SARS-CoV-2 and Skin: New Insights and Perspectives

Abstract

The SARS-CoV-2 pandemic has disrupted global health systems and brought the entire globe to its knees. Although born as a disease of the respiratory system, COVID-19 can affect different parts of the body, including the skin. Reports of ongoing skin manifestations of COVID-19 have gradually multiplied, pushing researchers to investigate the etiopathogenic mechanisms underlying these phenomena in more depth. In an attempt to investigate the possible association between SARS-CoV-2, ACE2, TMPRSS2 and skin manifestations, we performed immunohistochemical investigations of the ACE2 receptor and TMPRSS2 in nine skin samples from SARS-CoV-2-positive patients compared to a cohort of healthy controls. Furthermore, after consulting public databases regarding ACE2 mRNA expression in various cell populations resident in the skin, we conducted a literature review aimed at outlining the current state of this topic. We did not find statistically different immuno-expression of ACE2 and TMPRSS2 between the group of SARS-CoV-2-positive patients (nine skin biopsies) and the control group. Regarding ACE2, major immunolabeling was present in the epidermal keratinocytes and, rarely, in the fibroblasts and in the adenomeres of the eccrine sweat glands. Regarding the immune expression of TMPRSS2, we found no significant differences between the two groups, with a weak immune staining only in some skin cytotypes. From the review of the literature, we isolated 35 relevant articles according to the inclusion criteria adopted. ACE2 appears to be a target of SARS-CoV-2, although, other receptor molecules may potentially be implicated, such as TMPRSS2. Future studies with large cases and different molecular investigative methods are needed to further elucidate the mechanisms underlying the skin manifestations of SARS-CoV-2.

Extracellular Vesicle-Based SARS-CoV-2 Vaccine

“…However, it does exist in the S protein of SARS-CoV-2, and owing to the cleavage by furin, the S protein binds ACE2 strongly and spreads infection. (ii) Entry: After the S protein binds to the ACE2 receptor, an enzyme called TMPRSS2, a type II transmembrane serine protease, on the cell surface cleaves part of the S protein, altering its binding [ 7 , 40 , 41 ]. This triggers the fusion of the viral envelope with the cell membrane, allowing it to enter the cell.…”

Effects of Vitamin D on the Renin–Angiotensin System and Acute Childhood Pneumonia

“…The numerous effects of the RAS suggest that its regulation could be very useful in infectious diseases, such as bacterial pneumonia [ 31 ]. Finally, disorders of the RAS can be caused by viral [ 32 , 33 , 34 ] or neoplastic diseases, such as those affecting the kidneys [ 35 ] or multiple organs [ 36 , 37 ].…”

“GONE WITH THE WIND”: The Transitory Effects of COVID-19 on the Gynecological System

“…The main symptoms of coronavirus COVID-19 are of a respiratory nature (fever, cough and dyspnea, acute respiratory syndrome) [ 4 , 5 ], due to its ability to act on pneumocytes II [ 6 ] through the angiotensin-2 receptor (ACE2). However, other complications are also known that can affect the sense of smell [ 7 ], sight (eye pain, redness and conjunctivitis) and the cardiovascular system [ 8 , 9 , 10 ] as well as other districts [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], highlighting how this pathology is now to be considered multiorgan.…”