AccScience Publishing / MI / Online First / DOI: 10.36922/MI025500131
REVIEW ARTICLE

Long COVID: The roles of magnesium and angiotensin-converting enzyme 2

Patrick W. Chambers1*
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1 Department of Pathology, Torrance Memorial Medical Center, Torrance, California, United States of America
Received: 8 December 2025 | Revised: 12 January 2026 | Accepted: 20 January 2026 | Published online: 19 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The functions of magnesium (Mg) and angiotensin-converting enzyme 2 (ACE2) in lowering blood pressure are well known; however, their roles in long COVID (LC) remain unclear. This review proposes a hypothetical model that mechanistically links symptoms of LC to: (i) deficiencies in essential ACE2-dependent neutral amino acids, including tryptophan and methionine; (ii) altered Mg-dependent one-carbon metabolism; (iii) altered Mg-dependent autophagy; and (iv) altered Mg-dependent mechanistic target of rapamycin (mTOR) signaling, potentially modulated by rapamycin. Mg and vitamin D deficiency are linked to LC. All forms of vitamin D, including its cutaneous precursor, are Mg-dependent. Accordingly, Mg is proposed as an essential factor in the prevention and/or attenuation of LC. The SARS-CoV-2 virus targets ACE2-expressing cells, leading to the downregulation of ACE2 function. ACE2 and sodium-dependent neutral amino acid transporter are required for the absorption of tryptophan, methionine, and branched-chain amino acids, all of which are low in LC. Loss of ACE2 negatively impacts the Mg-dependent serotonin pathway, the Mg-dependent indole pathway, and the methionine-dependent one-carbon metabolism. Autophagy and mTOR kinase are Mg-dependent. Additionally, individuals carrying the methylenetetrahydrofolate reductase 677T allele—which is prevalent in many populations—may exhibit further impairment in one-carbon metabolism. Gut dysbiosis, present in almost 75% of long haulers, may enable Candida overgrowth. Candidalysin has been shown to upregulate mTOR and inhibit autophagy, similar to mechanisms employed by several viruses, including SARS-CoV-2, and may contribute to chronic fatigue. Although numerous linkages are outlined, this mechanistic model is hypothetical, and causal relationships require validation through clinical studies.

Keywords
Magnesium
Tryptophan
Methylation
Mechanistic target of rapamycin
Autophagy
Rapamycin
Funding
None.
Conflict of interest
The author declares he has no competing interests.
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Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing