The Relation between ACE Gene Polymorphism and the Severity of COVID-19 Infection

Abstract

Introduction. The coronavirus disease 2019 (COVID-19) pandemic, which emerged in China at the end of 2019, rapidly spread worldwide. The angiotensin-converting enzyme (ACE) gene contains an insertion/deletion (I/D) polymorphism that leads to a higher serum ACE level which is associated with several diseases and also with a high mortality rate in SARS. Therefore, this study aimed at assessing the association between ACE gene polymorphism and the risk and severity of COVID-19 disease in patients. Methodology. Forty-five SARS-CoV-2 infected patients and another random control group of 45 healthy individuals were included. The detection of ACE I/D gene polymorphism in both groups was done by PCR. Results. 53% of infected patients with SARS-CoV-2 had an ACE deletion/deletion genotype (D/D), 27% had an ACE deletion/insertion genotype (D/I), and 20% had an ACE insertion/insertion genotype (I/I). On the one hand, the D/D variant was significantly detected in the COVID-19 patients compared to the control subjects, whereas the I/I variant was significantly detected in the control subjects compared to the COVID-19 patients ( p = 0.004). The D/D variant subgroup showed the lowest lymphocytic count compared to the D/I or I/I subgroups. In addition, the C-reactive protein was significantly higher and the oxygen saturation was significantly lower in patients with the D/D allele compared to the other subgroups. Conclusions. ACE gene polymorphism, particularly the DD genotype, was observed to affect the severity of COVID-19 infection.

Endotheliopathy in Acute COVID-19 and Long COVID

“…ACE genotypes have been also linked to an increased risk for severe COVID-19 disease [248]. Most studies agree that a higher link exists between the ACE deletion/deletion (D/D) genotype and severe COVID-19 [246,249,250].…”

The Impact of ACE Gene Variants on Acute-Phase Reactants in Children with Rheumatic Heart Disease

“…In complicated cases with COVID-19, D-dimer levels were significantly higher in patients with D/D and I/D genotypes, indicating a potential biomarker of poor disease outcome [41]. In addition, COVID-19 severity was associated with the ACE D/D genotype and with high CRP levels [42]. Moreover, the I/D polymorphism was reported to show sexual dimorphism in young adults, with the DD genotype associated with higher maximal fat oxidation values than the ID/II genotype in men, and the ID/II genotype having higher maximal fat oxidation values in women [43].…”