黑人的SARS-CoV-2死亡率和对血管紧张素-2受体阻滞剂的温度敏感性
SARS-CoV-2 mortality in blacks and temperature-sensitivity to an angiotensin-2 receptor blocker
摘要：
热带气候引起皮肤色素沉着和控制体液体积、含盐量和压力的机制的适应。对于许多远祖迁移到温带气候的人来说，这些适应性被证明是有害的：自然选择减少了色素沉着，出现了对高血压的易感性。现在，一个额外的风险是冠状病毒引起的肺部炎症，这种炎症可能会因先天免疫差异而进一步加剧。高血压和冠状病毒具有共同的血管紧张素转换酶2（ACE 2），其降低血压〈动〉<动>并介导病毒进入。与不太详细的研究一致，一项长期病例报告显示，阻断一级血管紧张素受体引起的血压〈动〉<动>，在临界阻断剂剂量以上，通过进一步的温度依赖性下降得到补充，可能由ACE 2和二级血管紧张素受体介导。温度依赖性表明与热带遗传有关，以及阻断剂对冠状病毒感染进展的影响。积极的治疗结果应该来自于否定由主要血管紧张素受体介导的宿主促炎作用和伴随的由ACE 2通过其他受体介导的抵消抗炎作用的促进。这些影响可能涉及先天免疫系统成分（凝集素补体途径，NAD代谢组）。黑人的脆弱性--更有可能是基于生理而不是社会经济差异--提供了一个重要的线索，可能会指导治疗。
英文摘要：
Tropical climates provoke adaptations in skin pigmentation and in mechanisms controlling the volume, salt-content and pressure of body fluids. For many whose distant ancestors moved to temperate climes, these adaptations proved harmful: pigmentation decreased by natural selection and susceptibility to hypertension emerged. Now an added risk is lung inflammation from coronavirus that may be furthered by innate immune differences. Hypertension and coronavirus have in common angiotensin converting enzyme 2 (ACE2), which decreases blood pressure and mediates virus entry. In keeping with less detailed studies, a long-term case-report shows that decreased blood pressure induced by blocking a primary angiotensin receptor is supplemented, above critical blocker dosage, by a further temperature-dependent fall, likely mediated by ACE2 and secondary angiotensin receptors. Temperature-dependence suggests a linkage with tropical heritage and an influence of blockers on the progress of coronavirus infections. Positive therapeutic results should result from negation of host pro-inflammatory effects mediated by the primary angiotensin receptor and concomitant promotion of countervailing anti-inflammatory effects mediated by ACE2 through other receptors. These effects may involve innate immune system components (lectin complement pathway, NAD metabolome). Black vulnerability - more likely based on physiological than on socioeconomic differences - provides an important clue that may guide treatments.
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