Genetic Landscape of the ACE2 Coronavirus Receptor

Zhijian Yang, Erin MacDonald-Dunlop, Jiantao Chen, Ranran Zhai, Ting Li, Anne Richmond, Lucija Klarić, Nicola Pirastu, Zheng Ning, Chenqing Zheng, Yipeng Wang, Tingting Huang, Yazhou He, Huiming Guo, Kejun Ying, Stefan Gustafsson, Bram Prins, Anna Ramisch, Emmanouil T. Dermitzakis, Grace PngNiclas Eriksson, Jeffrey Haessler, Xiaowei Hu, Daniela Zanetti, Thibaud Boutin, Shih Jen Hwang, Eleanor Wheeler, Maik Pietzner, Laura M. Raffield, Anette Kalnapenkis, James E. Peters, Ana Viñuela, Arthur Gilly, Sölve Elmståhl, George Dedoussis, John R. Petrie, Ozren Polašek, Lasse Folkersen, Yan Chen, Chen Yao, Urmo Võsa, Erola Pairo-Castineira, Sara Clohisey, Andrew D. Bretherick, Konrad Rawlik, Tõnu Esko, Stefan Enroth, Åsa Johansson, Ulf Gyllensten, Claudia Langenberg, Daniel Levy, Caroline Hayward, Themistocles L. Assimes, Charles Kooperberg, Ani W. Manichaikul, Agneta Siegbahn, Lars Wallentin, Lars Lind, Eleftheria Zeggini, Jochen M. Schwenk, Adam S. Butterworth, Karl Michaëlsson, Yudi Pawitan, Peter K. Joshi, J. Kenneth Baillie, Anders Mälarstig, Alexander P. Reiner, James F. Wilson, Xia Shen

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: SARS-CoV-2, the causal agent of COVID-19, enters human cells using the ACE2 (angiotensin-converting enzyme 2) protein as a receptor. ACE2 is thus key to the infection and treatment of the coronavirus. ACE2 is highly expressed in the heart and respiratory and gastrointestinal tracts, playing important regulatory roles in the cardiovascular and other biological systems. However, the genetic basis of the ACE2 protein levels is not well understood. Methods: We have conducted the largest genome-wide association meta-analysis of plasma ACE2 levels in >28 000 individuals of the SCALLOP Consortium (Systematic and Combined Analysis of Olink Proteins). We summarize the cross-sectional epidemiological correlates of circulating ACE2. Using the summary statistics-based high-definition likelihood method, we estimate relevant genetic correlations with cardiometabolic phenotypes, COVID-19, and other human complex traits and diseases. We perform causal inference of soluble ACE2 on vascular disease outcomes and COVID-19 severity using mendelian randomization. We also perform in silico functional analysis by integrating with other types of omics data. Results: We identified 10 loci, including 8 novel, capturing 30% of the heritability of the protein. We detected that plasma ACE2 was genetically correlated with vascular diseases, severe COVID-19, and a wide range of human complex diseases and medications. An X-chromosome cis-protein quantitative trait loci-based mendelian randomization analysis suggested a causal effect of elevated ACE2 levels on COVID-19 severity (odds ratio, 1.63 [95% CI, 1.10-2.42]; P=0.01), hospitalization (odds ratio, 1.52 [95% CI, 1.05-2.21]; P=0.03), and infection (odds ratio, 1.60 [95% CI, 1.08-2.37]; P=0.02). Tissue- and cell type-specific transcriptomic and epigenomic analysis revealed that the ACE2 regulatory variants were enriched for DNA methylation sites in blood immune cells. Conclusions: Human plasma ACE2 shares a genetic basis with cardiovascular disease, COVID-19, and other related diseases. The genetic architecture of the ACE2 protein is mapped, providing a useful resource for further biological and clinical studies on this coronavirus receptor.

Original languageEnglish
Pages (from-to)1398-1411
Number of pages14
Issue number18
StatePublished - 3 May 2022
Externally publishedYes


  • COVID-19
  • Genome-Wide Association Study
  • SARS-CoV-2
  • angiotensin-converting enzyme 2
  • cardiovascular diseases


Dive into the research topics of 'Genetic Landscape of the ACE2 Coronavirus Receptor'. Together they form a unique fingerprint.

Cite this