[fr] La percée des secrets de l’hypertension artérielle et du système rénine-angiotensine-aldostérone (SRAA) est une des histoires légendaires de la médecine. Les expériences de Tigerstedt sur la rénine, puis le modèle d’hypertension rénale de Loesch et de Gollblatt, constituent un\ premier chapitre. La course pour élucider le mécanisme de l’angiotensine, l’angiotensinogène et l’enzyme de conversion de l’angiotensine par les équipes de Braun Menéndez et de Page est un deuxième chapitre. Le puzzle de cette élégante cascade biochimique se complète par la description de l’aldostérone isolée par les époux Tait avec Tadeus Rechstein, et, comme corollaire, la description par Conn de l’hyperaldostéronisme primaire. La compréhension physiopathologique du SRAA amène naturellement à la synthèse de l’anti-hypertenseur captopril par Ondetti et Cushman, inaugurant l’ère moderne des inhibiteurs de l’enzyme de conversion de l’angiotensine (IEC) et des antagonistes des récepteurs AT1 de l’angiotensine 2 (ARAII ou sartans). En mars 2020, une pandémie virale déclenchée par le SARS-CoV-2 embrase la planète. Ce coronavirus utilise comme porte d’entrée cellulaire l’enzyme de conversion de l’angiotensine 2 (ACE-2) du SRAA. La voie de signalisation SARS-CoV-2/ACE-2 et ses effets, sur les systèmes cardio-respiratoire et rénal, ouvrent un nouveau chapitre. L’interaction de cet axe SARS-Cov-2/ACE-2 avec les antihypertenseurs, mais aussi les activateurs et homologues de l’ACE-2 font objet d’une étude internationale active, à la recherche de cibles thérapeutiques. Cette recherche, que nous synthétisons dans cet article, est destinée à développer notre connaissance sur le SRAA et, nous l’espérons, à améliorer peut-être la prise en charge des patients avec COVID-19. [en] The breakthrough of the secrets of hypertension and the renin-angiotensin-aldosterone system (RAAS) is one of the legends of medicine. The first chapter is the one of Tigerstedt’s experiments about renin, and Loesch and Gollblatt’s model of renal hypertension. The race to elucidate the mechanisms of angiotensin, angiotensinogen and the angiotensin conversion enzyme cascade, by Braun Menéndez and Page teams, is a second chapter. The puzzle of this elegant cascade is completed by aldosterone isolation by the collaboration of Tait spouses and Tadeus Rechstein. As a corollary of these findings, Conn made the first description of primary hyperaldosteronism. The elucidation of RAAS pathophysiology naturally led to the synthesis of the antihypertensive captopril by Ondetti and Cushman, thereby opening the modern era of ACE inhibitors and ARII blockers. In March 2020, a viral pandemic caused by SARS-Cov-2 ignites the entire planet. This new coronavirus uses the RAAS angiotensin conversion enzyme type 2 (ACE-2) as a gateway. The SARS-CoV-2/ ACE-2 signalling pathway and its pathological effects on the cardio-respiratory and renal system of these patients initiate a new chapter. The interaction of SARS-Cov-2/ ACE-2 axis with anti-hypertensive agents, as well as with ACE-2 activators and ACE-2 homologs, takes a part of an active international study searching for therapeutic targets. This modern research, summarized in this article, will further develop our knowledge of RAAS and, hopefully, will improve the management of COVID-19 patients.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
VALDES SOCIN, Hernan Gonzalo ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service d'endocrinologie clinique
JOURET, François ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
VROONEN, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service d'endocrinologie clinique
SCHEEN, André ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de diabétologie, nutrition, maladies métaboliques
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie
Language :
French
Title :
Système rénine-angiotensine-aldostérone : bref historique et questionnements face à la pandémie COVID-19
Alternative titles :
[en] Renin-angiotensin-aldosterone system : brief history and questions related to the COVID-19 pandemic
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