Differential expression of angiotensin-converting enzyme-2 in human paranasal sinus mucosa in patients with chronic rhinosinusitis

Abstract

Objective Severe acute respiratory syndrome coronavirus-2 uses angiotensin-converting enzyme-2 as a primary receptor for invasion. This study investigated angiotensin-converting enzyme-2 expression in the sinonasal mucosa of patients with chronic rhinosinusitis, as this could be linked to a susceptibility to severe acute respiratory syndrome coronavirus-2 infection. Methods Ethmoid sinus specimens were obtained from 27 patients with eosinophilic chronic rhinosinusitis, 18 with non-eosinophilic chronic rhinosinusitis and 18 controls. The angiotensin-converting enzyme-2 and other inflammatory cytokine and chemokine messenger RNA levels were assessed by quantitative reverse transcription polymerase chain reaction. Angiotensin-converting enzyme-2 positive cells were examined immunohistologically. Results The eosinophilic chronic rhinosinusitis patients showed a significant decrease in angiotensin-converting enzyme-2 messenger RNA expression. In the chronic rhinosinusitis patients, angiotensin-converting enzyme-2 messenger RNA levels were positively correlated with tumour necrosis factor-α and interleukin-1β (r = 0.4971 and r = 0.3082, respectively), and negatively correlated with eotaxin-3 (r = −0.2938). Angiotensin-converting enzyme-2 immunoreactivity was mainly localised in the ciliated epithelial cells. Conclusion Eosinophilic chronic rhinosinusitis patients with type 2 inflammation showed decreased angiotensin-converting enzyme-2 expression in their sinus mucosa. Angiotensin-converting enzyme-2 regulation was positively related to pro-inflammatory cytokines, especially tumour necrosis factor-α production, in chronic rhinosinusitis patients.

Chronic Rhinosinusitis and COVID-19

“…Interestingly, given the lower risk for COVID-19 among CRS patients, a differential expression of ACE2 has been hypothesized. Along this line, a reduced expression of ACE2 messenger RNA (mRNA) and protein was observed in CRSwNP respiratory airway epithelial cells, including nasal polyps, 86,[89][90][91][92][93] and in olfactory mucosa 94 compared with noneosinophilic CRS and control subjects. Similar findings were reported in asthmatic patients.…”

Clinical and Laboratory Features of Various Criteria of Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

“…H T S [25,34,35,38,39,41,[43][44][45][46][47]50,51,61]. The risk of bias (methodological quality) was assessed using the Newcastle-Ottawa scale.…”

SARS-CoV-2 Infection (COVID-19) and Rhinologic Manifestation: Narrative Review

“…According to a recently published article, ACE2 expression in the sinonasal mucosa is lower in eosinophilic chronic rhinosinusitis (CRS) patients with type-2 inflammation than in patients with non-eosinophilic CRS or control subjects [ 30 ]. In addition, ACE2 regulation is positively correlated with proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin (IL)-1β in CRS patients, and negatively correlated with eotaxin-3, which chemokines related with eosinophil [ 30 ]. Another study reported that the expression of ACE2 in the sinonasal mucosa is influenced by the CRS endotypes in patients with nasal polyps.…”

“…In nasal epithelial cells, type 1 inflammation increases ACE2 expression, while type 2 inflammation decreases it [ 31 ]. Therefore, CRS type might be related to SARS-CoV-2 transmission, and an understanding of these findings might contribute to the prevention and control of COVID-19 infection [ 30 , 31 ].…”