Abstract
BackgroundThe first step in SARS-CoV-2 infection is binding of the virus to angiotensin converting enzyme 2 (ACE2) on the airway epithelium. Asthma affects over 300 million people world-wide, many of whom may encounter SARS-CoV-2. Epidemiologic data suggests that asthmatics who get infected may be at increased risk of more severe disease. Our objective was to assess whether maintenance inhaled corticosteroids (ICS), a major treatment for asthma, is associated with airway ACE2 expression in asthmatics.MethodsLarge airway epithelium (LAE) of asthmatics treated with maintenance ICS (ICS+), asthmatics not treated with ICS (ICS−), and healthy controls (controls) was analyzed for expression of ACE2 and other coronavirus infection-related genes using microarrays.ResultsAs a group, there was no difference in LAE ACE2 expression in all asthmatics vs controls. In contrast, subgroup analysis demonstrated that LAE ACE2 expression was higher in asthmatics ICS+ compared to ICS‾ and ACE2 expression was higher in male ICS+ compared to female ICS+ and ICS‾ of either sex. ACE2 expression did not correlate with serum IgE, absolute eosinophil level, or change in FEV1 in response to bronchodilators in either ICS− or ICS+.ConclusionAirway ACE2 expression is increased in asthmatics on long-term treatment with ICS, an observation that should be taken into consideration when assessing the use of inhaled corticosteroids during the pandemic.
Highlights
The global pandemic coronavirus disease-2019 (COVID19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by high morbidity and mortality, predominantly from respiratory failure [1]
Given that asthma affects over 300 million people, many of whom are on treatment with inhaled corticosteroids and may encounter SARS-CoV-2, we evaluated Large airway epithelium (LAE) angiotensin converting enzyme 2 (ACE2) expression in a cohort of predominantly mild to moderate nonsmoker asthmatics, treated with maintenance ICS (ICS+) vs not treated (ICS−)
Current epidemiologic data suggests that asthmatics who are infected with SARS-CoV-2 may be at increased risk of more severe disease [2, 3]
Summary
The global pandemic coronavirus disease-2019 (COVID19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by high morbidity and mortality, predominantly from respiratory failure [1]. Several studies examined ACE2 expression in asthmatics, including in the nasal, large airway epithelium (LAE) and lung biopsies [10,11,12,13,14,15]. None of these studies directly addressed the effects of chronic use of ICS on airway ACE2 expression in asthmatics. Given that asthma affects over 300 million people, many of whom are on treatment with inhaled corticosteroids and may encounter SARS-CoV-2, we evaluated LAE ACE2 expression in a cohort of predominantly mild to moderate nonsmoker asthmatics, treated with maintenance ICS (ICS+) vs not treated (ICS−). Methods: Large airway epithelium (LAE) of asthmatics treated with maintenance ICS (ICS+), asthmatics not treated with ICS (ICS−), and healthy controls (controls) was analyzed for expression of ACE2 and other coronavirus infectionrelated genes using microarrays
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