Background Infection by the SARS-Cov-2 virus produces in humans a disease of highly variable and unpredictable severity. The presence of frequent genetic single nucleotide polymorphisms (SNPs) in the population might lead to a greater susceptibility to infection or an exaggerated inflammatory response. SARS-CoV-2 requires the presence of the ACE2 protein to enter in the cell and ACE2 is a regulator of the renin-angiotensin system. Accordingly, we studied the associations between 8 SNPs from AGTR1, ACE2 and ACE genes and the severity of the disease produced by the SARS-Cov-2 virus. Methods 318 (aged 59.6±17.3 years, males 62.6%) COVID-19 patients were grouped based on the severity of symptoms: Outpatients (n = 104, 32.7%), hospitalized on the wards (n = 73, 23.0%), Intensive Care Unit (ICU) (n = 84, 26.4%) and deceased (n = 57, 17.9%). Comorbidity data (diabetes, hypertension, obesity, lung disease and cancer) were collected for adjustment. Genotype distribution of 8 selected SNPs among the severity groups was analyzed. Results Four SNPs in ACE2 were associated with the severity of disease. While rs2074192 andrs1978124showed a protector effectassuming an overdominant model of inheritance (G/A vs. GG-AA, OR = 0.32, 95%CI = 0.12–0.82; p = 0.016 and A/G vs. AA-GG, OR = 0.37, 95%CI: 0.14–0.96; p = 0.038, respectively); the SNPs rs2106809 and rs2285666were associated with an increased risk of being hospitalized and a severity course of the disease with recessive models of inheritance (C/C vs. T/C-T/T, OR = 11.41, 95% CI: 1.12–115.91; p = 0.012) and (A/A vs. GG-G/A, OR = 12.61, 95% CI: 1.26–125.87; p = 0.0081). As expected, an older age (OR = 1.47), male gender (OR = 1.98) and comorbidities (OR = 2.52) increased the risk of being admitted to ICU or death vs more benign outpatient course. Multivariable analysis demonstrated the role of the certain genotypes (ACE2) with the severity of COVID-19 (OR: 0.31, OR 0.37 for rs2074192 and rs1978124, and OR = 2.67, OR = 2.70 for rs2106809 and rs2285666, respectively). Hardy-Weinberg equilibrium in hospitalized group for I/D SNP in ACE was not showed (p<0.05), which might be due to the association with the disease. No association between COVID-19 disease and the different AGTR1 SNPs was evidenced on multivariable, nevertheless the A/A genotype for rs5183 showed an higher hospitalization risk in patients with comorbidities. Conclusions Different genetic variants in ACE2 were associated with a severe clinical course and death groups of patients with COVID-19. ACE2 common SNPs in the population might modulate severity of COVID-19 infection independently of other known markers like gender, age and comorbidities.
【초록키워드】 SARS-CoV-2, ACE2, Hospitalized, Hospitalization, susceptibility, obesity, severity, Cancer, Human, Genetic, rs2285666, SNPs, Infection, Comorbidities, intensive care unit, Lung disease, Comorbidity, Gender, risk, SARS-CoV-2 virus, diabetes, virus, hypertension, ICU, COVID-19 disease, renin-angiotensin system, Clinical course, COVID-19 infection, Single nucleotide polymorphism, severity of COVID-19, male, Older age, Genotype, death, SNP, age, outpatients, Genetic variant, Severity of disease, distribution, disease, single nucleotide polymorphisms, COVID-19 patients, association, marker, Outpatient, nucleotide, Analysis, angiotensin, ACE, ACE2 protein, Deceased, COVID-19 patient, lead, the cell, susceptibility to infection, Renin, 95%CI, increased risk, inheritance, multivariable analysis, death group, regulator, while, AGTR1, exaggerated inflammatory response, Hardy-Weinberg equilibrium, protector, rs1978124, ACE gene, Cell, multivariable, Course, Result, greater, selected, produced, analyzed, collected, the disease, modulate, demonstrated, expected, evidenced, admitted to ICU, G/A, I/D, increased the risk, patients with comorbidities, patients with COVID-19, recessive model, the severity group, 【제목키워드】 ACE2, severity of COVID-19, disease, ACE,