Summary Background
Angiotensin converting enzyme 2 HGNC (
ACE2 HGNC) serves as the host receptor for SARS-CoV-2, with a critical role in
viral infection MESHD. We aim to understand population level variation of nasopharyngeal
ACE2 HGNC expression in people tested for
COVID-19 MESHD and the relationship between
ACE2 HGNC expression and SARS-CoV-2 viral RNA load, while adjusting for expression of the complementary protease, Transmembrane serine protease 2 (
HGNC), soluble
ACE2 HGNC, age, and biological sex. Methods A cross-sectional study of n=424 participants aged 1-104 years referred for
COVID-19 MESHD testing was performed in British Columbia, Canada. Participants who tested negative or positive for
COVID-19 MESHD were matched by age and biological sex. Viral and host gene expression was measured by quantitative reverse-transcriptase polymerase chain reaction. Bivariate analysis and multiple linear regression were performed to understand the role of nasopharyngeal
ACE2 HGNC expression in
SARS-CoV-2 infection MESHD. The
ACE2 HGNC gene was targeted to measure expression of transmembrane and soluble transcripts. Findings Analysis shows no association between age and nasopharyngeal
ACE2 HGNC expression in those who tested negative for
COVID-19 MESHD (P=0[middot]092). Mean expression of transmembrane (P=1[middot]2e-4), soluble
ACE2 HGNC (P<0[middot]0001) and
HGNC (P<0[middot]0001) differed between
COVID-19 MESHD-negative and -positive groups. In bivariate analysis of
COVID-19 MESHD-positive participants, expression of transmembrane
ACE2 HGNC positively correlated with SARS-CoV-2 RNA viral load (P<0[middot]0001), expression of soluble
ACE2 HGNC negatively correlated (P<0[middot]0001), and no correlation was found with
HGNC (P=0[middot]694). Multivariable analysis showed that the greatest viral RNA loads were observed in participants with high transmembrane
ACE2 HGNC expression (B=0[middot]886, 95%CI:[0[middot]596 to 1[middot]18]), while expression of soluble
ACE2 HGNC may protect against high viral RNA load in the upper respiratory tract (B= -0[middot]0990, 95%CI:[-0[middot]176 to -0[middot]0224]). Interpretation Nasopharyngeal
ACE2 HGNC expression plays a dual, contrasting role in
SARS-CoV-2 infection MESHD of the upper respiratory tract. Transmembrane
ACE2 HGNC positively correlates, while soluble
ACE2 HGNC negatively correlates with viral RNA load after adjusting for age, biological sex and expression of
HGNC. Funding This project (COV-55) was funded by Genome British Columbia as part of their
COVID-19 MESHD rapid response initiative.