Increased ACE2 Expression in Bronchial Epithelium of COPD Patients who are Overweight

Abstract

Objective: Mortality from coronavirus disease 2019 (COVID-19) is increased in patients with chronic obstructive pulmonary disease (COPD). Furthermore, higher BMI is related to severe disease. Severe acute respiratory syndrome coronavirus 2 utilizes angiotensin converting enzyme 2 (ACE2) to gain cellular entry. Methods: Whether ACE2 bronchial epithelial expression is increased in COPD patients who have overweight compared with those who do not was investigated by RNA sequencing. Results: Increased ACE2 expression was observed in patients with COPD with overweight (mean BMI, 29 kg/m2) compared with those without overweight (mean BMI, 21 kg/m2) (P = 0.004). Conclusions: Increased ACE2 expression may cause increased severe acute respiratory syndrome coronavirus 2 infection of the respiratory tract. Overweight COPD patients may be at greater risk for developing severe COVID-19.