The role of the renin-angiotensin system, immunological and genetic factors in children with COVID-19 [Роль ренин-ангиотензиновой системы, иммунологических и генетических факторов в реализации COVID-19 у детей]

I. Nikitina, A. Donnikov, O. Krogh-Jensen, A. Lenyushkina, N. Degtyareva, A. Degtyareva,

It is a common fact that children are less susceptible to COVID-19 than adults, and they usually have milder forms often without symptoms, due to the age-related characteristics of their immune response and the features of the renin-angiotensin system (RAS). The recent studies have shown that the RAS elements are widely represented in the lungs, and they actively participate in the inflammation process in addition to their main vasoregulatory function. The cascade of RAS reactions is one of the key links in the pathogenesis of COVID-19, and it is analyzed from two positions: expression of ACE2 receptors and polymorphisms of certain genes of this system. The studies have demonstrated that the ACE2 transmembrane protein is both the “entry gate” for the virus, and it also plays a regulatory role, turning the pro-inflammatory vasoconstrictor angiotensin II into anti-inflammatory angiotensin (1-7) with vasodilating properties. A higher content of ACE2 in children as compared to that in adults maintains the RAS system balance and prevents the development of complications. It has been also found that certain genetic polymorphisms (AGTR1, AGTR2, ACE2, ACE) can cause the imbalance of RAS components, leading to more pronounced reactions of alveolocytes, vascular endothelium and smooth muscle fibers in response to SARS-CoV-2 infection due to a shift of the vasoconstrictor, proliferative and profibrotic mechanisms. The patients with certain genetic polymorphisms of NOS genes regulating vascular tone, cell growth and proliferation may have a genetic predisposition to the development of severe forms of COVID-19. © 2020 National Academy of Pediatric Science and Innovation. All rights reserved.


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  • 1. Version of Record от 2021-04-27


Об авторах
  • I. Nikitina
    Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
  • A. Donnikov
    Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
  • O. Krogh-Jensen
  • A. Lenyushkina
  • N. Degtyareva
  • A. Degtyareva
Название журнала
  • Rossiyskiy Vestnik Perinatologii i Pediatrii
  • 65
  • 4
  • 16-26
Ключевые слова
  • angiotensin converting enzyme 2; angiotensin II; angiotensin[1-7]; nitric oxide synthase; Article; blood vessel tone; cell growth; cell proliferation; child; coronavirus disease 2019; disease predisposition; genetic polymorphism; heredity; human; immune response; immunity; nonhuman; protein expression; renin angiotensin aldosterone system; Severe acute respiratory syndrome coronavirus 2; smooth muscle cell; vascular endothelium; virus entry
  • National Academy of Pediatric Science and Innovation
Тип документа
  • journal article
Тип лицензии Creative Commons
  • CC
Правовой статус документа
  • Свободная лицензия
  • scopus