Is highly expressed ACE 2 in pregnant women “a curse” in times of COVID-19 pandemic?

Abstract

Angiotensin-converting enzyme 2 (ACE 2) is a membrane-bound enzyme that cleaves angiotensin II (Ang II) into angiotensin (1–7). It also serves as an important binding site for SARS-CoV-2, thereby, facilitating viral entry into target host cells. ACE 2 is abundantly present in the intestine, kidney, heart, lungs, and fetal tissues. Fetal ACE 2 is involved in myocardium growth, lungs and brain development. ACE 2 is highly expressed in pregnant women to compensate preeclampsia by modulating angiotensin (1–7) which binds to the Mas receptor, having vasodilator action and maintain fluid homeostasis. There are reports available on Zika, H1N1 and SARS-CoV where these viruses have shown to produce fetal defects but very little is known about SARS-CoV-2 involvement in pregnancy, but it might have the potential to interact with fetal ACE 2 and enhance COVID-19 transmission to the fetus, leading to fetal morbidity and mortality. This review sheds light on a path of SARS-CoV-2 transmission risk in pregnancy and its possible link with fetal ACE 2.

Effect of SARS‐CoV‐2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study

“…The viral agent responsible for coronavirus disease 2019 (COVID‐19), SARS‐CoV‐2 enters host cells by interacting with the angiotensin‐converting‐enzyme receptor, the levels of which are increased in the pregnant uterus and placenta, making the latter a potential target for the infection 9,10 . This assumption has been subsequently strengthened by the reported increased prevalence of signs of decidual arteriopathy in pregnant women with SARS‐CoV‐2 infection, suggesting a potential connection between infection and impaired placental function 11‐13 .…”

SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies–a narrative review

“…In pregnant women, a 2-fold increase in the expression of ACE2 receptors is observed as in different organs, including the placenta, kidneys, and gravid uterus, compared with the non-pregnant women [ 65 ]. This might also enhance the risk of infection and the severity of the SARS-CoV-2 infection in pregnant women [ 66 ]. However, further studies are required to elucidate this.…”

Highly expressed ACE-2 receptors during pregnancy: A protective factor for SARS-COV-2 infection?

“…The authors concluded that the human placenta is capable of being infected, although the polarized expression of ACE-2 towards the fetal compartment and the scarce expression of TMPRSS2 in trophoblast, remote from maternal blood, may justify the rarity of vertical transmission of COVID-19 [34] . ACE-2 is abundantly present in the heart, lungs, intestine, kidneys, and fetal tissues [35] . In live fetuses, ACE-2 receptors are involved in myocardium growth, lung and brain development [35] .…”