Exploring the Demographics and Clinical Characteristics Related to the Expression of Angiotensin-Converting Enzyme 2, a Receptor of SARS-CoV-2

Abstract

Objective: Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, and has rapidly spread throughout the world. It has been reported that angiotensin-converting enzyme 2 (ACE2) is one of the major cellular entry receptors of SARS-CoV-2; thus, high ACE2 expression may increase susceptibility to infection. Therefore, we analyzed the expression of ACE2 in the blood to identify the individuals who may be susceptible to infection. Methods: In total, 229 subjects were enrolled in this study, and reverse transcription-quantitative polymerase chain reaction and ELISA assay was used to identify the level of ACE2 mRNA expression and ACE2 protein level in the blood. Demographic and clinical characteristics, including age, gender, weight, height, smoking habits, drinking habits, diabetes, and hypertension, were obtained using a face-to-face questionnaire. Independent Student's t-test, Pearson's linear correlation, logistic regression analysis, and multiple linear regression correlation were performed to assess the association between these factors and the expression of ACE2. Results: Higher level of ACE2 was observed in females, older subjects, subjects with hypertension, subjects with a cardiocerebrovascular disease, male smokers, and subjects with cancer (p < 0.05) than in other subjects. Multiple linear regression analysis showed that there is a statistically significant correlation between being a female and ACE2 expression (β = 0.550, p < 0.001), between older age and ACE2 expression (β = 0.197, p = 0.003), between smoking and ACE2 expression (β = 0.163, p = 0.037), and between cancer and ACE2 expression (β = 0.265, p < 0.001). Logistic regression analysis revealed that female subjects (odds ratio [OR] = 2.255, 95% confidence interval [CI] = 1.770-2.872), subjects with hypertension (OR = 1.264, 95% CI = 1.075-1.486), subjects with a cardiocerebrovascular disease (OR = 1.271, 95% CI = 1.023-1.579), subjects with cancer (OR = 1.695, 95% CI = 1.253-2.293), and subjects above 60 years of age (OR = 3.097, 95% CI = 1.078-8.896) are at an increased risk of infection due to their high expression of ACE2. Li et al. ACE2 Among Different Demographic Characteristics Conclusion: The level of ACE2 is higher in females, older subjects, smokers, and subjects with cancer than in other subjects, indicating that some of which are at higher risk for the severe forms of COVID-19 when they are exposed to the SARS-Cov-2.

Tobacco use as a well-recognized cause of severe COVID-19 manifestations

“…Most studies indicated that COVID-19 patients with COPD or smokers have an increased expression of ACE2 in bronchial epithelial cells in the respiratory tract as compared with healthy subjects [17][18][19][20][21][22][23].…”

Factors associated with SARS-CoV-2 transplacental transmission

“…Placental tissue was sampled as described above and used to measure the expression of SARS-CoV-2 receptors: ACE2 (Abcam; Discovery Drive, Cambridge, United Kingdom) and TMPRSS2 (Aviva Systems Biology, San Diego, CA) were assayed using commercial highly specific enzyme-linked immunosorbent assay kits validated for human tissue extracts. 19,20 Their inter-assay and intra-assay coefficients of variation were <12% and <10%, respectively. ACE2 and TMPRSS2 concentrations were corrected for the total protein content in each sample, measured by a colorimetric kit detecting copper reduction by proteins using bicinchoninic acid (Thermo Fisher, Waltham, MA).…”

Role of Vitamin D, ACE2 and the Proteases as TMPRSS2 and Furin on SARS-CoV-2 Pathogenesis and COVID-19 Severity

“…Li S, et al ( 27 ) reported that increased levels of sACE2 and ACE2 gene expression were found in female and elderly patients, but another study by Muus C, et al ( 28 ) found increased levels of ACE2 gene expression in male and elderly patients. However, our study showed no difference between the patients’ gender and both levels of sACE2 and ACE2 gene expression ( p = 0.074 and p = 0.741, respectively), but a significant decrease was found in both serum ACE2 and ACE2 gene expression levels as patients aged (both p <0.001) ( Figure 2 ).…”