ArticleGeroScience2021
Changes in the SARS-CoV-2 cellular receptor ACE2 levels in cardiovascular patients: a potential biomarker for the stratification of COVID-19 patients.
Article in GeroScience, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 22 citations in OpenAlex.
- ACE2 downregulation contributes to adverse cardiovascular and reproductive outcomes in female mice on high-fat diet.American journal of physiology. Heart and circulatory physiology · 2026Article
- Article
- ACE/ACE2 axis in cardiovascular disease and COVID-19: Molecular insights and therapeutic perspectives.Journal of cardiovascular and thoracic research · 2026Review
- Modulation of RAAS receptors and miRNAs in COVID-19: implications for disease severity, immune response, and potential therapeutic targets.BMC infectious diseases · 2025Observational
- Effect of Pituitary-Target Gland Axis on RAAS in the Context of COVID-19.International journal of medical sciences · 2025Review
- Distinct subsets of anti-pulmonary autoantibodies correlate with disease severity and survival in severe COVID-19 patients.GeroScience · 2024Article
- Serum AXL is a potential molecular marker for predicting COVID-19 progression.Frontiers in immunology · 2024Article
- Circulating angiotensin converting enzyme 2 and COVID-19.World journal of clinical cases · 2022Review
- Article
- The effects of biological sex and cardiovascular disease on COVID-19 mortality.American journal of physiology. Heart and circulatory physiology · 2022Article
- SARS-CoV-2 interacts with renin-angiotensin system: impact on the central nervous system in elderly patients.GeroScience · 2022Review
- Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms.Cardiology plus · 2022Review
- Circulating ACE2 activity predicts mortality and disease severity in hospitalized COVID-19 patients.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022Article
- Serum ACE2 Level is Associated With Severe SARS-CoV-2 Infection: A Cross-Sectional Observational Study.Biomarker insights · 2022Article
- Alterations in ACE and ACE2 Activities and Cardiomyocyte Signaling Underlie Improved Myocardial Function in a Rat Model of Repeated Remote Ischemic Conditioning.International journal of molecular sciences · 2021Article
Corrections and comments
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Authors and funding
24 authors at 3 institutions in 3 countries.
Funding
Abstract
Angiotensin-converting enzyme 2 (ACE2) is essential for SARS-CoV-2 cellular entry. Here we studied the effects of common comorbidities in severe COVID-19 on ACE2 expression. ACE2 levels (by enzyme activity and ELISA measurements) were determined in human serum, heart and lung samples from patients with hypertension (n = 540), heart transplantation (289) and thoracic surgery (n = 49). Healthy individuals (n = 46) represented the controls. Serum ACE2 activity was increased in hypertensive subjects (132%) and substantially elevated in end-stage heart failure patients (689%) and showed a strong negative correlation with the left ventricular ejection fraction. Serum ACE2 activity was higher in male (147%), overweight (122%), obese (126%) and elderly (115%) hypertensive patients. Primary lung cancer resulted in higher circulating ACE2 activity, without affecting ACE2 levels in the surrounding lung tissue. Male sex resulted in elevated serum ACE2 activities in patients with heart transplantation or thoracic surgery (146% and 150%, respectively). Left ventricular (tissular) ACE2 activity was unaffected by sex and was lower in overweight (67%), obese (62%) and older (73%) patients with end-stage heart failure. There was no correlation between serum and tissular (left ventricular or lung) ACE2 activities. Neither serum nor tissue (left ventricle or lung) ACE2 levels were affected by RAS inhibitory medications. Abandoning of ACEi treatment (non-compliance) resulted in elevated blood pressure without effects on circulating ACE2 activities. ACE2 levels associate with the severity of cardiovascular diseases, suggestive for a role of ACE2 in the pathomechanisms of cardiovascular diseases and providing a potential explanation for the higher mortality of COVID-19 among cardiovascular patients. Abandoning RAS inhibitory medication worsens the cardiovascular status without affecting circulating or tissue ACE2 levels.
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Registered trials
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