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ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection

Open access
Zhou, Lingli, Xu, Zhenhua, Castiglione, Gianni M., Soiberman, Uri S., Eberhart, Charles G., Duh, Elia J.·2020·The Ocular Surface

Abstract

Purpose Conjunctival signs and symptoms are observed in a subset of patients with COVID-19, and SARS-CoV-2 has been detected in tears, raising concerns regarding the eye both as a portal of entry and carrier of the virus. The purpose of this study was to determine whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2 entry/infection. Methods We analyzed human post-mortem eyes as well as surgical specimens for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2. Results Across all eye specimens, immunohistochemical analysis revealed expression of ACE2 in the conjunctiva, limbus, and cornea, with especially prominent staining in the superficial conjunctival and corneal epithelial surface. Surgical conjunctival specimens also showed expression of ACE2 in the conjunctival epithelium, especially prominent in the superficial epithelium, as well as weak or focal expression in the substantia propria. All eye and conjunctival specimens also expressed TMPRSS2. Finally, Western blot analysis of protein lysates from human corneal epithelium obtained during refractive surgery confirmed expression of ACE2 and TMPRSS2. Conclusions Together, these results suggest that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.

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Metadata

Authors
Zhou, L., Xu, Z., Castiglione, G. M., Soiberman, U. S., Eberhart, C. G., & Duh, E. J.
Venue
The Ocular Surface
Publisher
Elsevier BV
Published
2020-10
Volume
18
Issue
4
Pages
537-544
ISSN
1542-0124 (ISSN-L)
OpenAlex
W3035324760
Cited by
348
References
27
FWCI
50.61
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. https://app.cochat.ai/papers/10.1016/j.jtos.2020.06.007
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Zhou, L., Xu, Z., Castiglione, G. M., Soiberman, U. S., Eberhart, C. G., & Duh, E. J. (2020). ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. The Ocular Surface. https://doi.org/10.1016/j.jtos.2020.06.007

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