ACE2 Protein Expression During Childhood, Adolescence, and Early Adulthood

Bernadette Schurink, Eva Roos, Wim Vos, Marjolein Breur, Paul van der Valk, Marianna Bugiani

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Purpose and context. Angiotensin-converting enzyme 2 is the entry receptor for SARS-CoV and SARS-CoV-2. Variations in ACE2 expression might explain age-related symptomatology of COVID-19, that is, more gastro-intestinal symptoms and less pulmonary complaints. This study qualitatively investigated ACE2 protein expression in various organs from the fetal to the young adolescent stage. Method. Autopsy samples from lung, heart, liver, stomach, small intestine, pancreas, kidney, adrenals, and brain (when available) were obtained from twenty subjects aged 24 weeks gestational age through 28 years. Formalin-fixed paraffin-embedded 4-um-thick tissue sections were stained against ACE2. Key results. We showed that the extent of ACE2 expression is age-related. With age, expression increases in lungs and decreases in intestines. In the other examined organs, ACE2 protein expression did not change with age. In brain tissue, ACE2 was expressed in astrocytes and endothelial cells. Conclusions. Age-related ACE2 expression differences could be one substrate of the selective clinical vulnerability of the respiratory and gastro-intestinal system to SARS-CoV-2 infection during infancy.
Original languageEnglish
Pages (from-to)404-408
Number of pages5
JournalPediatric and developmental pathology
Issue number4
Early online date2022
Publication statusPublished - Jul 2022


  • ACE2
  • SARS-CoV-2
  • children
  • immunohistochemistry

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