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Nasal ACE2 Levels and COVID-19 in Children

Educational Objective
To understand how ACE2 may affect children’s susceptibility to COVID-19
1 Credit CME

Coronavirus disease 2019 (COVID-19) has disproportionately affected certain vulnerable populations. Studies noted higher rates of certain comorbidities such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease in patients infected with COVID-19 with severe disease.1 Additionally, areas with more racial/ethnic minorities and higher rates of poverty have been shown to have higher rates of COVID-19 hospitalization and death.2 After adjustment for comorbidities, age has been independently associated with increased mortality due to COVID-19.3 However, limited attention has been given to children, who appear to have lower risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality.

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Article Information

Corresponding Author: Ankit B. Patel, MD, PhD, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02132 (apatel38@bwh.harvard.edu).

Published Online: May 20, 2020. doi:10.1001/jama.2020.8946

Conflict of Interest Disclosures: Dr Patel reported receipt of grants from Relypsa and consulting fees from Third Rock Ventures. No other disclosures were reported.

References
1.
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775PubMedGoogle Scholar
2.
Wadhera  RK , Wadhera  P , Gaba  P ,  et al.  Variation in COVID-19 hospitalizations and deaths across New York City boroughs.   JAMA. Published online April 29, 2020. doi:10.1001/jama.2020.7197PubMedGoogle Scholar
3.
Mehra  MR , Desai  SS , Kuy  S , Henry  TD , Patel  AN .  Cardiovascular disease, drug therapy, and mortality in COVID-19.   N Engl J Med. Published online May 1, 2020. doi:10.1056/NEJMoa2007621PubMedGoogle Scholar
4.
Bunyavanich  S , Do  A , Vicencio  A .  Nasal gene expression of angiotensin-converting enzyme 2 in children and adults.   JAMA. Published online May 20, 2020. doi:10.1001/jama.2020.8707Google Scholar
5.
Zhou  P , Yang  X-L , Wang  X-G ,  et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin.   Nature. 2020;579(7798):270-273. doi:10.1038/s41586-020-2012-7PubMedGoogle ScholarCrossref
6.
Castagnoli  R , Votto  M , Licari  A ,  et al.  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review.   JAMA Pediatr. 2020;174(9). doi:10.1001/jamapediatrics.2020.1467PubMedGoogle Scholar
7.
Bialek  S , Gierke  R ,  et al; CDC COVID-19 Response Team.  Coronavirus disease 2019 in children—United States, February 12–April 2, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(14):422-426. doi:10.15585/mmwr.mm6914e4PubMedGoogle ScholarCrossref
8.
Bi  Q , Wu  Y , Mei  S ,  et al.  Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study.   Lancet Infect Dis. 2020;S1473-3099(20)30287-5. doi:10.1016/s1473-3099(20)30287-5PubMedGoogle Scholar
9.
Gudbjartsson  DF , Helgason  A , Jonsson  H ,  et al.  Spread of SARS-CoV-2 in the Icelandic population.   N Engl J Med. Published online April 14, 2020. doi:10.1056/NEJMoa2006100PubMedGoogle Scholar
10.
Sungnak  W , Huang  N , Bécavin  C ,  et al; HCA Lung Biological Network.  SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes.   Nat Med. 2020;26(5):681-687. doi:10.1038/s41591-020-0868-6PubMedGoogle ScholarCrossref
11.
Ziegler  CGK , Allon  SJ , Nyquist  SK ,  et al.  SARS-CoV-2 receptor ACE2 is an interferon-stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues.   Cell. Published online April 27, 2020. doi:10.1016/j.cell.2020.04.035Google Scholar
12.
Imai  Y , Kuba  K , Rao  S ,  et al.  Angiotensin-converting enzyme 2 protects from severe acute lung failure.   Nature. 2005;436(7047):112-116. doi:10.1038/nature03712PubMedGoogle ScholarCrossref
13.
Monteil  V , Kwon  H , Prado  P ,  et al.  Inhibition of SARS-CoV-2 infections in engineered human tissues using clinical-grade soluble human ACE2.   Cell. 2020;S0092-8674(20)30399-8. doi:10.1016/j.cell.2020.04.004PubMedGoogle Scholar
14.
Study to determine incidence of novel coronavirus infection in US children begins. National Institutes of Health website. Published May 4, 2020. Accessed May 11, 2020. https://www.nih.gov/news-events/news-releases/study-determine-incidence-novel-coronavirus-infection-us-children-begins
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