COVID-19 Review Volume 12, Issue 23 pp 24453—24461

Role of angiotensin-converting enzyme 2 in neurodegenerative diseases during the COVID-19 pandemic

Zhenyu Li1, *, , Xiaolin Xu2, *, , Meiling Yang1, , Jianping Feng1, , Cunming Liu1, , Chun Yang1, ,

  • 1 Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • 2 Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Wuhan 430030, China
* Equal contribution

Received: June 17, 2020       Accepted: August 15, 2020       Published: November 10, 2020
How to Cite

Copyright: © 2020 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) uses the angiotensin-converting enzyme 2 (ACE2) receptor for infecting and spreading in humans. Studies have shown that the widespread expression of ACE2 in human tissues may be associated with organ function damage (e.g., lung, kidney, and stomach) in patients with coronavirus disease 2019 (COVID-19). However, in neurodegenerative diseases, whose pathogenesis is closely related to advanced age, ACE2 plays a neurotrophic and protective role by activating the ACE2/Ang-(1-7)/Mas axis, thus inhibiting cognitive impairment. Early reports have revealed that the elderly are more susceptible to COVID-19 and that elderly patients with COVID-19 have faster disease progression and higher mortality. Therefore, during the COVID-19 pandemic, it is crucial to understand the role of ACE2 in neurodegenerative diseases. In this paper, we review the relationship between COVID-19, neurodegenerative diseases, and ACE2, as well as provide recommendations for the protection of elderly patients with neurodegenerative diseases during the COVID-19 pandemic.


Aβ: amyloid-β; ACE2: angiotensin-converting enzyme 2; AD: alzheimer’s disease; Ang: angiotensin; AT1R: angiotensin type 1 receptor; CFR: case fatality rate; COVID-19: coronavirus disease 2019; MS: multiple sclerosis; NSCs: neural stem cells; PD: parkinson’s disease; RAS: renin-angiotensin system; rhACE2: recombinant human angiotensin-converting enzyme 2; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; S: spike.