The contrasting role of nasopharyngeal angiotensin converting enzyme 2 (ACE2) transcription in SARS-CoV-2 infection : A cross-sectional study of people tested for COVID-19 in British Columbia, Canada
Creators: name: Nikiforuk, Aidan
name: Kuchinski, Kevin
name: Twa, David D. W.
name: Lukac, Christine
name: Sbihi, Hind
name: Basham, C. Andrew
name: Steidl, Christian
name: Prystajecky, Natalie
name: Jassem, Agatha
name: Krajden, Mel
name: Patrick, David, (Physician)
name: Sekirov, Inna
Publisher: name: Elsevier
Year: 2021

description: Background: Angiotensin converting enzyme 2 (ACE2) protein serves as the host receptor for SARS-CoV-2, with a critical role in viral infection. We aim to understand population level variation of nasopharyngeal ACE2 transcription in people tested for COVID-19 and the relationship between ACE2 transcription and SARSCoV-2 viral load, while adjusting for expression of: (i) the complementary protease, Transmembrane serine protease 2 (TMPRSS2), (ii) soluble ACE2, (iii) age, and (iv) biological sex. The ACE2 gene was targeted to measure expression of transmembrane and soluble transcripts. Methods: A cross-sectional study of n = 424 “participants” aged 1 104 years referred for COVID-19 testing was performed in British Columbia, Canada. Patients who tested positive for COVID-19 were matched by age and biological sex to patients who tested negative. Viral load and host gene expression were assessed by quantitative reverse-transcriptase polymerase chain reaction. Bivariate analysis and multiple linear regression were performed to understand the role of nasopharyngeal ACE2 expression in SARS-CoV-2 infection. Findings: Analysis showed no association between age and nasopharyngeal ACE2 transcription in those who tested negative for COVID-19 (P = 0092). Mean relative transcription of transmembrane (P = 000012) and soluble (P&lt;00001) ACE2 isoforms, as well as TMPRSS2 (P&lt;00001) was higher in COVID-19-negative participants than COVID–19 positive ones, yielding a negative correlation between targeted host gene expression and positive COVID-19 diagnosis. In bivariate analysis of COVID-19-positive participants, transcription of transmembrane ACE2 positively correlated with SARS-CoV-2 viral RNA load (B = 049, R² =014, P&lt;00001), transcription of soluble ACE2 negatively correlated (B= -085, R² = 026, P&lt;00001), and no correlation was found with TMPRSS2 transcription (B= -0042, R² =&lt;010, P = 069). Multivariable analysis showed that the greatest viral RNA loads were observed in participants with high transmembrane ACE2 transcription (B= 089, 95%CI: [059 to 118]), while transcription of the soluble isoform appears to protect against high viral RNA load in the upper respiratory tract (B= -0099, 95%CI: [-018 to -0022]). Interpretation: Nasopharyngeal ACE2 transcription plays a dual, contrasting role in SARS-CoV-2 infection of the upper respiratory tract. Transcription of the transmembrane ACE2 isoform positively correlates, while transcription of the soluble isoform negatively correlates with viral RNA load after adjusting for age, biological sex, and transcription of TMPRSS2. Funding: This project (COV-55) was funded by Genome British Columbia as part of their COVID-19 rapid response initiative.