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Reduced expression of COVID-19 host receptor, ACE2 is associated with small bowel inflammation, more severe disease, and response to anti-TNF therapy in Crohn's disease

By Alka A Potdar, Shishir Dube, Takeo Naito, Gregory Botwin, Talin Haritunians, Dalin Li, Shaohong Yang, Janine Bilsborough, Lee A. Denson, Mark J Daly, Stephan R Targan, Phillip Fleshner, Jonathan Braun, Subra Kugathasan, Thaddeus S. Stappenbeck, Dermot P B McGovern

Posted 23 Apr 2020
medRxiv DOI: 10.1101/2020.04.19.20070995

Angiotensin-Converting Enzyme 2 (ACE2) has been identified as the host receptor for SARS-coronavirus 2 (SARS-CoV-2) which has infected millions world-wide and likely caused hundreds of thousands of deaths. Utilizing transcriptomic data from four cohorts taken from Crohn's disease (CD) and non-inflammatory bowel disease (IBD) subjects, we observed evidence of increased ACE2 mRNA in ileum with demographic features that have been associated with poor outcomes in COVID-19 including age and raised BMI. ACE2 was downregulated in CD compared to controls in independent cohorts. Within CD, ACE2 expression was reduced in inflamed ileal tissue and also remarkably, from uninvolved tissue in patients with a worse prognosis in both adult and pediatric cohorts. In active CD, small bowel ACE2 expression was restored by anti-TNF therapy particularly in anti-TNF responders. Collectively our data suggest that ACE2 downregulation is associated with inflammation and worse outcomes in CD.

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