Association of Circulating ACE2 Levels With COVID-19

COVID-19 cases are rising substantially in Jordan. Since this is a novel virus, there is still much to be investigated surrounding its pathophysiology in order to attempt to find suitable treatments or better decision-making in the prognosis of the disease. This project aims to identify if soluble angiotensin-converting enzyme (ACE2) can be used as a prognostic factor for COVID-19 severity, which will allow clinicians to manage COVID-19 cases more efficiently. ACE2 is of interest since the coronavirus enters host cells through ACE2 receptors. It can slo be hypothesized that the irus may also bind to soluble ACE2, but without mediating its effects. It si, therefore, expected that those with higher levels of ACE2 would more likely have milder disease. This can potentially help improve survival rate, allowing clinicians to identify the higher-risk patients and monitoring them more closely.

Study Overview

• Status: Completed
• Conditions: COVID-19; COVID-19 Respiratory Infection
• Intervention / Treatment: Diagnostic test: ACE serum levels

Detailed Description

SARS-CoV-2 is a new isolate of coronavirus that caused an epidemic in Wuhan, China in December 2019. The virus has then spread to the rest of the world causing a pandemic, and the disease the virus causes was designated the name COVID-19.

The presence of underlying medical condition increases a risk of severe disease course. Diabetes and cardiovascular disease are amongst the conditions that are associated with the worst COVID-19 prognosis . Renal failure is also associated with more severe illness On another note, angiotensin-converting enzyme 2 (ACE2) is expressed in human airway epithelia, lung parenchyma, small intestine cells as well as in the heart, kidneys and testis It functions as both an enzyme and a receptor for viral entry as it is known that SARS-CoV-2 enters into human host cells mainly through the cellular receptor ACE2, . It is hypothesized that with the damage and loss of cells induced by infection, enzymatic ACE2 activity would be globally compromised, inducing a state of relative ACE2 deficiency. This leads to enhanced and protracted tissue and vessel exposure to Ang II and therefore vasoconstriction, enhanced thrombosis, increased tissue permeability and cytokine production resulting in inflammation Chronic angiotensin 1 receptor (AT1R) blockade elevates ACE2 expression . Unlike ACE1, however, ACE2 is insensitive to the actions mediated by ACE inhibitors . It might be appealing to propose that chronic use of ACE inhibitors or AT1R antagonists puts patients at particular high risk if they get infected with SARS-CoV-2, as ACE2 overexpression may facilitate viral replication in the lung tissue . However, results of some studies performed in healthy human subjects did not confirm such results. In vitro studies, on the other hand, depict reduced concentrations of soluble ACE2 despite the increase in membrane expression and tissue levels. Therefore, there is no current significant evidence regarding the effects of ACE inhibitors and ARBs on COVID-19 infection .

In contrast, mild or moderate ACE2 deficiency is unlikely to be protective from viral invasion either. This is due to the intrinsically high affinity of SARS-CoV-2 to ACE2 receptors The soluble form of ACE2 may be a biomarker of severity of COVID-19 progression in patients . This could be due to the fact that COVID-19 binds to the soluble form, leaving less to be bound to the ACE2 receptor and be taken up by host cells The aim of this project is to identify any association between ACE2 levels with severity of COVID-19.

• Study Type: Observational
• Enrollment (Actual): 261

Contacts and Locations

Study Locations

• Jordan
  • Amman, Jordan, 11972
    • The university of Jordan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All adult COVID 19 patients admitted to Jordan University Hospital during 3 months.

Description

Inclusion Criteria:

• Age: 18 and above
• Gender: both males and females.
• Confirmed diagnosis of COVID-19 for patients and confirmed absence of COVID-19

Exclusion Criteria:

• Healthy individuals: not being diagnosed with COVID-19 or at least has not been in close contact with a person diagnosed with COVID-19.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Covid-19 Patients; Blood sample from admitted patients will be drawn	Diagnostic test: ACE serum levels; Circulating ACE2 level will be measured
Control Patients; Blood sample from control group will be drawn	Diagnostic test: ACE serum levels; Circulating ACE2 level will be measured

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ACE2 level	Serum level of ACE2 in control and COVID 19 patients will be measured	3 months

Collaborators and Investigators

• Sponsor: Jordan University Hospital

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2022
• Primary Completion (ACTUAL): January 20, 2022
• Study Completion (ACTUAL): January 21, 2022

Study Registration Dates

• First Submitted: January 22, 2022
• First Submitted That Met QC Criteria: January 22, 2022
• First Posted (ACTUAL): January 25, 2022

Study Record Updates

• Last Update Posted (ACTUAL): February 8, 2022
• Last Update Submitted That Met QC Criteria: January 24, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19; Respiratory Tract Infections
• Other Study ID Numbers: 2021/5

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No