Data were generated by the Tilley research group.  Expression was quantified using Affymetrix HG-U133 Plus 2.0 microarrays.  It was observed that ACE2 expression was significantly increased (p < 0.005) in the small airway epithelium (SAE) of smokers compared to nonsmokers.  

Michigan State University

- Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19)

Clinical imaging data suggest that the small airway epithelium (SAE) in an important SARS-CoV-2 binding site.  
- expression versus nonsmokers
- expression versus nonsmokers by sex

ACE2 Expression in the Airway Epithelium of Smokers

Zhang, H., Rostami, M. R., Leopold, P. L., Mezey, J. G., O'Beirne, S. L., Strulovici-Barel, Y., & Crystal, R. G. (2020). Expression of the SARS-CoV-2 ACE2 Receptor in the Human Airway Epithelium. American Journal of Respiratory and Critical Care Medicine, (ja).
https://www.atsjournals.org/doi/full/10.1164/rccm.202003-0541OC
doi: 10.1164/rccm.202003-0541OC   

Expression of the SARS-CoV-2 ACE2 Receptor in the Human Airway Epithelium

Data were generated by the Tilley research group. Expression was quantified using Affymetrix HG-U133 Plus 2.0 microarrays.  It was observed that male smokers had significantly higher ACE2 expression in the small airway epithelium (SAE) than female smokers or nonsmokers of either sex (p < 0.005 in each comparison).  

ACE2 Expression is Increased in the Small Airway Epithelium of Male Smokers vs. Female Smokers and Nonsmokers

- Angiotensin-converting enzyme-2 (ACE2) receptor is the known receptor for SARS-CoV-2 as well as coronavirus NL63

- ACE2 receptor is expressed on the surface of type 2 pneumocytes in the lungs
- In samples taken from patients who smoke, an upregulation of ACE2 receptor could be seen in the airway epithelium

- In particular, ACE2 receptor was expressed at a higher concentration in the pneumocytes, alveolar macrophages, and the apical end of the small airway epithelium in smoking patients compared to non-smoking patients

- Previous observations show that SARS-COV-2 adhesion downmodulates ACE2 enzyme expression, increasing production and activation of other ACE enzymes leading to severe acute respiratory failure

- Overall, it was observed that smoking upregulates ACE2 receptor and this could be true for electronic cigarette users as well

- This upregulation is dangerous as SARS-CoV-2 utilizes this receptor to infect the airway epithelium, leading to severe acute respiratory failure


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