AUTHOR=Saad Halim , Jabotian Karna , Sakr Carine , Mahfouz Rami , Akl Imad Bou , Zgheib Nathalie K. 

TITLE=The Role of Angiotensin Converting Enzyme 1 Insertion/Deletion Genetic Polymorphism in the Risk and Severity of COVID-19 Infection

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.798571

DOI=10.3389/fmed.2021.798571

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Individuals infected with the COVID-19 virus present with different symptoms of varying severity. In addition, not all individuals are infected despite exposure. Risk factors such as age, sex, and comorbidities play a major role in this variability; however, genetics may also be important in driving the differences in the incidence and prognosis of the disease. An <italic>Insertion/Deletion</italic> (<italic>I/D</italic>) polymorphism in the <italic>ACE1</italic> gene (rs1799752) may explain these genetic differences. The aims of this study were to determine the potential role of <italic>ACE1 I/D</italic> genetic polymorphism in the risk of contracting COVID-19 as well as predicting the severity of COVID-19 infection.</p><p><bold>Methods:</bold> Three-hundred and eighty-seven non-related Lebanese subjects, 155 controls and 232 cases, who presented to the American University of Beirut Medical Center (AUBMC) for COVID-19 PCR testing were recruited. Clinical data were collected via filling a questionnaire and accessing the medical records. Peripheral blood was withdrawn for DNA isolation, and genotyping performed with standard PCR followed by band visualization on agarose gel.</p><p><bold>Results:</bold> In our study population, previously described risk factors such as gender, age, and comorbidities were associated with increase in disease susceptibility and severity. <italic>ACE1 I</italic> was the least common allele, and there was a positive association between <italic>ACE1 I</italic> and the risk of contracting the COVID-19 disease. More specifically, the frequency of <italic>II</italic> genotype was significantly higher among cases when compared to controls (<italic>P</italic> = 0.035) with individuals with the <italic>II</italic> genotype having greater risk for contracting the COVID-19 disease: OR = 2.074, <italic>P</italic> = 0.048 in the multivariate analysis. As for disease severity, the <italic>DD</italic> genotype and <italic>D</italic> allele were associated with increased risk for developing severe symptoms (OR = 2.845, <italic>P</italic> = 0.026 and OR = 2.359, <italic>P</italic> = 0.014, respectively), and the <italic>DD</italic> genotype with necessitating hospitalization (OR = 2.307, <italic>P</italic> = 0.042). In parallel, <italic>D</italic> allele carriers showed a significantly increased risk for developing hypoxia: OR = 4.374, <italic>P</italic> = 0.045.</p><p><bold>Conclusion:</bold> We found a positive association between <italic>ACE1 I</italic> and the risk of contracting the COVID-19 disease, and between <italic>ACE1 D</italic> and a worse outcome of the COVID-19 infection. Therefore, genotyping for <italic>ACE1 I/D</italic> polymorphism could be used to assess risk and predict severity for better prognosis and management of the disease.</p>