ACE deletion allele is associated with susceptibility to SARS-CoV-2 infection and mortality rate: An epidemiological study in the Asian population

Clin Chim Acta. 2020 Nov:510:455-458. doi: 10.1016/j.cca.2020.08.008. Epub 2020 Aug 10.


Background: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is believed to have emerged from Wuhan, China, and spreads over 215 countries worldwide. The spike protein of SARS-CoV-2 binds to angiotensin-converting enzyme-2 (ACE-2) receptors and enter the host cells. Several reports have been highlighted the importance of ACE-2 on the pathogenesis of COVID-19. In the present study, we hypothesize that a functional insertion/deletion polymorphism in the ACE gene could be associated with SARS-CoV-2 infection and mortality.

Materials and methods: PubMed and Google scholar search engines were used to obtained data on the prevalence of ACE I/D polymorphism in different countries of the Asia continent. Data on COVID-19 infection rate (per million), mortality/million, and percentage of recovery were acquired form worldometer website. The Spearman rank correlation test performed to investigate the correlation of allele 'D' with SARS-CoV-2 infection, mortality rate, and recovery percentage.

Results: Epidemiological investigation revealed a significant positive correlation of D allele of ACE polymorphism with SARS-CoV-2 infection (r = 0.502, p = 0.008, n = 26) and mortality rate (r = 0.620, p = 0.002, n = 22) in Asian population. However, no significant role of ACE I/D polymorphism was observed with recovery rate of patients from SARS-CoV-2 infection (r = -0.208, p = 0.352, n = 22).

Conclusions: Allele D of ACE insertion/deletion polymorphism is associated with the rate of infection and mortality in the Asian population.

Keywords: ACE; Asian population; COVID-19; SARS-CoV-2.

MeSH terms

  • Alleles*
  • Angiotensin-Converting Enzyme 2
  • Asian People / genetics*
  • COVID-19
  • Coronavirus Infections / enzymology
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / genetics*
  • Genetic Predisposition to Disease / genetics*
  • Humans
  • Pandemics
  • Peptidyl-Dipeptidase A / genetics*
  • Pneumonia, Viral / enzymology
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / genetics*
  • Polymorphism, Genetic
  • Sequence Deletion*


  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2