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Andrew M. South and Matthew A. Sparks

Novel therapeutics remain urgently needed to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19), including associated acute kidney injury. Angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 spike protein-binding site, is expressed in numerous tissues, including the lungs and kidneys. Soluble ACE2 is a potential therapeutic with dual roles: 1) binding SARS-CoV-2 to attenuate infection and replication and 2) shifting the renin-angiotensin system away from the pro-inflammatory angiotensin II and bradykinin pathways. There is precedent for using recombinant soluble ACE2 clinically. A pilot randomized clinical trial in 44 patients with acute respiratory distress syndrome (pre-COVID-19