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Bristow MR, Zisman LS, Altman NL, Gilbert EM, Lowes BD, Minobe WA, Slavov D, Schwisow JA, Rodriguez EM, Carroll IA, Keuer TA, Buttrick PM, Kao DP. Dynamic Regulation of SARS-Cov-2 Binding and Cell Entry Mechanisms in Remodeled Human Ventricular Myocardium. ACTA ACUST UNITED AC 2020; 5:871-883. [PMID: 32838074 PMCID: PMC7314447 DOI: 10.1016/j.jacbts.2020.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Using serial analysis of myocardial gene expression employing endomyocardial biopsy starting material in a dilated cardiomyopathy cohort, we show that mRNA expression of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) cardiac myocyte receptor ACE2 is up-regulated with remodeling and with reverse remodeling down-regulates into the normal range. The proteases responsible for virus-cell membrane fusion were expressed but not regulated with remodeling. In addition, a new candidate for SARS-CoV-2 cell binding and entry was identified, the integrin encoded by ITGA5. Up-regulation in ACE2 in remodeled left ventricles may explain worse outcomes in patients with coronavirus disease 2019 who have underlying myocardial disorders, and counteracting ACE2 up-regulation is a possible therapeutic approach to minimizing cardiac damage.
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Key Words
- ACE, angiotensin converting enzyme
- ACE2, angiotensin converting enzyme 2
- ARB, angiotensin receptor blocker
- BNP, B-type natriuretic peptide
- COVID-19, coronavirus disease-2019
- EmBx, endomyocardial biopsies
- F/NDC, nonischemic dilated cardiomyopathy with heart failure
- HFrEF, heart failure with reduced (<0.50) left ventricular ejection fraction
- IQR, interquartile range
- LOCF, last observation carried forward
- LV, left ventricle (ventricular)
- LVEF, left ventricular ejection fraction
- NF, nonfailing
- NR, nonresponder
- PCR, polymerase chain reaction
- R, responder
- RAS, renin-angiotensin system
- RGD, arginine-glycine-aspartic acid
- RNA-Seq, ribonucleic acid sequencing
- RV, right ventricle (ventricular)
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- angiotensin converting enzyme 2
- coronavirus disease 2019
- integrins
- mRNA, messenger ribonucleic acid
- proteases
- ventricular remodeling
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Affiliation(s)
- Michael R. Bristow
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
- ARCA Biopharma, Westminster, Colorado
- University of Colorado Cardiovascular Institute Pharmacogenomics, Aurora, Colorado
- Address for correspondence: Dr. Michael R. Bristow, Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, B-139 Research 2, 12700 East 19th Avenue, Aurora, Colorado 80045.
| | | | - Natasha L. Altman
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cardiovascular Institute Pharmacogenomics, Aurora, Colorado
| | - Edward M. Gilbert
- Division of Cardiology, University of Utah Medical Center, Salt Lake City, Utah
| | - Brian D. Lowes
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Wayne A. Minobe
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
| | - Dobromir Slavov
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
| | - Jessica A. Schwisow
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
| | - Erin M. Rodriguez
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
| | - Ian A. Carroll
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
- ARCA Biopharma, Westminster, Colorado
| | | | - Peter M. Buttrick
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cardiovascular Institute Pharmacogenomics, Aurora, Colorado
| | - David P. Kao
- Division of Cardiology, University of Colorado, Denver/Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cardiovascular Institute Pharmacogenomics, Aurora, Colorado
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