COVID-19 Infection and Circulating ACE2 Levels: Protective Role in Women and Children

Ciaglia, Elena; Vecchione, Carmine; Puca, Annibale Alessandro

doi:10.3389/fped.2020.00206

Cited by 206 publications

(244 citation statements)

References 21 publications

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“…Currently, there is no evidence to suggest that up-regulation of ACE2 is associated with increased COVID-19 susceptibility or severity. In fact, estrogens appear to up-regulate ACE2 while children and younger adults have higher ACE2 levels as compared to older people, which could explain the milder COVID-19 in women and younger people and suggest a protective effect [53,54]. Moreover, the contradictory findings about smoking in the literature, with studies published before the COVID-19 pandemic reporting that smoking and nicotine down-regulate ACE2 [3,4] and other studies published during the pandemic reporting that they up-regulate ACE2 [5][6][7], do not allow for solid conclusions regarding the effects of nicotine or smoking on ACE2.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?

2020

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The effects of smoking on Corona Virus Disease 2019 are currently unknown. The purpose of this study was to systematically examine the prevalence of current smoking among hospitalized patients with COVID-19 in China, considering the high-population smoking prevalence in China (26.6%). A systematic review of the literature (PubMed) was performed on April 1. Thirteen studies examining the clinical characteristics of hospitalized COVID-19 patients in China and presenting data on the smoking status were found. The pooled prevalence of current smoking from all studies was calculated by random-effect meta-analysis. To address the possibility that some smokers had quit shortly before hospitalization and were classified as former smokers on admission to the hospital, we performed a secondary analysis in which all former smokers were classified as current smokers. A total of 5960 patients were included in the studies identified. The current smoking prevalence ranged from 1.4% (95% CI 0.0-3.4%) to 12.6% (95% CI 10.6-14.6%). An unusually low prevalence of current smoking was observed from the pooled analysis (6.5%, 95% CI 4.9-8.2%) as compared to population smoking prevalence in China. The secondary analysis, classifying former smokers as current smokers, found a pooled estimate of 7.3% (95% CI 5.7-8.9%). In conclusion, an unexpectedly low prevalence of current smoking was observed among patients with COVID-19 in China, which was approximately 1/4th the population smoking prevalence. Although the generalized advice to quit smoking as a measure to reduce health risk remains valid, the findings, together with the well-established immunomodulatory effects of nicotine, suggest that pharmaceutical nicotine should be considered as a potential treatment option in COVID-19.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?

2020

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“…The increased incidence of symptomless cases of COVID-19 in children could be related to both exposure and host factors. Children's immune system is not well developed, and it is speculated that maturity and binding ability of ACE2 in children is lower [47]. Additionally, children often experience many viral infections.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic people with SARS-CoV-2 as unseen carriers of COVID-19: A systematic review and meta-analysis

Syangtan

Bista

Dawadi

et al. 2020

Preprint

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Background The asymptomatic patients with SARS-CoV-2 can act as an unseen carrier for magnifying the transmission of COVID-19. Aims This study was designed to appraise the burden of asymptomatic individuals and estimate their occurrence among different age groups and gender by reviewing the existing published data on asymptomatic people with COVID-19. Methods Three electronic databases: PubMed, Embase and Web of Science (WoS) were used to search studies as per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the search was limited to English language. The study population of this review includes asymptomatic individuals infected by COVID-19. All original articles which have reported cases of the COVID-19 patients with no symptoms until 31 April 2020 were included in the study. Random effects model was applied to analyze pooled data on the prevalence of symptomless cases among total COVID-19 infected patients and also on different age groups and gender. Results In the meta-analysis of 16 studies, comprising 2,788 COVID-19 infected patients, the pooled prevalence of asymptomatic cases was 48.2% (95% CI, 30%-67%). Among the asymptomatic patients, 55.5% (95% CI, 43.6%-66.8%) were female and 49.6% (95% CI, 20.5%-79.1%) were children. Conclusion About half of the COVID-19 infected patients were asymptomatic cases. Children and females were more apparent to be asymptomatic patient of COVID-19 and could act as unseen carrier of SARS-CoV-2. Symptom based screening only, might fail to identify all SARS-CoV-2 infections escalating the threat of global spread of SARS-CoV-2. Therefore, mass surveillance system tracking asymptomatic cases is a pressing need of public health, paying special attention to female and young children, which could aid in prevention and containment of this unprecedented pandemic.

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“…The sACE2 arises from proteolytic cleavage of the ectodomain of the membrane bound ACE2 by the metalloproteinase ADAM-17, also known as TNF-α converting enzyme (TACE) 25 . Circulating levels of sACE2 has been shown to be low in children of both sexes, but increases with age, more so in healthy males than in females, so that as adults serum sACE2 is higher in men than in women 26 .…”

Section: Resultsmentioning

confidence: 99%

Oral epithelial expression of angiotensin converting enzyme-2: Implications for COVID-19 diagnosis and prognosis

Srinivasan

Zunt

Goldblatt

2020

Preprint

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The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses the angiotensin converting enzyme (ACE)-2 as the host receptor for target cell entry. The extent and distribution of ACE-2 has been associated with the clinical symptoms of coronavirus disease (COVID)-19.Here we show by immunofluorescence analysis that the ACE2 is abundantly expressed in oral mucosa, particularly in the surface epithelial cells suggesting that these cells could represent sites of entry for SARS-CoV-2. Further, together with the reports on ACE2 ectodomain shedding, we discuss the rationale for the hypothesis that the ACE-2 measurement in saliva could be a marker for COVID-19 infection during early phase following SARS-CoV-2 exposure. Competing interest:The authors declare no competing interest.

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COVID-19 Infection and Circulating ACE2 Levels: Protective Role in Women and Children

Cited by 206 publications

References 21 publications

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?

Asymptomatic people with SARS-CoV-2 as unseen carriers of COVID-19: A systematic review and meta-analysis

Oral epithelial expression of angiotensin converting enzyme-2: Implications for COVID-19 diagnosis and prognosis

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