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 syndromecoronavirus- 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.

Editors

JACC: Basic to Translational Science Editor-in-Chief
Douglas L. Mann, MD, FACC

JACC: Basic to Translational Science CME Editors
Amanda Coniglio, MD
Michelle Kelsey, MD
Vishal Rao, MD

Authors
Michelle Kelsey, MD
Vishal Rao, MD
Amanda Coniglio, MD

Important Dates
Date of Release: September 28, 2020
Term of Approval/Date of CME/MOC/ECME Expiration: September 27, 2021