tetano
Editor, Senior Moderator
Clin Infect Dis
. 2021 Jan 3;ciaa1911.
doi: 10.1093/cid/ciaa1911. Online ahead of print.
Distinct disease severity between children and older adults with COVID-19: Impacts of ACE2 expression, distribution, and lung progenitor cells
Zhao Zhang[SUP] 1 2 [/SUP], Liyan Guo[SUP] 1 [/SUP], Li Huang[SUP] 1 3 [/SUP], Che Zhang[SUP] 4 [/SUP], Ruibang Luo[SUP] 5 [/SUP], Liang Zeng[SUP] 6 [/SUP], Huiying Liang[SUP] 7 [/SUP], Qiuhui Li[SUP] 5 [/SUP], Xiaoxia Lu[SUP] 8 [/SUP], Xianfeng Wang[SUP] 9 [/SUP], Chui Yan Ma[SUP] 2 [/SUP], Jianbo Shao[SUP] 10 [/SUP], Weiren Luo[SUP] 11 [/SUP], Le Li[SUP] 12 [/SUP], Li Liu[SUP] 13 [/SUP], Ziyue Li[SUP] 1 [/SUP], Xiaoya Zhou[SUP] 1 [/SUP], Xiaoxian Zhang[SUP] 1 [/SUP], Jie Liu[SUP] 1 [/SUP], Jinjian Yang[SUP] 1 [/SUP], Ka Yi Kwan[SUP] 13 [/SUP], Wei Liu[SUP] 14 [/SUP], Yi Xu[SUP] 15 [/SUP], Hua Jiang[SUP] 12 [/SUP], Hongsheng Liu[SUP] 16 [/SUP], Hui Du[SUP] 10 [/SUP], Yanheng Wu[SUP] 9 [/SUP], Guangyin Yu[SUP] 17 [/SUP], Junhui Chen[SUP] 17 [/SUP], Jieying Wu[SUP] 1 [/SUP], Jinqiu Zhang[SUP] 1 [/SUP], Can Liao[SUP] 1 [/SUP], Huanhuan Joyce Chen[SUP] 18 [/SUP], Zhiwei Chen[SUP] 13 [/SUP], Hung-Fat Tse[SUP] 2 [/SUP], Huimin Xia[SUP] 7 [/SUP], Qizhou Lian[SUP] 1 2 19 [/SUP]
Affiliations
Abstract
Background: Children and older adults with coronavirus disease 2019 (COVID-19) display a distinct spectrum of disease severity yet the risk factors aren't well understood. We sought to examine the expression pattern of angiotensin-converting enzyme 2 (ACE2), the cell-entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the role of lung progenitor cells in children and older patients.
Methods: We retrospectively analysed clinical features in a cohort of 299 patients with COVID-19. The expression and distribution of ACE2 and lung progenitor cells were systematically examined using a combination of public single-cell RNA-seq datasets, lung biopsies, and ex vivo infection of lung tissues with SARS-CoV-2 pseudovirus in children and older adults. We also followed up patients who had recovered from COVID-19.
Results: Compared with children, older patients (> 50 yrs.) were more likely to develop into serious pneumonia with reduced lymphocytes and aberrant inflammatory response (p = 0.001). The expression level of ACE2 and lung progenitor cell markers were generally decreased in older patients. Notably, ACE2 positive cells were mainly distributed in the alveolar region, including SFTPC positive cells, but rarely in airway regions in the older adults (p < 0.01). The follow-up of discharged patients revealed a prolonged recovery from pneumonia in the older (p < 0.025).
Conclusion: Compared to children, ACE2 positive cells are generally decreased in older adults and mainly presented in the lower pulmonary tract. The lung progenitor cells are also decreased. These risk factors may impact disease severity and recovery from pneumonia caused by SARS-Cov-2 infection in older patients.
Keywords: ACE2 expression and distribution; COVID-19; disease severity; lung progenitor cells; patients’ ages.
. 2021 Jan 3;ciaa1911.
doi: 10.1093/cid/ciaa1911. Online ahead of print.
Distinct disease severity between children and older adults with COVID-19: Impacts of ACE2 expression, distribution, and lung progenitor cells
Zhao Zhang[SUP] 1 2 [/SUP], Liyan Guo[SUP] 1 [/SUP], Li Huang[SUP] 1 3 [/SUP], Che Zhang[SUP] 4 [/SUP], Ruibang Luo[SUP] 5 [/SUP], Liang Zeng[SUP] 6 [/SUP], Huiying Liang[SUP] 7 [/SUP], Qiuhui Li[SUP] 5 [/SUP], Xiaoxia Lu[SUP] 8 [/SUP], Xianfeng Wang[SUP] 9 [/SUP], Chui Yan Ma[SUP] 2 [/SUP], Jianbo Shao[SUP] 10 [/SUP], Weiren Luo[SUP] 11 [/SUP], Le Li[SUP] 12 [/SUP], Li Liu[SUP] 13 [/SUP], Ziyue Li[SUP] 1 [/SUP], Xiaoya Zhou[SUP] 1 [/SUP], Xiaoxian Zhang[SUP] 1 [/SUP], Jie Liu[SUP] 1 [/SUP], Jinjian Yang[SUP] 1 [/SUP], Ka Yi Kwan[SUP] 13 [/SUP], Wei Liu[SUP] 14 [/SUP], Yi Xu[SUP] 15 [/SUP], Hua Jiang[SUP] 12 [/SUP], Hongsheng Liu[SUP] 16 [/SUP], Hui Du[SUP] 10 [/SUP], Yanheng Wu[SUP] 9 [/SUP], Guangyin Yu[SUP] 17 [/SUP], Junhui Chen[SUP] 17 [/SUP], Jieying Wu[SUP] 1 [/SUP], Jinqiu Zhang[SUP] 1 [/SUP], Can Liao[SUP] 1 [/SUP], Huanhuan Joyce Chen[SUP] 18 [/SUP], Zhiwei Chen[SUP] 13 [/SUP], Hung-Fat Tse[SUP] 2 [/SUP], Huimin Xia[SUP] 7 [/SUP], Qizhou Lian[SUP] 1 2 19 [/SUP]
Affiliations
- PMID: 33388749
- DOI: 10.1093/cid/ciaa1911
Abstract
Background: Children and older adults with coronavirus disease 2019 (COVID-19) display a distinct spectrum of disease severity yet the risk factors aren't well understood. We sought to examine the expression pattern of angiotensin-converting enzyme 2 (ACE2), the cell-entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the role of lung progenitor cells in children and older patients.
Methods: We retrospectively analysed clinical features in a cohort of 299 patients with COVID-19. The expression and distribution of ACE2 and lung progenitor cells were systematically examined using a combination of public single-cell RNA-seq datasets, lung biopsies, and ex vivo infection of lung tissues with SARS-CoV-2 pseudovirus in children and older adults. We also followed up patients who had recovered from COVID-19.
Results: Compared with children, older patients (> 50 yrs.) were more likely to develop into serious pneumonia with reduced lymphocytes and aberrant inflammatory response (p = 0.001). The expression level of ACE2 and lung progenitor cell markers were generally decreased in older patients. Notably, ACE2 positive cells were mainly distributed in the alveolar region, including SFTPC positive cells, but rarely in airway regions in the older adults (p < 0.01). The follow-up of discharged patients revealed a prolonged recovery from pneumonia in the older (p < 0.025).
Conclusion: Compared to children, ACE2 positive cells are generally decreased in older adults and mainly presented in the lower pulmonary tract. The lung progenitor cells are also decreased. These risk factors may impact disease severity and recovery from pneumonia caused by SARS-Cov-2 infection in older patients.
Keywords: ACE2 expression and distribution; COVID-19; disease severity; lung progenitor cells; patients’ ages.