Why COVID-19 may be less common in children than adults

The virus that causes COVID-19 uses a receptor known as ACE2, found on the surface of certain cells in the human body, to enter its victims. Now, Mount Sinai researchers have found that children have lower levels of ACE2 gene expression than adults, which may explain children’s lower risk of COVID-19 infection and mortality. Gene expression is a measure of how much a gene is transcribed.

These results, published in JAMA on Wednesday, May 20, may point to a potential biomarker of susceptibility to the virus, known as SARS-CoV-2.

“ACE2 expression may be linked to our susceptibility to COVID-19,” says lead author Supinda Bunyavanich, MD, MPH, Professor of Genetics and Genomic Sciences and Pediatrics, Icahn School of Medicine at Mount Sinai. “ACE2, which stands for angiotensin converting enzyme 2, is a receptor that some might be familiar with because of its role in blood pressure regulation. The coronavirus uses ACE2 to enter the human body, where it spreads. ACE2 is known to be present in our airway, kidneys, heart, and gut. In our study, we took this knowledge a step further, finding that there are low levels of ACE2 expression in the nasal passages of younger children, and this ACE2 level increases with age into adulthood. This might explain why children have been largely spared in the pandemic.”

The research focused on ACE2 due to its significance in COVID-19 infection. The nasal passages are usually the first point of contact for SARS-CoV-2 and the human body. Dr. Bunyavanich’s study is one of only a few examining the relationship between ACE2 in the airway and age.

The retrospective analysis, led by Dr. Bunyavanich, examined nasal passages epithelium from Mount Sinai Health System patients aged 4 to 60. The researchers found ACE2 gene expression in nasal epithelium was age-dependent, lowest in younger children and increasing with age into adulthood.

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Materials provided by The Mount Sinai Hospital / Mount Sinai School of Medicine. Note: Content may be edited for style and length.

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