[Skip to Content]
[Skip to Content Landing]

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close