Angiotensin-converting enzyme 2 connects COVID-19 with cancer and cancer immunotherapy

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than two million deaths. Underlying diseases, including cancer, are high-risk factors for severe COVID-19 outcomes. Angiotensin-converting enzyme 2 (ACE2), as a SARS-CoV-2 host cell receptor, plays a crucial role in SARS-CoV-2 invading human cells. ACE2 also has significant associations with cancer. Recent studies showed that ACE2 was inversely correlated with the activities of multiple oncogenic pathways and tumor progression phenotypes, and was positively correlated with antitumor immune response and survival prognosis in diverse cancers, suggesting a potential protective role of ACE2 in cancer progression. Positive expression of ACE2 is also correlated with programmed death-ligand 1 (PD-L1) in cancer. The positive associations of ACE2 expression with antitumor immune signatures and PD-L1 expression indicate that ACE2 expression is a positive predictor for the response to immune checkpoint inhibitors (ICIs). This was evidenced in multiple cancer cohorts treated with ICIs. Thus, ACE2 may build potential connections between COVID-19 and cancer and cancer immunotherapy. The potential connections suggest that ACE2 inhibitors may not be a good option for treating COVID-19 patients with cancer, particularly in cancer patients who are receiving immunotherapy. Furthermore, the relationships between ACE2, COVID-19, and cancer are worth confirming by more experimental and clinical data, considering that many cancer patients are at high risk for COVID-19.