Cited by 1,163COVID-19 Clinical Research StudiesSARS-CoV-2 and COVID-19 ResearchRenin-Angiotensin System Studies

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The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2

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Chen, Liang, Li, Xiangjie, Chen, Mingquan, Feng, Yi, Xiong, Chenglong·2020·Cardiovascular Research

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Abstract

A new type of pneumonia caused by a novel coronavirus SARS-CoV-2 outbreaks recently in China and spreads into many other countries. This disease, named as COVID-19, is similar to patients infected by SARS-CoV and MERS-CoV, and nearly 20% of patients developed severe condition. Cardiac injury is a prevalent complication of severe patients, exacerbating the disease severity in coronavirus disease 2019 (COVID-19) patients. Angiotensin-converting enzyme 2 (ACE2), the key host cellular receptor of SARS-CoV-2, has been identified in multiple organs, but its cellular distribution in human heart is not illuminated clearly. This study performed the first state-of-art single cell atlas of adult human heart, and revealed that pericytes with high expression of ACE2 might act as the target cardiac cell of SARS-CoV-2. The pericytes injury due to virus infection may result in capillary endothelial cells dysfunction, inducing microvascular dysfunction. And patients with basic heart failure disease showed increased ACE2 expression at both mRNA and protein levels, meaning that if infected by the virus these patients may have higher risk of heart attack and critically ill condition. The finding of this study explains the high rate of severe cases among COVID-19 patients with basic cardiovascular disease; and these results also perhaps provide important reference to clinical treatment of cardiac injury among severe patients infected by SARS-CoV-2.

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Background
Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review
Stefanou, Ε., Karvelas, N., Bennett, S., & Kole, C. (2023) · Current Treatment Options in Neurology · doi:10.1007/s11940-023-00747-6 · Cited by 12
“The SARS-CoV-2 target cells through the binding of spike (S) protein with angiotensin-converting enzyme 2 (ACE2) [8 • ], a membrane-bound aminopeptidase which plays a vital role in heart function, hypertension, and diabetes [9, 10].”
Market power evaluation in the electricity market based on the weighted maintenance object
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“However, in the case of smokers and patients with heart conditions, ACE2 levels are elevated compared to that in the healthy (41,42), partially accounting for the high pathogenicity in those populations.”
Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19
Lozahic, C., Maddock, H. L., & Sandhu, H. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.634291 · Cited by 11
“Further to this, ACE2 receptors are highly expressed in the heart and can lead to ACE2-dependent myocardial infarction (66).”
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Detecting SARS-CoV-2 Orf3a and E ion channel activity in COVID-19 blood samples
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Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs
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Preadmission Statin Treatment and Outcome in Patients Hospitalized With COVID-19
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“Nonischemic myocardial injury may also result from direct injury to myocytes by SARS-CoV-2 through angiotensin-converting enzyme 2 receptors.(17) The ability of statin treatment to ameliorate myocardial injury has been established in other settings.”
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COVID-19 Infection Is Associated With Increased In-Hospital Mortality and Complications in Patients With Acute Heart Failure: Insight From National Inpatient Sample (2020)
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Mechanism of COVID-19-Induced Cardiac Damage from Patient, In Vitro and Animal Studies
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COVID-19: The Impact on Cardiovascular System
Šikić, J., Planinić, Z., Matišić, V., Friščić, T., Molnar, V., Jagačić, D., Vujičić, L., Tudorić, N., Gršić, L. P., Ljubičić, Đ., et al. (2021) · Biomedicines · doi:10.3390/biomedicines9111691 · Cited by 10
“The ACE2 receptor, which is vastly concentrated in lung alveolar cells, can also be found on the endothelium of blood vessels and cardiac myocytes [28,29].”
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COVID-19 FAQs in paediatric and congenital cardiology: AEPC position paper
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Identification of the Hub Genes and the Signaling Pathways in Human iPSC-Cardiomyocytes Infected by SARS-CoV-2
Xie, L., Huang, Y.-F., Liu, Y., Liang, J., Deng, W., Lin, G.-L., Luo, H., & Guo, X. (2022) · Biochemical Genetics · doi:10.1007/s10528-022-10206-7 · Cited by 9
“The receptor-binding domain (RBD) of SARS-CoV-2 might bind tightly with human ACE2, which was strongly expressed in pericytes of human hearts, indicating the potential susceptibility of cardiomyocytes to SARS-CoV-2 (Chen et al. 2020).”
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COVID-19-associated myocarditis: clinical pattern and medical treatment
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Role of endothelial cells and angiotensin converting enzyme-II in COVID-19 and brain damages post-infection
Mehboob, R., von Kries, J. P., Ehsan, K., Almansouri, M., & Bamaga, A. K. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1210194 · Cited by 9
“Patients with COVID-19 may be more susceptible to cardiac injuries due to ACE-2’s lack of cardioprotective activity, or patients with heart failure may be more susceptible to catching SARS-CoV-2 and experiencing associated cardiac damage (47).”
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COVID -19 pandemic and paediatric population with special reference to congenital heart disease
Malviya, A., & Yadav, R. K. (2020) · Indian Heart Journal · doi:10.1016/j.ihj.2020.06.001 · Cited by 9
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Atrial Arrhythmias in Patients with Severe COVID-19
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SARS-CoV-2, Endothelial Dysfunction, and the Renin-Angiotensin System (RAS): A Potentially Dangerous Triad for the Development of Pre-Eclampsia
Illi, B., Vasapollo, B., Valensise, H. C. C., & Totta, P. (2021) · Reproductive Medicine · doi:10.3390/reprodmed2020010 · Cited by 9
“All the vascular cells, including ECs, smooth muscle cells, and accessory pericytes express ACE2, as well as the Transmembrane Serine Protease 22 (TMPRSS2) protease [30,31], which cuts Spike, the SARS-CoV-2 protein mediating the binding of the virus to ACE2 and cell infection, at the S1/S2 and S2′ sites and is respons…”
Background

Authors: Chen, L., Li, X., Chen, M., Feng, Y., & Xiong, C.
Affiliations: Fudan University (CN)
Renmin University of China (CN)
Corresponding author: Chen, Liang
Xiong, Chenglong
ORCID: Chen, Liang
Li, Xiangjie
Chen, Mingquan
Feng, Yi
Xiong, Chenglong
Venue: Cardiovascular Research
Publisher: Oxford University Press (OUP)
Published: 2020-03-30
Volume: 116
Issue: 6
Pages: 1097-1100
ISSN: 0008-6363 (ISSN-L)
1755-3245
DOI: 10.1093/cvr/cvaa078
PMC: PMC7184507
OpenAlex: W3014027512
Cited by: 1,163
References: 7
Citations by year: 2026: 19 · 2025: 32 · 2024: 64 · 2023: 148 · 2022: 210 · 2021: 332 · 2020: 355
FWCI: 34.28
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Cardiovascular Research (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Natural Science Foundation of China (81872673)
National Key Research and Development Program of China (2017YFC1200203)
Fudan University
Topics: Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords: ACE2, SARS-CoV-2, COVID-19 pandemic, cardiac injury, pericytes, microvascular dysfunction, heart failure, viral receptor expression, myocardial injury
MeSH terms: Betacoronavirus, Receptors, Coronavirus, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, Heart, Heart Diseases, Humans, Peptidyl-Dipeptidase A, Myocardium, Pneumonia, Viral, Receptors, Virus, Gene Expression, Coronavirus Infections, Pericytes, Gene Expression Profiling, Pandemics, Spike Glycoprotein, Coronavirus

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The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2

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