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Evaluation of COVID-19 based on ACE2 expression in normal and cancer patients
Peng Ren1, Caifeng Gong2, Shaohua Ma1
1Department of Thoracic Surgery, Peking University Third Hospital, Beijing, 100191, China.
Abstract:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is now a serious public health problem. Angiotensin-converting enzyme 2 (ACE2) recognized as the receptor of SARS-CoV is also necessary for SARS-CoV-2. However, the impact of ACE2 on SARS-CoV-2 susceptibility and the situation of malignant tumor patients in this outbreak are unclear. So, it is important to understand the expressions of ACE2 in different normal tissues and cancers. The results showed that the kidneys, duodenum, intestine, gallbladder and testis had the highest ACE2 expressions, followed by the colon, rectum and seminal vesicles. The lungs had a very low expression. ACE2 expressions were upregulated in renal cancer, gastrointestinal tumor and lung cancer. ACE2 expression levels may affect SARS-CoV-2 infection and severity. A total of 3,421 cases with COVID-19 have been collected. Among them, 43 cases (1.26%) had malignant tumor coexisting conditions. The rate of severe events for malignant tumor patients was 39.02% (16/41), while the rate of severe events for all patients was 10.79% (194/1,798). The clinical symptoms and signs were studied for the following three systems: respiratory (31-92%), digestive (10-13%) and urinary systems (3.38%). It seems that symptom severity is not related to protein expression levels. This might be the reason for SARS-CoV-2 showing higher regeneration index and susceptibility. More research is needed to explore the mechanisms and treatments.
Insights
Angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV-2 entry. While ACE2 expression varies by tissue, its upregulation in cancers like renal and gastrointestinal tumors may influence COVID-19 severity in cancer patients.
Area of Science:
- Oncology
- Virology
- Public Health
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a significant global health threat.
- Angiotensin-converting enzyme 2 (ACE2) is identified as the primary receptor for SARS-CoV-2 entry into host cells.
- The role of ACE2 expression in SARS-CoV-2 susceptibility and the clinical outcomes for cancer patients remain incompletely understood.
Purpose of the Study:
- To investigate the expression patterns of ACE2 in various normal human tissues and different types of cancer.
- To analyze the correlation between ACE2 expression levels and SARS-CoV-2 infection susceptibility and severity.
- To assess the clinical characteristics and outcomes of COVID-19 patients with coexisting malignant tumors.
Main Methods:
- Analysis of ACE2 expression data across normal tissues and cancer types.
- Retrospective collection and analysis of clinical data from 3,421 COVID-19 patients, including a subgroup with concurrent cancer.
- Comparison of severe event rates and clinical symptoms between cancer patients and the general COVID-19 population.
Main Results:
- Highest ACE2 expression observed in kidneys, duodenum, intestine, gallbladder, and testis; lungs showed low expression.
- ACE2 expression was upregulated in renal, gastrointestinal, and lung cancers.
- Malignant tumor patients had a higher rate of severe COVID-19 events (39.02%) compared to the overall patient cohort (10.79%).
- Clinical symptom severity did not appear directly correlated with ACE2 protein expression levels.
Conclusions:
- ACE2 expression patterns in normal tissues and cancers may influence SARS-CoV-2 infection dynamics.
- Cancer patients exhibit a disproportionately higher risk of severe outcomes from COVID-19.
- Further research is warranted to elucidate the underlying mechanisms and develop targeted therapeutic strategies.
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