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Cardiovasc Diabetol . Glycated ACE2 receptor in diabetes: open door for SARS-COV-2 entry in cardiomyocyte

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  • Cardiovasc Diabetol . Glycated ACE2 receptor in diabetes: open door for SARS-COV-2 entry in cardiomyocyte

    Cardiovasc Diabetol

    . 2021 May 7;20(1):99.
    doi: 10.1186/s12933-021-01286-7.
    Glycated ACE2 receptor in diabetes: open door for SARS-COV-2 entry in cardiomyocyte

    Nunzia D'Onofrio # 1 , Lucia Scisciola # 2 , Celestino Sardu 3 , Maria Consiglia Trotta 4 , Marisa De Feo 5 , Ciro Maiello 6 , Pasquale Mascolo 7 , Francesco De Micco 7 , Fabrizio Turriziani 2 , Emilia Municin? 8 , Pasquale Monetti 8 , Antonio Lombardi 8 , Maria Gaetana Napolitano 8 , Federica Zito Marino 9 , Andrea Ronchi 9 , Vincenzo Grimaldi 2 , Anca Hermenean 10 , Maria Rosaria Rizzo 2 , Michelangela Barbieri 2 , Renato Franco 9 , Carlo Pietro Campobasso 7 , Claudio Napoli 2 , Maurizio Municin? 8 , Giuseppe Paolisso 2 11 , Maria Luisa Balestrieri 1 , Raffaele Marfella 2 11

    AffiliationsFree article


    Rationale: About 50% of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) developed myocardial damage. The mechanisms of direct SARS-CoV-2 cardiomyocyte infection include viral invasion via ACE2-Spike glycoprotein-binding. In DM patients, the impact of glycation of ACE2 on cardiomyocyte invasion by SARS-CoV-2 can be of high importance.
    Objective: To evaluate the presence of SARS-CoV-2 in cardiomyocytes from heart autopsy of DM cases compared to Non-DM; to investigate the role of DM in SARS-COV-2 entry in cardiomyocytes.
    Methods and results: We evaluated consecutive autopsy cases, deceased for COVID-19, from Italy between Apr 30, 2020 and Jan 18, 2021. We evaluated SARS-CoV-2 in cardiomyocytes, expression of ACE2 (total and glycosylated form), and transmembrane protease serine protease-2 (TMPRSS2) protein. In order to study the role of diabetes on cardiomyocyte alterations, independently of COVID-19, we investigated ACE2, glycosylated ACE2, and TMPRSS2 proteins in cardiomyocytes from DM and Non-DM explanted-hearts. Finally, to investigate the effects of DM on ACE2 protein modification, an in vitro glycation study of recombinant human ACE2 (hACE2) was performed to evaluate the effects on binding to SARS-CoV-2 Spike protein. The authors included cardiac tissue from 97 autopsies. DM was diagnosed in 37 patients (38%). Fourth-seven out of 97 autopsies (48%) had SARS-CoV-2 RNA in cardiomyocytes. Thirty out of 37 DM autopsy cases (81%) and 17 out of 60 Non-DM autopsy cases (28%) had SARS-CoV-2 RNA in cardiomyocytes. Total ACE2, glycosylated ACE2, and TMPRSS2 protein expressions were higher in cardiomyocytes from autopsied and explanted hearts of DM than Non-DM. In vitro exposure of monomeric hACE2 to 120 mM glucose for 12 days led to non-enzymatic glycation of four lysine residues in the neck domain affecting the protein oligomerization.
    Conclusions: The upregulation of ACE2 expression (total and glycosylated forms) in DM cardiomyocytes, along with non-enzymatic glycation, could increase the susceptibility to COVID-19 infection in DM patients by favouring the cellular entry of SARS-CoV2.

    Keywords: ACE2; COVID-19; Cardiomyocyte; Diabetes; Heart; SARS-CoV-2.