Blood ACE2 Protein Level Correlates with COVID-19 Severity

Abstract

ACE2's impact on the severity of COVID-19 is widely discussed but still controversial. To estimate its role in aspects of the main risk factors and comorbidities, we involved post-COVID-19 patients in Ternopil region (Ukraine). The recruitment period was from July 2020 to December 2021. Medical records, treatment modalities, and outcomes were recorded and analyzed. The serum human ACE2 protein was measured with Cusabio ELISA kits (Houston, TX, USA). Statistical analysis was performed with SPSS21.0 software (SPSS Inc., Chicago, IL, USA). The level of the ACE2 serum protein was significantly higher (p < 0.001) in patients with mild symptoms compared to a more severe course of the disease, and inversely had changed from 1 to 90 days after recovery. In patients with mild COVID-19, ACE2 levels significantly decreased over time, while among critical patients, it increased by 34.1 percent. Such results could be explained by ACE2 shedding from tissues into circulation. Loss of the membrane-bound form of the enzyme decreases the virus' entry into cells. Our studies did not identify a sex-related ACE2 serum level correlation. The most common comorbidities were hypertension, cardiovascular diseases, respiratory diseases, and diabetes mellitus. All abovementioned comorbidities except respiratory diseases contribute to the severity of the disease and correlate with ACE2 blood serum levels.

Keywords: ACE2; COVID-19; comorbidity; post-COVID-19 patients; severity.

Figure 1

The distribution of patients according to severity of COVID-19 and BMI index (χ² = 61.23; p < 0.001, χ²—Pearson Chi-square test). *—The indices were significantly different compared to HQM group, p < 0.05. HQM—Home Quarantined with Mild COVID-19 course, HMO—Hospitalized with Moderate course, HSV—Hospitalized oxygen-dependent patients with Severe symptoms, HCR—Hospitalized Critical patients in ICU departments with artificial ventilation.

Figure 2

ACE2 serum protein levels in obese patients (Median, ng/mL) in different COVID-19 severity groups. *—significantly different compared to HQM group, p < 0.05. #—significantly different compared to HMO group, p < 0.05. HQM—Home Quarantined with Mild COVID-19 course. HMO—Hospitalized with Moderate course. HSV—Hospitalized oxygen-dependent patients with Severe symptoms. HCR—Hospitalized Critical patients in ICU departments with artificial ventilation.