Angiotensin II Promotes SARS-CoV-2 Infection via Upregulation of ACE2 in Human Bronchial Cells

Blockers of the renin‐angiotensin system (RAS) have been reported to increase the angiotensin converting enzyme (ACE)2, the cellular receptor of SARS‐CoV‐2, and thus the risk and course of COVID‐19. Therefore, we investigated if angiotensin (Ang) II and RAS blockers affected ACE2 expression and SARS‐CoV‐2 infectivity in human epithelial bronchial Calu‐3 cells. By infectivity and spike‐mediated cell–cell fusion assays, we showed that Ang II acting on the angiotensin type 1 receptor markedly increased ACE2 at mRNA and protein levels, resulting in enhanced SARS‐CoV‐ 2 cell entry. These effects were abolished by irbesartan and not affected by the blockade of ACE‐1‐ mediated Ang II formation with ramipril, and of ACE2‐ mediated Ang II conversion into Ang 1‐7 with MLN‐4760. Thus, enhanced Ang II production in patients with an activated RAS might expose to a greater spread of COVID‐19 infection in lung cells. The protective action of Angiotensin type 1 receptor antagonists (ARBs) documented in these studies provides a mechanistic explanation for the lack of worse outcomes in high‐risk COVID‐19 patients on RAS blockers.