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?:abstract
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The renin-angiotensin-aldosterone system plays a critical role in COVID-19 pathogenesis 1 The sex difference in the mortality rate and complications of COVID-19, and also the more favorable prognosis of children leads to new hypotheses regarding the protective and harmful factors in the treatment of these patients 2,3 Angiotensin-converting enzyme (ACE) plays a role in innate and adaptive immune responses as well as converting angiotensin and affecting different physiological functions 4 Understanding the expression of ACE on myeloid cells can be helpful in the treatment of infections [ ]to adults, children have a higher level of ACE 4 Although SARS-CoV-2 binds to ACE2 for entering the host cells, children are more immune against this virus;this is possibly due to a high level of ACE in children and its effects on immune responses 4 Moreover, although children have a higher level of renin, angiotensin, and aldosterone compared with adults and also a higher amount of fluid in their bodies, they have lower blood pressures5;one of the reasons behind this is the high level of angiotensin 1-7 that acts as a vasodilator and anti-inflammatory agent against angiotensin 2 By injecting angiotensin 1-7, the renin-angiotensin-aldosterone axis will become active to prevent a further drop in blood pressure, the ACE level will rise, and the ACE2 level will reduce owing to the accumulation of angiotensin 1-7 8 This means that providing high levels of angiotensin 1-7 and ACE while reducing inflammatory bradykinin will be protective against ACE2, the entry site of the virus into the host cells 8 Finally, the controlled injection of angiotensin 1-7 as a modulator of the renin-angiotensin-aldosterone system and the compensation of a possible drop in blood pressure by infusion of intravenous fluids and alpha agonists may be able to reduce the severity of COVID-19 infection since the host is given an opportunity to induce specific immunity
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