부산대학교 도서관

Few stories in the history of medical research can generate interest and inspire as much as the mythical journey from ‘Poison to Panacea’. When Ferreira travelled from Santiago to London to work in the laboratory of Sir John Vane, he could not have imagined that a bite from Bothrops jararaca, a Brazilian viper, could give rise to angiotensin-converting enzyme (ACE) inhibitors, which to date have arguably the strongest portfolio of placebo-controlled trials in medicine. After the discovery of these drugs, the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) I was conducted and proved pivotal in the practice of cardiology. CONSENSUS I gave both hope and belief—hope that breathless patients with advanced congestive heart failure (CHF) could be treated with a drug that can impact significantly the natural history of the disease, and belief that a new class of medicine had finally arrived as a result of this study and of many subsequent others that have shown that ACE inhibitors have a demonstrable efficacy in patients with left ventricular dysfunction with or without CHF symptoms, in those after an acute myocardial infarction, and even in the prevention of myocardial infarction and its associated sequelae in the context of primary or secondary prevention. Treatment of all these patients is supported by both American and European guidelines, expert opinion, and convincing clinical trials. It is a practical first-line recommendation to all clinicians, healthcare providers, and policymakers to mirror the details of the main trials as much as possible with regard to the drug, dosage, and frequency of administration. This chapter describes the journey of the ACE inhibitor drug class from its origins—the poisonous venom of the Brazilian pit viper Bothrops Jararaca to its use (rather than non-use) during the actual Covid-19 pandemic.