Key result
Inhaled corticosteroids fail to alter the lower circulating ACE2 levels linked to childhood asthma.
Why the study?
Asthma patients did not show the expected high COVID-19 morbidity and mortality, prompting investigation into ACE2 differences in asthma versus nonasthma children and the effect of inhaled corticosteroids on ACE2 expression.
Does asthma or inhaled corticosteroid use affect circulating ACE2 levels in children?
Cross-Sectional (n=157)
Does asthma or inhaled corticosteroid use affect circulating ACE2 levels in children?
p-value: p=.013
Children with asthma have lower circulating ACE2 levels compared to non-asthmatic children, which is unaffected by inhaled corticosteroid use, potentially explaining their lower expected COVID-19 morbidity.
Suggests potential mechanism for milder COVID-19 in asthmatic children independent of ICS; hypothesis-generating and requires prospective validation.
BACKGROUND: The global spread of coronavirus disease 2019 (COVID-19) has resulted in a significant disease burden, yet asthma patients do not have the expected high morbidity and mortality rates in the pandemics of COVID-19. OBJECTIVE: To find the difference of angiotensin-converting enzyme 2 (ACE2) in asthma and nonasthma children and evaluate the effect of inhaled corticosteroids (ICS) on its expression. METHODS: The ACE2, immunoglobulin E (IgE), and eosinophils were tested in different children. RESULTS: A total of 157 children aged 3-16 years were enrolled. The expression of ACE2 in asthma children were lower than nonasthma children (T = -2.512, p = .013). Allergic nonasthma children had a significant higher ACE2 expression than children with allergic asthma (p = .013) and nonallergic asthma (p = .029). The expression of ACE2 had no significant difference between first-diagnosed asthma children and that had been treated with ICS for ≥6 months (F = 0.028, p = .598). The allergic asthma children showed a significantly higher eosinophils cells (EC) count than the allergic nonasthma (W = 200, p < .001) and nonallergic nonasthma children (W = 1089, p < .001). Nonallergic asthma children also had a significant higher EC count than the allergic non-asthma (W = 182.5, p < .001) and nonallergic non-asthma (W = 200.5, p < .001) children. There was no significant difference in IgE levels between asthmatic children and non-asthmatic children (W = 2792.5, p = .18). CONCLUSION: Circulating ACE2 levels in asthmatic children were lower than those in non-asthmatic children and ICS treatment for ≥6 months did not affect the expression of ACE2 in peripheral blood in the asthma children.
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Ma et al. (2023) conducted a cross-sectional in Asthma (n=157). Asthma vs. Non-asthma was evaluated on Expression of circulating ACE2 (p=.013). Asthmatic children had significantly lower circulating ACE2 levels than non-asthmatic children (p=0.013), and inhaled corticosteroid treatment for ≥6 months did not affect ACE2 expression.
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