RAS Peptide Dynamics Predict COVID-19 Respiratory Deterioration and Outcomes
Worsening COVID-19 patients showed progressive RAS activation with rising renin and Ang I, declining ACE activity, and a shift toward the Ang 1-7 pathway, alongside increasing endothelial dysfunction markers.
Quick Facts
What This Study Found
Worsening COVID-19 patients showed rising renin and Ang I (p<0.001), declining Ang II/Ang I ratio (p<0.001), increasing Ang 1-7 (p<0.001), and rising ADMA (p<0.001), with 28-day outcomes predicted by renin, Ang I, Ang 1-7, and ADMA.
Key Numbers
How They Did This
Single-center prospective observational study of 155 hospitalized COVID-19 patients with plasma RAS peptides and ADMA measured at admission (D0) and day 3 (D3), stratified by WHO respiratory trajectory.
Why This Research Matters
Understanding how RAS peptides change during COVID-19 could improve risk stratification and guide the use of RAS-targeting therapies in critically ill patients.
The Bigger Picture
RAS dysregulation is central to COVID-19 pathophysiology. This study maps how specific RAS peptides change as disease progresses, informing therapeutic strategies targeting the RAS system.
What This Study Doesn't Tell Us
Single-center. Observational design. Only two timepoints measured. Cannot determine if RAS changes drive disease or result from it.
Questions This Raises
- ?Could early RAS peptide profiles guide ACE inhibitor decisions in COVID-19?
- ?Is the shift toward Ang 1-7 protective or simply a marker of severity?
- ?Would continuous RAS monitoring improve COVID-19 patient management?
Trust & Context
- Key Stat:
- 57% worsened Patients who deteriorated showed distinctive RAS peptide activation patterns detectable by day 3 of hospitalization
- Evidence Grade:
- Prospective observational study with serial biomarker measurements. Well-designed for biomarker discovery, though causal relationships remain unclear.
- Study Age:
- Published in 2025.
- Original Title:
- Renin-angiotensin system activation and oxidative stress in hospitalized COVID-19 patients: a single-centre prospective observational study.
- Published In:
- Intensive care medicine experimental, 14(1), 15 (2026)
- Authors:
- Eleuteri, Davide, Del Tedesco, Filippo, Silvia, Federico, Tucciariello, Caterina, Ruggiero, Ersilia, Gervasoni, Jacopo, Santucci, Lavinia, Primiano, Aniello, Petrucci, Martina, Torelli, Ernico, Cianci, Rossella, Giannarelli, Diana, Cutuli, Salvatore Lucio, De Pascale, Gennaro, Bello, Giuseppe, Maria, Calabrese, Masullo, Matteo, Urbani, Andrea, Di Santo, Riccardo, Antonelli, Massimo, Montini, Luca
- Database ID:
- RPEP-15139
Evidence Hierarchy
Frequently Asked Questions
How do RAS peptides relate to COVID-19?
The virus that causes COVID-19 enters cells through ACE2, part of the RAS system. This study shows that as COVID-19 worsens, the RAS system becomes progressively dysregulated, with specific peptide changes that predict who will deteriorate.
Could measuring these peptides help treat COVID patients?
Possibly. If doctors could identify patients whose RAS system is becoming dysregulated early, they could adjust treatment accordingly — potentially using or avoiding RAS-targeting medications based on individual peptide profiles.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-15139APA
Eleuteri, Davide; Del Tedesco, Filippo; Silvia, Federico; Tucciariello, Caterina; Ruggiero, Ersilia; Gervasoni, Jacopo; Santucci, Lavinia; Primiano, Aniello; Petrucci, Martina; Torelli, Ernico; Cianci, Rossella; Giannarelli, Diana; Cutuli, Salvatore Lucio; De Pascale, Gennaro; Bello, Giuseppe; Maria, Calabrese; Masullo, Matteo; Urbani, Andrea; Di Santo, Riccardo; Antonelli, Massimo; Montini, Luca. (2026). Renin-angiotensin system activation and oxidative stress in hospitalized COVID-19 patients: a single-centre prospective observational study.. Intensive care medicine experimental, 14(1), 15. https://doi.org/10.1186/s40635-026-00857-w
MLA
Eleuteri, Davide, et al. "Renin-angiotensin system activation and oxidative stress in hospitalized COVID-19 patients: a single-centre prospective observational study.." Intensive care medicine experimental, 2026. https://doi.org/10.1186/s40635-026-00857-w
RethinkPeptides
RethinkPeptides Research Database. "Renin-angiotensin system activation and oxidative stress in ..." RPEP-15139. Retrieved from https://rethinkpeptides.com/research/eleuteri-2026-reninangiotensin-system-activation-and
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.