Could fat tissue hold the key to why some people experience more severe COVID-19?

17th August 2020

Lower levels of a key molecule in fat tissue are linked with health conditions that are risk factors for severe COVID-19, according to new research from TwinsUK.

ACE2 is a molecule our body’s cells use to regulate processes in our blood vessels, such as blood pressure, wound healing and inflammation. It also plays a key role in managing our heart and kidney functions to keep us healthy.

We know from recent research however that the coronavirus that causes COVID-19 also uses ACE2 molecules in the body as a gateway to infect our cells.

Faced with these two counteracting roles for ACE2, the TwinsUK team wanted to understand the link between ACE2 and the severity of COVID-19 experienced by individuals,  particularly as conditions such as obesity and type 2 diabetes, as well as heart and kidney conditions, put people at greater risk of severe COVID-19.

The body makes ACE2 molecules using instructions provided by the ACE2 gene. The researchers analysed ACE2 gene expression levels in fat tissue from over 760 TwinsUK participants and a further approximately 700 participants from the METSIM and FUSION studies. The team studied how ACE2 gene expression levels in fat tissue were linked with participants’ known pre-existing conditions, and measures of health such as cholesterol levels.

Lead authors Dr Julia El-Sayed Moustafa and Dr Kerrin Small explained:

“Doctors and researchers quickly realised that reactions to SARS-CoV-2 (coronavirus) infection vary widely between people, and that obesity and type 2 diabetes, as well as other factors, increase the risk of suffering from severe COVID-19. Through this research, we show that people living with these conditions often have lower gene expression levels of ACE2 in their fat tissue compared to the general population.”

Drs El-Sayed Moustafa and Small continued:

“Fat tissue is important not only for energy storage, but also for signalling in the body. Further studies will be needed to establish whether lower starting levels of ACE2 gene expression in this important tissue then contribute to COVID-19 severity.”

El-Sayed Moustafa et al. ACE2 expression in adipose tissue is associated with COVID-19 cardio-metabolic risk factors and cell type composition. medRxiv, 2020.

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