Data were generated by the Tilley research group. Expression was quantified using Affymetrix HG-U133 Plus 2.0 microarrays.  It was observed that male smokers had significantly higher ACE2 expression in the small airway epithelium (SAE) than female smokers or nonsmokers of either sex (p < 0.005 in each comparison).  

Michigan State University

- Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19)

Clinical imaging data suggest that the small airway epithelium (SAE) in an important SARS-CoV-2 binding site.  
- expression versus nonsmokers
- expression versus nonsmokers by sex

ACE2 Expression in the Airway Epithelium of Smokers

Zhang, H., Rostami, M. R., Leopold, P. L., Mezey, J. G., O'Beirne, S. L., Strulovici-Barel, Y., & Crystal, R. G. (2020). Expression of the SARS-CoV-2 ACE2 Receptor in the Human Airway Epithelium. American Journal of Respiratory and Critical Care Medicine, (ja).
https://www.atsjournals.org/doi/full/10.1164/rccm.202003-0541OC
doi: 10.1164/rccm.202003-0541OC   

Expression of the SARS-CoV-2 ACE2 Receptor in the Human Airway Epithelium

Data were generated by the Tilley research group.  Expression was quantified using Affymetrix HG-U133 Plus 2.0 microarrays.  It was observed that ACE2 expression was significantly increased (p < 0.005) in the small airway epithelium (SAE) of smokers compared to nonsmokers.  

ACE2 Expression is Increased in the Small Airway Epithelium of Smokers vs. Nonsmokers

ACE2 Expression is Increased in the Small Airway Epithelium of Male Smokers vs. Female Smokers and Nonsmokers

- Angiotensin-converting enzyme-2 (ACE2) receptor is the known receptor for SARS-CoV-2 as well as coronavirus NL63

- ACE2 receptor is expressed on the surface of type 2 pneumocytes in the lungs
- In samples taken from patients who smoke, an upregulation of ACE2 receptor could be seen in the airway epithelium

- In particular, ACE2 receptor was expressed at a higher concentration in the pneumocytes, alveolar macrophages, and the apical end of the small airway epithelium in smoking patients compared to non-smoking patients

- Previous observations show that SARS-COV-2 adhesion downmodulates ACE2 enzyme expression, increasing production and activation of other ACE enzymes leading to severe acute respiratory failure

- Overall, it was observed that smoking upregulates ACE2 receptor and this could be true for electronic cigarette users as well

- This upregulation is dangerous as SARS-CoV-2 utilizes this receptor to infect the airway epithelium, leading to severe acute respiratory failure


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