). Although cigarette smoking has been in constant decline since the 1950's, the introduction of e-cigarettes or electronic nicotine delivery systems 10 years ago has attracted former smokers as well as a new generation of consumers. Nicotine is a highly addictive substance, and it is currently unclear whether e-cigarettes are "safer" than regular cigarettes or whether they have the potential to reverse the health benefits, notably on the cardiopulmonary system, acquired with the decline of tobacco smoking. Of great concern, nicotine inhalation devices are becoming popular among young adults and youths, emphasizing the need for awareness and further study of the potential cardiopulmonary risks of nicotine and associated products. This review focuses on the interaction between nicotine and the renin-angiotensin system (RAS), one of the most important regulatory systems on autonomic, cardiovascular and pulmonary functions in both health and disease. The literature presented in this review strongly suggests that nicotine alters the homeostasis of the RAS by up-regulating the detrimental angiotensin converting enzyme (ACE)/Angiotensin (Ang)-II/Ang-II type 1 receptor (ATR) axis and down-regulating the compensatory ACE2/Ang-(1-7)/Mas receptor axis, contributing to the development of CVPD.

Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis

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Cigarette smoke exposure and inflammatory signaling increase the expression of the SARS-CoV-2 receptor ACE2 in the respiratory tract

“…Several contrasting findings exist in the literature on ACE2 and cigarette exposure 76–81 . In particular, it has been reported that nicotine and/or cigarette smoke has the potential to downregulate ACE2 expression in certain tissues or cell types 76–79 . In this manuscript, we focused our analysis on factors affecting ACE2 expression in the mammalian lungs and associated respiratory epithelia.…”

Renin-angiotensin system at the heart of COVID-19 pandemic

“…Smoking habit: cigarette smoking could also interact with susceptibility to SARS-CoV-2 infection. Although chronic lung damage induced by smoking would increase susceptibility to severe forms of viral pneumonia, available literature strongly suggests that nicotine upregulates the detrimental angiotensin-converting enzyme (ACE) but downregulates the compensatory ACE2/ANG-(1-7) receptor axis [21]. Thus, the hypothesis that cigarette smoking is either detrimental or provides a counterintuitive protective effect, warrants specific epidemiologic and clinical studies.…”