ACE2 polymorphisms interplay with the apelinergic peptide system: potential tools for COVID-19 diagnosis and treatment

ACE2 polymorphisms have been previously linked to increased susceptibility to multiple diseases and are currently linked to SARS CoV-2 susceptibility and complications. Notably, ACE2 transcribed or regulated proteins include the activity of metaloproteinsase-2 and apelin-13 and 36, might be linked to abnormal immune responses and complications. Furthermore, potential genetic or serological tests might be developed to detect the higher vulnerable groups to SARS CoV-2 complications and/or mortality. Furthermore, we hypothesize that diabetic and obese patients suffer from exhausted and/or abnormally functioning apelinergic peptides that predispose them to a higher severe COVID-19 risk. Moreover, infusion of apelin-13 to treat selected critical cases of COVID-19, especially those complaining of refractory advanced heart failure not responding to other drugs, might be considered for clinical trials.