Abstract: TH-PO0338
Alternative Pathway of RAAS Is Basally Overactivated in Patients Diagnosed with Severe COVID-19
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Martínez Díaz, Irene, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- Vilardell, Jordi, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- Nunez-Delgado, Sara, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- García de Frutos, Pablo, Institut d'Investigacions Biomediques de Barcelona, Barcelona, CT, Spain
- Ortiz Pérez, José Tomás, Hospital Clinic de Barcelona, Barcelona, CT, Spain
- Cano Camara, Antonio, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- Llorens Cebrià, Carmen, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- Morales, Albert, Institut d'Investigacions Biomediques de Barcelona, Barcelona, CT, Spain
- Jacobs Cachá, Conxita, Vall d'Hebron Institut de Recerca, Barcelona, CT, Spain
- Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, CT, Spain
Background
Angiotensin-converting enzyme 2(ACE2) is a key factor in maintaining balance in the renin angiotensin aldosterone system(RAAS) and the main cellular receptor for SARS-CoV-2 virus. We hypothesize that an increase in soluble ACE2(sACE2), due to viral entry, could be related to RAAS imbalance in patients with COVID-19 and may have an impact on its severity or associated complications, such as pulmonary thromboembolism(PTE).
Methods
Serum samples were collected during 2020 from a cohort of COVID-19 patients at their first emergency attendance. A RAAS Fingerprint analysis was performed in patients: I)Without ICU admission(n=20);II)Admitted to ICU(n=18);III) Admitted to ICU who developed PTE(n=23). The levels of the different angiotensin peptides were analyzed by mass spectrometry and subrogate markers of ACE activity(ACE-S), ACE2 activity(ALT-S) and renin activity(PRA-S) were calculated. We analyzed the adrenal response by measuring the aldosterone.
Results
Those admitted to the ICU had decreased levels of angiotensin I, II, III and IV, suggesting higher angiotensinogen consumption. PRA-S was decreased and ALT-S was increased in ICU patients compared to non-critically ill patients. No differences were found in ACE-S. Those patients who developed PTE had higher levels of aldosterone as compared to patients who did not develop PTE, suggesting increased adrenal response(Figure 1).
Conclusion
The alternative RAAS pathway was basally increased in patients with severe COVID-19, as we found it in all ICU patients, regardless of PTE. Aldosterone and AA2 ratio were basally increased in patients who developed PTE, possibly due to a basal increase in adrenal response.
Funding
- Government Support – Non-U.S.